Twin pregnancy: Understanding the care you need

A twin pregnancy is a unique journey for expectant parents, bringing both excitement and, understandably, questions regarding prenatal care and delivery. This article provides clear answers to frequently-asked-questions about twin pregnancies, helping you prepare for a happier, healthier pregnancy.

What are the chances of having twins?

The chances of conceiving twins depend on many factors. On average, about 1 in every 250 natural pregnancies results in twins. However, the likelihood of twin pregnancies increases significantly for women undergoing fertility treatments, such as in vitro fertilisation (IVF) or ovulation-stimulating medications.

Maternal age also plays a role. Women over the age of 35 are more likely to conceive twins due to an increase in the production of a hormone called follicle-stimulating hormone (FSH), which can lead to the release of multiple eggs during ovulation. Additionally, genetics can influence the likelihood; women with a family history of fraternal twins may be more likely to conceive twins themselves.

There are two types of twins: fraternal (dizygotic) and identical (monozygotic). Fraternal twins result from two separate eggs fertilised by two different sperm and are the more common type of twin pregnancy. Identical twins, on the other hand, result from a single fertilised egg that splits into two embryos and are rarer, occurring in about 3 to 4 per 1,000 births worldwide.

Are twin pregnancies high-risk?

Twin pregnancies are generally considered high-risk due to the increased risk of complications for both the mother and babies, including preterm birth, gestational diabetes, pre-eclampsia, and fetal growth restriction.

Expectant mothers of twins may also experience more intense symptoms. Many women experience greater fatigue, more severe morning sickness, and higher weight gain due to the added physical demands of carrying two babies. Common symptoms like back pain, pelvic pressure, heartburn, and shortness of breath may also occur earlier and be more severe. Additionally, swelling in the legs and ankles, as well as varicose veins, can occur as the body adjusts to the higher blood volume.

What prenatal care will I need if I’m pregnant with twins?

Prenatal care for twin pregnancies requires more frequent and careful monitoring than for a singleton pregnancy, with appointments typically scheduled every two to four weeks. These prenatal visits will begin in the second trimester and increase in frequency as the pregnancy advances.

If you are expecting twins, you can anticipate a personalised care plan that includes:

Additional ultrasounds

Twin pregnancies are usually detected through ultrasound in the first trimester, typically between 6 to 8 weeks. Subsequent ultrasounds will then allow your obstetrician to monitor each baby’s growth, amniotic fluid levels, and placental function.

Twin pregnancies can involve either dichorionic twins (with two separate placentas) or monochorionic twins (with one shared placenta). Monochorionic twins face specific risks, such as twin-to-twin transfusion syndrome (TTTS), a rare condition that occurs when one twin receives more blood flow than the other. Early detection is crucial to manage and correct any imbalances in blood flow.

Specialised blood tests and screenings

Prenatal care for twin pregnancies also includes additional blood tests to check the mother’s iron levels for anaemia along with other nutritional markers, as twins often require higher amounts of nutrients like iron and calcium. Additionally, tests for gestational diabetes and pre-eclampsia will be conducted more frequently and at an earlier stage to ensure the mother’s health.

Preventive measures for preterm birth

Twin pregnancies carry a much higher risk of preterm birth. To help prevent early labour, preventive measures like cervical length monitoring and progesterone supplements may be recommended.

Along with these medical interventions, expectant mothers carrying twins will be advised to prioritise rest, proper nutrition, and staying hydrated, as well as avoiding strenuous activities that could place extra strain the body. A balanced, nutrient-rich diet, with increased intake of folic acid, iron, calcium, and protein, will help support both the mother and the babies throughout the pregnancy.

Will I have to deliver twins via C-section?

The delivery options for twins depend on several factors, such as the position of each baby, the mother’s health and age, and any complications that may have developed during pregnancy.

If both babies are in a head-down position, a vaginal delivery may be possible, provided there are no other complications. However, if one or both twins are in a bottom-first or sideways position, a C-section is often recommended for a safer delivery.

Monochorionic twins sharing a placenta are at a higher risk for complications, and may need to be delivered earlier, sometimes by C-section. In contrast, dichorionic twins, who have separate placentas, generally have a lower risk, but delivery recommendations will still depend on the specific circumstances of the pregnancy.

In the UK, around 60% of twin deliveries are performed via C-section. Even if a vaginal delivery is initially planned, an epidural is often recommended for pain relief to enable a quick transition to a C-section, if complications arise during labour or if one twin encounters difficulties during delivery.

Twin pregnancies often end around 36 to 37 weeks, and many obstetricians will recommend delivery by 38 weeks. This is because carrying twins longer can increase the risk of complications for both the mother and babies. For many women, this timeline will provide an opportunity to schedule an elective C-section if a vaginal delivery may not be the safest option.

Ultimately, the decision regarding how to deliver twins - whether via C-section or vaginally - will be based on a comprehensive assessment of the mother and the babies’ health, the babies’ positions, and any complications that arise. Your obstetrician will carefully discuss the safest and most practical delivery method for you.