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Pregnant with Twins: What to Expect

Learning you’re pregnant with twins likely causes a rush of emotions. Some women are excited about the prospect of twins — double the cuteness and baby snuggles! Others may feel a little uncertain or even overwhelmed. After all, there are two babies rather than just one. Not to mention, twin pregnancies come with added risk compared to a typical single-baby pregnancy (or “singleton” pregnancy).

Let’s look at how twin pregnancies differ from single-baby pregnancies, from conception to birth.

Signs You Might Be Having Twins

There are some early signs to watch for that could indicate you’re pregnant with twins, but every pregnancy will be a unique and different experience for each woman.

Faster Weight Gain and Severe Morning Sickness

Some women who have twin pregnancies will have more severe morning sickness and faster weight gain. Does that indicate twins? Maybe, maybe not. These symptoms can happen in any pregnancy, so they are not definitive signs of twins.

Blood Test

Blood tests can also reveal the likelihood of twins within the first few weeks after your missed period. Higher than expected beta results could indicate twins.

Ultrasounds

But the only definitive answer to whether you’re having twins is an ultrasound. You’ll most likely find out if you are pregnant with twins when you have your first-trimester ultrasound, which is scheduled for around 7 or 8 weeks gestation.

Differences Between Twin Pregnancies vs. Singleton Pregnancies

Mothers expecting multiples can expect to have a bit more on their plate. You should plan on finding support through friends, family, and local support groups. Your doctor may have some insight into resources available in your area.

Even uncomplicated pregnancies with twins can cause women to feel more tired than they would if they were only carrying one baby. Ensure you eat enough nutrient-dense foods during pregnancy to meet your body’s nutritional needs, too. Pay close attention to your iron intake. You may want to supplement iron through prenatal vitamins and eat plenty of iron-rich foods.

Women expecting twins can also plan on delivering their babies before the 40-week mark of pregnancy. Even in twin pregnancies considered lower risk, delivery may be recommended by 36 to 38 weeks.

Breastfeeding twins has unique challenges but is still possible. Connect with a lactation consultant to help overcome challenges associated with nursing twins so you can continue breastfeeding for as long as possible.

Typical Weight Gain with Twins

Weight gain during pregnancy is expected — and healthy. Your body will be growing two tiny humans! That means you can expect to gain, on average, about 45 pounds during a twin pregnancy. This is about 10 pounds more than a singleton pregnancy.

Body Mass Index (BMI) Pre-pregnancy	Recommended Weight Gain
18.5-24.9	37-54 lb
25-29.9	31-50 lb
>/= 30	25-42 lb

Keep in mind pregnancy weight includes:

increased fluids, such as amniotic fluid and blood supply,
increased fat stores so your body can sustain the pregnancies,
and of course the weight of the babies themselves.

Types of Twin Pregnancies

Fraternal vs. Identical Twin Pregnancies

Many people are already familiar with the differences between fraternal and identical twins. Fraternal twins occur when two eggs are released, fertilized, and implanted. They are the more common type of twins. Identical twins occur when a single egg is split into multiple identical embryos.

But there is another way multiple pregnancies are classified, which affects how closely they are monitored.

Mono/Di vs Di/Di vs Mono/Mono Twin Pregnancies

There are three main types of twin pregnancies:

Mono-chorionic, di-amniotic (Mono/Di): they share one placenta and have their own amniotic sacs; these twins are identical.
Di-chorionic, di-amniotic (Di/Di): they each have their own placenta and amniotic sacs; they could be identical or fraternal.
Mono-chorionic, mono-amniotic (Mono/Mono): they share both a placenta and an amniotic sac; these twins are identical.

Di/Di twin pregnancies carry the lowest risk of the three types because both babies have their own placenta and amniotic sac. When both babies share one placenta, there is the risk of one baby getting the majority of the blood flow. Twin transfusion syndrome occurs in 10 to 15 percent of Mono/Di twin pregnancies.

Prenatal Care for Twin Pregnancy: Week by Week

Prenatal appointments for multiples will be very similar to singleton pregnancies for the first two trimesters unless the pregnancy is high risk.

Prenatal appointments for singletons typically include:

Checking your weight
Checking your blood pressure
Performing a fundal measurement — your OBGYN will measure the distance from your pubic bone to the top of your uterus to determine the baby’s size and growth rate
Monitoring fetal heart rate — your OBGYN will listen to and monitor your baby’s heartbeat
Ultrasounds, according to schedule

Because fundal measurements are not an accurate way to estimate the babies’ growth during a twin pregnancy, as they are in typical pregnancies, you can expect to get regular ultrasounds after the 20-week mark.

