Pregnant with Twins? Here’s Everything You Need to Know (and Then Some)

1. Your Morning Sickness Will Be On Steroids

According to the American College of Obstetricians and Gynecologists (ACOG), morning sickness and breast tenderness may be more severe than with a single fetus pregnancy. And, if you’re like me, the first trimester will be filled with nausea, vomiting, extreme fatigue and about six weeks of lying to your co-workers that you keep catching the stomach flu.

2. Gaining Weight Is Important

Weight gain is important to support your babies, and according to Mayo Clinic, the recommendation is typically 37 to 54 pounds depending on your weight pre-pregnancy. I went in for my 12-week appointment and found out that I had lost 8 pounds (see: extreme morning sickness). To keep track of my weight, my doctor recommended I see a nutritionist to make sure I was on track.

3. Your Belly Will Get Big…fast

Prepare for the onslaught of comments, “Wow, you’re huge! I swear you’re double the size of my friend who’s due around the same time!” Before you punch anyone in the face, just remember: You’re carrying double. Ignore the slights and off-color remarks because there is no way to stay “small” when pregnant with twins. 

4. You Will Quickly Learn Not Freak Out When You Hear 'high-risk Pregnancy'

As if you’re not already scared out of your mind, after you see those two heartbeats, your doctors will most likely sit you down and go over all of the risks that come with twin pregnancy. Any pregnancy with multiples considered “high-risk.” That doesn’t mean you will necessary experience those risks, but the likelihood is increased.

5. Prepare For An Early Birth

A preterm birth is very real. Per ACOG: “More than one half of all twins are born preterm. Triplets and more are almost always born preterm.” So be prepared to spend time in the NICU post birth.

6. You Will Google 'vanishing Twin Syndrome'

One of the risks of being pregnant with twins is vanishing twin syndrome, where, according to the American Pregnancy Association, the fetal tissue of one twin is absorbed by the other twin, placenta or the mother. (It’s also known as the miscarriage of one of the fetuses.) This loss can heartbreaking and scary, but studies find that this phenomenon occurs 83 percent of the time in the first trimester and usually leads to healthy, normal pregnancies.

7. Words Like ‘chorionicity’ And ‘amnionicity’ Will Roll Off Your Tongue

There are actually three types of twins based on the whether each baby has its own chorion (the membrane that surrounds the fetus) and amniotic sac (the fluid-filled sac in a woman’s uterus)—yep, the sharing issues start in the womb! The ACOG describes them as such:

1. Dichorionic–diamniotic—Twins who have their own chorions and amniotic sacs. They typically do not share a placenta and can be fraternal or identical.

2. Monochorionic–diamniotic—Twins who share a chorion but have separate amniotic sacs. They share a placenta and are identical.

3. Monochorionic–monoamniotic—Twins who share one chorion and one amniotic sac. They share a placenta and are identical.

Monochorionic babies have a higher risk of complications, including twin–twin transfusion syndrome (TTTS), explains the ACOG.

8. Your Life Will Basically Become Doctors’ Appointments

Because of said risks, you’ll (probably) have to see your doctor every week for the last few months of pregnancy to make sure things are progressing normally. Between that, the non-stress tests that are also mandatory at the end of twin pregnancies and often times a maternal fetal medicine appointment (aka your high-risk doctor), you’ll feel like you live at the doctor’s office…and you kinda do.

9. You’re More Likely To Have Complications

The whole high-risk pregnancy thing applies to your health as well. This, according to the University of Rochester Medical Center, includes: Gestational high blood pressure, gestational diabetes, anemia, postpartum hemorrhage and more. This all sounds very, very scary. But the extra care and appointments are designed to keep an eye on these things so you can solve them as you go.

10. You May Need Iron Infusions

My doctors caught my anemia (thank you, fetuses for leaching my iron reserves), and so I had weekly iron infusions at the hospital.

11. The Third Trimester Is Exciting

You’ve made it this far, you’re probably not as sick anymore, and you can finally enjoy your little double trouble journey. 

12. You Will Feel Like You’re Going To Tumble Forward

Come the third trimester and you’re like a bear hibernating for winter—your belly will get huge. Sure, I only gained 35 pounds total in my pregnancy, but every single one of those pounds was in my belly, and at five foot three, I felt like the Leaning Tower of Pisa.

