How long do twins stay in the womb

Twin Pregnancy: Answers from an Expert

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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.

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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 | 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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Scientific research in recent years has revolutionized the knowledge of prenatal life, allowing us to discover how the relationship between twins begins already during pregnancy. Thus, certain forms of interaction continue even after birth. In fact, when born, twins seem to retain the same position as in the womb. If, for example, during pregnancy one of the two tended to "take up more space" and appear more lively and active, this type of temperament will also be observed later. Those who moved more and took up more space will have a more extroverted and dominant temperament than a twin who was less active in the abdomen and will continue to act more shy.

Gemini are in constant interaction with each other and condition each other both in terms of physical and mental development. For this reason, they may have a difficult identification process or socialization difficulties due to the excessive isolation of the twin pair, but also develop competition , because at the same time they may exhibit identical needs that must be satisfied, and therefore compete with each other to get the attention of parents.

Parents may find it difficult to make time for each twin individually and may therefore feel guilty. Therefore, we have prepared a number of tips and tricks to better prepare for the arrival of twins in your home.

Accept Your Pregnancy

Many parents are willing to accept the possibility of multiple pregnancies in case of artificial insemination. But, such news is still confusing: there is panic and anxiety about the difficulties that you may have to face, the woman is at risk, because multiple pregnancy requires special management.

A man, on the other hand, often thinks about practical aspects: is there enough space in the house, is the car big enough, can he provide everything he needs for two children at once? But once the shock wears off, there is joy and a sense of belonging to the " Special Parents of ".

Choice of names

It is better to avoid names that are too similar (Maria/Margarita, Igor/Egor, Masha/Misha), so as not to get confused and underline that in fact these are two different people even if they have the same eye and hair color and were born on the same day. And also, it is recommended not to call them, for convenience or in a hurry, "twins". It is also a recommendation to grandparents, uncles, nannies, teachers: everyone should be called by their proper name so they can feel unique and grow as a person.

Twin Breastfeeding: Mission Possible

Being a mother of twins does not mean giving up breastfeeding. According to neonatologists, this is not only possible, but also desirable. Although, obviously, it can be difficult and may take some time (as well as the support of relatives). But in the interests of the health and relationship of mother and child: feeding promotes uterine contraction and, therefore, a faster return to normal size; breast milk protects babies from infections . In addition, when two people eat, breastfeeding saves the family budget. And if a woman manages to do both at the same time, she also saves time. Mothers who, for various reasons, are unable to breastfeed can still re-establish precious contact with their children at other times.

Connecting dads

Breastfeeding can be shared with the father: while one twin is breastfeeding, the other can drink (mother's milk using a breast pump) from a bottle with the father. After all, in families with twins, the father tends to be more active and more involved in daily life and childcare, and tends to be the primary attachment figure on the same level as the mother, who cannot manage two children at the same time.

Learn to Delegate

No parent is all-powerful, and while having a baby usually puts a strain on new parents, having two, at least initially, makes the task even more difficult from an organizational standpoint. That is why it is so important to learn to ask for help and entrust grandparents, friends, nannies, so as not to overwork. Separation between two children is a more onerous task than usual, and parents of twins, especially mothers, should not feel guilty about not coping on their own. So it’s better to organize support for yourself in time.

Relationship with each of the twins

It is important that mom and dad find time for each child. For example, on Saturday they can go out with one of the twins while the other stays with their grandparents, and the next week it's the other way around so that each child has their own moments with their parents. Be careful not to trigger the mechanism when one twin is tied to mom and the other to dad. Both must have an individual relationship with each of them.

Toys: the same or different? No hard and fast rules

Common sense tells you not to buy two identical toys, but to make sure that one child plays with the other's toys. But in practice, this must be evaluated on a case-by-case basis: for example, there are especially conflicting twins. And if they both want the same thing, take duplicates. If children are of different sexes, as they age, their interests will separate and it will be easier to pick up toys, although not without the fact that they will continue to exchange toys.

The task of parents is to recognize, tolerate and transform rivalry in order to help children cope with it without much suffering.

Different grades at school: assess individually

Parents often wonder whether they should be enrolled in the same class or even the same school. And in this case, there is no single answer that would suit everyone. There are those who are convinced that differentiation is positive, allowing the personality of each of them to emerge. But this is not universal. In any case, studies have found no difference in social or academic performance between those twins who attended the same class and those who did not.

Extra-curricular activities

When it comes to children of different sexes, most likely their interests and hobbies will differ.
With regard to identical twins, if possible, it is best to separate extra-curricular activities because they may represent an opportunity for a non-traumatic separation from the twin, who is the fundamental figure of attachment. But such an assessment should not prevail over the interests of the children, and if they coincide, there is no point in forcing one to do gymnastics and the other to swim.

Conflict resolution

Like siblings fight, twins fight, except that their fights tend to be more intense because the twins start competing in the womb: for space, for food, for survival. A competition that then turns into a competition to get the attention of adults and satisfy needs that often come together.

But, conflicts are also a way to express yourself and try to distinguish yourself from others. Advice to parents: give everyone what they need. Because even if they have the same material needs, they are not the same at the same time, and it is important to have your own approach based on the characteristics of each of them.

Do not compare

This is true for all parents, especially for parents of twins. Comparisons should be avoided because they can fuel rivalry and the idea that the other represents a restriction of freedom. Equally relevant for all parents is the advice: do not always agree with one at the expense of the other, or value only the goals and successes of one: it is important to try to encourage both, using their respective strengths and small or large “talents”.