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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 10-14 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 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 the health 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, but mothers of multiples will also have scans during the last two months of 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.
Can I have screening tests?
The sonographer can take measurements during the routine scan at 10-14 weeks to assess the babies’ chances of having Down’s syndrome. (Mothers expecting singletons usually have a blood test too, but this doesn’t work so well in multiple pregnancies so is not used.) If a high probability is found, you will be offered a diagnostic test that can determine more accurately whether each baby has the syndrome.
Diagnostic tests carry a small risk of miscarriage because an instrument is inserted into the uterus. The procedure can be more complex in multiple pregnancies, so you may need to go to a specialist hospital. Some people prefer not to have diagnostic tests, and the hospital will be able to talk through any risks before you make your decision.
Tests for other rare conditions may be offered where there is a family history.
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 be rushed through the system: if you need extra time to work through that 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.
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. Tamba 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.
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 Tamba for help and support.
Follow the links to find out more on finding out you are expecting multiples, looking after yourself, common symptoms in multiple pregnancies, complications, preparing for your babies’ arrival, work and finance, and birth plans.