Antenatal care for women expecting twins or more
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.
Below Specialist Midwife for Multiples, Sandra Bosman, answers some FAQ about what to expect when you're expecting multiples. Log in or register today to see the whole playlist, which includes information about care plans and what tests to expect.
It's worth taking a look at the 'Good care from nurses and midwives code'. The code outlines what good care looks like and what you should expect when receiving care.
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.You will be offered a non-invasive screening test for Downs Syndrome. This is offered between 10 and 14 weeks of your pregnancy and is sometimes done at your dating scan. This is called the combined test, this is the test the NHS recommends if you choose to have screening. It will not harm you or your babies. If you decide to have this, a blood sample will be taken from you and at your dating scan the fluid at the back of each babies neck is measured (nuchal test).
If you are expecting triplets or more the nuchal test alone is performed. The information from these two tests is used to work out the risk of each baby having downs syndrome. Whether your babies’ identical or non-identical and whether they share a placenta, is very important in understanding your options.
The non –invasive quadruple blood test is available form 14 weeks and one day, this is offered only if you are too late for the combined test; you will be referred to the screening midwife prior to the test in order to explain the detection rates. If you have a higher risk result you will be offered an invasive diagnostic test. About 3-4% of diagnostic tests result in a miscarriage in multiple pregnancy. It is up to you whether or not you have the further test. Making that decision can be difficult you may like to speak with your hospital screening midwife or ARC antenatal results and choices www.arc-uk.org. More information can be found on The Healthy Multiple Pregnancy guide on the Tamba website. There are also non-invasive DNA tests for Downs Syndrome often branded as the Harmony o(r NYFTY test) available from 10 weeks, these are mainly available in the private sector as not available in most NHS hospitals.
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.
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. 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.
Tamba regularly conducts research to better understand families’ experiences of pregnancy, birth and the early months. Tamba 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.
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.
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