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video showing how to put your twins to bed safely

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Twins and Multiple Births Association (Tamba)

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Information page

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If you are expecting multiple babies, including the possibility of giving birth to twins, there are options to consider. Read about planning for vaginal or caesarean birth.

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NICE guidelines for twin and multiple pregnancy and birth

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NICE guidelines for twin and multiple pregnancy and birth

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Overview | Twin and triplet pregnancy | Guidance | NICE

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This guideline covers the care that should be offered to women with a twin or triplet pregnancy in addition to the routine care that is offered to all women during pregnancy. It aims to reduce the risk of complications and improve outcomes for women and their babies

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An experienced midwife's view

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Antenatal care

Depending on the gestation when the diagnosis of the twin pregnancy is made, the following should be discussed with the woman, and her partner if appropriate.

Nutrition and Diet

I find it helpful to ask the woman to keep a diet diary for a few days, including a weekend day. I then go through the diary with her identifying whether there is an adequate intake of :

1. Calories with a good balance of carbohydrate protein and fat

2. Adequate vitamins

3. Adequate sources of the important minerals and trace elements.

If we identify any deficiencies we discuss ways of improving nutrition. I stress the importance of eating well.

Exercise and rest

We discuss lifestyle and any adjustments that should be made. I take the opportunity to inform the woman of any appropriate groups, classes or support organizations that she may care to join.

The place of birth

I explore with the woman her wishes and feelings on this subject and inform her of the options open to her in her geographic area. Should the woman choose to give birth to her babies in hospital, I would inform her of her rights to decide who will be in attendance during her labour and at the births. I would tell her that the practitioners attending her can give her advice, but have no power to stop her eating or drinking, if she feels like doing so, nor have they any power to restrict her movements or insist on being present. In fact her rights are exactly the same as they would be at home.

Depending on the gestation I discuss with the woman the advantages of having an ultrasound scan to determine chorionicity. Should she agree, with that information gained, I discuss the increased risks of a twin over a singleton pregnancy. I point out that while most twins are fine there are increased risks, and that the risks are greater if the twins are monozygotic (identical).

Depending on how much the woman wants to know at each consultation, I try to ensure that she understands that the labour could be preterm and that she is at increased risk of pregnancy-induced hypertension. This is a good time to discuss some forward planning, and that she should try to ensure that there are relatives, friends, available to help with other children, shopping cooking, housework etc in the latter part of the pregnancy, and in the first month or so after the births. In my experience dizigotic twins often go to term, and the woman really needs domestic support as she is big and ungainly, and easily tired. She may find an abdominal supportive garment helpful or support tights may help as there is an increased risk of varicose veins.

I encourage her to monitor her babies' growth by the feel of her clothing, particularly from 28 weeks or so. I ask her to observe how her clothes are getting tighter. I ask her to let me know if she does not notice increased girth, and also to inform me urgently if she observes a dramatic increase in girth; this is particularly important in monozygotic twins.

I plan to see her at frequent intervals, but make sure she feels able to access me, or my locum, if she has any concerns. In my experience women who are encouraged to monitor growth and how they feel, are very good at recognizing deviations from normal. Though while women should be encouraged to take some responsibility for their health, this does not relieve the professional attendant from vigilant care.

There should be a full discussion of the labour, what the attendants will want to do, and what the woman and her partner feel that they will want. A tentative plan for labour should be made and updated as necessary. This should include discussion of various birth positions.

If the woman is having midwife-only care the following list, which is not exclusive, are reasons to seek appropriate medical input:-

Lack of observed growth

Hydramnios

Any abnormal urinalysis

Any signs or symptoms of labour prior to 36 weeks

Abnormal results of full blood count

Any signs or symptoms of PIH

The Labour

Most twin labours progress well. The woman should be supported in the way that is most appropriate for her and that has been planned.

If a hospital labour has been chosen, I feel that it is good practice to do a 20 minute or so CTG trace of the fetal hearts in early labour, taking great care to ensure that one is actually recording two heart beats and not just hearing the same heart in two different places. This is an easy mistake to make with a CTG monitor if the twins are monozygotic, as the heart rates can be very similar. Even if a CTC monitor is used there should also be auscultation by two practitioners using two Pinards stethoscopes simultaneously. They will be listening in different places and this can corroborate the opinion that there are two fetal hearts.

In the home situation, the twins' hearts should be auscultated at frequent intervals. The midwife will have "got to know" these babies during her antenatal care. I suggest listening every 20 minutes or so in early labour, increasing the frequency as the labour progresses. If the membranes rupture, the heart sounds should be listened to immediately, and every 10 minutes or so thereafter, preferably just as a contraction is going off.

Maternal observations of pulse temperature and blood pressure and urinalysis should be made at the onset of labour, and I suggest that the maternal pulse should be felt at frequent intervals throughout, usually at the time one is listening to the FHs .