13. Your Body Will Get…weird

Your ankles may enlarge, and your hands may numb (at least mine did). According to WebMD, "[Up] to 35 percent of women get pain or weakness in their wrist during pregnancy, usually in the third trimester. Fluid retention during pregnancy puts more pressure on the carpal tunnel, which runs from your wrist to the bottom of your palm.” And the plan of treatment, you ask? Two words: Wrist guards. Yep, you get to wear sweet Velcro wrist guards on one (or both in my case) of your hands. I looked like a whale getting ready to hit up the roller rink.

14. A Home Birth Isn’t In The Cards

Your best friend swears by the beauty of her home birth, which is great and all, but save the home births for low-risk pregnancies. Dr. Neda Ghaffari, a perinatologist at the University of California, San Francisco, told NPR, “delivering in the hospital is generally safer than being at home, because a team of practitioners is always available in case of emergency, which any woman can experience during labor. A mother may begin hemorrhaging, for instance, or the baby may become blocked in the birth canal.”

Mayo Clinic explains that “vaginal delivery is often possible if the first baby is in a head-down position. If not, a C-section might be recommended. In some cases, complications after the vaginal delivery of the first twin might require a C-section delivery for the second twin.” You may even have the choice before you go into labor to just decide on the C-section instead of attempting a vaginal birth. So yes, many twin pregnancies result in a C-section either because the mother chose this option or because the doctor deemed it medically necessary. In my case, both my children were breech, therefore, I had no choice. 

16. Recovery After A C-section With Twins Is Extra Challenging

You just had a major surgery. And now you have not one, but two tiny humans to care for. In all honestly, this was probably the hardest part for me. Be kind to your body and say yes to help (see #21).   

17. Breastfeeding Might Come Easy To One Baby And Not The Other

My daughter picked it all up very quickly, but my son was a different story. He wouldn’t latch and preferred to be bottle-fed. We had an amazing lactation consultant come out (psst: most hospitals have lactation specialists) and help us get him to latch but he needed a nipple shield, and then I had to somehow wean him off that. On top of the other parenting skills we had to learn, breastfeeding, for me, was incredibly stressful.

18. You Will Feel Like A Cow

When they do both miraculously latch, you will feel like a big beautiful farm animal. I recommend buying a special breasting feeding pillow for twins (lifesaver). This one on Amazon isn’t exactly cheap, but it’s highly rated.

19. Don’t Judge Yourself Too Hard

If breastfeeding works for you, that’s wonderful. For me? It didn’t work out as magically as I had hoped. After five months of pumping and bottle feeding, I gave up and was never happier. With hindsight, if I were to do this all over again, I would have 100 percent formula fed my twins and never looked back. Not only because I believe formula these days is amazing, but also because I would have saved myself so many tears. 

20. The Risk Of Postpartum Depression And Anxiety Is Higher

According to NPR, “A 2009 study, published in the journal Pediatrics, found that new moms of multiples were 43 percent more likely to have postpartum depression than were mothers of singletons.” While you can’t control the future, you can try to prepare for the challenges to your mental health you may face. Shop for a therapist before you give birth so you can turn to them in crisis if need be and keep an open dialogue with your doctor so they can help you down the line.

21. It’s Essential To Create A Support Community

Because of these risks to parents’ mental and emotional health, building a community to help you cope with the stress and isolation of caring for two babies is really, really important. Whether it’s a Facebook group for parents of multiples in your area, a weekly visit from your mother to watch the babies for an hour while you stare at a wall (any wall) or new moms’ book club where all you do is complain about babies, welcome any emotional and physical support with open arms.  

22. Do Small Things For Your Other Kids

When you have twins, all of your attention goes toward them in the early days. And though you will be running on empty, little gestures like a favorite meal, a toy from Amazon, a family movie night, will help your non-twin kids transition into this new world as well.

23. Take People Up On Their Offers

On that note…say “yes” to favors. Unless you are Beyoncé, you will need them. Ask your relatives to stay over. Tell your neighbor a vegan lasagna actually sounds great. The first few months home with twins will be exhausting, sleepless and highly emotional. But you will learn so much about yourself, your partner and your family. Good luck (you’ll need it), but you got this.

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