How early can you have twins

Giving birth to twins | Pregnancy Birth and Baby

Twins are more likely to be born early, often before 38 weeks, so it's important to understand your birth options. Less than half of all twin pregnancies last beyond 37 weeks.

Because of the likelihood that your babies will be born early, there is a good chance one or both of them will spend some time in special care.

As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or doctor early in your pregnancy.

You should also discuss where you would like to give birth. You will most likely be advised to give birth in a hospital because there's a higher chance of complications with a twin birth.

It's common for more medical staff to be involved in the birth of twins, such as a midwife, an obstetrician and two paediatricians - one for each baby.

While the process of labour is the same as when single babies are born, twin babies are more closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once your waters have broken. You will be given a drip in case it is needed later.

Vaginal birth

About one third of all twins are born vaginally and the process is similar to that of giving birth to a single baby. If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when the mother already has good pain relief.

If the first twin is in a head down position (cephalic), it's usual to consider having a vaginal birth. However, there may be other medical reasons why this would not be possible. If you have had a previous caesarean section, it's usually not recommended you have a vaginal birth with twins.

If you have a vaginal birth, you may need an assisted birth, which is when a suction cup (ventouse) or forceps are used to help deliver the babies.

Once the first baby is born, the midwife or doctor will check the position of the second baby by feeling your abdomen and doing a vaginal examination. If the second baby is in a good position, the waters will be broken and this baby should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.

Caesarean section

You may choose to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a caesarean section later in the pregnancy as a result of potential complications. You’re nearly twice as likely to have a caesarean if you’re giving birth to twins than if you’re giving birth to a single baby.

The babies' position may determine whether they need to be delivered by caesarean section or not. If the presenting baby - the one that will be born first - is in a breech position (feet, knees or buttocks first), or if one twin is lying in a transverse position (with its body lying sideways), you will need to have a caesarean section.

Some conditions also mean you will need a caesarean section; for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.

If you have previously had a very difficult delivery with a single baby, you may be advised to have a caesarean section with twins. Even if you plan a vaginal birth, you may end up having an emergency caesarean section.

This could be because:

one or both babies become distressed
the umbilical cord prolapses (falls into the birth canal ahead of the baby)
your blood pressure is going up
the labour is progressing too slowly
assisted delivery doesn't work

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if it becomes distressed.

After the birth

After the birth, your midwife will examine the placenta to determine what type of twins you have. Twins can either be fraternal or identical.

If your babies need special care

Depending on where you plan to give birth, you may need to go to another hospital with appropriate facilities if complications in your pregnancy indicate you're likely to have an early delivery. This may not be near to home, so make sure to check there are enough beds for both your babies in the neonatal unit.

Ask if your chosen hospital has a transitional care unit or a special care nursery. These are places that allow mothers to care for their babies if they need special care but not intensive care. These hospitals are more likely to be able to keep you and your babies in the same place.

You might also want to ask if your hospital has cots that allow co-bedding (where your babies sleep in a single cot), if this is appropriate and if you want your babies to sleep together.

If you have one baby in the hospital and one at home, you will need to think about splitting your time between the two. When you visit your baby in hospital, ask if you can bring their twin and if co-bedding is allowed during visits.

If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is having trouble feeding. You may then need to put the twin who can feed on the breast to encourage milk production in order to get enough milk to feed both babies.

Check if your hospital offers support from a community neonatal nurse, which would allow for you and your babies to leave hospital earlier, for example if your baby is still tube-fed.

When you go to clinics for follow-up appointments, it's a good idea to ask not to be booked into early morning appointments. Getting out of the house with two babies, particularly if one is unwell, can be difficult.

For more information and support, visit Twins Research Australia.

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Twin Pregnancy: Answers from an Expert

Twin Pregnancy: Answers from an Expert | Johns Hopkins Medicine

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When you’re expecting twins, you know you’ll need two of everything for your registry. But what about staying healthy during your pregnancy? Do you need to double your food intake, weight gain and visits to the doctor? With regard to the babies, are there two placentas and two amniotic sacs, or can they share these?

