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World-first twin pregnancy growth chart
Dichorionic/Diamniotic
ANTENATAL CARE PATHWAY FOR WOMEN WITH UNCOMPLICATED TWIN PREGNANCY (Dichorionic/Diamniotic - two placentas, two sacs)
You will have at least 8 appointments of which at least 6 will include scans
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Appointment |
What Should Happen |
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Dating scan between 11 and 14 weeks
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Your midwife or doctor should give you information about:
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Your midwife or doctor should:
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16 weeks with multiples midwife |
Your midwife should give you information about:
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Your midwife should:
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20 weeks with multiples midwife and team |
Your midwife or doctor should give you information about:
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Your midwife or doctor should:
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24 weeks with multiples midwife and team |
Your midwife or doctor should give you information about:
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Your midwife or doctor should:
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26 weeks with multiples midwife (if not already discussed) |
Your midwife should give you information about:
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Your midwife should:
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28 weeks with multiples midwife and team |
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Your midwife or doctor should:
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30 weeks with multiples midwife (if not already discussed) |
Your midwife should give you information about:
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Your midwife should:
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32 weeks with multiples midwife and team |
Your midwife should give you information about:
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Your midwife or doctor should:
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34 weeks with multiples midwife |
Your midwife should give you information about
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Your midwife should:
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36 weeks with multiples midwife and team |
Your midwife or doctor should give you information on:
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Your midwife or doctor should:
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37 weeks with multiples midwife |
Your midwife or doctor should: If babies haven’t arrived discuss induction of labour or caesarean procedure and discuss course of steroids if necessary.
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Top tips to help
- Make sure you are comfortable and have everything you need to hand
- Wear a top that provides you with some coverage - a shirt with a vest top is one option
- To achieve ‘hands free’ pumping, purchase a hands free expressing bra or modify a well fitted maternity bra by cutting a hole in each cup so that the breast shield is next to the breast and held in place
- Use a pump that allows you to express from both breasts at the same time
- Keep a picture, clothing or a video of your babies close to hand if you are unable to express next to your babies as this helps with milk production
- Breast massage is useful to relax and warm the breasts
- Expressing during or just after skin to skin cuddles with your babies is especially helpful
- Don’t worry about volumes – in the early days it is normal to only produce small amounts of milk by expressing. The technique for expressing requires practice and you will find that the amount of milk you produce will usually increase over time and with regular practice.
- Make sure that you have the correct breast shield size - too big or too small will not be so comfortable and milk volume will be affected.
- Have the vacuum set at a comfortable setting – there shouldn’t be any pain or tenderness.
Vaginal birth
It’s a good idea to write a birth plan expressing your wishes on pain relief, who will be present at the birth, positions for delivery, and whether you want zygosity testing to see if the babies are identical (the placentas will be examined and cord blood sent for analysis, for which you may have to pay), as well as anything else that’s important to you. Bear in mind that the plan will need to be flexible, taking account of how your labour goes.
Multiples are nearly always recommended to have continuous monitoring during labour, even when they haven’t been induced. Your midwife will strap a belt with small pads and sensors onto your tummy to assess your babies’ heartbeats and the intensity and frequency of contractions. You should still be able to move into different positions as you labour. If external monitors can’t clearly pick up two separate heartbeats (sometimes this is difficult if they are very close), the first baby can be monitored internally using a fetal scalp electrode attached to the babies’ scalp.
The first stage of labour consists of uterine contractions that push the babies head down into the pelvis and open the cervix. Once it is 10cm dilated, you are ready for the second stage: pushing them out. Some hospitals will automatically transfer you to an operating theatre at this point. The benefit of being in the operating theatre is there is a bigger space to accommodate the larger team present at a multiple birth and there is quick access to surgery if it is needed during the delivery. The drawback is moving during labour and being in a relatively more clinical and noisy environment than most delivery rooms. The number of people in the room or theatre will vary, but usually includes an obstetrician, anaesthetist, two midwives, one paediatrician for each baby, as well as students and junior staff. If you feel strongly that you don’t want lots of people present, ask for all non-essential staff to wait outside the room until they are needed. The essential staff will include the obstetrician, midwives and paediatricians and they may require assistance from the others for some of their tasks.
It can take anything up to two hours to deliver the first baby. Sometimes mothers are encouraged to give birth on their backs. It’s worth discussing your options on different birth positions and hospital policy beforehand. With support from your midwives, it is possible to deliver twins safely in different positions, including standing, squatting and on all fours.
If the second stage is going slowly or the babies seem to be developing distress, you may be advised to have an assisted delivery using forceps or ventouse (a vacuum device that attaches to the baby’s head). Both procedures often involve an episiotomy (small cut to the vaginal wall) which is done under local anaesthetic if you haven’t already had an epidural.
After the first baby is born, the doctor will check the position of the second. It may be necessary to manually move the baby into a head down position. This can be done externally, but it may be necessary to pull the baby out by its feet or to turn the baby internally, which requires pain relief if you haven’t already had it.
It may only be a few minutes before the second baby is born, and it is usually less than 20 minutes. Second babies usually deliver more quickly and easily than first babies.
You should have an opportunity to cuddle your babies before the third and final stage of birth, when you deliver the placenta. Waiting to deliver the placenta naturally can take up to an hour and is not recommended with twins because the larger placentas carry a greater risk of bleeding. Your midwife will probably recommend you have an injection of a drug (Syntocinon or Syntometrine) to contract the uterus and help the placenta deliver quickly, usually within ten minutes. This means you don’t need to push and you will lose less blood.