Picture this…you find out you’re pregnant. You go for an ultrasound, and your sonographer happily tells you there is one healthy heartbeat…then a second heartbeat…or more?! Many women don’t have to imagine this scenario. And if you’re one of the expecting mamas who recently found out they’re pregnant with twins or triplets, this article is for you. Here are six things to expect during your multiple pregnancy.
1. You’ll Have More Appointments
More babies means more appointments! It’s important to be prepared for an influx of appointments in your schedule in the coming months. As your babies grow, you’ll have more visits with your provider to make sure your pregnancy is progressing well and healthfully, as well as more visits with any specialists keeping an eye on you and your babies.
This also includes more ultrasounds throughout your pregnancy. It will be important for your provider to keep a close eye on your developing babies to make sure their growth and measurements are progressing, their blood flow looks normal, and their organs are functioning properly. It’s common to have ultrasounds every four to six weeks once you hit the second trimester, however if your care team has any concerns it could be more frequently. As your care team keeps track of the babies, they’ll typically start referring to them as Baby A, Baby B, and so on.
2. There’s a Higher Risk of Complications
Multiple pregnancy means that there are more variables and potential complications—for both mama and babies alike. 15-20% of women pregnant with twins develop preeclampsia, a condition where a pregnant person develops high blood pressure. Women pregnant with multiples are also at a higher risk of gestational diabetes, as well as placenta previa or abruption.
An important complication to observe in multiples is called twin-to-twin transfusion syndrome, a condition that can occur when multiples share a placenta (also known as a monochorionic placenta). This condition causes one fetus to get too much blood, while the other gets too little. Twin-to-twin transfusion occurs in 5-15% of monochorionic twins. Your babies will be closely monitored for any developing complications, and potentially treated by a perinatologist, or doctor specializing in pregnancy complications.
3. C-sections Are More Common
More than one baby means more than one set of variables when it comes to labor and delivery. To ensure the safety of all babies and their mama, your provider may recommend scheduling a C-section for their delivery. Of course, there are a lot of different factors that play a part in this decision. A few things your provider will keep an eye on include:
- Position of the babies: In twins, if both babies are head down, there is a greater chance for a vaginal birth. However if one or more baby is breech or transverse, a C-section is likely the safest method of delivery. If you are pregnant with more than two babies, a C-section is highly likely.
- Size of the babies: If one baby is much smaller than the other, a vaginal birth could be dangerous for the smaller one.
- Number of placentas: If your babies share one placenta, a C-section is more likely. The reason? It’s extremely dangerous to deliver the placenta before all of your babies are born. A C-section ensures that the babies are born first, and the placenta is removed last.
4. Your Weight and Nutrition Goals will Be Different
While women with singleton pregnancies are typically advised to gain between 25 to 35 pounds, the number increases with the number of babies. For twins, a woman with a “normal” BMI at the start of her pregnancy will likely aim for a weight gain of 37 to 54 pounds.
More babies means more calories, too. While double the babies certainly doesn’t mean you’re eating for three, you will need to eat a bit more than for a single pregnancy. A good rule of thumb for those with a normal BMI is typically to increase their caloric intake about 600 calories a day starting in the second trimester. While this might seem like a lot, ensuring you and your babies are getting good nutrients and gaining appropriate weight can help lower your risk of preterm labor.
5. Early Labor is Likely
Around 50% of twins are born early, while triplets can come even sooner. After all—as your babies start to hit growth spurts, your uterus runs out of room quickly! In fact, 38 weeks is considered “full term” for twins, rather than 40 weeks like a singleton baby. Because of these early births (most twin pregnancies deliver around 36 weeks), the babies are typically smaller too, with the average twin weighing around 5.5 pounds.
6. You Should Prepare for a Potential NICU Stay
Because of the likelihood of an early birthday, your multiples might need specialized care in the NICU (Neonatal Intensive Care Unit) after delivery…and they might not! But it’s good to be prepared for this possibility. Babies of all ages and sizes receive care in the NICU for a number of different reasons, and our NICU team does a wonderful job supporting, strengthening, and monitoring your babies.
We know that the idea of the NICU can be overwhelming, but our providers, nurses, social workers, and lactation consultants will be with you every step of the way to get your little ones ready to go home. Our NICU at Women & Babies Hospital is part of Children’s Hospital of Philadelphia’s renowned Division of Neonatology—a network with more than a dozen locations—and has access to the most advanced research and innovative, successful treatments for critically ill newborns.
While there are a lot of other things you will encounter during your pregnancy with multiples, we hope this list gets you off to a good start on expectations of the next several months. We’re wishing you—and your babies—a happy and healthy pregnancy.