How Giving Birth Is Different When You're Having Twins

Photo: Stephen Lovekin/REX/Shutterstock.
Amal Clooney gave birth to twins this week, and we know that Beyoncé's are also imminent. (Or, as internet rumors suggest, they may already be here!) So what is it actually like to be pregnant with — and then give birth to — more than one baby? Well, in addition to the extra body growing inside of you, having twins also comes with an increased risk for certain complications, and a higher likelihood of having a C-section. And the reasons for those complications are, you guessed it: complicated.
"Everything you feel with a single birth is multiplied with twins," says Diana Ramos, MD, associate clinical professor of obstetrics and gynecology at the Keck University of Southern California School of Medicine. During pregnancy, you can expect to feel full more quickly after meals, deal with extra fatigue, and even have some difficulty breathing because your uterus is pushing on your lungs more. You might also have more severe breast tenderness and morning sickness than you would with a single pregnancy.
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On top of that, Dr. Ramos explains that those who are pregnant with twins are at a higher risk for developing high blood pressure (preeclampsia) and gestational diabetes. Having either condition during pregnancy increases your risk for developing it again later in your life.
When labor begins, contractions aren't physiologically different from contractions related to a single baby, but "the patient may perceive them differently," says Iffath Hoskins, MD, a clinical associate professor of obstetrics and gynecology at NYU Langone Medical Center. Those contractions may be more difficult to distinguish from the typical Braxton Hicks (sometimes referred to as "false labor"). Or they may be more intense or come with an irregular pattern due to the extra enlargement of the uterus. Your doctor will give you guidelines to help you figure out whether it's time to head to the hospital or if it's better to wait it out.
Twins also mature faster in the womb than single babies. Although we're not totally sure why that happens, Dr. Ramos says it may be partly due to extra stress that comes with having more than one fetus. "Stress releases hormones that cause earlier maturity," she says.
That, plus the larger size of the uterus, is why twins are usually delivered earlier, Dr. Hoskins says. They're typically born around 37 weeks, which is considered full term, but is three weeks before the "due date."
And delivery presents some interesting challenges. For one, the position of each twin matters a lot: One may come head first, which is ideal for a vaginal birth, but the other may be in a feet-first or butt-first (breech) position. "Depending on the position of the first baby, the mom may elect to have a C-section," Dr. Ramos says. Or, if the first baby is head down and the second one is breech, some OBs may opt to try to turn the second baby around or just wait and see what happens when the second baby comes. Sometimes the second baby turns on its own after the first has been delivered because it has some extra room to move. But in other cases, the first baby is delivered vaginally and the second via C-section.
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Another concern is that the fetal heart rate may drop and contractions may slow after the first baby is delivered, Dr. Hoskins says: "If either one of the two babies shows a worrisome fetal heart rate pattern, the doctor may decide to do a C-section."
Whether you have a vaginal birth or a C-section, having twins means there may be some extra people in the delivery room. That may include pediatricians and people on hand to care for both babies, Dr. Ramos says. But having an audience that large may not necessarily be your ideal birth scenario. So try to mentally prepare yourself for the possibility of a larger-than-expected crowd, or even work with a doula who can make sure you're as comfortable as possible.
The other major challenge is breastfeeding. Dr. Ramos says new parents are often concerned about figuring out which twin to breastfeed first and how much milk their body can produce. But, at least when it comes to the amount of milk, there's nothing to worry about, Dr. Ramos says. "Your body compensates and will develop enough breastmilk." Working with a lactation consultant can help you figure out the rest.
If it feels like you're seeing more twins these days, you're not imagining it. Multiple pregnancy is becoming more common in the U.S. among celebs and mere mortals alike thanks to the rise of in vitro fertilization (IVF) and other treatments that allow more of us to have babies later in life (though, of course, not all twins happen because of fertility treatments). So your chances of having twins are higher now than they've been before — whether or not you're actually hoping for that double trouble.
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