Antenatal Care for Twins and Multiple Pregnancies: What You Need to Know

Pregnancy is a special and exciting time, but it can also come with its fair share of challenges. Expecting parents of twins or multiples may face unique challenges that require specialized care. From managing the increased nutritional and caloric needs to monitoring for potential complications, it’s important for expecting parents of twins or multiples to have access to accurate information and support. In this blog post, we will discuss the important aspects of prenatal care for twins and multiple pregnancies, including nutrition, prenatal tests, and screenings, managing stress and anxiety, choosing the right healthcare provider, preparing for delivery and postpartum care, and common misconceptions about twin and multiple pregnancies. We will also discuss the available support and resources that can help expecting parents navigate the unique challenges of a twin or multiple pregnancies.

Preparing for twins or multiple pregnancies: what to expect

It’s important to note that it’s always best to consult with a healthcare provider for personalized advice and to get the most accurate information about what to expect during a twin or multiple pregnancies. A brief overview includes:

Increased physical demands of a twin or multiple pregnancy, such as increased fatigue and the need to rest more often.
Increased emotional demands, such as increased stress and anxiety can come with the added responsibility of caring for more than one baby.
More frequent prenatal appointments, such as ultrasound and non-invasive prenatal testing (NIPT) are carried out to monitor the growth and development of the babies.
The importance of planning ahead, such as preparing the nursery, stocking up on baby essentials, and discussing the birth plan with your healthcare provider shouldn’t be undermined.
Prepare financially, such as creating a budget, and understanding the options available to you regarding health insurance and maternity leave.

Risks and complications associated with twin or multiple pregnancies

Twin and multiple pregnancies come with an increased risk of certain complications compared to singleton pregnancies. Some of the risks and complications associated with twin and multiple pregnancies include:

Premature birth: Twins and multiples are more likely to be born prematurely, which can lead to a host of health problems for babies. According to the Centers for Disease Control and Prevention (CDC), about 60% of twins and almost all higher-order multiple births (such as triplets or quadruplets) are born prematurely, before 37 weeks of pregnancy. This is compared to about 10% of singletons born prematurely. The risk of premature birth increases as the number of fetuses in the pregnancy increases. Twins are more likely to be born prematurely than singletons because the uterus becomes crowded and the placenta may not function as well as it should. Additionally, the risk of preterm labor and delivery is also higher in multiple pregnancies.
Low birth weight: Twins and multiples are more likely to be born at a low birth weight, which can lead to health problems for the babies such as respiratory distress, jaundice, and anemia. According to the Centers for Disease Control and Prevention (CDC), about 12% of twins are born with a low birth weight (less than 2,500 grams or 5 pounds, 8 ounces). This is compared to about 8% of singletons born with low birth weight. The risk of having a low birth weight baby increases as the number of fetuses in the pregnancy increases. Additionally, twin infants are more likely to be born small for gestational age (SGA) than singletons, which means they are smaller in size than expected for their gestational age. The rate of SGA twins ranges from 20 to 30%. It’s important to note that the risk of having a low birth weight or small for gestational age baby increases with prematurity, and as a result, twins and multiples are more likely to be born prematurely and have a lower birth weight. However, this is not always the case, and many twins and multiples are born at normal weight and size.
Twin-to-twin transfusion syndrome (TTTS): This is a rare but serious condition that can occur in identical twins who share a placenta. It occurs when the blood vessels in the placenta allow for an uneven flow of blood between the twins, which can lead to one twin receiving too much blood and the other too little.
Placental abruption: This is a serious condition in which the placenta separates from the uterus before delivery. It can cause heavy bleeding and can be life-threatening for both the mother and the babies.
Gestational diabetes: Expecting mothers of twins and multiples are at a higher risk of developing gestational diabetes, a form of diabetes that develops during pregnancy.
Hypertension: Expecting mothers of twins and multiples are at a higher risk of developing hypertension, or high blood pressure, during pregnancy.
Cesarean delivery: The percentage of twins and multiples born via cesarean section (C-section) varies depending on several factors, such as the position of the babies, the gestational age, and the experience and preference of the healthcare provider. According to the Centers for Disease Control and Prevention (CDC), about 32% of twin deliveries in the United States are by c-section, compared to about 31% of singleton deliveries. However, the rate of c-sections increases as the number of fetuses in the pregnancy increases. For example, the rate of c-sections for triplets is about 74%. It’s important to note that in some cases, a vaginal birth may be possible for twins or multiples, depending on the position of the babies and other factors. However, in some cases, a c-section may be necessary for the safety of the mother and the babies. It’s important to have an open conversation with your healthcare provider about the delivery options and choose the one that best suits your needs.

It should be remembered that not every twin or multiple pregnancy will have an issue, as with the care received from an expert healthcare professional along with self-care, the majority of twins and multiples are delivered healthy.

Nutrition and prenatal care for expecting twins or multiples

Proper nutrition during a twin or multiple pregnancy is essential for the health and development of the babies. Expecting mothers of twins or multiples need to consume more calories and nutrients than women carrying one baby.

