My twin pregnancy –
What does it mean for me?
Congratulations on the good news
Finding out you have a twin pregnancy can be
a pleasant surprise but for some expectant
mothers, it can be a daunting prospect! Either
reaction is completely normal.
At Homerton Hospital, we would like to
support you through this pregnancy. To help
you understand more about your pregnancy,
we have designed this leaflet to introduce you
to some of the words you may hear your
midwife or doctor say about your pregnancy,
and give you some idea about the care you will
be offered.
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Diagnosis
Your doctor or midwife may have first suspected a twin pregnancy when
feeling your abdomen, they noticed your womb was larger than expected
for your dates and they referred you for an early scan. But usually twin
pregnancy is first diagnosed when you attend for your dating scan
between 10 and 14 weeks. This scan will also help to determine the type
of twin pregnancy you are carrying.
Types of twins
There are two types of twins – dichorionic and monochorionic.
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Dichorionic twins - You may hear your doctor call the twins
‘dichorionic’ (DC). What this means is that the twins usually come from
two different fertilized eggs and therefore will look different from each
other, can be different genders and are no more alike than brothers and
sisters. This is the more common type of twin pregnancy and is often
associated with pregnancies from fertility treatment.
These twins are always in separate sacs of fluid – ‘diamniotic’ (DA).
Approximately 20% of DCDA twins are identical, and come from a
single fertilised egg that has split very early
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Monochorionic twins - You may hear your doctor describe the twins
as ‘monochorionic’ (MC). What this means is that the twins have come
from the same fertilized egg and will therefore look the same and will
be the same gender.
Usually these twins will grow inside their own sac of fluid and will be
‘diamniotic’ (DA). Rarely they may share the same sac of fluid and will
be called ‘monoamniotic’ (MA).
In your blue notes you may notice your pregnancy described as DCDA
(dichorionic diamniotic pregnancy), MCDA (monochorionic diamniotic
pregnancy) or MCMA (monochorionic monoamniotic pregnancy).
We aim to identify monochorionic twins, as there are increased risks with
this type of twin pregnancy, so we offer an increased number of scans.
Usually we can tell at approximately 12 weeks whether your twins are
monochorionic or dichorionic.
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Antenatal care
Because twin pregnancies are special, we like to follow-up our expectant
mothers in the antenatal clinic regularly. This is to reassure you and your
partner and to ensure that the pregnancy is progressing well. This will
involve monitoring your blood pressure closely, checking for any protein in
the urine, regular blood tests to check your iron levels and sugar levels and
ultrasound scans.
Problems during pregnancy
As you will be carrying two babies, problems which affect ‘singleton’
pregnancies may occur but can be exaggerated, such as morning sickness,
heartburn, ankle oedema (swelling), constipation and varicose veins.
Furthermore you can expect the weight gain to be greater than a
‘singleton’ pregnancy which means problems like backache or tiredness
may be worse.
Twin pregnancies also have a higher risk of:
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low iron levels – ‘anaemia’.
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one or both babies being small – either because one of the placentas
may not be working so well (“growth restriction”) or because of shared
placenta problems with identical twins
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delivering before 37 weeks gestation – ‘premature labour’.
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babies requiring admission to Special Care
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vaginal bleeding before labour.
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diabetes in pregnancy – ‘gestational diabetes’.
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high blood pressure and protein in the urine – ‘pre-eclampsia’
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cerebral palsy
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perinatal death including stillbirth
We usually recommend scanning non-identical twins every four
weeks from 20 weeks, and identical twins every two weeks from
16-22 weeks, and every three weeks thereafter.
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Labour and delivery
Your doctor will discuss with you the best method and time for delivering
your babies. Because of the increased risk of the placentas not working
so well in advanced pregnancy, we usually recommend delivering DC
twins from 37 weeks, and MC twins at approximately 36 weeks, as
continuing beyond 38 weeks increases the risk of fetal death. A planned
caesarean section may be recommended depending on the position of
your babies or if premature labour is likely, or if there are other
complicating factors. Otherwise, you may go into labour naturally, or you
may be offered induction of labour at the appropriate time. At Homerton,
we recommend that all twin deliveries happen in the Consultant led
Delivery Suite and not the Homerton Birth Centre or at your home. This
is so that we can monitor twin pregnancies closely during labour.
