Twin pregnancy

If the ultrasound shows that you are expecting twins, and one baby—around which your thoughts have recently been revolving—suddenly becomes two, you might initially feel overwhelmed. Next, there will surely be some questions about pregnancy and childbirth: What is special about a twin pregnancy? Is it twice as exhausting? What should I consider? And what about the delivery? We will answer these and other questions for you in this article.

How do twins form?

Identical twins

25 percent of twins develop into identical (monozygotic) twins. monozygote ) Base, 75 percent on dizygotic ( dizygote ). In identical twins, it will be an egg fertilized by a sperm cell and dividing within three days after fertilization into two nuclei , which then migrate separately to the uterine wall. Upon reaching the uterus, the embryos implant with identical inheritance information mostly in separate fruit cavities, and each develops its own Placenta . If that is the case, it is called a dichoriale Twin pregnancy, which usually proceeds without complications. In rare cases, it happens that the fertilized egg only splits after implantation in the uterus. As a result, only one placenta develops, which is shared by the two embryos – this is then called a monochorial Twin pregnancy. The embryos develop either in a common amniotic sac ( monochorial-monoamniotic ) or in two separate ( monochorial-diamniotic ). If twins share a placenta, this can lead to undernutrition and growth retardation of one child. Additionally, if they develop in a shared amniotic sac, there is a risk of a Umbilical cord knotting . To detect these risks early and, if necessary, take measures, monochorionic twin pregnancies are monitored very closely by medical professionals.

Fraternal twins

Fraternal twins develop when in to develop two eggs in one cycle and be fertilized by two different sperm . The embryos always have their own amniotic sac and a separate placenta. Since they develop from different eggs and sperm, the genetic makeup of fraternal twins differs, and they can also be of different sexes.

Even though multiples are always a little miracle, the probability of expecting multiple children at the same time increases after the age of 35. The reason for this may be that the female body mobilizes all reserves with increasing age, and it becomes more common for multiple ovulations to occur per cycle. Also, with or , which couples increasingly use with age, multiple eggs are often fertilized. In both cases, the probability of a pregnancy with fraternal twins increases. Some families have several sets of twins – then there is probably a familial predisposition. However, there is no way to naturally induce a twin pregnancy.

When can I find out if I am expecting twins?

If you are expecting multiples, you will probably find out quite early and have enough time to prepare for life with several babies. In the Ultrasound examinations During pregnancy, your doctor specifically checks whether it could be a multiple pregnancy. Especially twins developing in two separate amniotic sacs (regardless of whether they are identical or fraternal) can be detected early on with ultrasound; in the case of identical twins in one amniotic sac, it is approximately between the 8th and 12th week of pregnancy so far. From the 16th week of pregnancy onwards, it is no longer possible to determine whether your children have a shared or separate gestational sacs. Therefore, especially the first ultrasound examination important to determine whether the twins share the amniotic sac and/or placenta in order to closely monitor associated risks.

How does the body change during pregnancy?

Medically, every twin pregnancy is automatically considered as High-risk pregnancy – but that does not mean that it cannot still proceed without complications. In general, pregnancy with twins places more demands on your body than expecting just one child:

• Especially connective tissue, pelvic floor, muscles, skeleton, and skin are heavily challenged by the volume and weight of several children.

• Your weight gain is slightly higher, averaging 15 to 20 kilograms.

• During a twin pregnancy, the body automatically produces more hormones. The increased release of the pregnancy hormone HCG can cause you to experience more severe typical symptoms such as initial nausea .

• The risk of high blood pressure, fluid retention, or bleeding is also slightly increased during a twin pregnancy.

What does medical care look like during a twin pregnancy?

To better monitor your well-being and the development of your children and to be able to respond promptly to possible complications, the Frequency of Preventive examinations higher during a twin pregnancy . Depending on whether you are expecting identical or fraternal twins, the prenatal care, including four to six ultrasound examinations, will initially probably every two to three weeks and towards the end of pregnancy, even weekly. The focus of your doctor is especially on possible growth retardation or undernutrition of your children as well as on signs of premature Contractions . Since the risk for a Preterm birth In the case of a twin pregnancy, the length of the cervix is also regularly monitored, and the cervix is prophylactically reinforced if necessary.

There remains the risk of the so-called monochorionic twin pregnancy. fetofetal transfusion syndrome (FFTS or Twin Syndrome). In this case, one twin figuratively takes away the shared blood supply from the second child. As a result, it can not only lead to Insufficient supply and growth delays to come from a child, also the Overfeeding complications with the second child can occur. Regular ultrasound examinations are therefore especially important during a twin pregnancy to detect any potential discrepancies in the babies' growth early on and to treat them if possible.

Even though close medical monitoring is recommended, there are no guidelines on how often prenatal care should take place during a twin pregnancy. Instead, the frequency of examinations depends on the individual circumstances and the course of the pregnancy. Therefore, it is best to discuss with your doctor how often the examinations make sense for you.

What should I pay attention to during pregnancy?

