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The Truth About Twins

8 Important Questions and Answers About the Twin Experience

Becoming pregnant with twins is a double blessing for sure, but carrying and giving birth to two babies at the same time comes with added challenges. Here are answers to some frequently asked twin questions and tips for moms and moms-to-be of twins.

1. How likely is it that I will become pregnant with twins? 

Roughly 3 percent of live births in the United States are twins. Twin pregnancies are more common for patients who are of advanced maternal age (one of my least favorite terms), which means thirty-five or older at time of delivery. Twins are also more common in patients who undergo fertility treatments. And since pregnancy at later ages and fertility treatments are more common these days, twin pregnancies are also becoming more common. 

Maternal family history increases the chance of conceiving twins. If twins run in the father’s side of the family, that does not increase his chance of fathering twins, but it does increase the chance of passing the twin gene on to his daughter(s). Fraternal twins are the type of twins that run in the family, while identical twins are not genetic. 

Interestingly, tall women (over 5’5”) and clinically obese women have a greater chance of conceiving twins.  

2. What risks come with twin pregnancy?

Some of the risks of twin pregnancies include low birth weight (also called growth-restricted babies), congenital
anomalies, preterm delivery, and preeclampsia – a complication marked by high blood pressure in the mother. Preterm delivery is one of the most significant risks because babies who are born prematurely are at increased risk for complications after they are born.  

There are different types of twin pregnancies. A dichorionic/diamniotic pregnancy is the most common and least risky. These babies are usually fraternal which means they each have their own placentas and amniotic sacs. The next type is called monochorionic/diamniotic twin gestation. This is a riskier type of twin gestation where identical twins share one placenta but have their own amniotic sacs to separate them. The babies can share circulation, which can lead to a complication called twin-to-twin transfusion syndrome (which can result in a disproportionate blood supply). The highest risk twin gestation is called monochorionic/monoamniotic, where identical twins share a placenta and an amniotic sac. In addition to the possibility of developing twin-to-twin transfusion syndrome, these babies are at high risk for in utero cord entanglement. 

3. How will my prenatal care be different if I’m pregnant with twins?

Twin pregnancies require increased surveillance compared to singleton pregnancies. Patients who are pregnant with twins are generally seen at more frequent intervals. Many of these visits will include an ultrasound to make sure the babies are growing normally. Sometimes, the care will be shared between the patient’s general OB/GYN and a high-risk pregnancy specialist called a perinatologist.  Together, they work to ensure a safe and healthy pregnancy with the best outcomes for mom and babies. 

Starting at twelve weeks, your doctor might recommend that you begin taking a daily low-dose aspirin to help prevent preeclampsia.

4. What should I do in terms of self-care if I’m pregnant with twins? Will I need to eat more?

Generally speaking, maintaining an active lifestyle that includes moderate exercise is healthy and encouraged throughout a twin pregnancy. That usually means moderate aerobic exercise, combined with plenty of stretching and rest, is recommended and safe.  

Since growing twins requires more energy, more caloric intake is required. The goal is to eat around 600 more calories per day than usual. Of course, these extra calories should come from lean proteins, vegetables, and fruit.Moms that start the pregnancy at a normal weight are recommended to gain between thirty-seven and fifty-four pounds. Those who are overweight at the start of pregnancy should aim to gain between twenty-five and fifty pounds. 

5. How are twins delivered?

Even the most uncomplicated twin pregnancies are delivered prior to the due date at thirty-eight weeks. If complications should arise, such as growth restriction, preeclampsia, or preterm rupture of membranes, earlier delivery may be indicated. 

It is always our hope to deliver twins vaginally; however, that is not always possible and is highly dependent on the twins’ positions inside the uterus and their individual sizes. For instance, if the presenting twin (or first twin in the birth canal) is breech (feet down), it is recommended that a Cesarean section be performed for safe delivery. If the presenting twin is vertex (head down), vaginal delivery is preferred if feasible. Sometimes, the first twin is delivered vaginally, but the second baby needs to be delivered by C-section. For this reason, most twin deliveries take place in the operating room to facilitate a quick pivot to C- section for the second twin if required. 

6. What are some helpful resources for twin moms and moms-to-be?

Some of the best resources are your physicians. Both your OB/GYN and your pediatrician have expert knowledge about these wonderful pregnancies and babies. For help with determining the necessary supplies, understanding and recognizing pregnancy symptoms, and a general overview about what to expect with multiples, I recommend Finding other twin moms (locally and virtually) can also be a great source of knowledge and comfort. Check out Richmond Area Moms of Multiples ( to meet local twin families.

7. How about resources for nursing twin babies?

The local hospitals all have excellent resources when it comes to immediate postpartum lactation support, should you choose to breastfeed. Once discharged after delivery, there are plenty of lactation resources within the Richmond community. Ask your pediatrician or OB/GYN about breastfeeding resources or check the La Leche League in Richmond on Facebook. 

8. Any last tips?

Anything you can do ahead of time will save you much-needed time after the babies are born. Try preparing and freezing meals a month before the twins are due. Wash all their new little onesies. When it comes to getting all the baby stuff, prioritize items that will help give you a break, like bouncy seats.

If preparation is key before your twins arrive, flexibility will be crucial afterwards. One schedule for two babies is not mandatory. If you can feed them both simultaneously, that’s wonderful; but don’t worry if your babies don’t fall asleep, wake up, or feed at the same time. They are two different, tiny people with their own personalities, so aiming for a general routine is just fine. 

Above all, be kind to yourself and remember there is no shame in asking for help. 

Inspired by her ophthalmologist mother to become a physician, Allison Giles, DO, loves being an OB/GYN at Virginia Physicians for Women because she gets to help women during some of the most important moments of their lives. She grew up on a farm in Maryland and now lives with her husband and two daughters in Richmond’s West End.
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