What should I do when I find out I'm having twins?

If you’re pregnant with twins, a healthy lifestyle and good antenatal care will help you manage your pregnancy and give your babies the best start in life.

You might be thrilled at the thought of having twins. But on the other hand, you might be worried about how you’ll manage. In some cases, you might have expected it, or it might have been a surprise.

Whatever your feelings, the more you know about what's ahead, the better you'll be able to deal with it.

What type of antenatal care do I need?

It's important to get good antenatal care. This is the care you get while you are pregnant. You can choose to have a midwife, an obstetrician, or a doctor look after you.

Having a healthy lifestyle and diet during pregnancy is important. Eat well, take gentle exercise, drink lots of fluid and, if you feel stressed, ask for support from friends and family, or talk to your midwife or doctor.

Some people think that if you are pregnant with twins, you need a lot of extra food. That's not true. The type of food you eat is more important for your babies than how much you eat. Talk to your midwife or doctor about the best diet for you. You might also be advised to take certain supplements, such as folate and iron supplements.

Make sure you look after yourself. Being pregnant with twins can be more tiring both physically and emotionally. All of the common pregnancy discomforts are likely to be more noticeable with twins.

It's vital to attend all your appointments so your midwife or doctor can see what type of twins you have, check your dates and pick up any problems.

What are the different types of twins?

There are two types of twins - fraternal twins and identical twins.

Fraternal twins

Fraternal twins are formed from the fertilisation of two eggs 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, inner membrane (the amnion) and outer membrane (the chorion). They don't usually look identical and might or might not be the same sex.

Identical twins

Identical twins are formed from the splitting of one embryo. They are also known as 'monozygotic twins'.

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

• Almost one third of identical twins have their own placenta, inner membrane, and outer membrane. The medical term for these twins is ‘dichorionic diamniotic’ or DCDA twins.
• Almost two-thirds of identical twins share the same placenta and chorion, but have their own amnion. These are ‘monochorionic diamniotic’ or MCDA twins.
• The rest — only about 4% of identical twins — share everything, and are called ‘monochorionic monoamniotic’ (MCMA) twins.

Although identical twins are the same sex and are genetically identical, they can develop quite different personalities. You can find a good description of the different types of monozygotic twins, with pictures, at the Twins Research Australia.

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, although home birth for twins is rare because of the higher risk of complications. You may find this decision overwhelming, so start talking about it to your midwife or doctor early in your pregnancy.

You may think that caesarean section is the only option, but talk to your midwife or doctor about whether vaginal birth is possible. Even if you try for a vaginal birth, you might eventually need to have a caesarean section, as with any other pregnancy.

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?

Most twin pregnancies are healthy. But complications can happen, and some are more likely with twins. These include:

• miscarriage
• vanishing twin syndrome — a twin that is seen on ultrasound early but disappears by the next ultrasound
• high blood pressure and pre-eclampsia
• gestational diabetes
• haemorrhage (bleeding) around the birth
• premature birth
• complications during labour
• low birth weight

Having a doctor or midwife keep an eye out for these problems is important.

What is twin-twin transfusion syndrome?

Identical twins who share the same placenta and chorion can sometimes share a condition called twin–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.

Most identical twins don’t get TTTS. But if they do, it is more likely to happen to MCDA twins than to MCMA twins.

If your twins have TTTS, there are many different ways to treat it - ask your doctor for advice.

Where can I get more information about having twins?

Find more information about twins at the Twins Research Australia and the Australian Multiple Birth Association.