As with all mothers-to-be, a multiple pregnancy is divided into three phases of about three months each, known as the first, second and third trimesters.
The first ultrasound scan usually takes place at the end of the first trimester, at around 11-14 weeks’ gestation. This will confirm the number of foetuses, how many placentas there are and whether they are in separate or shared amniotic sacs. If the babies share an amniotic sac they are certain to be identical. But sometimes identical twins have one sac each, so the presence of two amniotic sacs does not rule out your babies being identical.
The sonographer will also check to see if the babies share a placenta (monochorionic), which can lead to complications. Sometimes this is hard to see, but if it appears to be the case then your obstetric team will want to scan the babies regularly to make sure they continue growing well.
All pregnant mothers are given an anomaly scan at 18-22 weeks to check the babies are developing normally. Mothers of multiples not only get an anomaly scan but will be scanned throughout their pregnancy to check on their babies’ growth and positioning. The timing and frequency of these scans varies according to the number of babies, their chorionicity (whether they share a placenta), hospital procedure, and whether anything else needs monitoring.
With twins, the health team will check the position of the leading baby at about 34 weeks to decide how they should be delivered.
NICE Quality standard 46 sets out the care you should receive during and the timing of appointments and scans depending on the type of multiple pregnancy you have.
Ask if the hospital has a midwife or doctor who specialises in multiple births and try to arrange your antenatal appointments with them.
You may have a list of questions. Don’t feel rushed at your appointments: if you need extra time to work through your list, ask for it. You may want to know, for example, what the hospital procedure is for multiple births and what special arrangements there are for antenatal care in multiple pregnancies. It may also be useful to find out if the hospital has a midwife who specialises in breastfeeding support for mothers of multiples. Make sure you mention any symptoms you are having, even if you think they are probably normal. The doctor or midwife can put your mind at rest or investigate further if need be.
If you are unhappy with your hospital care, ask to speak to another doctor or midwife. All hospitals have a complaints procedure. You can also contact us at Twins Trust for help and support. Antenatal classes are especially important in multiple pregnancy. As twins or more often arrive a little early, it’s best to ask about and book antenatal classes now to make sure you complete them before the babies arrive – with twins, try to complete the course by the 34th week of pregnancy; for triplets, by the 30th week. Some hospitals have special antenatal classes for multiple pregnancies. Twins Trust runs antenatal classes solely for multiple mums and dads where you can meet other parents who are expecting twins, triplets or more. Parents who have attended tell us both the classes and the opportunity to share experiences with others in the same boat are enormously helpful.
Twins Trust regularly conducts research to better understand families’ experiences of pregnancy, birth and the early months. Twins Trust uses the feedback from the research to campaign for improvements in care for multiple birth families. Keep an eye on our website and social media for details of our current campaigns.