Fetal movements in twins: knowing when to seek help

Understanding your twins’ movements

Feeling your babies move can help you connect with them during pregnancy. Their movements also give you important information about their wellbeing.

If you’re expecting twins, you might wonder whether you should feel twice as many kicks. You may also find it difficult to tell which baby is moving.

There’s no set number of movements you should feel each day. What matters is becoming familiar with your babies’ usual pattern and noticing changes. You don’t need to keep a daily kick count.

Your awareness of their movements is valuable, even when you can’t distinguish between them. If babies movements are less or absent, contact your maternity team.

Why reduced movements in twins need checking

Movements are part of your babies’ development. They can also be affected by how well the placenta supplies oxygen and nutrients.

A baby who isn’t receiving enough oxygen may move less to conserve energy. Reduced movements can therefore be a warning sign that a baby needs assessment [1–3].

Twin pregnancies need additional monitoring because some complications are more common than in pregnancies with one baby. These include premature birth and babies growing more slowly than expected.

Twins who share a placenta, known as monochorionic twins, also need monitoring for complications such as Twin-to-Twin Transfusion Syndrome (TTTS). This affects the balance of blood flow between the babies.

Reduced movements don’t tell you what’s causing a change. They also don’t automatically mean something is wrong. However, they should always be checked.

If your babies are moving less or you can’t feel movements, call your maternity unit immediately. Don’t wait until tomorrow or your next appointment, even during the night.

What research tells us about movements in twins

There’s less research into fetal movements in twins than in pregnancies with one baby. Much of the guidance therefore draws on evidence from singleton pregnancies.

One study looked at reduced movements after 34 weeks in dichorionic twin pregnancies, where each baby has their own placenta.

It found that a combined measure of health complications after birth was more common following reduced movements: 29.5%, compared with 19.2%. Admission to a neonatal intensive care unit was also more common [6].

These findings support taking changes seriously. However, they don’t predict what will happen in your pregnancy or mean reduced movements cause these complications.

A separate UK study involving 181 mothers found no increased likelihood of adverse outcomes among those reporting reduced movements.

It also found an association between receiving no information about movements early in pregnancy and poorer outcomes. This doesn’t prove that a lack of advice caused those outcomes [7].

Together, these studies show why more research is needed. They don’t change the advice to seek prompt assessment whenever you’re concerned.

Getting support when movements change

Tell your maternity team what you’ve noticed, including when the reduction in movements started and whether movements feel weaker or less frequent.

If you can’t tell which baby is moving, explain this too. You don’t need to identify the baby before contacting them.

Your assessment will depend on how many weeks pregnant you are and your individual circumstances. The team may check both babies’ heartbeats and monitor their heart rate patterns using cardiotocography (CTG).

An ultrasound may also be needed to assess growth, the fluid around each baby and blood flow [1,6]. Your team will explain the findings and any next steps.

Don’t use a home Doppler to reassure yourself. Hearing a heartbeat doesn’t show that a baby is well.

If you’re still worried after an assessment, or movements change again, contact your maternity unit immediately. Previous reassuring checks shouldn’t stop you from seeking help again.

You’re not wasting anyone’s time. Your concerns matter, and your maternity team is there to assess your babies and support you.

References

1. Whitworth, M., et al., Reduced Fetal Movements Green-Top Guideline No. 57. BJOG, 2026. 133(8): p. e70-e92.
2. Carroll, L., L. Gallagher, and V. Smith, Pregnancy, birth and neonatal outcomes associated with reduced fetal movements: A systematic review and meta-analysis of non-randomised studies. Midwifery, 2023. 116: p. 103524.
3. Ter Kuile, M., J. Erwich, and A.E.P. Heazell, Stillbirths preceded by reduced fetal movements are more frequently associated with placental insufficiency: a retrospective cohort study. J Perinat Med, 2022. 50(6): p. 668-677.
4. Gibson, J., et al., Antenatal Care: General, in MBRRACE-UK Perinatal Confidential Enquiry: Stillbirths and neonatal deaths in twin pregnancies. , E.S. Draper, et al., Editors. 2021, The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester: Leicester, UK.
5. Mulder, E.J., et al., Fetal behavior in normal dichorionic twin pregnancy. Early Hum Dev, 2012. 88(3): p. 129-34.
6. Levy, M., et al., Reduced fetal movements is twin pregnancies and the association with adverse neonatal outcomes. Eur J Obstet Gynecol Reprod Biol, 2020. 246: p. 165-168.
7. Greatholder, I., et al., Evaluating antenatal risk in twin pregnancies-A feasibility study to identify modifiable factors associated with adverse pregnancy outcomes. Acta Obstet Gynecol Scand, 2023. 102(5): p. 585-596.