Multiple pregnancies occur in around 1 in 90 women, but there are some factors that increase your chances of conceiving twins or more. Factors include being a bit older (35 or older), taking certain fertility treatments, or having a family history of twins.

So let’s take a look at what you need to know about having multiple births.

Will I require extra monitoring during pregnancy?

All multiple pregnancies are high-risk and require extra monitoring during pregnancy.

The type of twin pregnancy is important, and whether the babies share a placenta (MCDA twins) or their placentas are separate (DCDA twins), the type of delivery you need will depend on any complications that arise and the positioning of the twins. The main concern is whether the twins will be born prematurely. It is likely that as you come to the end of your pregnancy, you will have extra scans to monitor the babies and check that the placenta is still providing enough oxygen to each baby. Monochorionic twins who share a placenta will be scanned every couple of weeks.

So, what are the possible complications?

There are certain complications surrounding twins that mean a Caesarean section is planned:

Foetal complications. For identical twins who share a placenta, twin-to-twin transfusion syndrome (TTTS) is a condition that occurs if there is a direct link between the babies and can put their lives at risk. Twins with TTTS need specialised treatment to either reduce the fluid around one of the babies or separate the circulations.

Maternal complications. If you’re carrying twins, you have a higher risk of developing certain conditions, such as pre-eclampsia, because of the larger placental mass, which could add additional strain on the kidneys and circulation. These conditions could mean that you will be advised to have an early delivery.

Going into labour early. It’s very likely you will go into labour early with twins, so be prepared to go into labour at around 37 weeks. With triplets, you will be advised to deliver by Caesarean at around 34 weeks. And with quadruplets, it’s 32 weeks.

Mid-labour complications. You will require continuous monitoring of both heartbeats using a CTG machine. This is done by placing an elastic belt around your abdomen for each baby to get a clear reading of both heartbeats.

Delivering the first twin. The chance of needing forceps or ventouse is the same as if you were only delivering one child. The first twin will likely need to be assisted so that the doctor can quickly access the second twin. After the first twin has been delivered, the cord will be cut, but the placenta will remain until the second twin has been delivered.
Delivering the second twin. The medical team will confirm the positioning of your second child by doing an internal examination or using a scan. As the second baby’s head or bottom enters the pelvis, you may experience strong contractions as the second sac of water breaks. If problems arise, forceps or ventouse will be used. If the second twin is bottom first, the doctor will help assist. It is not common for the second twin to be delivered by Caesarean section when the first was a vaginal birth, but if the second baby needs an urgent delivery, then this may be recommended.

Delivering the placenta Giving birth to twins increases your risk of postpartum haemorrhage, so active management of the third stage is advised.

What do I need to know about multiple births?

Unii’s Giving Birth Journey explores having twins and other multiples.