Having twins

When a couple finds out they are having twins, it can come as a genuine surprise. Shock, anxiety and denial combined with utter joy are common reactions. “How will we manage?”, “How can we afford them?”, “Our house is too small”, “We won’t cope”, “They must be wrong”, are some of the more common responses.

There is not a right way to respond to the news of having twins and it can take time to process this news. This is why it helps to just aim for an easy life for the first few weeks after having a twin pregnancy confirmed and to avoid being so busy that you don’t have a chance to process the reality. Although every woman has some chance of conceiving with twins, finding this out for sure is another thing entirely.

Denial, shock numbness and even anger are common emotions in the early days of having a twin pregnancy diagnosis. But with time reality soon descends and most women just learn to accept the fact that they are having 2 babies, instead of 1.

There is no definite time frame when couples will know they are having twins. There are just too many individual factors to consider. Perhaps twins may already run in your family, you’ve had twins before, or you’ve had fertility assistance – all of these factors will increase your likelihood of having twins.

Some women suspect almost from the moment of conception that “something” is different. Their senses of taste, smell and alertness change so remarkably that not only do feel they are pregnant but are strongly suspicious they are having more than one baby.

Symptoms of twin pregnancy

• Some women will “just know” they are pregnant with twins. This may be before they have even had confirmation that they are pregnant. They may dream, sense or have a vision or inherent belief that they are pregnant with twins.
• Some women will be told they are pregnant with twins by their partner, relatives, family or very close friend. Although there is often no evidence to support this claim, when their twin pregnancy is confirmed it really comes as no surprise.
• Feeling very nauseous from early in the pregnancy. This is sometimes so extreme that the mother finds it difficult to tolerate anything but the blandest, easiest to digest foods.
• Extreme intolerance to foods, smells, textures and appearance of some foods. Commonly meat, seafood, coffee and tea are the first substances to be found repugnant.
• The womb is “large for dates”, which reflects the fact that two embryos, rather than one is present.
• Extreme breast tenderness – to the point where it may be too uncomfortable to wear a bra. Some women find they need to wear crop tops as an alternative until their breasts become more comfortable.
• Wanting and needing to wee much more frequently. Although urinary urgency is a common early pregnancy symptom, when pregnant with twins, this is much more magnified.
• Utter exhaustion and a feeling of being unable to get through each day. This again, is a common pregnancy symptom but is exacerbated during a twin pregnancy.
• Higher levels of hCG. This may be reflected in a very early pregnancy urine test. Even before a missed period, the level can be so high that there is an immediate, strong and clear positive confirmation on the pregnancy testing stick. For women who have undergone fertility treatment, blood tests may reflect a very high concentration of hCG early after conception.
• Some women will experience more uterine cramping, which is not associated with any blood loss. This can be a symptom of round ligament pain and is due to the womb expanding relatively quickly.
• A sense that your heart has to work harder than it usually does. Many women are aware that their resting heart rate is higher than normal. This is a sign of their heart having to pump out a greater blood volume with each heart muscle contraction in order to supply the womb with oxygen-rich blood.
• Moodiness, being prone to tears and feeling mentally unstable. Again, changing moods are a common pregnancy symptom, but when pregnant with twins, they tend to be more extreme.
• You may find you can feel your babies moving much earlier in your pregnancy. Women pregnant with twins say that they are conscious of feeling movements, known as quickening, earlier than the standard 15-16 weeks.

How is a twin pregnancy confirmed?

Although you, your partner or your healthcare practitioner may suspect you are pregnant with twins, it is not until twins are confirmed that you can be 100% sure:

• Ultrasound, where two embryos are clearly defined on the screen
• Hearing two separate heartbeats on a Doppler
• In the absence of sound ante-natal care, it is still possible that a twin pregnancy may not be evident until two babies are born

As mentioned above, many women are not surprised when they find out they are pregnant with twins. It may run in the family, or previous fertility treatments have made it more probable.

But if you’ve never had anything to do with twins other than knowing they exist, then your reaction is likely to be very different. Once you’ve recovered from the initial shock of finding out you’re having twins, your practical side will emerge. Exactly when this happens is highly individual.

It’s never too early to start planning for managing two babies and it’s worth remembering that less than 50% of twin pregnancies extend beyond 38 weeks. Prematurity is common when having twins and many couples aim to be organised from around 30 weeks. Similarly, pregnancy complications are more common, so being organised and doing some planning is important. Don’t leave everything to the third trimester because you’re likely to find yourself running out of time and getting stressed out.

Extra care during twin pregnancy

You will probably find that you have more ultrasounds and check-ups during your twin pregnancy than if you were carrying one baby. The foetal screening scan at 18 weeks will be more thorough and time consuming, especially if the babies are not being cooperative by lying in the best positions to be able to see them both clearly. You may also need to have Doppler studies to examine the blood flow through each of the baby’s umbilical cords.

The amniotic fluid volume will also need to be monitored as this is one way of ensuring the babies’ kidneys are working effectively.

Twins generally grow at the same rate as singleton babies until they are between 32 and 35 weeks. After this stage of gestation, space becomes a real issue and there is simply not the room for them to grow at the same rate. By this stage, mothers that are pregnant with twins can start to become very uncomfortable and to feel as if they can’t move as easily as they’d like to. Stretch marks are also common in the third trimester when the collagen fibres in the skin tear because they cannot stretch anymore.

You may find you are confined to bed rest at home or admitted to hospital for monitoring. This is one way of being able to monitor blood pressure regularly and also in reducing the risk of premature birth.

