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Finding out you are pregnant with twins can be scary. When I first found out I was pregnant with twins, I wasn’t all that excited. I honestly never even pictured myself with more than one child.

While the shock sank in that I was carrying two, I started researching twin pregnancy. I was surprised to find out that a multiples pregnancy was SO different from a singleton pregnancy.

What stood out most in my mind, and what I have seen most expecting twin mommas ask more than anything else was “are the risks real?” And now that I have entered twin momma land, I can assure you, those risks of twin pregnancy are real.

Not only are the risks of twin pregnancy real, but they can happen to anyone. It doesn’t matter if you stick to the strictest of diets, take supplements, or regularly exercise. It is like cancer. Cancer doesn’t pick the weak. It does not judge. Cancer just comes. And that is exactly how most problems occur in twin pregnancy.

I didn’t take the risks all that seriously. In the beginning read up on what they were and that they existed, but I didn’t think anything would happen to me. I had di/di twins and was a very healthy 22 year old! Yep. I was wrong.

At 29 weeks, I went in for a screening and I didn’t go home for the next five weeks. 

I had severe pre-eclampsia. And I had no idea. I was swollen, but my mom swelled and nothing was wrong during her pregnancy. It was hard to breathe, but I had 50+ pounds of baby, blood and other fluids inside of me! I am so so SO thankful for my doctor noticing something was up that day and getting me checked into L&D. If he wouldn’t have noticed, I would have been in the ER delivering probably that next morning. It was that serious.

Because of my experience, I decided to write about all of the main risks of twin pregnancy. I hope you take them a little more seriously than I did!

Lets get started-

The Real Risks of Twin Pregnancy

• C-Section

The most common risk of them all- a cesarean. Odds are both babies will not be head down when it comes time for delivery. I think that once you find out you are having mulitples, you should make yourself okay with either form of delivery. But odds are it’ll be via c-section.

Communicate with your doctor and find out what your risks are for a cesarean and who she decides if that is what’ll happen. My doctor was all for a vaginal birth as long as baby A was head down. She wasn’t worried about B. She would either flip him, deliver him breech, or hopefully he would just flip on his own. But once it was time to deliver, my baby A was butt first in my pelvis. C-section it was!

I recommend reading up on what actually happens during a c-section (both an emergency and a scheduled one). I knew the basics of what would happen, but once it was time for my emergency c-section, I was so nervous and couldn’t stop shaking.

• Bed Rest

Another very common risk of a multiples pregnancy is health provider mandated bed rest. Whether it is moderate (you can stay HOME) or severe (hospitalized) it sucks.

I was on hospital bed rest from 29 weeks until I delivered at almost 33 weeks, and then for another week since my BP wouldn’t regulate. In the moment- it SUCKED. I was stuck in a bed, couldn’t stand for longer than going to the bathroom or a quick shower, had people constantly checking this and that, couldn’t sleep with my husband (in both the PG and Rated R way) and I was stuck eating hospital food day in and out. But now that I look back on it, and even when I was getting ready to leave the hospital, I missed it.

While you can’t really prepare yourself for bed rest, you can read up on some tips to keep in mind for if it was to happen. Those tips are from Twiniversity and are some of the best I have read. Especially the end facts about muscle loss.

• Preterm Birth

Something you have probably heard from the beginning is that you are at risk for early babies! And it is very true. About 60% of twin births are premature, with an average birth around 35 weeks.

While I was in the hospital, I prepared myself for premature babies by looking at pictures of moms holding their 2, 3 and 4 pound little ones. I had my husband look at those images as well. I think that is the best thing I did for us because once our littles were born, we weren’t as shocked at their small size. They are almost three months old now and they are just now the size I was when I was born (but I was also a very large baby).

Something else that helped was asking about the NICU before hand. Learn as much as you can because walking through those doors is going to hit you hard. Hopefully your babies will not need any NICU time, but it is always better to be informed before hand than walking into it all blind.

• Low Birth Weight

Typically, twins are smaller at birth than singletons. About 50% of twins have a low birth weight, meaning born at less than five pounds eight ounces. LBW is mainly caused by premature birth, which makes sense. Both of my little’s had LBW. But for their gestation, their weights were actually pretty great.

