How is pregnancy with twins different to pregnancy with one baby?

If you are pregnant with twins, you may feel well and have an uneventful pregnancy. However, being pregnant with twins carries higher risks than being pregnant with one baby.

You’ll be offered monitoring more often during your pregnancy if you’re having twins, to make sure everything is going well.

Being pregnant with twins can be more tiring, both physically and emotionally. You will probably gain more weight. All the common pregnancy discomforts are likely to start earlier and be more noticeable with twins. Try to look after yourself, and rest when you can.

Your babies are more likely to be born early. Where you give birth is your choice, but your health team might recommend that your babies are born in a hospital that has facilities to care for twins. Talk to your doctor or midwife about what you can expect when you give birth to twins.

What type of antenatal care do I need?

It's important to have good antenatal care. If your twin pregnancy is considered higher risk, you will probably need to have a specialist obstetrician look after you.

You might have your pregnancy care in a special multiple pregnancy clinic, staffed by obstetricians, midwives and other health professionals you may need to see.

You’ll need to have more health checks and ultrasounds — when and how often depends on the type of twins you’re having. When you attend all your appointments, your midwife or doctor can monitor you and your babies’ health and identify any problems early.

It’s very important that you have an ultrasound before 14 weeks of pregnancy, to work out if your twins share a placenta or not.

For more information on maternity services available in rural Australia, see the links below in the resources and support section.

What are the different types of twins?

There are different types of twins: fraternal twins and identical twins.

Fraternal twins

Fraternal twins are formed when two eggs are fertilised by two different sperm. They are also known as 'dizygotic twins', or 'non-identical twins'.

With fraternal twins, the two fetuses (developing babies) each have a separate placenta and sac. The sac consists of an inner membrane (called the amnion) and an outer membrane (called the chorion).

Fraternal twins don't usually look identical (but they may look similar, like any other non-twin siblings) and might or might not be the same sex.

Identical twins

Identical twins are formed when one fertilised egg splits in two. They are also known as 'monozygotic twins'.

There are different types of identical twins, depending on what they share in the womb.

• Almost 1 in every 3 pairs of identical twins have their own separate placenta, inner membrane and outer membrane. The medical term for these twins is ‘dichorionic diamniotic’ or DCDA twins.
• Almost 2 in every 3 pairs of identical twins share the same placenta and chorion but have their own amnion. These are ‘monochorionic diamniotic’ or MCDA twins.
• Less commonly, only about 4 in 100 pairs of identical twins, share everything. They are called ‘monochorionic monoamniotic’ or MCMA twins.

Identical twins are always the same sex and have the same genes.

If you have triplets or more, the principles are similar.

What are my options for giving birth to twins?

In Australia, you can choose to give birth in a public hospital, a private hospital, at a birth centre or at home. You may find this decision overwhelming, so start talking about it to your midwife or doctor early in your pregnancy. They may recommend against a home birth for twins because of the higher risk of complications.

Talk to your midwife or doctor about your options for vaginal or caesarean birth. It’s good to discuss your options ahead of time, as your birthing plan will need to take your individual circumstances into account.

Twins are more likely than single babies to be born premature (before 37 weeks) and there is a chance they may spend time in a neonatal intensive care unit (NICU) or special care nursery (SCN).

Are there any complications having twins?

There is a higher risk of complications if you’re pregnant with twins. Some complications can happen in any pregnancy, but are about twice as likely with twins.

There are other complications that can only happen with twins who share a placenta. This is why you will need extra monitoring if you’re having MCDA or MCMA twins.

Complications that can happen in any pregnancy

Problems during pregnancy that are more common with twins include:

• miscarriage
• anaemia
• hyperemesis gravidarum
• high blood pressure and pre-eclampsia
• gestational diabetes
• congenital disorders in your babies — these are more likely in identical twins

Birth complications are also more likely, such as:

• haemorrhage (bleeding) after the birth
• premature birth
• malpresentation and cord prolapse
• low birth weight

'Vanishing twin'

This refers to a twin that is seen on an early ultrasound, but disappears by the next ultrasound. It happens when one twin miscarries during the first trimester of pregnancy. Most of the time, this won’t cause any problems for the other twin.

Read more on the physical and emotional effects of experiencing a pregnancy loss.

Other complications

Identical twins who share the same placenta and chorion (monochorionic) can sometimes develop a condition called twin to twin transfusion syndrome (TTTS). In this condition, blood flows from one twin to the other, resulting in one baby getting too much blood and the other baby not getting enough. This affects the health of both babies, sometimes severely. This condition is rare and only affects a very small number of monochorionic twin pregnancies, most identical twins won’t get TTTS. If your twins have TTTS, there are several different ways to treat it and your care will be transferred to a medical specialists and hospital who is able to take care of you and your babies.

If your twins share a placenta there are added risks, and your health team will closely monitor both your babies, as the health of each twin affects the other.

With MCMA twins, there is a chance that the babies’ umbilical cords could become tangled together and put both babies’ lives at risk.

How can I look after myself if I'm having twins?

Having a healthy lifestyle during pregnancy is important. Eat a healthy and balanced diet, get some gentle exercise and drink lots of fluids.

The type and amount of food you eat is very important for your babies. Talk to your midwife or doctor about the best diet for you. Your health team might also advise you to take certain supplements, such as folate, iodine and iron.

Find out more about healthy eating in a twin pregnancy.

Resources and support

When you’re expecting twins, the more you know about what's ahead, the better you'll be able to manage all that lies ahead. It’s a good idea to get to know other families having twins, who can relate to your experience.

You can find more information, advice and support at Twins Research Australia and the Australian Multiple Birth Association.

If you’re feeling anxious about having twins, ask for support from your friends and family. You can also talk to your doctor, midwife or social worker.

If you live outside of a major city, you can find out more about maternity services available to you below:

• Maternity services in remote Northern Territory
• Maternity services in rural NSW
• Maternity services in rural Queensland
• Maternity services in rural South Australia
• Maternity services in rural Tasmania
• Maternity services in rural Victoria
• Maternity services in rural Western Australia