For low-risk twin pregnancies, expect to get ultrasounds at 24, 28, 32, and 36 weeks. Higher-risk pregnancies, such as mono-chorionic twins, may have ultrasounds every two weeks starting as early as 16 weeks gestation.

You can also expect regular non-stress tests every two weeks in the third trimester, during which your doctor will listen to the babies’ heartbeats for 20 to 30 minutes. This helps to assess how well the babies are tolerating pregnancy.

What Are the Chances of Having Twins?

The Odds of Twins

Everyone wants to know what their chances of having twins are. It turns out, older women are more likely to get pregnant with twins. At the age of 20, a woman has a 1% chance of getting pregnant with twins, but at age 40, that likelihood jumps to a 7% chance.

Genetic Factors of Having Twins

There is also some genetic tendency with twins. If someone in your immediate family had twins or if you are a twin, then you may be more likely to get pregnant with twins.

How to Get Pregnant with Twins

Women who are taking fertility prescriptions to induce ovulation may have a greater likelihood of having twins.

If a woman is using IVF to get pregnant, she can request a twin pregnancy. However, it is important to note that twin pregnancies carry more risk than single-baby pregnancies.

But there are no known herbs, supplements, foods or sex positions that are proven to increase the odds of having twins.

Risks of Twin Pregnancies

Although some women may think a twin pregnancy is more desirable, given that one pregnancy results in two babies, most practitioners would caution them about the increased risk of complications.

Common risks of being pregnant with twins include:

Higher likelihood of developing gestational diabetes
High blood pressure
Increased risk of preterm delivery
Higher likelihood of needing a C-section
Risk of twin-twin transfusion syndrome in mono-chorionic pregnancies

What to Expect During Labor and Delivery of Twins

Recommended delivery timing varies depending on the type of twin pregnancy and is as follows:

Di/Di: delivery by 36-38 weeks is recommended due to an increased risk of stillbirth at 40 weeks
Mono/Di: delivery recommended at 36 weeks
Mono/Mono: delivery at 32 weeks

If you are pregnant with twins, it isn’t certain that you’ll have to have a C-section, but it is fairly likely. The capability of a woman to deliver twins vaginally depends on the position and sizes of the babies. If the first baby is head down and the babies are the same size or baby one is larger, then a vaginal delivery for both babies can be attempted.

At Madison Women’s Health, we often encourage women to have an epidural when delivering twins. Having an epidural in place can save time if an emergency C-section is needed. It can also make the experience more tolerable if the second baby is breech (positioned feet first) and needs assistance.

If a woman wants to deliver twins vaginally, the delivery will begin in a normal labor room where the baby and mother will be monitored closely. When the mother begins to push, she will be moved to the Operating Room (OR) in case an emergency C-section is needed. There will likely be a pediatrician, anesthesiologist, surgical tech, and an ultrasound technician present to monitor the vital signs of the mother and baby.

The healthcare team knows that twin deliveries carry more risk, so these measures should be taken to keep the mother and baby safe.

Talk with your provider about making the experience as relaxing as possible by incorporating calming music and having a support person present. (Want some ideas for making your birthing experience as calm as possible? Read this blog post.) Assuming your babies don’t need medical support when they are born, you should still be able to do skin-to-skin contact immediately after delivery.

Community Support for Twin Pregnancies

When you learn you’re having twins, you will probably have many questions. At Madison Women’s Health, we’ve delivered many twins. Some of us have even had twins ourselves! But we know some of the best advice, tips, and tricks for how to cope when you’re outnumbered by babies comes from other parents who have been there, done that!

We encourage you to get involved in a community support group for parents of multiples. In Madison, we recommend “Moms of Multiples.” You’ll also want to speak with a lactation consultant.

Finally, if you have supportive friends and family nearby, remember to ask them for help. Chances are they would love a few extra moments to snuggle your little ones so you can get some much-needed rest. If you have any questions or concerns about having twins, please speak with your OBGYN. We’re here for you every step of the way.

Dr. Dickmeyer has been providing healthcare for women in the Madison area since 1998 and is a founding member of Madison Women’s Health. Her specialties include minimally invasive surgical techniques, high and low risk obstetrics, pelvic floor disorders and postmenopausal medicine.

August 25, 2022/by Karla Dickmeyer

Exercise During Pregnancy: Which Activities are Safe and Which You Should Avoid

Pregnancy

Exercising during pregnancy is an excellent way to maintain a healthy pregnancy and create positive habits that you can pass along to your child. Exercise benefits both you and your baby in many ways.

