Holy crap there is more than one in there!

[Tarot]

Being pregnant with more than one baby is great news! It is also very overwhelming! There are a lot of health issues that won’t effect a singleton pregnancy that will most certainly effect you. Educate yourself on the risks to you and your babies because after all, you are your best advocate. When you are done here, head over the forum Multitasking and ask some questions.

Did you know?
One birth in 80 is a twin birth.
The rate of monozygotic twins (twins from a single egg) is relatively constant in different cultures and geographic areas. However the rate of spontaneous dizygotic twins (fraternal twins) varies from a low of 3 per 1000 births in Eastern Asia to 16 per 1000 births in some African regions. The North American rate is about 8 per thousand births. These are spontaneous rates, assisted pregnancies often result in multiple births.
There are now more than 40,000 children under 5 who are multiples.
Older women are more likely to conceive multiples.
There are more male-male twins than female-female twins, but in triplet pregnancies there are more girls than boys.

Are they Identical?
It is natural for parents to want to learn all they can about their babies and this includes their zygosity (or genetic makeup). You may be wondering if your multiples with be identical or fraternal. Even if your babies have already been born, the zygosity of the babies may not be clear.
Since identical twins are never truly identical (for example - fingerprints are always different), it is more accurate to talk about monozygotic and dizygotic twins. Monozygotic twins develop from one fertilized egg, which splits either before or after it implants in the lining of the uterus. Dizygotic twins are the result of two fertilized eggs.

How can you tell?
There are many different sources of information that can help you and your doctor determine zygosity.
Blood type is usually determined after delivery. If your babies have different blood types, they are dyzygotic twins.
Ultrasound during pregnancy can reveal information about the structure of the placenta, which can provide clues to zygosity. Two placentae does not always mean that the babies are dyzygotic; two placentae may develop if the egg splits before it implants in the wall of the uterus. However, analysis of the placenta after the birth may help clarify your questions.
If you are still left with more questions than answers, DNA testing can be used. Monozygotic multiples have the same DNA, while dyzygotic twins would be no more similar than any other siblings. Use this link to learn more about DNA testing for zygosity.

If you are expecting more than one child, you will have many of the same concerns as any other pregnant women.

Nutrition
You will want to ensure that your diet is sufficient to maintain your own health and to provide nourishment for the developing fetuses. You may be uncertain about whether you need nutritional supplements and you may wonder about how much weight it is appropriate for you to gain when you are expecting more than one baby.
There is little nutrition research on multiple pregnancy and well-founded guidelines do not exist yet. These recommendations are, therefore, adapted from information on single and twin pregnancies and clinical experience. They are general and are not meant to replace the one-on-one care that you are getting from your caregiver. If you have specific concerns, ask for an appointment with a registered dietitian.

Weight Gain
The following numbers should only be used as a general guide, because they are based on limited published data. There is really not enough information available to suggest guidelines for quadruplets and quintuplets.
Weight gain patterns are very individual. The rate of gain and the total weight gain are both important. Expect gradual weight gain.
The desirable total weight gain depends on your pre-pregnancy weight as well as the number of babies you are expecting. You may expect to gain more weight then suggested below, if you were underweight before pregnancy and less weight if you were overweight before pregnancy.

Weight Gain for Multiple Pregnancy (in pounds)

Twins Triplets



Total Gain 35-45 45-55


First Trimester 4-6 lbs 1.5 lbs a week



Second and
Third Trimester 1.5 lbs a week 1.5 lbs a week






Discomforts of Multiple Pregnancy
There are a number of discomforts associated with any pregnancy. Common ones include a variety of aches and pains, gastrointestinal concerns like morning sickness and variety of other concerns. More information about coping with these discomforts can be found on the general pregnancy section of this health centre.
There are some concerns that make be more common among women expecting multiples.
Fatigue
Being tired is an almost universal complaint among pregnant women, however mothers with multiples report higher fatigue levels than those carrying a single fetus. Did you even wonder why pregnant women are so tired? Your body is doing tremendous work right now. For example, the amount of blood in your body doubles with twins to adjust to the demands of the pregnancy. Amazing! This makes iron intake especially important to prevent anemia. Also during sleep, more growth hormone is released which is necessary for the development of your babies - so sleep when you can and don't feel guilty.
Balancing the demands of everyday life with the need for rest and sleep can be a challenge. Elizabeth Noble, in her book Having Twins suggests two half-hour naps every day. If you have ever had premature labour, try to lay down at least two hours in the day and nine at night.
Contractions or Tightenings
Women pregnant with multiples often experience tightenings or contractions, which can begin early in pregnancy (less than 20 weeks) and continue throughout. (Some doctors call this a higher baseline of contractions.) They are generally mild, although they feel different from the painless Braxton Hicks contractions that most women experience late in pregnancy. Women most often report having them when they are fatigued, such as in the evening. Sometimes lying down and resting will help.
You should report any pattern in these contractions to your caregiver. It is always important to listen to your body and know what is normal for you. If the contractions increase in frequency or a pattern emerges, contact your caregiver.
Shortness of Breath
As your pregnancy progresses, especially with more than twins, you may find it difficult to get in a good breath of air. For many women, this is because of the size of your expanding uterus. Position changes sometimes help. Sleeping with extra pillows and modifying your activity is essential.
Getting Around
A woman carrying multiples has incredible changes going on inside her body. By the time a woman with twins is 18 weeks pregnant, her uterus is twice the size of a woman with a single pregnancy. One mom who had quadruplets said that by 26 weeks, her uterus was 46 week size! A mom with triplets commented that the only place she was comfortable the hot summer she waited for her delivery was in a friend's swimming pool.
Being prepared for eventual difficulties in moving or bedrest is especially important for those expecting more than twins. Planning ahead for friends and family member who can help is essential. We offer a page of suggestions for dealing with visitors and getting help after the baby is born. you might want to implement some of the early. Our pages on bedrest also offer some survival strategies!

