By Raising Children Network
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Twins ultrasound image credit iStock/Lpettet
Pregnant with twins? You might be surprised, excited, in denial and more. A twin pregnancy is more complicated than a single pregnancy, so you’ll need more visits to health professionals, and more tests and checks along the way. Here’s what to expect.

Finding out you’re pregnant with twins

If you have very early and noticeable pregnancy symptoms like nausea or vomiting, you might wonder whether you’re having twins.

You might also suspect you’re having twins if you’ve had fertility treatment – especially if you had more than one embryo transferred, or if you used certain fertility drugs to help get pregnant.

The only definite way to find out whether you’re having twins or other multiples is with an ultrasound scan.

The best time to have this ultrasound is at 10-12 weeks of pregnancy. This is when your health professional can say for sure how many fetuses, placentas and amniotic sacs there are. This information is important in looking after you during your pregnancy, and will also let you know if you have identical or non-identical twins.

You can’t rely on hormone tests to find out whether you’re pregnant with twins.

Pregnant with twins: antenatal care and birth options

Because a twin pregnancy is more complicated than a single pregnancy, health professionals usually recommend specialist antenatal care, rather than shared care or midwife-only care. If you have any complications, specialist checks can pick them up early, which means they can be treated early.

You might be advised to see an obstetrician. Obstetricians are skilled and experienced in managing mother and baby health problems and complications associated with twin pregnancy. 

Also, health professionals will usually recommend you give birth in a hospital, rather than in a birth centre or at home. Hospitals have the back-up facilities you might need for any complications of a twin pregnancy, such as premature birth.

Find out about antenatal care and carers, as well as birth settings, with our award-winning Birth Choices interactive guide.

Tests, checks and appointments during twin pregnancy

If you’re pregnant with twins, you’ll need a higher level of care, which means more appointments and tests during your pregnancy.

You probably won’t need lots of extra blood tests, but you will need more ultrasounds.

If you have twins with separate placentas, it’s generally recommended that you have ultrasounds at around 10-12 weeks, 18-20 weeks, 28 weeks and 34 weeks. You might have more frequent ultrasounds than this. 

A twin pregnancy with babies sharing one placenta is potentially more complicated, so ultrasounds every two weeks from 12 weeks are generally recommended.

If you’re pregnant with twins, you’ll have more frequent antenatal appointments. Antenatal appointments are a good chance to get health and lifestyle support if you need it and to get information about your pregnancy, labour, birth and early parenting.

Potential health complications in a twin pregnancy

Women with twin pregnancies are more likely to have pregnancy health problems and complications such as gestational diabetes, high blood pressure (also known as pre-eclampsia), premature labour and bleeding.

Twins who share a placenta might have extra complications. Sometimes their blood supply is shared unequally, which can cause health problems for both twins. Or if the placenta itself is shared unequally, this can mean that one twin doesn’t get enough nutrients and doesn’t grow as well.

You can’t stop some of these complications from happening. But you can reduce your chance of having them – or stop them from getting worse – by going to your antenatal appointments and telling your obstetrician, doctor or midwife if you have any physical symptoms or feelings that something is wrong.

Not all pregnancy health problems are physical. If you have emotional changes that last longer than two weeks or that get in the way of your daily life, it could be a sign of depression or another problem. Talk with your midwife or doctor about any emotional changes. You can also call Lifeline on 131 114, Beyond Blue on 1300 224 636 or PANDA on 1300 726 306.

Twin pregnancy symptoms and body changes

Many women who are expecting twins find that they have quite noticeable and very early pregnancy symptoms, including tiredness, emotional ups and downs, nausea, vomiting and constipation.

Also, body changes with a twin pregnancy are much more marked than with a single pregnancy.

If you’re pregnant with twins, you might gain 16-20 kg (compared to 10-15 kg with a single pregnancy). Unfortunately, stretch marks, bloating, varicose veins and haemorrhoids are all more common in a twin pregnancy. These changes might affect the way you feel about your body.

You can talk with your doctor or midwife about the changes in your body and how you feel about these changes.

Keep up to date with the changes in your body and your baby’s development with our week-by-week pregnancy emails.

Healthy eating and twin pregnancy

Healthy eating in pregnancy is about a healthy, well-balanced diet, full of vitamins and minerals.

When you’re pregnant with twins, your doctor or midwife might recommend that you get expert advice about your dietary intake of protein, carbohydrates, folate, iron, calcium, fats and overall nutrients. Dietitians have qualifications and skills to give you expert nutrition and dietary advice.

Will my twins be born early?

Health professionals usually aim for twins to be born at 37-38 weeks unless problems develop earlier or there’s a good reason to delay birth.

On average, triplets are born at around 33 weeks, twins are born at around 36 weeks, and single babies at around 40 weeks. Around 5% of all twin pregnancies are born before 28 weeks. This is considered extremely premature.

If you know your twins will be born early, you can get ready for premature birth.

Vaginal or caesarean birth

It’s good to talk with your obstetrician and midwife about your health, your babies’ health and whether vaginal or caesarean birth will be better for the birth of your twins.

If you’re having twins, you’re almost twice as likely to have a caesarean birth.

Your obstetrician will discuss with you the most appropriate time and ‘way’ for you to give birth to your twins.

Preparing for parenting twins

Parenting twins can be very rewarding, and very challenging at times too. Here are ways to get ready for parenting twins:

  • Communication with your partner is an essential part of continuing a healthy relationship. Pregnancy is a wonderful opportunity to discuss and share your thoughts and expectations for the future. You might like to watch our video on relationships in pregnancy and early parenting and read about pregnancy and healthy relationships.
  • Look at our resources on breastfeeding. You can breastfeed your twins, and it’s good for you and for your baby’s health. You’re likely to need some expert assistance and advice when you’re getting started. Ask your birth hospital if there are classes specifically designed for expectant parents of twins.
  • Read about services and support. As a parent of twins, you’ll find that life is very busy, so it’ll help to have support from family and friends.
  • Enrol with the Australian Multiple Birth Association (AMBA). The AMBA offers help, a range of support services and links to other services for new parents of twins. You might also like to enrol your twins in the Australian Twin Registry (ATR).
  • Last updated or reviewed 01-12-2014
  • Acknowledgements This article was developed in collaboration with Associate Professor Mark P. Umstad, Director of Maternity Services, Royal Women’s Hospital, Melbourne; and Associate Professor Jeffrey Craig, Group Leader, Early Life Epigenetics, Murdoch Childrens Research Institute, Honorary Principal Research Fellow, University of Melbourne and Deputy Director, Australian Twin Registry.