Your Multiple / Twin Pregnancy

Like in any pregnancy, we do not have control over every aspect of how things turn out.  You could do everything right, and still have low birthweight or preterm infants, and some people who seem to do nothing right often have healthy newborns!  However, by taking charge of those things over which you do have control, you can increase your chances at having a healthy pregnancy that ends with two healthy babies in your arms.


The first thing you’ll want to do once twins are suspected is confirm chorionicity. We have more information about the importance of chorionicity in pregnancy and birth planning here: Did You Just Find Out It’s Multiples? 

Most moms who’ve had healthy twin pregnancies will agree that the single most important factor in improving twin pregnancy outcomes is nutrition.  Cut out (or cut down on) refined starches, increase your leafy greens, up the protein (way up!), and drink lots of water!  Most “experts” on multiple pregnancy recommend at least 100 grams of protein for a twin pregnancy.  Dr. Barbara Luke- whose counsel has helped a growing number of mothers of multiples to have healthy, term pregnancies with fewer incidences of pre-eclampsia- recommends moms expecting twins consume 176 grams of protein each day, and moms expecting triplets consume 200 grams of protein.

This sounds overwhelming, and not every mother can work those amounts of protein into the daily diet, but keeping high-protein snacks handy (such as nuts, boiled eggs, low sugar protein shakes, and cooked meat if you aren’t vegetarian) can help you meet your daily goals.  And cutting out salt isn’t always the best approach to reducing swelling.  Salting your food to taste will encourage a healthy blood volume to supply necessary oxygen and nutrients to your growing babies.(see about The Brewer Diet)  And remember, now is not the time to focus on your figure!  Now is the time to revel in how amazing your body is, what it is able to do, and how gloriously big that beautiful twin belly is, housing not just one but two big babies!

It’s sometimes mind-numbing to plan out meals and count grams of protein every day; however, many mothers of multiples who’ve closely approximated these guidelines regularly give birth to full term twins as big as most singletons.  And don’t be too discouraged if increased nausea (as is often reported in multiple pregnancies) makes it difficult for you to maintain this nutrition regimen from day one of your pregnancy.  Many women who suffered extreme “morning sickness” for the first halves of their pregnancies, even losing weight, picked up with a strong nutrition regimen from 20 weeks forward and still had healthy, perfect babies!

Not all preterm labor can be prevented.  However, two of the greatest contributing factors are often dehydration and over-exertion.  For this reason, many “experts” on twin pregnancy recommend drinking between a gallon and a gallon and a half of water every day.  It might be helpful to have a refillable liter bottle, and drink 4-5 liters of water each day.

As far as rest goes, don’t wait on your doctor to put you on bedrest before you rest!  Listen to your body’s cues.  If you feel tired or overworked, or are feeling more Braxton Hicks contractions than usual, get some horizontal rest time.  Recruit help for some of the housekeeping or child care you typically do.  For the last trimester of your multiple pregnancy, many experts recommend getting 6 hours each day of horizontal resting time, even in an uncomplicated pregnancy.  While there is no evidence to support bedrest as a treatment for preterm labor, there’s nothing wrong with listening to your body when it’s letting you know you need to take it easier. Every day those preterm babies stay inside of mommy is one more day of growth and lung and brain development.  Every day they stay in could be one less day they have to spend in the Neonatal Intensive Care Unit.

If you are motivated for a vaginal birth, evidence-based practices support a vaginal birth as long as the presenting baby (Baby A) is vertex (head down), no matter how Baby B presents (although women have certainly given birth vaginally to two breech twins, even footling).  After Baby A is out, Baby B has plenty of room to move (or be moved), thus peer-reviewed studies demonstrate that vaginal birth is a reasonable option for mothers with a vertex Baby A.

Although there is no peer-reviewed evidence to support Optimal Fetal Positioning for vertex babies, some mothers swear by OFP, and many have had success with breech or transverse babies turning using the exercises described at Spinning Babies.(see about Spinning Babies)

In addition to OFP, many natural twin mamas have reported great outcomes (including a breech twin turning to vertex) after regular treatment from a chiropractor trained in treating pregnant women, particularly using the Webster technique.(see about International Chiropractic Pediatric Association)

Although many twin mamas will report that the first trimester, with its extreme nausea, was difficult, most twin mamas will agree that the most challenging part of a multiple pregnancy was the last trimester.  Between feeling as big as a whale, doctor-recommended or self-imposed bedrest, difficulty getting around, and having to ride the motorized scooter at the grocery store, it’s easy to see how some women who had previously been gung ho about wanting to carry their twins to 40 weeks can crumble under the pressure.  Even the strongest of us, by 36 weeks (if not sooner), were begging for mercy!

This is where you have to call upon every bit of strength within you to resist the urge to beg for an induction or cesarean!  Remember, even babies born between 36-39 weeks often have signs of prematurity.  Babies born via induction or cesarean (and remember, induction increases your chances of having a cesarean) have added risks beyond those of a natural, spontaneous, vaginal birth, including increased risks of respiratory distress and longer NICU stays.

Overall, one of the greatest things you can do to help yourself and your babies during your multiple pregnancy is to RELAX.  Yes, there are some slightly increased risks during your multiple pregnancy (these risks are further increased if your babies share a placenta and/or are at risk for Twin to Twin Transfusion Syndrome).  But the risks in a normal, healthy multiple pregnancy are usually not that much greater than a singleton pregnancy.  Naturally-minded mothers of multiples regularly comment that things turned out much better than they had anticipated, and that they wished they would have enjoyed their pregnancy more, rather than living in constant worry about what could go wrong.  In any pregnancy, it is good monitor the situation and have a healthy respect for the unexpected.  This, however, should not be the focus of your pregnancy– those precious babies should!  Take control of those things you can control, and remember to go easy on yourself about those things you couldn’t control.  This is the recipe for a healthy multiple pregnancy and birth!

Recommended books: Having Twins and More: A Parent’s Guide to Multiple Pregnancy, Birth, and Early Childhood by Elizabeth Noble.

This is by far the most frequently recommended book for naturally-minded mothers of multiples. When You’re Expecting Twins, Triplets, or Quads: Proven Guidelines for a Healthy Multiple Pregnancy by Barbara Luke

Although this book has a strong medical focus and is not decidedly natural in its approach to birth, it is the most frequently recommended book for good nutrition in multiple pregnancy.


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