Here are some key points to consider when it comes to nutrition and prenatal care for expecting twins or multiples:

Increased Caloric Needs: Expecting mothers of twins or multiples require an additional 300-500 calories per day to support the growth and development of the babies.
Adequate Protein: Expecting mothers of twins or multiples need to consume an adequate amount of protein to support the growth of the babies’ cells and tissues. The American College of Obstetricians and Gynecologists (ACOG) recommends that women with twin pregnancies consume an additional 20-25 grams of protein per day, which is equivalent to an additional 2-3 servings of protein-rich foods per day.
Increased Iron: Expecting mothers of twins or multiples are at a higher risk of developing anemia due to the increased blood volume and iron requirements during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) recommends that women with twin pregnancies consume an additional 27 milligrams of iron per day, which is equivalent to about twice the amount of iron needed for a singleton pregnancy. Expecting mothers should consume more iron-rich foods, such as leafy greens, red meat, and fortified cereals, or take iron supplements as prescribed by their healthcare provider.
Folic acid: Expecting mothers of twins or multiples should consume an adequate amount of folic acid to reduce the risk of neural tube defects in the babies. The folic acid requirements for expectant mothers of twins or multiples are generally the same as for those with singleton pregnancies. The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women consume 600 micrograms of folic acid per day, regardless of whether they are carrying a singleton or multiple pregnancy.
Omega-3 fatty acids: Expecting mothers of twins or multiples should consume an adequate amount of omega-3 fatty acids to support the development of the babies’ brains and eyes. The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women consume at least 200 milligrams of DHA (docosahexaenoic acid) per day, which is an omega-3 fatty acid, regardless of whether they are carrying a singleton or multiple pregnancy.
Hydration: Expecting mothers of twins or multiples should drink enough water to stay hydrated and support the growth of the babies. The Institute of Medicine (IOM) recommends that pregnant women consume at least 3.3 liters (about 13 cups) of total water per day, which includes water from beverages, food, and other sources.
Avoiding certain foods: Expecting mothers of twins or multiples should avoid certain foods such as raw fish, undercooked meat, and soft cheeses, that can increase the risk of food poisoning and harm the babies.

It’s always best to consult with a healthcare provider or a registered dietitian for personalized advice on nutrition during twin or multiple pregnancies.

Choosing the right healthcare provider for twin or multiple pregnancy

One of the most important things for delivering healthy twins or multiples is choosing the right healthcare provider. Here are a few key points to consider when choosing a healthcare provider for twin or multiple pregnancies:

Experience: Look for a healthcare provider who has experience in caring for twin or multiple pregnancies. An experienced provider will be able to identify and manage any potential complications that may arise during the pregnancy.
Specialization: Find a healthcare provider who specializes in high-risk pregnancies as twin or multiple pregnancy falls under the category of high-risk pregnancies.
Availability: Make sure that your healthcare provider is available to you throughout the pregnancy, and that they have the resources and support team necessary to manage a twin or multiple pregnancy.
Communication: It’s important to feel comfortable with your healthcare provider, and that you can communicate openly and honestly with them. Make sure that your provider is willing to listen to your concerns and answer your questions.
Location: Consider the location of your healthcare provider and whether it is convenient for you to travel to their office for appointments and delivery.
Insurance: Make sure that your healthcare provider is covered by your insurance plan and that you understand the costs associated with your pregnancy and delivery.

After research of your own, do ask for recommendations from family, friends, and other expectant mothers and have a look at online reviews before finalizing your healthcare provider. Be sure to interview potential healthcare providers and ask questions to find the best fit for you and your babies.

Managing stress and anxiety during a twin or multiple pregnancy

Pregnancy in itself leads to stress and anxiety, and the thought of having more than one newborn at once can take its toll on the parent’s mental health. Here are a few key points to consider when it comes to managing stress and anxiety during a twin or multiple pregnancy:

Recognize the signs: It’s important to recognize the signs of stress and anxiety, such as difficulty sleeping, changes in appetite, fatigue, and irritability. If you know the problem, you can look for solutions so keep a lookout for these symptoms.
Communicate with your healthcare provider: Talk to your healthcare provider about your feelings and ask for their support and guidance. They may be able to offer resources or referrals to help manage stress and anxiety.
Create a support network: You need to surround yourself with a support network of friends, family, or other expecting mothers of twins or multiples who can offer emotional support and understanding. Don’t shy away from asking for help. Ask for help and in turn help people when they need it.
Self-care: Make time for yourself and engage in activities that you enjoy, such as reading, exercising, or listening to music. It’s also important to get enough sleep, eat a healthy diet, and stay hydrated.
Counseling or therapy: Seek counseling or therapy to help manage stress and anxiety if you find yourself in an unmanageable situation. A therapist can provide coping strategies and techniques to help manage feelings of stress and anxiety.
Mindfulness: Practice mindfulness techniques such as meditation or yoga to help reduce stress and anxiety. There is enough research that suggests that these practices calm a turbulent mind.
Education: Educate yourself about twin or multiple pregnancies and the potential risks and complications. It can help to manage stress and anxiety when you feel more informed and in control.