Johns Hopkins maternal-fetal medicine specialist Jeanne Sheffield answers eight commonly asked questions.

Do twins share a placenta and an amniotic sac?

While some twins may share a placenta and an amniotic sac, that is not the case for the vast majority of pregnancies. Here are three major possibilities that exist:
- Two placentas and two amniotic sacs. A twin pregnancy with two placentas and two amniotic sacs is the optimal twin pregnancy, as each baby has its own nutritional source and protective membrane.
- One placenta and two amniotic sacs. In pregnancies with one placenta and two amniotic sacs, you will definitely have identical twins. Additionally, when your babies share a placenta, there is a greater risk for complications, such as twin-to-twin transfusion syndrome. Your physician will closely monitor your pregnancy to check for potential problems.
- One placenta and one amniotic sac. This is the riskiest and rarest type of twin pregnancy. Fetal complications can arise due to tangling of the umbilical cords or an imbalance in nutrients, blood or other vital life supporting systems.
Do I need to double my caloric intake during a twin pregnancy?

A common misconception surrounding twin pregnancy is that you need to double your caloric intake to provide your babies with enough nutrients. However, pregnancy nutrition guidelines aren’t simply based on the number of babies you’re carrying. Instead, they’re based on your body mass index at the time you became pregnant.

Your doctor will make individualized recommendations based on your starting weight. On average, it’s estimated that a woman’s caloric requirements will increase about 40 percent for a twin pregnancy. What’s most important, though, is that a woman eats as healthy as possible.
Do I need to take different prenatal vitamins for twins?

If you’re pregnant with twins, you should take the same prenatal vitamins you would take for any pregnancy, but your physician will recommend extra folic acid and iron. The additional folic acid and extra iron will help ward off iron-deficiency anemia, which is more common when you’re pregnant with multiples.
Will I need to visit my doctor more frequently?

While every pregnancy is different, most women carrying twins will have more frequent prenatal visits than women carrying only one baby. If your twins are sharing one placenta, you will automatically have a more frequent monitoring schedule.

If your pregnancy doesn’t have complications, your prenatal visits may not differ much from a singleton pregnancy until you get to the end of your second trimester. At that point, you’ll be seen more frequently because there is a higher risk of pre-eclampsia and preterm labor.
Do I have to see a maternal-fetal medicine specialist for a twin pregnancy?

Maternal-fetal medicine specialists see high-risk pregnancies, but not every twin pregnancy will fall into this category.

To find the best care provider for your twins, make sure that the physician is comfortable managing twins, including vaginal delivery of twins rather than only offering a cesarean section (C-section) for delivery.
Are all twin pregnancies delivered preterm?

A little more than half of twin pregnancies end in preterm delivery (before 37 weeks). While 40 weeks is the full gestation period of the average pregnancy, most twin pregnancies are delivered at approximately 36 weeks (range 32-38 weeks depending on the type of twin pregnancy).

Unfortunately, preventing preterm labor with multiples is more challenging than with a singleton pregnancy because the interventions used with singleton pregnancies are not as effective with multiples.
Can bed rest reduce the risk of preterm delivery?

Scientific data show that bed rest does not prevent preterm delivery. In fact, bed rest can increase your risk of developing blood clots and have negative financial and social consequences.

Although bed rest is not prescribed as frequently as it once was, your doctor may suggest reducing your activity level if you’re showing signs of early labor at the end of your second trimester or early in your third trimester.
Is labor and delivery significantly different with twins?

Labor is generally the same whether you’re having one baby or two. During delivery is when things differ significantly.

When it’s time to deliver your twins, you will go to an operating room even if you are delivering vaginally. This is a safety precaution known as a double setup. Following the vaginal delivery of the first baby, there is a small risk of an emergency cesarean section for the second baby. There is also the possibility of the second twin being delivered breech, which is a safe form of vaginal delivery if the obstetrician is experienced in this type of delivery.