How will my babies be delivered?
During labour, twins are more likely to become distressed. In established
labour, the uterus should contract for approximately 45 seconds every
three minutes; during this time, the bloodflow to the placentas may be
reduced, so twins may show signs of distress during labour. It is therefore
very important that we monitor both twins’ heart beats very carefully
during the labour. This may be done either using a belt on your tummy,
or by breaking the waters around the first twin and placing a small clip
on the first baby’s head. Twins are more likely to require medical
intervention (vacuum, forceps or caesarean section) than single babies. If
the first baby (twin 1) is coming head first (cephalic), and there are no
other complicating factors, you should be able to try for a vaginal birth.
However, if twin 1 is not head down at the time of labour, then a
caesarean section may be recommended as the safest option.
After the babies are born, there is a slightly increased risk of you bleeding
– the uterus has been over-stretched by having two babies. We therefore
recommend “active” management of delivery of the placentas, which
involves giving you an injection to help the uterus contract strongly and
the placentas to separate.
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After twin 1 is born, we are never certain whether or not the placenta of
twin 2 is still working satisfactorily. We therefore recommend reducing
the delay in delivering twin 2. If there are concerns about the heartbeat
of twin 2, the doctor may need to deliver your baby using vacuum or
forceps or turn the baby and deliver twin 2 feet first. Sometimes, your
uterus stops contracting for a while after twin 1 is delivered, so we usually
recommend a hormone (Syntocinon) infusion as soon as the first baby is
born to bring back the contractions.
If twin 1 has been born vaginally, we would always hope to deliver the
second baby vaginally as well. However, in rare or exceptional
circumstances a caesarean section may be required for the delivery of
your second baby even if your first baby is born vaginally. This may be
due to twin 2 being in a position not suitable for vaginal delivery or if
there is an abnormality in the heart tracing requiring urgent delivery.
At the time of delivery, whether vaginally or by caesarean, there will be a
team dedicated to your care, and to each baby. This will include the
midwifery, obstetric, paediatric, anaesthetic and support staff.
Pain relief during labour
Epidurals are often recommended for pain relief in labour but are not
compulsory. This is because we are keen that the second baby should be
delivered fairly quickly after the first, and the doctor may need to
intervene, which would be easier for both you and the doctor if you have
an epidural. You can discuss with your doctor about what pain relief you
would prefer in the antenatal clinic.
Having a caesarean section
Your doctor may recommend a caesarean to deliver the babies. Usually,
you would come in on the morning of the procedure having had nothing
to eat or drink from midnight. Your partner may stay with you during the
delivery. We recommend that you are awake during the procedure, which
is usually performed in the morning. We have further information leaflets
about having a Caesarean at Homerton.
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After the babies are born
We would hope that you will breast feed both your babies which ever way
they are delivered. The midwives will help you as much as possible, and
show you how you can successfully feed them both.
Further information
The midwifery and obstetric teams are happy to answer questions you may
have. Further support and advice can also be found at the following
organisations:
Twins and Multiple Births Association (TAMBA)
2 The Willows, Gardner Road,
Guildford, Surrey GU1 4PG
Tel: 01483 304442
Web: www.tamba.org.uk
The Multiple Births Foundation
Hammersmith House Level 4,
Queen Charlotte’s and
Chelsea Hospital, Du Cane Road, London W12 0HS
Tel: 020 3313 3519
Web: www.multiplebirths.org.uk
Homerton University Hospital NHS Foundation Trust
Homerton Row, London, E9 6SR
Tel: 020 8510 5555
Website: www.homerton.nhs.uk
Authors: Midwifery team
Date: September 2012 Review date: September 2014
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Homerton serves a culturally diverse community, which is reflected by both our patients and staff. We are fully
committed to providing equal and fair treatment for everyone who uses our hospital.