Beware of symptoms, indulge in self-care, and ask for help, you will do just fine!

The role of prenatal ultrasound in twin or multiple pregnancy

An essential tool for monitoring the growth and development of twins or multiples throughout pregnancy is prenatal ultrasonography. When it comes to the use of prenatal ultrasound in twin or multiple pregnancy, keep the following considerations in mind:

Prenatal ultrasound can be used to keep an eye on the babies’ size, weight, and location within the uterus as well as their overall growth and development. Healthcare professionals can use this information to identify any potential issues and choose the best course of action.
Prenatal ultrasonography can be used to spot deformities or structural flaws in the developing fetus, such as chromosomal abnormalities, neural tube anomalies, and heart issues.
Prenatal ultrasound can be used to measure amniotic fluid levels, which are crucial for the health and development of the unborn child.
Prenatal ultrasonography can be used to predict when a baby will be delivered based on the gestational age and level of development of the child.

Prenatal ultrasound tests are imperative to ensure the healthy growth and development of the infant and in case of twin or multiple pregnancies, these tests should be conducted more frequently.

Preparing for delivery and postpartum care with twins or multiples

Preparing for delivery and postpartum care with twins or multiples can be challenging, but with the right planning, it can be done successfully. Here are a few key points to consider when it comes to preparing for delivery and postpartum care with twins or multiples:

Delivery options: Discuss the different delivery options with your healthcare provider and choose one that best suits your needs. Expecting mothers of twins or multiples may have the option of vaginal delivery, cesarean delivery, or a combination of both.
Birth plan: Create a birth plan with your healthcare provider, including the delivery options, pain management, and any special requests.
Support: Identify a support person or people who will be present during the delivery, and make sure they know what to expect and what their role is.
Postpartum care: Consider hiring a postpartum doula, who can provide emotional and physical support during the first weeks after delivery.
Breastfeeding: If you plan to breastfeed, it’s important to educate yourself on how to breastfeed twins or multiples. Consult a lactation consultant to help you with breastfeeding or take a breastfeeding class.
Help: Identify sources of help in advance, such as friends and family, who can help with meals, laundry, and other household tasks.
Emotional preparedness: Be prepared for the emotional demands of caring for two or more newborns, and take the time to take care of yourself and your emotional well-being.

Common misconceptions about twin and multiple pregnancies

There are many misconceptions about twin and multiple pregnancies that can lead to confusion and misunderstanding. Here are a few common misconceptions about twin and multiple pregnancies:

Myth: Twins and multiples are always born prematurely. While it is true that twins and multiples are more likely to be born prematurely, many are born at full term.
Myth: Twins and multiples are always born small. Not all twins and multiples are born small, many are born at a normal weight and size.
Myth: Twins and multiples are always identical. Only about one-third of twins are identical, the rest are fraternal.
Myth: All twins and multiples are born via c-section. Many twins and multiples can be born vaginally, depending on the position and size of the babies and other factors.
Myth: Twins and multiples are always the results of fertility treatments. While fertility treatments can increase the likelihood of twin and multiple pregnancies, many are the result of spontaneous ovulation. The percentage of twins and multiples that are born as a result of fertility treatment varies depending on the type of treatment and the population being studied. According to the Centers for Disease Control and Prevention (CDC), about 1 in 8 or 12% of all twin births in the United States are a result of fertility treatment. However, the rate is much higher in certain populations, for example, about 1 in 3 or 33% of twin births among women aged 40 years and older are a result of fertility treatment.

Support and resources for expecting parents of twins or multiples

Unique challenges await parents of twins or multiples so, it is crucial to have all the support and resources at hand. Here are a few types of support and resources that can be beneficial for expecting parents:

Support groups: Joining a support group of other expecting parents of twins or multiples can provide emotional support and a sense of community. These groups often provide information and resources on twin and multiple pregnancies, as well as opportunities to connect with other families going through similar experiences.
Online resources: There are many online resources available for expecting parents of twins or multiples, including blogs, forums, and websites that provide information and support.
Professional support: Hiring a postpartum doula or lactation consultant can provide additional support and guidance during the postpartum period.
Books and magazines: Many books and magazines provide information and advice on twin and multiple pregnancies, as well as parenting multiples.
Healthcare provider: It’s important to have a healthcare provider that has experience in twin and multiple pregnancies, and who can provide accurate information and support throughout the pregnancy and delivery.

You are not alone, 3 pregnancies out of 100 results in twins, and 1 results in multiples. with time, there has been an upsurge in twin and multiple pregnancies and healthcare systems and societies are more prepared for them. Feel lucky for being blessed with more than one blessing at a time and we can’t emphasize enough, ask for help when needed! Have a happy pregnancy and thereafter 🙂