Pregnant with twins

There are 2 types of twins — fraternal twins and identical twins.

Fraternal twins

Fraternal twins happen when 2 eggs are fertilised by 2 different sperm. Fraternal twins are also called 'dizygotic twins', or 'non-identical twins'.

Fraternal twins don't usually look identical. They may look similar, just like any other brothers or sisters. They may or may not be the same sex.

Fraternal twins each have a separate placenta and sac as they develop in your uterus (womb).

Identical twins

Identical twins happen when 1 fertilised egg splits in 2. The split happens after the egg is fertilised.

When this happens, the twins are identical because they both have the same genes. It's also why they are always the same sex. They are also known as 'monozygotic twins'.

There are different types of identical twins. It depends on whether they share a placenta or amniotic sac.

• Dichorionic Diamniotic (DCDA) — each baby has its own placenta and its own amniotic sac. This is the most common type of twin pregnancy.
• Monochorionic Diamniotic (MCDA) — your babies share a placenta but are each in their own amniotic sacs.
• Monochorionic Monoamniotic (MCMA) — your babies share a placenta and are in the same amniotic sac. This is a rarer type of twin pregnancy.

If you are expecting triplets or more, the placenta and sac can be shared in the same ways that are listed for twins.

Most people who are having twins have a healthy pregnancy and give birth to healthy babies. But there are more risks with twin pregnancies compared to being pregnant with one baby.

You will be offered more checks during your pregnancy. This is to make sure everything is going well.

Being pregnant with twins can be more tiring, both physically and emotionally. You are more likely to have:

• backache
• heartburn
• morning sickness
• swollen ankles
• tiredness
• varicose veins

These will get better after you have your babies. Try to look after yourself and rest when you can.

Talk to your doctor or midwife about what you can expect when you give birth to twins.

It's important to have good antenatal care during your pregnancy.

You'll need to have more health checks and ultrasounds. When you go to your appointments, your midwife or doctor will check you and your babies' health. This will show up any problems early.

It's very important to find out if your twins share a placenta. This type of pregnancy needs careful monitoring.

Generally, in Australia, you can choose to give birth in a:

• public hospital
• private hospital
• birth centre
• at home

Talk to your midwife or doctor about your options ahead of time. Your birth plan will need to take your individual circumstances into account.

They may recommend against a home birth or birth centre for twins. This may be because of the higher risk of complications at the time of giving birth.

Your health team might recommend that your babies are born in a hospital that has services to care for twins. This is because your babies are more likely to be born early (before 37 weeks).

Premature babies sometimes need to spend time in a neonatal intensive care unit (NICU) or special care nursery (SCN).

There is a higher risk of complications if you're pregnant with twins. Some complications can happen in any pregnancy. But these issues are 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 health checks if you're having MCDA or MCMA twins.

Complications that can happen in any pregnancy

Problems can happen during any pregnancy. However, some problems that happen more often with twins are:

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

Birth complications are also more likely, such as:

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

'Vanishing twin'

This is the term used when an early ultrasound shows there are twins. By the time of your next ultrasound, one fetus can't be seen anymore.

This happens because one twin has miscarried early in your pregnancy. Most of the time, this won't cause any problems for the other twin.

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

Other complications

Identical twins who share the same placenta and amniotic sac can sometimes get a condition called 'twin-to-twin transfusion syndrome' (TTTS).

When this happens, blood flows from one twin to the other. This causes one baby to get too much blood. The other baby does not get enough blood. This affects the health of both babies. It can sometimes be very severe.

It's important to know that TTTS is rare. It only affects a very small number of monochorionic twin pregnancies. Most identical twins won't get TTTS.

If your twins have TTTS, there are different ways to treat it. Your care will be transferred to medical specialists. You will be referred to a hospital that can take care of you and your babies.

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 from The Royal Women's Hospital.

When you're expecting twins, it's important to know what to expect. It can be helpful to get to know other families having twins. They 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're having twins, you may be able to get the Newborn Upfront Payment and Newborn Supplement.

Find out more about maternity services available in rural Australia.