Expecting twins: what changes, and how to prepare

The types, and why it matters

Non-identical (dizygotic) twins come from two eggs, always have separate placentas and sacs, and are the more common type. Identical (monozygotic) twins come from one egg and may share a placenta, a sac, or both, depending on when the split occurred.

The scan term to know is chorionicity — whether the twins share a placenta. This is best determined in the first trimester, and it drives everything about the monitoring plan.

Twins sharing a placenta (monochorionic) need much closer surveillance, typically scans every two weeks, because of the risk of twin-to-twin transfusion syndrome, where blood flow between them becomes unequal. It is treatable when caught, and catching it is what the extra scans are for.

The monitoring and the risks

Expect more of everything: more antenatal visits, growth scans every two to four weeks, and closer watching for blood pressure and anaemia.

The raised risks in twin pregnancy: preterm birth (the most common), pre-eclampsia, gestational diabetes, anaemia, growth restriction of one or both babies, and postpartum haemorrhage. Knowing them is not the same as expecting them — most twin pregnancies in good care produce two healthy babies.

Preterm labour signs matter more than usual: any regular tightening, cramping, pelvic pressure or watery leaking before 37 weeks needs same-day assessment. Steroid injections for lung maturity are often given if early delivery seems likely.

Delivery is usually planned around 36-37 weeks for twins sharing a placenta and 37-38 weeks for those with separate placentas — earlier if complications develop. Vaginal delivery is possible when the first twin is head-down and the pregnancy is uncomplicated; many twin births end in caesarean, and the plan should be discussed in advance.

Nutrition and looking after yourself

Higher requirements across the board: more calories, more protein, and considerably more iron and folic acid — anaemia is very common in twin pregnancies and needs active monitoring and often higher-dose supplementation.

Weight gain targets are higher than for a single pregnancy; your obstetrician will set yours. Small frequent meals help when the bump crowds the stomach early.

Rest is more important and harder to get. Strict bed rest is not routinely recommended, but the practical fatigue and physical strain are real — reduce commitments earlier than you would otherwise, and plan for the third trimester to be significantly harder.

The physical symptoms arrive sooner and stronger: breathlessness, heartburn, back pain, swelling and sleep problems. Everything in our week-by-week series applies, several weeks earlier.

Preparing for two

Choose the hospital for its NICU. Twins are frequently born early and often need at least short-term newborn care, and delivering at a facility with that capacity avoids a transfer at the worst moment.

Get practical help arranged before the delivery, not after — two newborns is a genuinely different proposition, and the households that cope are the ones with a plan. Grandparents, paid help, a rota of relatives, and lowered domestic standards for six months.

Feeding: breastfeeding twins is entirely possible, including tandem feeding, and supply builds to demand — get a lactation counsellor lined up rather than working it out alone. Many mothers use a mix of breastfeeding, expressing and formula, and that is a workable plan rather than a failure.

Equipment: two of the essentials, one of most other things. Practical priorities are somewhere safe for each baby to sleep, a twin-feeding pillow, and a pram that suits your actual doorways and lifts. Skip the rest until you know what you need.

When to see a doctor

Go immediately: any regular tightening, cramping or pelvic pressure before 37 weeks; leaking fluid or bleeding; severe headache with visual changes or sudden swelling; reduced movements from either baby; severe abdominal pain; or high fever. In a twin pregnancy the threshold for going in should be deliberately low.

Never miss a scan appointment, particularly with monochorionic twins — the two-weekly scans exist to catch a specific, treatable complication before it becomes serious.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: Will I definitely need a caesarean? — Not necessarily. Vaginal birth is possible when the first twin is head-down and there are no other complications, and many hospitals support it. Discuss the plan and the hospital's experience early, and prepare for both outcomes.

Q: Can I keep working? — Many women do, with earlier reduction than in a single pregnancy. Discuss your specific situation, the physical demands of your job and your commute with your obstetrician, and plan maternity leave to start earlier than 36 weeks.

Q: How can I feed two babies? — Tandem feeding with a twin pillow, or one at a time in rotation, or a combination with expressed milk and formula. Supply generally rises to meet demand. Arrange lactation support before delivery — this is the single most useful preparation you can make.

Q: Do twins run in families? — Non-identical twins have a familial and maternal-age component, and fertility treatment raises the chance considerably. Identical twinning appears to be largely random.