Physical Activity and Activity Restrictions
Activity restrictions are not uncommon especially for women carrying more than twins. If you are unclear about what activities are appropriate for you, use the activities question sheet to clarify with your doctor what you should and shouldn't do.
Exercise
Pregnancy is not a time to begin a new exercise program! However, if you have always been active and would like to continue with your regime during a multiple pregnancy, consider the following:
Is the activity low impact?
Can I modify my program?
How far into the pregnancy do I plan to continue?
Moderate exercise like walking and swimming tend to be the safest. For some women, exercise in the upright position and any bouncing is a trigger for contractions. For others, it is not. (We know of one dance teacher who "tapped" her way to 38 weeks with twins.) While it may be possible for a woman expecting twins to continue to exercise, if you are expecting more than two you will likely need to do less and less as the pregnancy continues. Going for short walks or swims may be all your can do and even this may not be possible later. Monitor yourself closely and stop if there are ANY concerns.
If you have signs of premature labour, you are advised to stop exercising. As the pregnancy progresses, especially with more than twins, you will probably find your daily activity and movement a challenge. Discuss any exercise program with your doctor.
Sex
Whether or not you continue to make love during your pregnancy is an individual choice and varies with your situation. Some women are at higher risk of going into premature labour after sex and these women will be advised against intercourse. If you are advised to avoid intercourse, explore other ways to share intimacy with your partner. Make sure your are clear about what your doctor advises. For example, in addition to avoiding intercourse, some women are advised to avoid breast stimulation.
Bedrest and Other Activity Restrictions
Routine bedrest for no other reason than that you are expecting multiples has not been found to be beneficial. However, you may be told to rest in bed after you have had signs of premature labour. Since almost all women with more than twins, and many women carrying twins, have some premature labour or cervical ripening, it is not surprising that many women pregnant with multiples have questions about activity restrictions. More detailed information about bedrest and hospitalization as well as tips for coping with activity restrictions can be found in our pages on high-risk pregnancy.
Like all labours, labour with twins or more is a journey into the unknown. Will it start early? Will it be fast or slow? Will everything go well? Will I have a caesarean? How much will it hurt? It's impossible to know these things ahead of time. Some women with twins give birth without medications at 38-40 weeks while others give birth at 30 weeks by caesarean. As with any other labour, some issues come up that are unexpected and which may change the plans you made with your caregiver.
Premature Labour
Multiples tend to be born earlier than singletons. Prematurity (being born before 37 weeks) is responsible for many of the problems multiples may have as newborns.

Average Duration of Multiple Pregnancy

Singletons -

40 weeks

Twins -

37 weeks

Triplets -

34 weeks

Quadruplets -

32 weeks

If you are expecting multiples you may already have been counselled about the risk of premature labour, but how do you know there is a problem? Use this link, to learn more about the signs of premature labour.
Vaginal or Caesarean Birth?
All triplets and quadruplets are born by Caesarean. Use this link to learn about Caesarean births.
If you are having twins, your caregiver may also talk to you about the increased possiblity of a Caesarean birth. About 50 percent of women have a vaginal birth with twins.
It is difficult to predict what will happen at the delivery of twins. Whether you have a caesarean or vaginal birth depends on many factors including:
your health
the babies' health
the number of babies
the position of the placenta
the position of the babies in the uterus
The babies' position is usually the most important deciding factor for how the babies will be born. It is also the most unpredictable, because babies move so often during pregnancy! Twins can settle in many different positions.
If at least the first baby is head down, you have the best chance of having a vaginal birth. Sometimes it is possible to turn the second baby after the first is born. Later in your pregnancy, ask your caregiver to discuss it with you.
Emotional Reactions
These days, most parents find out early in the pregnancy that they are having more than one baby. It is often a time of mixed emotions. For many couples, it may be completely unexpected and for others it may come after years of trying to become pregnant. When they hear they are having more than one baby, some parents report feelings of absolute jubilation while others weep openly - not tears of joy. Parents may be distressed about the loss of time with an older child or be anxious about the outcome of a multiple pregnancy. Feeling overwhelmed is also common. All of these reactions are normal and no one need ever feel guilty about how they feel.
We fought, we cried, we resented, we talked, we laughed, and we survived.

-A mother of 10 month old quads

If you are concerned about your feelings, speak to someone about these issues as early as possible in your pregnancy. Multiple Births Canada and Triplets, Quads and Quints Association (TQQ) are two organizations exclusively for those expecting multiples. These organizations are parent-to-parent support programs that link you with other multiple birth familes in your community.
Make it a point of discussing your feelings with your partner - often your concerns are very similar.
You may also want to talk to your caregiver, who may be able to refer you to more resources in your area.
Dealing with other People's Reactions
Like all expectant parents, couples having multiples are often subjected to unsolicited advice - usually from well meaning individuals. Keep a cool head and a sense of humour.
Of course, many people delight in the news of multiple blessings and bring well wishes instead. Research shows that women expecting multiples are just as happy as those expecting only one child. A British study of over 12000 women compared the emotional well being of women expecting twins versus a single child. The study showed that women related similar feelings of well-being. The authors concluded that the women's emotions are often buoyed by the attention paid to the special status and uniqueness of this pregnancy.

um, and of course twins of opposite sex are fraternal.(dizygotic?) so if you have a boy and a girl, they aren't identical (mono)
seems obvious but some people don't know.