Double the Love - expecting twins.

Every year in New Zealand around 1000 couples find themselves expecting twins, triplets or occasionally even more babies. Multiple births are more common than they were years ago, due to the advancing average age of mothers and the associated rise in assisted reproductive techniques, in particular the use of fertility drugs.

Twins account for over 90 per cent of multiple births - wow!

There are two types of twins – identical (monozygotic) and fraternal (dizygotic). To form identical twins, one fertilised egg (ovum) splits and develops two babies with exactly the same genetic information and identical twins are always the same sex, This differs from fraternal twins, where two eggs (ova) are fertilised by two sperm and produce two genetically unique children, this is more common than identical twins and your baby's may be the same sex or different sexes. Contrary to popular belief, the incidence of twins doesn’t skip generations.

Factors that increase the odds of having twins

Some people are more likely than others to give birth to twins. The factors that increase the odds include are; people in their 30s and 40s have higher levels of a hormone called oestrogen than younger people, which means that their ovaries are stimulated to produce more than one egg at a time (more eggs, potentially more babies), the greater the number of pregnancies you've had already, the higher the odds of conceiving twins, you are more likely to conceive fraternal twins if you are a fraternal twin, and assisted reproductive techniques – many procedures rely on stimulating the ovaries with fertility drugs to produce eggs and, often, several eggs are released per ovulation.

Having twins (or more) is considered a higher risk, you can still have a midwife if you choose, but will usually mean you will have other specialists involved such as an obstetrician and a pediatrician - one for each baby.

Twins are more likely to be born early, often before 38 weeks, so it’s important to understand your birth options. 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 (SCBU). As twins are often born prematurely, it’s a good idea to discuss birth options with your LMC 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.

While the process of labour is the same as when single babies are born, twin babies are more closely monitored.

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 you already have good pain relief - but this is always your choice.

Caesarean section

You may choose to have an elective caesarean from the outset of your pregnancy, or your LMC may recommend a caesarean section later in the pregnancy as a result of 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 also determine whether they need to be delivered by caesarean section. If the presenting baby - the one that will be born first - is in a breech position (feet, knees or bum first), or if one twin is lying in a transverse position (with its body lying sideways), you will need to have a caesarean section.

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 during labour, the umbilical cord is in front of your baby, your blood pressure is going up, your labour is progressing too slowly, assisted delivery doesn’t work and 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 of your babies

After the birth, your LMC will examine the placenta to determine what type of twins you have. If your babies need special care, you may need to go to another hospital such as in Wellington that has appropriate facilities if complications happen during your pregnancy or if one or both of your twins require specialist care. These hospitals are more likely to be able to keep you and your babies in the same place. If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is unable or having trouble feeding.

Remember - you will have double the love, double the hugs, double the chubby cheeks and squishy baby kisses, double the grins and double the blessings!