A pregnancy is an exciting and often overwhelming time in a woman’s life. With twins the excitement can double, and so can the stress. Many aspects of pregnancy are different when having multiple babies, but if your pregnancy is being monitored by healthcare professionals there is little need for worry. Thousands of women give birth to healthy twins and triplets every day.
A woman’s body can adapt to having several babies at once—or multiples, as they are often called—quite well. There are, however, a few things to keep in mind if you are expecting more than one baby.
Twins, triplets, or, on very rare occasions, quadruplets or even more babies can develop in the mother’s womb at the same time. This happens either when a single egg is fertilised by a single sperm and then divides into several embryos, or when more than one egg is released simultaneously and each one is fertilised by separate spermatozoa. When more than one egg is released during ovulation, this is called hyperovulation.
There are two types of twins: identical and fraternal.
Identical or monozygotic twins develop from one egg fertilised by a single sperm, that divides into two embryos early in the pregnancy. The identical twins can share a placenta and have different amniotic sacs, have separate placentas and amniotic sacs or, on rare occasions, share both the placenta and the amniotic sac. In this case, it is harder to monitor the pregnancy.
This type of pregnancy is believed to be less to do with genetics and have more to do with chance. Identical twins have the same genetic makeup. They will have the same DNA, be of the same biological sex, and have the same visual qualities—hair colour, eye colour, build, etc. Identical twins do, however, develop their own personalities and are separate individuals. A common myth is that identical twins have the same fingerprints; this is not true.
Fraternal or dizygotic twins develop from two different eggs fertilised by two different sperm. They are not genetically identical, and their traits will be as similar or dissimilar as those of siblings born in separate pregnancies. Women with a family history of twins are genetically more likely to have fraternal twins. Fraternal twins usually have separate placentas and amniotic sacs.
Triplets may be identical, or all develop from seprate eggs. Perhaps surprisingly, it is not uncommon for two of the triplets to be identical, while the third develops from a separate egg that has fertilised by a different sperm.
If the babies have separate amniotic sacs, they will usually be fraternal. If ultrasound scans show only one amniotic sac, it is assumed that the babies will be identical, but that is not always the case.
Some data show that in the 21st century more twins are being born every year than ever before.
It is estimated that about 1 in 250 natural pregnancies is a twin pregnancy. Advances in medicine have allowed mothers to safely carry twin pregnancies to delivery, even when they would have likely resulted in miscarriage in the past. Where fertility treatments are involved, the rate of multiple pregnancies skyrockets, leading to even more twins being born.
Some other factors that may contribute to an increasing rate of twin pregnancies include lifestyle and older age at the time of pregnancy. Hyperovulation is more common in women over the age of 30 and in women who are taller and heavier. Hyperovulation is also a genetically inherited trait, meaning that the more twins are born, the more their descendants will also produce fraternal twins.
If multiple babies are developing inside your womb, some of the early signs of pregnancy may be different. The hormone Human Chorionic Gonadotropin (hCG), which supports the development of the embryo in the first trimester, is produced in larger quantities in a multiple pregnancy. This hormone is also responsible for morning sickness and for breast tenderness. Increased levels of hCG can be a sign of twin pregnancy. This can be measured in blood or urine tests.
If you suspect a twin pregnancy, your doctor can order tests to confirm. Most mothers find out they are having multiple babies during a routine ultrasound scan, often around 12 weeks of pregnancy.
Once it is established that a woman is expecting more than one baby she will be monitored more closely at more frequent antenatal appointments in case of complications. Of course, not every twin pregnancy will be high risk.
Due to higher-than-average levels of pregnancy hormones, the first trimester is likely to come with more severe morning sicknesses, tender breasts, fatigue, frequent urination, heartburn, and other attendant symptoms of pregnancy. These conditions will most likely ease in the second trimester at around the time when the “bump” begins to show that you are indeed having twins.
Because you are carrying two babies at once, the strain on your body will be larger: back pain is common, potentially causing difficulty sleeping. Your body will produce more blood to ensure both babies have the oxygen and nutrients they need; the extra blood also results in higher blood pressure.
You will naturally gain more weight to support the development of both babies, but you don’t need to “eat for three”. A woman pregnant with a single baby gains an average of 25 pounds during pregnancy; twin mothers gain 35 to 55 pounds, depending on body type.
As for all pregnancies, doctors recommend a healthy, diverse diet that includes sufficient nutrients from all the different food groups, resulting in gradual weight gain.
Some of the risks that come with a twin or multiple pregnancy include:
Your health care provider will monitor you closely to screen for potential risks and prescribe prenatal supplements such as folic acid and iron to help reduce the possibility of anaemia.
Twins and triplets are often born prematurely. If a regular pregnancy lasts 40 weeks, twins are often born at 34 to 38 weeks. If the babies are born after week 37, this is considered normal and there is no need for additional concern as long as they are healthy. If they are born earlier, they will need some extra care as do all preemies.
If labour does not start on its own within this time period, your doctor might recommend inducing the birth, as carrying twins to full term comes with additional risks for both mother and children.
Delivery by caesarean section is more likely with twin and triplet births, as they often develop in breech position (feet or bottom first). If the first baby to be born is facing the right way, the babies can be delivered. Sometimes a woman will deliver the first baby vaginally but require a C-section for the second. It is possible to deliver a breech baby vaginally if an experienced healthcare professional is assisting at the birth.
Sometimes two sets of doctors or midwives assist at twin births—one team for each baby.
Pregnancies with multiple babies are challenging. They demand even more from your body than a singleton pregnancy. Carrying multiple babies shifts your centre of gravity forwards and it takes longer for the body to return to normal after delivery. These stressors can be overwhelming, so it is extremely important for mothers to take care of their own well-being, both physically and mentally.
Postpartum depression is quite common in mothers of twins due to the extreme hormonal changes they experience and to the overwhelming nature of suddenly having to care for two or more babies 24/7, especially when they are premature.
All new mothers should ask for help from people they trust—loved ones, family members, friends. Mothers of multiple babies should absolutely delegate some tasks and let others help or risk succumbing to exhaustion. Asking for help will benefit the babies and the mother.
From the very first days the psychological aspects of raising twins can present additional challenges: What if I confuse them? What if one of them gets more attention than the other? Will I ever have time for myself again? Talk to people you trust and consider therapy to help you process difficult emotions. Remember that no matter what, you are their mother, and they are your children. Mixing them up on occasion is completely normal for young twin parents. Soon enough their personalities will shine through, and you will have no difficulty telling them apart.
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