The woman should be encouraged to maintain an intake of nourishing fluids of her choice, and in early labour if she feels hungry she should have what she fancies to eat. Small nourishing easily digested snacks are usually preferred. In the latter part of the first stage when contractions are frequent and strong, few women want to eat, but most will want to drink water, This should be facilitated. She should be encouraged to rest and keep her batteries charged in early labour but should be encouraged to mobilize if that is what she wants as labour progresses and intensifies.

Vaginal examination should be performed if the membranes rupture and as the attending professional feels the need. The reasons for VE examination should of course always be explained and consent gained.

The midwife will know what the woman's veins are like as she will have taken blood during the pregnancy. If the woman's veins are difficult to access the insertion of a venflon should be considered and discussed with the woman

The Births

There should be three competent practitioners present who have rehearsed their roles.

Provision should be made to resuscitate two babies. In the hospital setting two resuscitaires should be available in the birth room or immediately adjacent . At home two resuscitation stations should be set up with heated pads, bags and masks, airways and 02 available.

There should also be the usual provision to deal with excessive post-partum blood loss from the mother.

During the second stage the woman is encouraged to assume whatever position she finds easiest. As the presenting part becomes visible and the birth of twin 1 is imminent I encourage the woman to assume a hands and knees position. If this feels wrong for her she should be assisted to whatever position she feels is right for her.

I suggest the following roles for the three attendants, whom I call midwives A, B and C:-

Mw A assists the mother to birth twin 1

Mw B is ready to receive twin 1 if resuscitation is required; it rarely is. Twin 1 goes into mother's arms and is assisted to suckle by MwB

Mw C assists Mw A to help the mother to recline and palpates the abdomen to ascertain the lie of twin 2. She auscultates the FH and reports her findings to Mw A. Sometimes the FH of Twin 2 is slow. If it is above 110 , there is little cause for concern, it usually picks up quickly. Mw C auscultates as frequently as possible.

If there is a transverse lie Mw A and Mw C attempt to massage the head down. This often happens spontaneously with the return of contractions.

If the lie remains transverse (this is highly unlikely in the primigravida), Mws A and C do an external and possibly internal podalic version.

Once the lie of twin 2 is longitudinal the return of contractions is patiently awaited and the mother continues to suckle twin 1.

FH auscultation frequently.

Once contractions resume Mw B is available to take Twin 1 if the mother needs to use her arms to push, or the father may cuddle his baby.

The mother is encouraged to push with the contractions and may need to have Mw C place her open hands on the maternal abdomen to brace the abdominal muscles. I like the mother to be in the all fours position so that if the presentation is breech, I have the access and room to assist the birth if appropriate.

The second sac of membranes may rupture spontaneously; if they do not, they may be ruptured when the presenting part of twin2 is below the ischial spines, or seen or felt at the vulva.

Mw A assists the birth of twin 2 and Mw C takes twin 2 and is ready to resuscitate if necessary. Second twins often need some help to breathe and usually a few minutes of bag and mask is sufficient. The parents welcome their babies and everybody gets their breath back.

While Mw B's priority is the care of twin 1 this baby is usually in good condition and Mw B is available to give assistance where needed. However provision must be made for Mw B to be fully occupied with twin 1

The 3rd stage is managed as the midwives and the woman have agreed. I usually use expectant management but many midwives will prefer to actively manage the 3rd stage. When expectant management is used and the signs of placental separation and descent are noted, the mother may need to have her abdomen supported by the midwife's outstretched hands as she pushes the placenta out. It is important to have oxytocic drugs checked and readily available. If active management of the 3rd stage is chosen controlled cord traction is applied to both cords simultaneously once the oxytocic drug has taken effect.

Reasons to seek medical consultation/assistance/ input, or advise transfer to hospital if at home.
At the onset of the labour

1. If there is any concern about the condition of either baby, suboptimal fetal heart sounds and rates.

2. In a primigravida if the presenting twin is not a longitudinal lie and the presenting part is not engaged. In a multigravida if the lie is not longitudinal or if presenting part is high and does not engage as the contractions strengthen.

3. If there is a raised blood pressure or fever or maternal tachycardia.

4. If there is any excessive vomiting which does not respond to simple measures.

5. If there is any abnormality in urinalysis.

6. If the midwife has any concerns she should be able to discuss them with a Medical colleage or her supervisor of midwives.

During the Labour.

1. If the labour does not progress well. ie if the contractions once established do not come oftener last longer get stronger. If the presenting part does not descend. And if the cervix does not efface and dilate

2. If there is any concern about the fetal or maternal condition.

3. If the lie of twin 2 is not longitudinal and a version is not easily accomplished.

I feel it is good practice if the woman is at home to inform the hospital to which one would transfer if indicated, that the woman's labour has started. The midwife might wish to keep the hospital staff informed of the progress of the labour. This will depend on geography and local circumstances. Good relationships between professional colleages are always extremely important and especially so in the case of twins.
Mary Cronk Back to Mary Cronk's homepage

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Depending on the gestation when the diagnosis of the twin pregnancy is made, the following should be discussed with the woman, and her partner if appropriate. I find it helpful to ask the woman to keep a diet diary for a few days, including a weekend day.

