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Pregnant with more than one baby

Pregnant with more than one baby

So you're pregnant and it's twins…triplets…or more! You're probably feeling hugely excited about the idea of being a mum, and more than a little anxious about how you'll cope with more than one baby at a time.

From now on life will be busy – there's no doubt about that – but with the right medical advice and some advance preparation, having more than one baby can be every bit as fabulous as you've dreamed it would be.

Since there are risks attached to carrying two or more babies, all through your pregnancy you'll get extra care from your doctor and midwife. You'll have more scans and antenatal checks, so be reassured by their positive feedback and take the opportunity of your regular meetings with them to voice any fears or concerns you have.

Let your mind focus on eating well, taking gentle exercise, and doing as much pre-birth preparation as you can. Starting parentcraft classes a month earlier than normal is a good idea because when there's more than one baby, they can be born early (premature) and it's worth getting a grasp of the basics before they arrive.

On the practical side, making sure you have car seats to get them home, somewhere for them to sleep, clothes for the first few days, and nappies and changing equipment will make things much easier. And line up lots of help for immediately before and after the birth. Then sit back and enjoy this time with your partner as you start to get to know your new babies.

What you're having

Most parents want to know if their babies are going to be identical. Part of the fun of having twins or more is working out how you're going to tell them apart. But there's also a sound medical reason for finding out if they're identical or not before they're born.

This is because one of the major complications of twin births is a condition called Twin to Twin Transfusion (TTT), which happens when one baby takes too much of the blood supply (and grows too big) while the other doesn't get enough (and is too little). This can only happen when the babies share a placenta, and usually this would only be the case with identical twins. But as with all things in birth, it's not that simple. Here's how the professionals will tell what you're having.

Twins can be identical (called Monozygotic or MZ), or non-identical (called Dizygotic, DZ, or fraternal).

Identical (MZ) twins happen when one fertilised egg splits and forms two babies. They'll be both boys or both girls and will have the same genetic make up. This accounts for a third of the twins in the UK.

Fraternal (DZ) twins happen when two eggs are released and fertilised at the same time. These babies will be no more alike than any siblings and can be different sexes. Two thirds of twins in the UK are DZ.

Even if a scan shows your babies share one placenta, this does not necessarily mean your babies will be identical, because two placentas can fuse just as easily as one placenta can 'fork' (separate).

A more definitive guide is the sacs the babies lie in. If the scan shows they have one chorionic sac each, they will be fraternal twins. If they're both in the same chorionic sac, they'll be identical, and therefore at risk of TTT. The sacs can be seen in the early 10-14 week scans and it's worth pressing your scanner operator to look for them because if your babies are in the same sac then you'll need even closer monitoring.

For those babies who are in separate sacs but are the same sex, a DNA test after birth is the only real way to tell if they're identical. This isn't available as a matter of course on the NHS, so you have to have it done privately, and it usually involves taking a swab of cheek cells from each child. TAMBA (Twins & Multiple Births Association) or The Multiple Births Foundation (see further information below) have more information about these zygosity tests.

Triplets are most often Trizygotic (TZ), which means three eggs have been produced and fertilised at the same time. Sometimes they're DZ where two eggs have been fertilised and one has split to make twins. Very rarely they're MZ, where one egg splits, and one of the new eggs splits again.

Quads, quintuplets and more will be a combination of DZ and MZ. It's estimated that less then one third of triplets or bigger sets of babies are conceived without fertility treatment.

When your babies will be born

It's very likely that your babies will be born before 40 weeks.

  • With twins, 37 weeks is considered full term.
  • With triplets, 34 weeks is considered full term
  • With quads, 32 weeks is considered full term.

You can have a natural delivery if there aren't any complications, but it's best to prepare yourself for the likelihood that your babies will spend some time in a neonatal or special care baby unit (SCBU).

Your care during pregnancy

Unless some sixth sense has already been at work – and some mums do suspect because they feel extremely sick or their tummy grows very quickly – your first 12-14 week scan is probably the first time you'll discover you're having more than one baby. It's been known for twins to be spotted at the first scan, and a third or fourth baby to appear from behind its siblings in the next one. In fact 6% of triplets and 16% of quads aren't spotted until later scans.

After that you'll have scans more frequently than you would for just one baby. This is because it's very hard to tell how well each of your babies is growing just from measuring the size of your bump. If your babies are in two sacs, you'll probably be scanned every four weeks between 20 and 32 weeks, and then every fortnight. If they're in one sac you'll be scanned every fortnight from 16 weeks because of the risk of TTT. During these scans the operator will be looking to see how well each of your babies is growing.

You'll also have more visits to your midwife or doctor – usually the same frequency as the scans. During these, your blood pressure and urine, and sometimes your weight, will be checked, as in a normal pregnancy. However since some conditions, such as pre-eclampsia, are more common in multiple pregnancies, it's vital that you attend all your routine antenatal appointments.

Start taking folic acid

You need to take extra folic acid from the moment you start trying to conceive right up until you are 12 weeks pregnant. This helps prevent spina bifida and other related conditions. Folic acid is a B vitamin found naturally in green leafy vegetables such as broccoli and spinach and is added to some breakfast cereals and breads.

