Hi! I’m guessing you might be reading this page because you just found out you are going to have twins, triplets, or more! First of all, take a few deep breaths. You can do this. It is a BIG shock to find out you are expecting more than one baby, and you may need to give yourself some time to get used to the idea. Whatever you’re feeling is just that — your feelings — and nobody, not even you, should judge you for whatever it is that you are feeling right now. Your feelings will change, intensify, fluctuate, soften, and become more complex as the pregnancy progresses anyway, so just accept them for what they are at this moment.
The first thing you’ll want to find out (other than simply how many babies are in there!) is chorionicity. Depending on when and whether an egg split, your twins may be identical or fraternal (and triplets or more may be in various combinations of identical and fraternal). Fraternal twins are always what we call di-di, or DCDA (dichorionic, diamniotic), which means they have separate sacs and separate placentas. Identical twins can be either di-di, mono-di (or MCDA – monochorionic diamniotic), or rarely mono-mono (MCMA – monochorionic monoamniotic). You can find out much more about chorionicity by reading our post, One Placenta, Two Placentas, Identical, Fraternal?. The short version is this:
- Di-di twins are nowhere near as risky as the others, and in fact only have slightly increased risks compared to singletons. Identical or fraternal, each baby has his or her own placenta. Although the placentas may fuse over the course of the pregnancy, this is not the same as sharing a placenta.
- In both mono-di and mono-mono configurations, the twins share a placenta. However, the risks of mono-di and mono-mono differ considerably. At some points in pregnancy, it can be hard to tell whether or not your twins who share a placenta have separate sacs, and the best time for determining if there is a membrane between them is between 10 and 14 weeks. If different ultrasounds have suggested different findings, the ultrasound done within that time frame is likely to be most accurate.
- If your twins are mono-mono, your course of action for your pregnancy will almost certainly differ considerably from what you had hoped for and envisioned, as monoamniotic twins are at significantly higher risk for TTTS and other complications. Give yourself time to process your feelings, grieve for the easy pregnancy and birth you may have been hoping for, and seek out information and support from those who have been there. Have faith, and remember that once your babies are here safely, you can focus on parenting them the way you hope!
- If your twins are mono-di, you will probably want to have more frequent monitoring of your pregnancy for signs of TTTS. Bi-weekly ultrasound beginning at 16 weeks, while it may sound excessive, is recommended for finding signs of TTTS early, when you can still do things to improve your outcomes like modify your nutrition and activity (Dr. DeLia, the foremost TTTS expert, recommends drinking 3 cans a day of Ensure or Boost, for example), or (in extreme cases) qualify for laser surgery that can save your babies’ lives.
Our community is full of moms of multiples who are natural childbirth advocates, and even mothers who have declined all routine ultrasound in previous pregnancies. Most of them agreed to at least one ultrasound once twins were suspected to try to determine chorionicity. While most twin pregnancies, especially di-di ones, progress normally and have healthy outcomes, knowing chorionicity can help you make truly informed decisions about your pregnancy and birth care.
Once you know chorionicity, you’re ready to set about having the healthiest pregnancy you can have, and planning for your birth, which may be in a hospital, birthing center, or home, depending on where you feel safest.
The kind of provider and location you choose for your birth will vary based upon a lot of factors specific to you. The key is to do your research, evaluate your past history and family planning principles, assess what resources are available to you, and do what you know is best for you, your babies, and your family.
RESEARCH + INTUITION = DECISION
- Do your research. This may include things like learning about the birth process if this is a first birth for you. Learn what interventions are common during pregnancy and what their risks and benefits are. Learn what specific issues come up because of the chorionicity of your multiple pregnancy. Learn what you can do to prevent those issues. Learn what the incidence is of complications such as TTTS (1 in 7 of monochorionic pregnancies), Learn what the incidence is of acute TTTS (1.8-5.5% of all monochorionic pregnancies). Weigh all of these facts out against the risks and benefits of any proposed interventions.
- Evaluate your past history and family planning principles. A mother who had experienced 18+ months of PTSD after a particularly traumatic cesarean might be more inclined toward a vaginal birth than a mother without that history, knowing that the risks of PTSD and flashbacks could potentially be higher for her in a repeat cesarean. A mother whose ideal is to have a large family might be more heavily inclined toward vaginal birth than someone who only wanted one or two children, knowing that a primary cesarean increases her chances of ending up with a repeat cesarean, and that pregnancy risks to both the mother and the baby increase with each successive cesarean. A mother for whom birth is viewed as a rite of passage or natural bodily process might be less inclined toward routine cesarean than a mother for whom birth is a medical event, or a means to an end. These are the types of things that weigh into pregnancy and birth planning that are not as easily quantifiable, but are valid influences on the choices we make. And remember, your plans can be fluid and you can opt to stick to the original plan unless specific complications arise, and evaluate at that point what course of action you want to take. IF complications arise, you can still request to do things (as much as possible) in a way that leaves you feeling safe and involved.
- Assess what resources are available to you. Sometimes your options where you live are wonderful, and other times they leave a lot to be desired. You may find that your local doctor(s) believe in a routine cesarean for all multiples or routine induction. You may find that your local doctor(s) have no real clue about chorionicity and the importance of monitoring for TTTS. You may find that midwives in your state may be able to legally attend out-of-hospital births for multiples, or that they are restricted by licensing regulations from attending them, or that they are flying under the radar in your state anyway. Find out where you stand and if it’s possible to find a provider locally with whom you could feel comfortable and safe. If not, look around. Broaden your geographic radius a bit if need be. If you are comfortable with and hoping for a home birth, talk with local doulas and ICAN leaders about providers who might be supportive. Connect online with other moms who have homebirthed their multiples and ask for referrals. Women should give birth where and how they feel safest, and having multiples should not automatically rule that out.
Once your babies are here, you may be interested in attachment parenting, cosleeping, breastfeeding, babywearing, and more, and we’ll be here to support you as you walk that journey! Just because you are having multiples does not mean you cannot still have parenting ideals, and don’t let anyone tell you that you must formula-feed, use cry-it-out sleep training, or have a million gadgets if those practices are not your ideals. Some mothers may choose these parenting options, but plenty of mothers are not. Seek out support from moms who have “been there and done that,” and you’ll be amazed at how much you can do!
Congratulations on your multiples, and we wish you a safe, happy, and healthy pregnancy and birth!