Having Twins? Here’s What You Need to Know

Pregnancy

Getting prepped for twins doesn’t just mean doubling up on your baby supplies. The twin journey begins within, with keeping yourself and your babies healthy. That starts during early pregnancy, by making sure you’re eating right and eating enough.

Morning Sickness

“Gaining weight in the first trimester of a twin pregnancy is difficult,” says Dr. Sherry Ross, OB/GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. “Morning sickness is so much worse.”

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Try eating small meals more often throughout the day, and eating lots of protein. Severe morning sickness that results in weight loss could indicate that you have a severe form of morning sickness called hyperemsis gravidarum (HG). This can require a stay in the hospital and treatment with intravenous (IV) fluids. Even if you don’t have HG, you could require IV fluids if you vomit too much from morning sickness.

You should be reporting on your morning sickness whenever you see your doctor, and with twins, you will be seeing your doctor a lot more. The exact number of appointments will depend on your doctor’s policies and suggestions, and on the health of your pregnancy. You can also expect more ultrasounds. “A twin pregnancy could have an ultrasound every two or three weeks, or even once a week, depending on fetal and maternal health,” says Ross.

Weight Gain

During your appointments, the doctor will be checking to determine if your weight gain is healthy, and if you’re at risk for conditions that develop more commonly during a twin pregnancy, such as gestational diabetes and pre-eclampsia.

A healthy diet during pregnancy is critical to helping you avoid long-term health issues for you and your babies, especially if you develop gestational diabetes. A diet high in vegetables, low glycemic fruits, and lean proteins will help keep everyone healthy.

“We look for a weight gain of 35 to 45 pounds in twin pregnancies,” says Dr. Ross. You should expect to be eating 300 extra calories a day for each fetus. Taking pregnancy supplements will help make sure you and your babies are getting all of the necessary nutrients.

In additional to a prenatal vitamin, your doctor will probably prescribe calcium, iron, folic acid, and perhaps vitamin D.

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Pre-eclampsia and Other Concerns

If you’re over 40 or have high blood pressure before you get pregnant, you may be at higher risk for developing pre-eclampsia. This is especially true if you’ve had pre-eclampsia during previous pregnancies.

Pre-eclampsia usually develops after 20 weeks of pregnancy. It can also develop earlier in pregnancy, or, in some cases, postpartum. It’s characterized by high blood pressure and high amounts of protein in the urine, and can be fatal to the mother or her babies if left untreated. It can cause complications like liver damage, placental abruption, and bleeding.

Your doctor will be monitoring your blood pressure, and testing your urine for signs of increased protein output.

While twin pregnancies can have additional health concerns, the most common concern according to Ross is pre-term delivery. “You don’t want any contractions before 37 weeks,” she says. Some twin moms will be on bedrest to allow the babies plenty of time for healthy development.

Delivery

Ross advises twin moms to prepare themselves for delivery several weeks earlier than moms expecting just one child. “Get everything out of the way. Take the hospital tour early, have your baby shower early,” she says. You can expect to deliver between weeks 37 and 39.

Twin moms can expect longer, and perhaps more eventful, labors than singleton moms. “There’s always drama in twin deliveries,” says Ross. That has a lot to do with your twins’ classification, or how they are occupying your womb. There are three possible classifications:

• Monochorionic monoamniotic (Mo-Mo): The babies share a placenta and an amniotic sac
• Monochorionic diamniotic (Mo-Di): They share a placenta but each has her own amniotic sac
• Dichorionic diamniotic (Di-Di): They each have their own placenta and their own amniotic sac

You’ll know the situation with your twins early in your pregnancy. Concerns about delivery arise for Mo-Mo twins because they risk getting tangled in each other’s umbilical cords. “Mo-Mo pregnancies are always delivered by Caesarian as soon as is safely possible,” says Ross. Those extra ultrasounds you get during your pregnancy will be monitoring your babies and their umbilical cords if they are Mo-Mo twins.

Regardless of what classification your twins are, the birthing room is prepared for both vaginal and Caesarian deliveries. “If the presenting baby is in a vertex position,” meaning her head is pointed down, “there’s a better chance we’ll go with a vaginal delivery,” says Ross. “It gets a little more complicated if the second baby is not vertex.” Your doctor can attempt to turn the baby, or deliver her breech, but a Caesarian to deliver the second baby once the first has been delivered vaginally is not unheard of.

The Takeaway

Twin pregnancies might seem like they ask a lot of a mother-to-be, but they last barely nine months. Get plenty of rest and eat well to keep yourself and the little ones healthy. Before you know it, you’ll be greeting two adorable new faces, doubling up on onesies, and counting 20 new fingers and 20 new toes.