Common problems

As in any pregnancy, mums-to-be can suffer morning sickness, indigestion, heartburn, piles, backache, varicose veins, swollen hands and feet and tight, itchy skin (see our section on Pregnancy Problems). But when you're carrying more than one baby all of these can be worse. That's perhaps because there are more hormones circulating in your bloodstream, or your body is carrying a much heavier load. The remedies for coping with them are the same as for single babies.

More serious complications

These conditions are more common in women having more than one baby and if you have any concerns about them you should contact your doctor or midwife immediately.

  • Vaginal bleeding is almost three times more common in twin pregnancies, although no one knows exactly why.
  • Pre-eclampsia is three to five times more common in twin births. It comes on earlier, progresses more rapidly and is more severe.
  • Excess amniotic fluid affects around 5% of women having more than one baby and usually develops in the third trimester. It's often linked to other conditions, such as TTT, gestational diabetes and severe pre-eclampsia.
  • Twin to Twin Transfusion (TTT).
  • Poor growth of one or more of the babies, perhaps because of TTT.
  • Premature labour.

What about screening?

The 20-week scan, which is usually called the anomaly scan, will carefully look at each baby and check his heart, stomach, abdominal wall, and spine, as with any pregnancy – so it will take longer than with a single baby.

If you're expecting more than one baby you can be screened for disorders and disabilities, but it's a complicated and more risky business. Before you decide to go ahead with screening, it's worth thinking about what you'd do if you did discover that one baby had a serious disability.

The nuchal translucency test is useful in multiple pregnancies, because it looks at each baby in turn. It's also felt to be the most effective way to screen for Down's syndrome when there's more than one baby.

You can have amniocentesis, and with twins the doctor may be able to insert just one needle to sample both sacs, which reduces the risk of miscarriage. But it's more difficult to do with more than one baby and you'd need to be referred to a specialist fetal medicine centre.

Chorionic villus sampling (CVS) can also be carried out, but if once it's done the medic finds he has two lots of genetically identical tissue, he won't be able to be sure whether he definitely has one sample from each baby, or if the babies are identical twins. Again, this would probably have to be done at a specialist fetal medicine centre.

How you'll feel

Over the coming months you can expect to get big faster than your friends who are expecting single babies, and feel more tired. By the time you're 28 weeks, you'll look and feel as big as a mum-to-be with a single baby at 40 weeks.

The more babies you are having the more weight you'll be expected to gain – a maximum of 23kg for twins, 27kg for triplets, and 36kg for quads. There is a theory that the better nourished you are in early pregnancy, the better your babies will grow and the less time they'll spend in SCBU, but it's not an idea held by all experts.

The amount of blood in your body will also expand dramatically. If you were having one baby, your volume of blood would increase by 50%, but with twins, it will almost double. This means your heart's having to work a lot harder, which is why it's important to rest and not to take strenuous exercise. Pelvic floor exercises are vital, and gentle swimming will help to keep you fit and the buoyancy of the water will give you a break from the heaviness of your body.

Your babies will also take more of your reserves of iron and folic acid, so eating a balanced healthy diet is even more important than with single babies.

Put your feet up as much as you can. As you get bigger, make time for an afternoon nap, and don't be worried if at some point your midwife or doctor suggests a few days in hospital. A study by TAMBA found that 32% of mums carrying twins, and 65% carrying triplets were admitted to hospital for rest during their pregnancy.

If you work, ask your boss if you can come in later and leave earlier to avoid the busiest commuter times, and get your partner to take on more of the household chores so that your evenings and weekends can be dedicated to taking it easy. Although most women try to work as long as possible to get the maximum amount of maternity leave after their baby's born, you may have to think about stopping work a bit earlier. And if you feel up to it, having sex is fine provided you haven't had any vaginal bleeding or other complications.

Getting ready

For most mums-to-be, especially first time mums, it's almost impossible to imagine what life will be like once your babies are here. But when you're having more than one baby, if you can prepare yourself practically and emotionally in advance, you'll feel more in control and cope better with any difficulties.

  • Start roping in help. You're going to need loads after the birth, so start by encouraging your partner, and other family and friends, to help. Whether it's household chores, shopping or filling your freezer with food for after the birth, it will be fewer things for you to worry about or to sap your energy.
  • Go on your antenatal and parentcraft classes around a month earlier than with a single baby, and if all the advice is geared to having one baby, don't be afraid to ask how it will affect you. When you're on your hospital visit, have a look round the Special Care Baby Unit
  • When you're making your birth plan, be prepared to be flexible. With more than one baby, things can go wrong and quickly, which may mean making changes.
  • t's worth thinking about where your babies will sleep (research has shown they can happily sleep together for the first three months in your room without added risks), how you'll get them home from the hospital, and how you're going to feed.
  • Many pregnant women feel superstitious about buying clothes and equipment before their baby's born, but you'll cope better if you have at least basic equipment – somewhere for the babies to sleep, at least one changing area and mat, a few sleepsuits, nappies, and cotton wool. And for you, sanitary towels and a good supply of disposable pants.
  • Think about what you're going to call your babies.
  • And finally, talk to other mums of twins and more. They're in the best position to give you advice about cots and buggies, feeding and routines, and – most importantly of all – how to enjoy the wonderful experience of being a mum to two, three or more.
For more information visit:

Department of Obstetrics & Gynaecology Singapore at this link.