As long as you exercise safely and follow recommendations from your OB provider, exercise has been shown to be safe in pregnancy without risks to your baby. While you may need to modify some exercises, especially as your baby grows and your body changes, you don’t need to purchase special equipment. Stay consistent and listen to your body and you can exercise safely throughout your pregnancy!

Benefits of Exercising During Pregnancy

When you exercise throughout your pregnancy, you’re more likely to achieve a healthy level of weight gain. (Read our blog post about how much weight you should gain while pregnant.) You’ll also be much less likely to experience gestational diabetes, gestational hypertension (high blood pressure), and other disorders. Your baby will benefit from your exercise, too, with lower rates of preterm birth, C-section deliveries and low birth weight.

Regular physical activity can help reduce your body aches and pains, especially if you have back pain or sciatic pain. Exercise also helps strengthen your heart and blood vessels. Plus, you’ll find it easier to lose your pregnancy weight after your baby is born.

Physical activity even does wonders for your mental health! Aerobic exercise—whether you’re pregnant or not—reduces anxiety and depression during pregnancy and can help increase your energy levels. Women who exercise during pregnancy may be able to reduce their risks of postpartum depression.

How to Get Started Exercising While You’re Pregnant

Because every pregnancy and body is different, it’s important to meet with your OB provider before you get started. Some women can maintain their same level of activity and exercise throughout their pregnancy, and others may need to scale back in the beginning and at the end. Your doctor or midwife will help you determine the best approach.

It’s so important to listen to your body while you’re exercising. The easiest way to know if you’re “overdoing it,” is by doing a “talk test.” As long as you can carry on a light conversation while exercising, you’re probably not over-exerting yourself.

If exercise is a new habit you’re trying to build while pregnant, start slowly and add more minutes to your exercise routine each week. For example, start with 10-20 minutes per day 2-3 days a week, and then build up to maybe 30 minutes per day 3-5 days a week.

Some women like tracking their exercise and watching aerobics videos designed for pregnancy. Many of our patients have enjoyed using an app called Expecting and Empowered. While it isn’t free, it may help give you the motivation that you need to get started and stay consistent.

Here are some safe pregnancy exercises to get started.

Try any of these for 20-30 minutes a day, on most or all days of the week:

walking — this is the best way to get started!
swimming
stationary cycling / spinning
aerobic exercises
dancing
resistance exercises (weights, resistance bands, strength training) — use good ergonomics and form to avoid injury
stretching and prenatal yoga
hydrotherapy/water aerobics
kegels to strengthen your pelvic floor (do this during pregnancy and postpartum)

If you were already doing higher intensity and longer workouts before you got pregnant, like jogging and aerobics, and you have an uncomplicated pregnancy, you can probably keep up those activity levels. Your doctor will help you determine if you have any restrictions or if you need to increase your calorie intake.

Specialty Exercises During Pregnancy

If you experience back pain while pregnant, consider adding core strengthening exercises for your abdominals and your back. Yes, you CAN do abdominal exercises while you’re pregnant, but you will need to modify them a little bit and limit how much time you lay flat on your back. Your OB provider or physical therapist will be able to give you exercises that are safe for your specific situation.

You can strengthen your pelvic floor while you’re pregnant by performing kegels during and after your pregnancy. To perform kegels, contract the muscles that you would use to stop your urine stream. Hold for 3 seconds, and then relax for 3 seconds. Repeat this 10 times, in the morning, afternoon, and evening. Try to increase your hold by 1 second each week until you reach 10 second holds.

Exercises to Avoid While Pregnant

It’s important that you avoid activities that could increase your risk of falling or sustaining abdominal trauma. Be sure that when you’re exercising, you don’t raise your core body temperature to an unsafe level (that is, above 102.2° F).

Activities to avoid:

contact sports (football, volleyball, softball, wrestling, jiu jitsu, ultimate frisbee, etc.)
extensive jumping (some jumping may be ok as long as you modify the exercises to reduce the risk of losing your balance)
full sit-ups, leg raises
scuba diving
horseback riding
skiing, snowboarding
hot yoga
exercising in hot, humid weather

Who Shouldn’t Exercise While Pregnant

If you have a high risk or complicated pregnancy, make sure to ask your OB provider about the types of exercises you can do while pregnant. In general, it is always good to touch base with your OB provider regarding your exercise routine and goals in pregnancy so they help you establish a safe routine for YOU.

When to Stop Exercising During Pregnancy

It’s very important that you listen to your body while you exercise. If you can’t carry on a light conversation while you’re working out, slow down, drink some water and then resume at a lower intensity after you have caught your breath.

If you’re used to using a heart rate monitor during exercise, you may find that it isn’t as useful of a tool to measure your exertion levels. That’s because your heart rate rises during pregnancy. Passing the “talk test” will be a more reliable measure of how hard your body is working.