Of women giving birth to twins over 32 weeks, only about 4 percent who try for a vaginal delivery will have a combined vaginal and cesarean section delivery. While it doesn’t happen very often, by delivering both babies in the operating room, physicians are better prepared to protect the health of the mother and the babies.

Although being pregnant with twins can seem very different, your doctor will treat your pregnancy like any other unless a complication occurs.

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Giving birth to twins: natural childbirth or caesarean - Parents.ru

Photo: Getty Images/Moment RF

obstetrician-gynecologist of the highest category

Total options for childbirth in a woman expecting the birth of twins, as in any pregnancy two: natural childbirth or caesarean section. Natural childbirth in such a situation is not uncommon. Prenatal hospitalization should be prepared, but it is not required.

Depends on circumstances

Giving birth to twins is always associated with an increased risk. Two babies require twice as many nutrients, and if it turns out that there are abnormalities in the condition of the children, natural childbirth can be too much for them. The doctor will also take into account the parity (whether the woman gave birth before), whether there were complications during pregnancy and childbirth, the health status of the expectant mother, her age, the dimensions of the twins and other details.

When babies live in the uterus independent of each other, that is, they are bichorionic, biamniotic twins, each with a separate fetal bladder and its own placenta, this is an ideal option and the dream of any obstetrician-gynecologist. Such births are associated with the lowest risk. In most cases, they go away naturally. Most likely, the birth of bichorionic, biamniotic twins in a perfectly healthy woman, whose pregnancy went almost without complications, will take place in a natural way, if they are correctly located in the uterus - longitudinally and head down. The parameters of babies are also taken into account: the weight of each child should be more than 1800 g, but less than 3500 g. Also, children should not have hypoxia, and the gestation period should be more than 32 weeks. nine0009

If the placenta is the same for two, but the fetal bladders are different, this circumstance will complicate the course of childbirth, but nothing more. Pregnancy and childbirth of monochorionic and monoamniotic twins are associated with the greatest risk for mothers and babies, when babies share not only the placenta, but also the fetal bladder. This is a very rare case and a direct indication for surgery.

To reduce the risk

Giving birth to twins is always associated with great risk for both mother and baby, so doctors always try to make it as safe as possible. In most cases, with weak labor activity, they will prefer a caesarean section, rather than stimulation of the process. However, everything here is so individual that there can be no universal recipe. That is why doctors try to take into account all the nuances, carefully study the medical record of the expectant mother and try to prepare for possible features during childbirth in advance. nine0009

Photo: Getty Images/E+

Natural birth

Usually twins are born a little earlier - at 37-38 weeks of pregnancy. The process begins and goes almost the same as with the birth of one child. Doctors welcome free behavior in childbirth and methods of natural anesthesia: breathing techniques, hypnobirth, etc. Epidural anesthesia is not a contraindication.

The cervix dilates at the same rate. The waters pour out spontaneously, or according to indications, an amniotomy is performed (opening of the fetal bladder). The first baby is born, and there is a pause - usually from 5 minutes to 2 hours. Doctors use the break to perform vaginal and ultrasound examinations to determine the position of the second child in the uterus. If he is located longitudinally, then he will be born faster than his older brother or sister. Since the cervix is already open, the second amniotic sac is opened. It takes literally a couple of intense contractions and another attempt for the second twin to declare itself. The process ends with the birth of one or two afterbirths - placentas and fetal membranes. nine0009

Options available

If the water breaks early and the anhydrous gap is too long, there is a risk of infection for children and women. In such a situation, doctors act depending on the circumstances. If everything is fine with mom and babies, they will try to help the woman give birth on her own.

But after the birth of the first child, there is a risk of premature detachment of the normally located placenta of the second baby. Indeed, after the first twin was born, the volume of the uterus decreases rapidly, which can provoke a rapid decrease in intrauterine pressure and placental abruption. And this is a serious threat to the health and life of both mother and child. Therefore, as a rule, doctors open the fetal bladder of the second baby, without waiting for it to happen by itself. If the doctors are worried about something, they will resort to surgery. nine0009

In most cases, twins are born weighing about 2500-2800 g. At the same time, one is heavier than the other by about 200-300 g.

