Antenatal Care
Antenatal Care
During a twin pregnancy you will be checked out more carefully than in a single pregnancy to be sure that any complications are detected and treated as soon as possible.
A good diet and extra rest are important. You will be given iron and vitamins to stop anaemia developing.
Regular antenatal visits will allow the growth of your womb to be checked. To make sure that both babies are growing several ultrasound scans will be performed throughout the pregnancy. When twins share either a sac or placenta you will be offered particularly careful ultrasound scans between 18 and 24 weeks, as a fast build up of fluid can occur at this time. If the twins share a placenta but are in different sacs, a build up of fluid is usually due to one twin getter a better blood supply than the other. This is called twin-to twin transfusion syndrome. This condition must be treated. There is a website called www.twin2twin.org which will answer any of your questions relating to this condition.
Antenatal care is still likely to differ and will depend largely upon which type of twins you are expecting. There are more risks involved with identical twins (monochorionic) so monitoring will be more intense than with fraternal twins (diochorionic). The reason for this is diochorionic twins (fraternal) have their own placentas but monochorionic twins share a placenta and in some cases even share an amniotic sac.
You are likely to see a consultant on a regular basis opposed to a regular midwife visit and it is likely that your babies will be delivered in hospital and if early a stay in a Special Care Baby Unit may even be necessary.
My babies were born in different areas of the UK and as they were different types of twin pregnancies my antenatal care differed.
With my first set of twins (fraternal boy/girl) my antenatal care was completely hospital based. I had a dating scan at 12 weeks and then the “anomaly” scan at 20 weeks. From this point onwards I had fortnightly appointments at the hospital and was always seen by the consultant or the registrar as well as a midwife. Both my blood and urine were checked. I am rhesus negative so my blood was monitored a little more frequently than would normally be the case. I was also scanned fortnightly and then weekly till the date of my c-section.
There was a little episode at 31 weeks when I so happened to be at one of my regular appointments. The midwife didn’t like how I was looking or walking and wanted to do some thorough checks. I was hooked up to a fetal heart monitor and contraction monitor. They suggested by their findings that I may be going into premature labour. I was given an internal examination by the registrar who told me he had his fingers on my son’s head which was fully engaged. No wonder I was walking funny! Much to my annoyance I was admitted to hospital. I was given steroid injections to develop the babies’ lungs just in case. I was told to wait – I think we were waiting for some labour pains. They never came. So I discharged myself much to the doctor’s surprise and promised I would be back at 4am for another steroid injection.
Sensibly I went back at 4am (more sensible to stay over night but I wasn’t a tough mummy then!). And so, the care carried on. Every week I went back to the hospital to be checked. We were all getting larger. At 37 weeks I was given a membrane sweep and sent home to wait. Nothing happened. Those babies were way too comfy enjoying my Saturday night curry and X Factor entertainment. I had another at 38 weeks by the most senior consultant. Her membrane sweeps were supposed to help bring on labour without fail. Nope, it didn’t work so at my request we booked in for a C-section at 39 weeks plus 4 days on the premise that I was likely to go into labour beforehand anyway. I never did……….
My second twin pregnancy was a little more complicated. I was given an ultrasound at 8 weeks at my local hospital and discovered that I was expecting identical twins.
I was sent to the Harris Birthright centre at Kings College Hospital for my dating scan at around 12 weeks. The fetal unit at Kings College is probably the best fetal unit in the world and specialises with every aspect of fetal development. This particular scan was a very thorough and comprehensive scan to ascertain exactly which type of twins I was carrying. I was back there every two weeks thereafter to check for signs of TTTS (Twin to Twin Transfusion Syndrome).
The scans took about an hour and at times the sonographers found it difficult to read all the Doppler’s and take other measurements as sometimes one twin would be in a very difficult position. Occasionally, I was asked to return one week later if they weren’t able to take certain measurements. It was a very exhausting journey to and from the hospital in London and sometimes it was a whole day missed from work for both my husband and I. We often sat in a waiting room for 3 hours or more waiting to be seen but despite the long wait and tiresome day the care we received at Kings was second to none.
In between my appointments at Kings I had to visit my local hospital to see my consultant who was likely to deliver my babies. My consultant had a very positive attitude to delivering identical twins and I felt quite reassured that I was receiving the best advice. They too scanned but their equipment was no way near as sophisticated as Kings’ and often we would come away with measurements that did not accord to the measurements we had been given at Kings.
The pregnancy was smooth although at times we had concerns over TTTS as Twin 2 was consistently showing up on the small side and the difference between the babies was getting larger. We never actually experienced TTTS other than concerns and we were never diagnosed as having the condition.
The measurements of the girls were constantly monitored and at 25 weeks a consultant at Kings said that it just seemed that Twin 2 was on the small side (and I can tell you at 2 years of age , although fairly tall she is extremely petite!) but it was unlikely that TTTS would set in. It normally sets in between 16-25 weeks. We were advised to go for a C Section on the basis that Twin 2 was on the small side and they didn’t rate her chances of going through two labours and the fact that they shared a placenta was not the best circumstances for a natural birth either. Labour can bring on acute TTTS apparently.
So, we were discharged and advised if there were any problems whatsoever to go straight back. The local hospital took up the fortnightly scans and my consultant and a midwife saw me fortnightly also.
My consultant was brilliant. She knew that I wanted to try for a natural birth despite the advice from Kings and the fact that I had previously had a section with the first set of twins but she remained positive about trying if everything was in place. She often warned me that the babies were likely to come early and told me that just because the first set never made an early appearance don’t expect this set to go the distance. For some unknown reason identical twins generally come early. I was advised to get my bags packed and ready for 30 weeks. So I did as I was told and packed our bags.
At around 32 weeks the hospital decided to check my cervix. The results indicated that I had a long cervix which is also good news but it had started to efface. I was given steroid injections just in case. At 34 weeks my local hospital indicated that they weren’t happy with the scan results saying they were concerned that there was a possible onset of TTTS. I was booked for a scan the very next day at Kings.
We were reassured at Kings that all was well but because Twin 2 was definitely on the small side of small I was to be delivered at 35 weeks by c section. So that was that, everything changes in an instant. This wasn’t really what I wanted but at the same time I wasn’t going to risk the health of the babies so was booked in for a section at 35 weeks. I was prepped by the local hospital and bloods were taken and I was sent home with antibacterial shower wash to use prior to my hospital visit.
The big day came and off I went nervously to hospital only to be told that there wasn’t enough staff on special care baby unit to take the babies and the consultant on duty wouldn’t deliver unless there were for obvious reasons. My consultant came to see me and instructed us to go home and return on Wednesday 12th April where we would be treated as an emergency as I couldn’t be left any longer. This was just the worst thing to happen and I was really hoping I would go into labour.
Two days passed and on the Wednesday morning we went back in. The staff really took good care of me and my husband and everyone was chatting in theatre whilst getting prepared so as to calm the nerves. If you would like to read my birth story please see the Twin Stories Section.
Disclaimer: The information on this website does not constitute medical advice, it is for your reference only from my personal experience of delivering twins twice. Always seek professional and current advice from a registered medical practitioner.