If you experience any of the following warning signs, stop exercising and follow up with your OB provider:

vaginal bleeding;
abdominal pain;
regular painful contractions;
amniotic fluid leakage;
shortness of breath BEFORE exertion;
dizziness;
headaches;
chest pain;
muscle weakness affecting balance;
or calf pain or swelling.

Listen to Your Body to Stay Healthy & Safe!

Whether you’re new to regular exercise or wondering if you need to scale back from pre-pregnancy activity, the most important thing to do is listen to your body! Stay well hydrated. And stop if you experience any of the above warning signs. Your OB provider will be your best resource as you get started or resume activity.

Exercising has so many benefits for you before, during, and after your pregnancy. At Madison Women’s Health, we’re excited to support you in your journey toward health and wellness. We’re glad that you’re interested in developing healthy habits for you and your family that will serve you for years to come.

Check out our prenatal yoga classes for our pregnant patients.

Dr. Shefaali Sharma has been providing healthcare to women in Madison since 2012 and joined Madison Women’s Health in 2016. She specializes in high- and low-risk obstetrics, pre-conception counseling, management of abnormal uterine bleeding, multi-modal approaches to pelvic pain, and contraceptive counseling.

July 21, 2020/by Dr. Shefaali Sharma

Pregnancy Weight Gain: What is Average and What is Recommended by OBGYNs?

Family Planning, Pregnancy

Your weight gain during pregnancy is important not only for your baby’s growth and development, but also for your health during and after your pregnancy.

It’s important to have a healthy perspective on pregnancy weight gain even though it can be a very sensitive, personal topic. While some women enjoy the “freedom of eating for two” as soon as the first trimester’s morning sickness goes away, others get upset when they see the scale creep past numbers they’ve never seen before. Most women are concerned about getting back to their pre-baby weight.

But a healthier perspective falls somewhere in the middle.

The weight you gain while pregnant supports your baby’s growth and development while you are pregnant and supports breastfeeding your newborn. However, too much weight gain can lead to problems like diabetes, heart disease, pre-term delivery, or even miscarriage and still birth. And even your pre-pregnancy weight affects your child’s weight and health as they grow older.

Paying attention to your pregnancy weight gain and returning to your pre-baby weight is not about meeting body image or societal standards—rather, it’s about achieving optimal health for you and your baby. At Madison Women’s Health, we care about your health and your baby’s health. That’s why we want to help you understand the recommended weight gain for pregnancy and the risk factors for carrying an unhealthy amount of weight while you’re pregnant.

So what is the “right” amount of weight you should gain while pregnant?

The National Academy of Medicine created these guidelines to help women estimate how much weight they should gain while pregnant, based on her BMI (body mass index) before pregnancy.

Average Weight Gain During Pregnancy:

Underweight: Gain 28-40 pounds
Healthy weight: Gain 25-35 pounds
Overweight: Gain 15-25 pounds
Obesity: Gain 10-20 pounds

If you have twins, you’ll gain a little more weight:

Healthy weight: Gain 37-54 pounds
Overweight: Gain 31-50 pounds
Obesity: Gain 25-42 pounds

Gaining Weight at the Right Rate

Your pregnancy weight gain will be gradual, with some jumps and plateaus. What matters the most is your overall weight gain. Most women don’t gain very much weight during their first trimester. But in the second and third trimesters, you can expect to gain 1/2 to 1 pound per week.

Your OBGYN will track your weight gain with you at your monthly check-ups and may recommend changes to your nutrition or activity levels. Experiencing major weight gains, like 15 pounds in 4 weeks, would not be considered healthy. Your doctor will make recommendations to help you slow your weight gain.

Source: https://nam.edu//www/wp-content/uploads/2019/12/Table-1.png

What Makes Up Your Pregnancy Weight

Based on a healthy pregnancy weight gain of about 25 pounds, this is where your pregnancy weight goes:

baby: 7-8 lbs
amniotic fluid: 2 lbs
placenta: 1.5 lbs
increased blood volume: 3-4 lbs
increased fluid volume: 2-3 lbs
larger breasts and uterus: 3-5 lbs
increased fat stores to support nutrition during pregnancy and for breastfeeding afterward: 6-8 lbs

(Source: https://nam.edu/the-current-understanding-of-gestational-weight-gain-among-women-with-obesity-and-the-need-for-future-research/)

Risks of Gaining Too Much Weight While Pregnant

Your weight before and during pregnancy plays a large role in your health and your baby’s health. If you are overweight at the time of conception, or if you gain more than the recommended amount during pregnancy, you and your baby can be at risk of the following:

fetal anomalies,
preeclampsia,
heart disease,
gestational diabetes,
depression,
stopping breastfeeding early,
developing sleep apnea,
preterm delivery,
delivery requiring induction,
C-section,
miscarriage,
and still birth.