If you are pregnant with multiples, it is advisable to seek early assistance. Midwife to find someone who will accompany you through pregnancy and support you with advice and assistance. Take good care of yourself by drink a lot and complaints such as high blood pressure, nausea, Fluid retention and counteract protein in the urine. As in every pregnancy, you should now also pay special attention to a healthy and balanced diet pay attention to provide your children with sufficient nutrients. During a multiple pregnancy, the blood volume increases even more than in a singleton pregnancy. Therefore, it is often recommended to prophylactic iodine and iron preparations to be taken. It is best to discuss this with your gynecologist.

Since the probability of a premature birth is increased in multiples, you should Organizational and logistical aspects , including the preparation for birth and Postpartum , complete it as early as possible. This way, you can take it easier towards the end of pregnancy and rest as much as possible, which in turn reduces the risk of preterm birth.

Maybe you're wondering whether to participate in a Childbirth Preparation Course during pregnancy, also useful in the case of twins. The answer is: yes. There are special prenatal classes for expectant parents of multiples - both online and in person. Here, you will learn about the special aspects of the birth process and receive a lot of information for the time after birth, such as topics on breastfeeding and feeding. And even if you only attend a "regular" childbirth preparation course and it is already certain that your children will be born via Cesarean section will be born into the world, you will benefit from certain elements of the course such as gymnastics, pelvic floor exercises, or relaxation exercises. Your midwife can help you find the right exercises for you.

What is special about a twin birth?

Many expectant parents of twins wonder whether their children can be born naturally. If this is your first birth, a Vaginal delivery generally possible , as long as the leading baby is in a head-down or longitudinal position. Both children should also have reached a certain weight, and their weights should not differ significantly. Usually, this leads to a Birth in the hospital , preferably with maximum pediatric care, come into play.

Once the first twin is born, it may happen that your second baby turns again thanks to the newly gained space in the uterus . Your midwife and your doctor are prepared for this situation and will try to change the position of the second child so that it, like its sibling, can come into the world naturally. If there is no other option and the second twin has turned into a position that makes a vaginal birth impossible, or if sudden supply issues for the second child are observed, it may be necessary to deliver your second child by cesarean section. However, this is only necessary in rare cases.

Although a natural birth of twins is possible, the proportion of Cesarean sections in twin pregnancies still higher than in single pregnancies. A cesarean section may be necessary, for example, if your babies are in an unfavorable position, if they are particularly large or small, or if there are other risks for you or the babies during a natural birth. When deciding whether your twins will be born naturally or a cesarean section is the safer choice, your doctor and midwife will support you. It is best to schedule a consultation between the 30th and 34th week of pregnancy to Birth Planning at the maternity hospital.

As already mentioned Most twins are born a little earlier. , on average in the 37th week of pregnancy, when they are also considered mature. The reason for this is that the uterus with two children is under higher tension, which can lead to premature labor. Under certain circumstances, the birth will also consciously initiated earlier or a cesarean section scheduled before the due date. In monochorial Twins sharing a placenta usually have their planned delivery between the 34th and 37th week of pregnancy, as the risk of under-supply for one twin increases in the last weeks. If the children also share a common amniotic sac ( monochorial-monoamniotic ) are usually born between the 32nd and 34th week via cesarean section, as the risk of umbilical cord knotting would otherwise be too high. Even before birth, midwives, obstetricians, prenatal diagnosticians, and pediatricians work closely together to make the pregnancy and the start of your child's life as safe as possible.

Triplets and quadruplets are born in most cases by cesarean section in a hospital equipped with maximum pediatric care and a neonatal intensive care unit. The reason for this is that three or more children usually do not meet the requirements for a natural birth, and therefore it would be too risky: if the 34th week of pregnancy has not yet been reached, if at least one of the children weighs less than 2,000 grams, if one of the children is more than 500 grams heavier than one of its siblings, or if the first baby is not in a head-down position, a cesarean section is always performed as a precaution.

What practical things should be kept in mind?

Maternity protection

If you are expecting twins, in Germany the begins Maternity protection like in a singleton pregnancy six weeks before the estimated due date, but after the birth, it extends to 12 weeks – also four weeks longer than after the birth of a single child. If your babies are born earlier than the estimated due date, the missed maternity leave is added at the end so that you do not lose any time. After a twin birth, you also have the right to a extended follow-up care . For the best information, contact your health insurance provider directly.

Parental leave

The parental leave is calculated per child – for twins, you and/or your partner in Germany are therefore entitled to up to a total of six years Parental leave. These 36 months can be divided into up to three sections, but the rule also applies to twins that at least twelve months of parental leave per child must be taken within the first three years of life.

Parent and child benefits

Since the Parental allowance to serve as compensation for your loss of earnings, it will also apply to twins or multiples paid out only once . However, you will receive a so-called Multiple Births Surcharge . For twins, you receive €300 on the basic parental allowance or €150 on the parental allowance plus. For triplets, the allowance doubles, and for quadruplets, it triples.

The Child benefit however will per child paid so that the payment doubles for twins. Some federal states and municipalities also offer support to parents of twins additional financial assistance . Detailed information about the organizational aspects of multiple pregnancies can be obtained, for example, from pregnancy counseling centers or other contact points that your midwife can recommend to you.

There is no manual for life with multiples – nevertheless, we hope that this article has answered some of your questions about twin pregnancies and has helped you to face this exciting phase of life with confidence. Daily life with twins is certainly a challenge – but a beautiful one that you can look forward to. We wish you all the best for this special pregnancy and the time afterward!