If you are a negative blood group, you may need to have prophylactic Anti-D during your second and third trimesters at around 28 and 34 weeks. Be guided by your obstetrician or midwife about this; there is no one consistent approach that applies to all mothers.

If you are at risk of going into premature labour, you are likely to have at least one dose of corticosteroids. These help to mature the babies’ lungs so they are less likely to need breathing support when they are born.

Practical considerations when having twins

• Your healthcare rebate and entitlements may be affected; find out early in your pregnancy what you are covered for. Premature baby care can be extremely expensive. Find out your status and coverage by your medical aid early in your pregnancy to avoid unwanted and avoidable costs.
• Housing – number of rooms, bathroom access, yard, living space and storage. Children may be small but their “stuff” takes up a lot of room.
• If you are considering renovating your home to accommodate your bigger family, be aware that any renovation ALWAYS takes longer than predicted and costs more than you think it will. Do you really need this extra stress when you are pregnant with twins or is moving house a preferable option? Only you and your partner can know what’s right for you.
• Your neighbourhood – is it child friendly, are there other families to connect with, and is it safe?
• Consider how you are going to feed your twins. Speak with your midwife about what you can do to prepare your body and your mind for breastfeeding twins.
• Every time you do grocery shopping, buy at least one thing to set up the nursery. Toiletries, diapers, baby wipes and baby wash can all be stockpiled through your pregnancy to minimise additional financial pressure when they twins are born.
• Cook meals and freeze them for when you are pressed for time after the twins are born.
• Nursery furniture – research your options such as buying new or second-hand and doing deals for buying double of everything. You will be amazed at how generous other parents can be in lending their baby equipment, so don’t be afraid to ask.
• Access to community resources such as doctors, child health clinics, nursery schools, schools, parks. If you have to, could you walk to the shops/ doctors?
• Make a list of support people that you can call on for help. Get their contact numbers and availability so that you don’t ever feel you need to care for the babies all by yourself.
• Check with your employer to see what your parental leave entitlements are.
• Car size – many couples need to size up when it comes to accommodating twins, especially if they already have older children. Also check car child restraints and consider spending more on the long-term options. You will have more time when you are pregnant to research this than when you have two babies to care for.
• If you are not a naturally organised person, then learn how to be. Go to a store that specialises in storage and organisation. Get a calendar and a diary and get into the habit of entering important dates, medical appointments and reminders. The secret to managing twins is routine and if you’re a bit chaotic, this won’t help. Ask one of your more organised friends for tips; they’re sure to love sharing their ideas with you!
• Talk with your older children about the twins, how much they will be able to help you and let them know they are special too. Try to set aside some special time with them each day.
• Make sure your camera is working and the batteries are charged. Twins have a habit of coming early and you want to be prepared.
• Pack your hospital bag nice and early. Not having to think about this and ticking it off your “to do list” will free your mind up for other necessities.
• Go away for a few days with your partner before the twins are born. Have some couple time and focus on what you both need to do to stay strong and united. The early days of caring for one new baby can be very demanding, but this is especially the case with twins.

What can I do during my twin pregnancy?

Because of the increased obstetric risks during a twin pregnancy, it’s easy for mothers themselves to feel overlooked. The focus of obstetric staff may be so concentrated on the pregnancy and the twins, that you could feel you as a person are going unnoticed. And although healthcare professionals mostly try really hard not to do this, it can still happen. This is why it is so important for all pregnant mothers to advocate for themselves and have a say in their care. And to speak up if you feel you’ve become a “walking womb” for hatching your twins!

• Look after yourself. Simple tasks such as eating healthy foods, getting rest and good quality sleep, regular exercise and maintaining healthy relationships is really important during any pregnancy. But they are all especially important when carrying two babies.
• You may benefit from seeing a dietician. It’s important to ensure you have enough folate, protein, iron and nutrients to support sound pregnancy health.
• Make time to chill out. Your body is working 24 hours a day to grow and support two babies towards maturity. That means there will be times when you will feel tired even though you won’t consider you’ve done much.
• Think about finishing paid work earlier. You may find you are simply too tired to work past your second trimester. Investigate your leave entitlements with your HR (Human Resources) department; you will need to get a doctor’s certificate for this, so don’t leave it until you’re already exhausted. Plan early and let your boss know you may be leaving earlier than other mothers that have applied for parental leave.
• Speak with your healthcare provider about your birth options. Read what you can and ask lots of questions. Fear and anxiety can only be helped by being as informed as you can be.
• If you have older children, organise some regular, reliable and supportive care for them. Quarantining some time with your partner before the twins are born will help both of you to focus on strengthening your relationship.

But I still don’t feel excited about having twins – am I a bad parent?

Sometimes expectant parents can feel very differently about having twins. A mother may feel more apprehensive than her partner, who could view having twins as just about the best thing that ever happened. The practical reality of coping with more than 1 baby at a time can weigh especially heavily on mothers. Although you may feel you should be delighted, your reality may be very different.

No matter how many times you hear “you’ll be alright… you’ll cope”, you could still find yourself worrying. Building anxiety creates feelings of stress, which then impacts on the ability to sleep and enjoy everyday life. If you or your partner feel this way it is important that you seek mental health support. Start with your GP, who can speak to you about referral to a psychologist. Recognising how you feel and acknowledging it is the first step to feeling better.

Having twins is a joy, but it is also made easier by some planning and organisation.