In addition to those risk factors, babies who are born to women who are obese are also at risk of:

higher percentage of body fat,
childhood obesity,
lifelong metabolic syndrome,
and asthma.

But there is good news! If women who are overweight or who have obesity lose even a small percentage of weight prior to conception, they can impact the health of their pregnancy. For example, if a woman weighing 300 pounds loses just 15 pounds, she would improve both her health and her baby’s health. A 5% weight loss is the perfect starting goal prior to pregnancy – and can reduce the risk of complications. Once that goal is reached, it’s good to reassess and set a new goal.

Risks of Gaining Too Little Weight While Pregnant

Some women struggle to gain weight during pregnancy. This is typically caused by hyperemesis, which is excessive nausea and vomiting in pregnancy. Eating disorders that lead to continued restrictive eating are also causes.

If a woman doesn’t gain enough weight, her baby is at risk because it isn’t getting the proper nutrients. Babies born to underweight women are at risk of:

being small for gestational age,
growth problems,
and failure to thrive.

How to Achieve Healthy Weight Gain While Pregnant

Instead of becoming anxious about weight gain or permissive about unhealthy eating habits, focus on staying active and eating a balanced diet.

Make an eating plan

Choose a healthy eating plan that you can continue. There isn’t one specific pregnancy diet to follow. Instead, your healthy pregnancy diet should consist of lean proteins, healthy fats, fruits and vegetables. (Whether my patients are pregnant or not, I usually recommend the Mediterranean diet—it meets all the nutrition requirements, isn’t very restrictive, and will give you many satisfying meal plan options.)

Eat nutritious food

Focus 95% of your diet on healthy, nutritious food. Then, the remaining 5% should be other choices you really enjoy. If ice cream is your thing, take time to savor it—it’s ok! For more information about food during pregnancy, read our article about food cravings, aversions, what to eat and what to avoid.

Add a Few Calories

Add about 300 calories per day to maintain a healthy weight while you’re pregnant. That’s like adding another slice of bread, a cup of cottage cheese, or a couple more ounces of meat at your meals. If you are overweight, you will not need to add as many calories. There is no need to “eat for two!”

Listen to your body

Pay attention to your hunger cues. Stop eating before you feel too full.

Stay Active

Stay moderately active every day. If you struggle with your weight or body image, your pregnancy is a great time to reset your focus on overall health and establish healthy eating and exercise habits. You’ll be making a positive step for your child and yourself.

Any patient at Madison Women’s Health who starts a pregnancy when overweight or obese is given the option of a nutrition consultation. When you work with a nutritionist, you will learn how to choose healthier options, how to create healthier habits, and even how you could change your dietary preferences.

Getting Back to Your Pre-Baby Weight

The majority of women gain a healthy amount of weight during pregnancy, and much of that weight is lost soon after delivery. But about 60% of the time, women still retain about 10 pounds of their pregnancy weight gain 12 months later. And 40% of women maintain 20 pounds of their weight gain even after their baby is one year old.

When should you lose that baby weight so it doesn’t become a permanent weight gain?

Weeks 1-6: Don’t worry about your pregnancy weight for your first six weeks with your new baby. Instead, focus on recovery, connecting with your baby, getting enough sleep, and establishing breastfeeding. Check with your OBGYN about resuming more activities at your postpartum visit!
Months 3-6: It’s okay to begin working toward a healthy weight at this point. This should be gradual and your diet should continue to support breastfeeding.
Months 7-12: Add more activity to your daily routine. Just as you gained your pregnancy weight gradually, you will lose it gradually. Give yourself time to lose the weight in a healthy way.

If you haven’t returned to your pre-baby weight by the time your baby is one year old, then consider making more changes to your nutrition and exercise. You can also request a nutrition consult to learn how to get all the nutrients your body needs without overdoing it on calories.

At Madison Women’s Health, we want to support your health before, during, and after your pregnancy. We’re here to help you learn how to make the best decisions so you can be well.

Dr. Kate Sample has been providing healthcare to women in Madison since 2002 and is a founding member of Madison Women’s Health, specializing in high and low risk obstetrics; minimally invasive surgical techniques; pelvic floor disorders; and exercise, weight loss and obesity. She is a Diplomate of the American Board of Obesity Medicine and is trained in Cognitive Behavioral Therapy for weight loss through The Beck Institute.

May 26, 2020/by Kate Sample

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