If your babies are born with LBW, nothing is necessarily wrong. They will just look different. Their heads might be weirdly large, or they’ll be lacking body fat.

Something you would need to worry about if your littles had LBW would be them keeping warm and making sure they eat enough. If they are born with a LBW however, they will more than likely be sent to the NICU to be what they call ‘growers and feeders’.

• Gestational Diabetes

Carrying multiples just means you are at risk for some crappy things- like GD. I dreaded that test. It adds so much more into an expecting mothers life when its the last thing she needs. Thankfully- I was one of the lucky ones in this department. So I can’t talk from experience.

However, after doing research, I found that GD is a form of (usually) temporary diabetes that will go away once the babies are born. Just like normal diabetes, you will have to monitor your blood sugar during that time and your OB might want you to make some dietary changes depending on how severe it is.

GD can have some side effects in regards to your babies. It can lead to high blood pressure, preterm birth, jaundice and obesity.

• TTTS

You are at risk for TTTS if you are carrying identical twins. TTTS or Twin to Twin Trasfusion Syndrome, is when the shared placenta between identical twins does not evenly distribute nutrients to both twins. This means that one twin does not get enough nutrients, which effects their development.

I did not have identical twins, so I do not know much about TTTS. You can, however, read up on it on the TTTS Foundation website here.

• Pre-Eclampsia

Pre-E is the risk I know best. It is a sickness that affects both you and your babies. Ultimately, if it is not closely monitored it can lead to their death and yours. Scary, but very very true.

The tell tale signs of Pre-E are:

• Excessive swelling
• Extreme weight gain (1-2 pounds per day)
• Swelling in face and hands
• Pain in upper abdoman
• Seeing spots
• Headache that will not go away
• Protein in urine
• High Blood pressure (160/105)

Pre-E is basically your body working against you. Doctors believe it is caused by the placenta (or in my case, both placentas). The only way to cure it is to deliver the babies (and placentas). So when it is caught early on (before 34 weeks) the goal is to keep you safe with the babies inside. It is kind of like a balancing act. Which is why it has to be so closely monitored in L&D.

On one hand, the doctors need to keep you healthy. And on the other, they need to keep the babies healthy. That is why most doctors will do everything they can to keep the babies in until 34 weeks. So when I went in at 29 weeks with severe Pre-E, I had every doctor and nurse running in and out of my room doing everything they could to keep my babies inside. This is because ultimately, your body is the best place for the babies. But once Pre-E starts to worsen and your kidneys and liver start to shut down, the mindset switches to keeping you alive.

It was time for me to deliver when my headache wouldn’t go away. My blood pressure was through the roof and not going down, but my headache also meant my brain was starting to swell. Your brain swelling can cause seizures.

If I would have made it to 34 weeks, we would have scheduled a c-section in order to deliver the babies. 34 weeks if when most doctors feel comfortable delivering when a mother has Pre-E because the babies are developed enough to hopefully thrive without (or with very minimal) NICU time.

• Vanishing Twin Syndome

The risk no one wants to think about- loss of a baby. During the first trimester, the American Pregnancy Association estimates 21-30 % of twin pregnancies experience VTS, leaving one baby behind. Ultimately, one fetus absorbs the other, leaving one heartbeat.

In most cases, there isn’t a known cause. Doctors can examine the placenta after birth for more information, in which case they might find abnormalities in the absorbed twin.

I was terrified of VTS. Because of the risk of losing one baby, we didn’t announce our pregnancy until my second confirmation ultrasound at 12 weeks. The days leading up to that 12 week ultrasound were unbearable. I had nightmares of losing one of them or even both of them. I was shaking by the time of my appointment. But then seeing those two beats on the screen again gave me the best kind of relief.

Now- don’t worry.

I know I just gave you a lot of scary information, however, the best thing you can do for yourself is stay informed. Learn more about the risks I mentioned and ask your OB about any questions you might have. I am no doctor, I am just trying to help you guys stay on your toes just in case something were to happen.

If you have any other questions about Pre-E, bed rest, or preterm birth, go ahead and send me an email. I would be happy to help you along the way.

It was a rough journey, and that is why I am here today to share with you guys that it DOES get better. 

I mean, look at them now!