But Wait! Twins & More…
Having a more than one baby in there (twins or triplets etc.) may change the recommendations for your antenatal, birth and postnatal care. Here is a brief explanation of the different types of multiple pregnancies. We’ll also talk about how they may increase the risk for some pregnancy conditions or complications.
There are several different types of multiples, and this will also contribute to your care plan.
Usually, twins as Monozygotic (one egg – identical) or Dizygotic (two eggs – fraternal or non-identical). Often your care provider will refer to them as MCDA (identical) or DCDA (not identical). Opposite sex twin pairs, (boy/girl) comprise approximately 1/3 of all twin births and are always dizygotic. We will recommend extra scans to determine this. If you would like to know if your same-sex twins are identical, it can be determined by a DNA test.
In the first trimester, you must select a care provider that you can easily access should you have any concerns. Sometimes common pregnancy discomforts such as morning sickness can be quite debilitating with all those extra hormones in your body. In the second and third trimesters, there are additional risks for MCDA twins. These include Twin to Twin Transfusion Syndrome (TTTS), and the obstetric team will recommend close monitoring of your pregnancy to diagnose such rare complications.
Twin pregnancies increase the risk of pregnancy-related complications such as high blood pressure, gestational diabetes and anaemia (43). A recent study comparing the risks of these complications found that these risks were multiplied by four with twins. It also found that due to these increased complications, caesarean section was advised in a higher number of twin pregnancies than in single pregnancies (43).
The good news is that these conditions usually disappear in the postnatal period. For example, a study looking at long term effects on the mother’s heart between twin and singleton pregnancies found that there were no differences in the incidences of cardiovascular events (44).
Two everyday decisions families who are expecting twins face are:
- Vaginal birth or caesarean?
- When should or will this most likely be?
Choosing whether to have twin babies vaginally or by caesarean section and when this should happen, will depend on your clinical picture. Your care provider should discuss the risks and benefits of all options to help you decide what is best for you and your babies.
Twins – the evidence
In a study looking at outcomes for the babies of 1398 women, with the first twin head down, no benefits of planned caesarean surgeries were found compared to vaginal births (45). A caesarean section presents its own set of risks to both mother and babies. It is important to remember that the position of your babies closer to birth and any complications will influence recommendations regarding the mode of childbirth.
Often the babies themselves will decide when they are to be born! The chances of spontaneous labour for twin babies before term are high. A high-quality trial supported recommendations that uncomplicated twins be born at 37 weeks gestation (46).
Will I need an induction?
The chances of you having spontaneous labour are high, as multiple pregnancies rarely go to term. If you are 36-37 weeks pregnant, we may recommend induction. The use of epidural anaesthesia is higher with induction; epidural is also commonly recommended in a twin vaginal birth.
Will my babies need to go to the Special Care nursery?
Admission to the will depend on the size, wellbeing and gestation of the babies. We may recommend steroid injections before the babies are born, particularly before a planned caesarean at or before 36 weeks. This medication helps babies that are coming early with their breathing. Some babies may need help with feeding, and there is a team of professionals in hospitals and the community who can help you care for your baby’s needs. If your babies need some help with feeding, you can still do skin to skin and ask to see a Lactation Consultant.
Sometimes they may need additional feeds through a tube to help them gain weight. You can feed them expressed breast milk or formula. Some hospitals have donor breastmilk available; there are also milk banks in some regions where you can find donor breastmilk.
Just like with single pregnancies, skin to skin has many benefits for twin babies, including regulating breathing, heart rate, blood sugar levels, temperature, bonding and breastfeeding. If you have a multiple pregnancy, your babies will likely spend time in a Special Care or Intensive Care nursery. Try and get to do a tour of the nursery before your babies are born.
Will I produce enough breastmilk for twins?
Women with twins or more can produce milk enough for your babies. For some, it comes naturally, but others will need plenty of support and stimulation to increase and maintain supply. Feeding your babies is a personal decision. The breastfeeding section outlines the many benefits of breastmilk.
Breastmilk is the best food source for babies, and even more so for premature babies. However, the decision is yours, and you need to do what works for you. Some women choose to express and exclusively give their babies breastmilk. Some will decide to mixed feed, and others only formula feed. The most important thing is that your babies are fed and gaining weight.
Strategies to increase breastfeeding success:
- Have a plan.
- Talk to midwives or Lactation Consultants to get advice and a plan in place.
- If not available in your area, online resources such as the Australian Breastfeeding Association has twin feeding information, so investigate what supports are available in your area.
- Research the basics – breastfeeding is all about supply and demand. We can produce enough to feed two or even more babies!!
- Express to stimulate your supply and demand feed babies.
- Expressing after feeds will help boost your supply and stimulate milk production.
- There are a variety of positions for breastfeeding twins, experiment whilst in hospital and ask the midwife to help you with attaching your babies to the breast.
Tips from previous twin mother’s experiences:
- Is your partner able to take holidays from work?
- Have a roster for family and friends – put a chore list for them on the fridge
- Freeze some easy to prepare meals before the birth.
- Have a schedule but expect that it won’t always go to plan
- Some mothers find feeding babies together helpful. If they sleep at the same time, it may help to keep up with the other tasks.
- Other mothers find that feeding each baby separately suits them better. You will find what works best for your family and trust your instincts.
- You don’t need to buy double of everything, can commonly use for both the babies and save money and space.
Multiple Births – Support Available
Some of the most helpful advice will probably come from other twin or triplet mothers in your area. They are usually only too pleased to pass on their experiences. Contact with your local Multiple Birth Association can be invaluable. They have parenting twins’ booklets, and newsletters if you do not live close to a support group. Please click here to access their website.
There are also Facebook groups, and Twin Registries have interesting studies into twins. You might consider joining as it brings twins and researchers together for vital health research that benefits everyone. For example, twins are extraordinary to research as they help differentiate between the effects of nature (genetics) and nurture (environment) on our health. Twin Registries also aim to support twins and their families, providing evidence-based educational resources.
Janice Rowe (BSW (Hons), BMid), Clinical Midwife
Image by Aldona Griskeviciene, used under license from Shutterstock.com