Delivery
Carrying more than one baby usually means
that you will give birth or be advised to give
birth earlier than 40 weeks gestation; therefore
these discussions take place well before this
time:
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For dichorionic twins this discussion will
take place at around 34-36 weeks
gestation and, in general it will be
planned for your babies to be delivered at
between 37/38 weeks gestation.
For monochorionic twins this discussion
will take place around 32-34 weeks
gestation with a plan for their delivery by
36 weeks.
For triplets this will take place around
31-32 weeks. It is very likely that you will
be advised that a caesarean section is
the safest way to deliver your babies and
the aim will be for this to take place
around 34 weeks’ gestation. This is
because it is very difficult to accurately
monitor the heart rates of more than two
babies during
labour and a caesarean delivery are much
less stressful for them.
Feeding your Babies
Feeding your babies is your choice and you
will be supported and offered advice for
whichever method you choose. If you wish to
breastfeed it is important to know that your
body will be able to produce sufficient milk for
two or three babies. Our Infant Feeding
Specialist will be available to support and
advise you.
At home
Once you go home try to make the most of
help offered and get as much rest as
possible. There are many organisations that
can provide information and support for
mothers. We have listed some contacts on
the back page of this leaflet and your Midwife
and Health Visitor may also know of groups
near where you live or other mothers of twins
or triplets who may be happy to pass on tips
about how they coped.
Further information
Twins & Multiple Births Association (TAMBA)
0800 138 0509 (Freephone) www.tamba.org.uk
The Multiple Births Foundation (MBF)
0208 383 3519 www.multiplebirths.org.uk
Twin to Twin Transfusion Syndrome Association
www.twin2twin.org
Adapted from: Royal Chesterfield Hospital v1
2011
Women and Children’s
TWINS & MULTIPLE
PREGNANCIES
Author A El-Matary. V3
Date: March 2011, next review date: December 2019
Information accurate at time of going to print.
Darent Valley Hospital
Darenth Wood Road
Dartford
Kent
DA2 8DA
Antenatal Clinic: 01322 428190
Community Midwives Office:
01322 428753
www.dvh.nhs.uk
Finding out you are expecting more than one
baby can be a big surprise. You may feel a
mixture of excitement and anxiety. You may
have many questions and we have tried to
answer some of them for you.
How common are multiple pregnancies?
Twins are special but they are not rare. They
occur in about 1 in 80 pregnancies. Triplets are
rare and they occur in about 1 in every 6000
births.
Types of twins
It is likely that you have been informed about
your multiple pregnancy at your first antenatal
ultrasound scan. From this first scan the
sonographer will have been able to tell you
whether you are carrying monochorionic or
dichorionic twins. Knowing which type of twins
you are carrying is very important for your care
during pregnancy. This is equally important if
you have been found to be carrying triplets or a
greater number of babies.
Most twins are dichorionic. (Non-identical) This
means that each baby has its own placenta
and two membranes around them as they
develop.
A much smaller number of twins are
monochorionic (Identical). This means that they
share the placenta. Extra checks are needed
with identical twins to be made because the
babies can experience problems as they grow.
Antenatal care
As you are having more than one baby we
advise that a Consultant Obstetrician leads your
maternity care.
You will still see your Community Midwife
regularly for your routine checks and for advice,
but you will also be seen at the hospital
Antenatal Clinic so that your pregnancy can be
closely monitored because of the increased risk
of pregnancy complications such as anaemia
(low blood iron levels), gestational diabetes
(diabetes caused by pregnancy), pre-eclampsia
(high blood pressure related conditions) and
premature labour/delivery.
With a multiple birth pregnancy it is also quite
common to have increased symptoms of
pregnancy such as morning sickness,
heartburn and constipation and later on
backache, varicose veins, ankle-swelling
because of the extra weight you will be
carrying. Talk to your Midwife or G.P. so they
can recommend the best and safest way to
alleviate these symptoms.
Many women expecting twins or triplets suffer
from anaemia. Your blood iron levels will be
checked regularly and you may need to take
iron supplements during the pregnancy. It is
also recommended that you take folic acid
throughout the pregnancy, not just for the first
three months.
Antenatal screening
All screening tests will be discussed with you in
detail by your doctor or midwife.
A nuchal translucency (NT) scan is available at
approximately 12 weeks of pregnancy to assess
your risk of having a baby with Downs
Syndrome. Blood screening tests are not
accurate in twin pregnancies. For more
information please refer to the National
screening committee leaflet regarding Downs
syndrome and multiple pregnancies.
Scans
At 16 weeks fortnightly scans will commence for
mothers who are carrying monochorionic twins
to check on the babies’ growth. This is because
of the risk of ‘Twin to Twin Transfer syndrome’
(TTTS). See later in this leaflet for more details.
At about 20 weeks you will have the detailed or
anomaly scan which checks the major physical
structures of the babies.
If you are carrying dichorionic twins you will
have four-weekly scans from 24 weeks to
make sure that both your babies are both
growing well, gaining weight and are healthy.
It is possible that one or both twins could be
underweight (growth restricted) and will need
more frequent scanning or early delivery, but
you will be advised regarding this.
If you are having triplets or a higher multiple you
will also be offered frequent scans to closely
monitor the size and health of your babies. You
may also be referred to a Feto-Maternal
Specialist for additional support, checks and
information during your pregnancy.
We recommend a measurement of the cervix by
scan from 20 weeks to predict the likelihood of
preterm labour.
What is TTTS?
In TTTS the two babies will be connected by
several blood vessels in the placenta. Usually
the blood flow through these vessels is balanced
between the babies but sometimes there is an
unbalanced flow and one baby receives too little
blood whereas the other baby receives too much
blood.
If TTTS starts to develop mothers are referred
to a Feto-Maternal Specialist who will decide if
treatment is necessary.
Looking After Yourself
Having twins or triplets can make you very tired
and it is important for your own health, as well
as the health of your babies, that you have
enough rest.
If you are working you will
probably need to stop work much earlier than if
you were having just one baby. Make the most
of help offered by friends and family both before
and after your babies are born.