Only surgery

operations. An unconditional indication for caesarean section is the common fetal bladder of babies. During childbirth, the umbilical cords can get mixed up, and there is a high risk of premature detachment of the placenta. Usually, surgery is also inevitable in case of preterm birth - before the 33-34th week of pregnancy. nine0009

Planned caesarean section abroad for monochorionic twins is often done at 33-34 weeks, in Russia they prefer to wait until 36 weeks. It is inevitable in case of health problems in the expectant mother, if the birth of large children is expected (their total weight exceeds 6500 g), with a transverse arrangement of two babies or their hypoxia. The need for surgery may also arise during natural childbirth. Triplets are an indication for a planned caesarean section at 34–35 weeks of gestation. nine0009

Postpartum period

In the first hours after childbirth, the woman and children are carefully observed. In the mother of twins, and even more so of triplets, the uterus is overstretched and slowly returns to “pre-pregnant” parameters. Doctors monitor its contraction and the amount of blood that is released from the genital tract. If the uterus does not contract well, oxytocin may be administered to the woman to prevent bleeding.

Uterine discharge should stop at 5-6 weeks postpartum. If this did not happen or the discharge, after it had disappeared, for some reason resumed again, you should visit a gynecologist. He will do an ultrasound, determine further treatment tactics and give recommendations for a better recovery. nine0009

Photo: Sarah Kastner/Getty Images/Westend61

Key to success

The birth of twins is always a cause for concern for both the expectant mother and professionals. In this situation, it is important to strictly follow the recommendations of doctors during pregnancy and give birth in a maternity hospital, which has both adult and pediatric intensive care units. Properly chosen tactics of conducting childbirth is the key to success. Choose a doctor who you absolutely trust and who already has experience in conducting such unusual births. nine0009

More useful and interesting materials for expectant mothers - in our channel on Yandex.Zen.

Lyubov Prishlaya

A woman gives birth to twins at an interval of 11 weeks - expert material, Lahta Clinic

When Lilia Konovalova became pregnant with twins, she never expected that she would have to give birth twice. And yet, a 29-year-old woman from Northern Kazakhstan had to be hospitalized twice: in May she gave birth to a daughter, and then in the first days of this month [ August 2019 ] she had a son.

“He just wasn't in a hurry to go out into the world,” L. Konovalova remarked in an interview with Daily Mail .

Twins born 11 weeks apart. Such a large gap is rare, but not unique (the world record - the birth of twins with a difference of 87 days - was set in 2012). However, not only the age difference distinguishes this case. The fact is that each of the twins was born in a separate, own uterus. nine0009

Lilia Konovalova has an anatomical anomaly called uterus didelphys, which actually means the presence of two uteruses. This phenomenon is surprisingly common - in about one woman in two thousand - and is formed at the stage of intrauterine development of the female fetus, when the two fallopian tubes, instead of merging into a single uterus, develop as two separate cavities. But at the same time, the chances of such a pregnancy as in Konovalova , that is, the successful bearing of twins in two wombs, are negligible - according to " Scientific American ", they are one in 50 million (even the probability of simply conceiving twins in each uterus separately for a woman with uterus didelphys does not exceed 1:25,000).

However, such cases have already been documented. In 2009, a Michigan woman also having uterus didelphys gave birth to two girls from different wombs, and in 2014 a British citizen with the same anomaly gave birth to triplets: two were born in one uterus, the third in another.

But in none of the listed cases, children were born with such a large time interval that a second hospitalization in the maternity hospital was required - almost three months after the first birth. This means that Konovalova's case is rare in two aspects at the same time. nine0009

From time to time in obstetrical and gynecological practice there are situations when, after the birth of the first twin, the contractions subside. Sometimes, if the first-born twin turns out to be extremely premature, doctors decide to leave the second in the mother's womb - until the term is as close to normal as possible. This is exactly what happened to Lilia Konovalova , according to " The Washington Post ".