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video showing how to carry twins in a non-twin designed sling

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Practical support for families in need

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Home-Start is a local community network of trained volunteers and expert support helping families with young children through their challenging times. We are there for parents when they need us the most because childhood can't wait.

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Your reaction to finding out that you're pregnant with twins may have been anything from surprise to shock. But there are lots of reasons to be excited about bringing two babies into the world at the same time. Here are just a few of them:

1. Knowing that you're only going to have to go through pregnancy once to end up with two children.

2. Enjoying the fun of choosing two baby names that fit together perfectly.

3. Being able to hold one baby in each arm while feeling a huge rush of love and pride.

4. Watching your babies sleep peacefully, side by side.

5. Only having to establish one routine.

6. Getting all the sleepless nights over and done with in one go.

7. Watching them carve out their own identities as they grow.

8. Knowing that they are going to have a best friend in each other for life.

9. Enjoying the attention that twins inevitably attract.

10. Feeling confident that they can help each other on their first day at school.

11. Discovering all their amazing little differences.

12. Watching them create their own secret language and games.

13. Knowing that they will never be lonely.

14. Loving the fact that they are constant playmates and can entertain each other.

15. Feeling special because you've joined the exclusive club of twin mums.

16. Not having to give baby number two (if only by a few minutes!) hand-me-downs.

17. Only having to bake one birthday cake and throw one birthday party a year - in the early years at least.

18. Seeing them learning and encouraging each other to reach their milestones.

19. Watching them taking care of each other when one is upset or hurt.

20. Knowing that their shared history means they have one of life's most unbreakable bonds.

Get some great coping tips for the first months with your twins.

Last reviewed: January 2020

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Your reaction to finding out that you're pregnant with twins may have been anything from surprise to shock. But there are lots of reasons to be excited about bringing two babies into the world at the same time. Here are just a few of them: 1.

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By twin parents

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Tips for Parents of Twins - Designed For Twins

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Browse tips for parents of twins written by parents of twins. Share these top tips with other parents of twins or send us your twin tips.

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Twins Clubs | Resources Centre | Twins UK

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Twins UK - dedicated to families with twins, triplets, quads. Specialist products and information helping make life with multiples easier and more enjoyable. Home of Twin Tips

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Joining a twins and multiples club can be a great source of support for parents of twins, triplets and multiples.

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info and support

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Freephone helpline for all twins and multiple related issues

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Whether you would like to chat about expecting twins, triplets or more; feeding, sleeping, starting school, friendships, getting to grips with the teenage years, or anything multiples related, Twinline can provide the support you need.

Sometimes you just may need a listening ear from somebody who understands. All our trained volunteers are parents of twins.

This is a free service and available to everyone.
Call us: 0800 138 0509
Twinline is open Monday to Friday from 10am to 1pm and from 7pm to 10pm
If you would prefer not to call but would still like to contact us for some support, complete our online form or email us: [email protected]
Ask Twinline

Here's how Twinline has helped just some of our callers:

" Twinline is such an excellent idea. I rang on several occasions when things got tough at home. My partner works long shifts and it has been good to have someone to talk to," mother of multiples.

"We spoke to a great lady. She was calm, supportive and reassured us we were doing a great job with our twins. As she spoke from experience - we felt immediate relief. Our twins are now three and a half years old and thriving," mother of twins.

"Sometimes it gets to the point where you need to speak to someone who knows the fear and the frustration and the joy of having twins," Sarah.

"Twin mums are expected to be in a routine and I think they put a lot of pressure on themselves. So when the routine goes out the window, they panic and don't know who to ask for support. They need to have the confidence to pick up the phone and talk - because the person on the other end of the line is going to support them and not judge," Joanna.
Do you need a translator?
If you would like to find out more about Twins Trust support services, but struggle with English, we can provide you with an interpreter to help you access this service. All you have to do is call the office, or get someone to call on our behalf, on 01252 332344 and request a translator.

From there we will then organise a time and date to give you a call with a translator on the line. Our translation services are provided by LanguageLine Solutions, who can translate into more than 180 different languages.

See our translation page for more information.

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Whether you would like to chat about expecting twins, triplets or more; feeding, sleeping, starting school, friendships, getting to grips with the teenage years, or anything multiples related, Twinline can provide the support you need. Sometimes you just may need a listening ear from somebody who understands.

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Twins Trust breastfeeding peer supporters

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Twins Trust breastfeeding peer supporters

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Breastfeeding help

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Includes a video specifically on special care twins and multiples

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK.

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Follow three mothers as they share their tips on the joys and challenges of feeding twins.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

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At Best Beginnings we believe in the power of collaboration to create and provide quality-assured and evidence based information for families. All of our content is co-created with parents and healthcare professionals and vetted by external Healthcare bodies and parents. Read more

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Follow three mothers as they share their tips on the joys and challenges of feeding twins. Vimeo Video http://www.vimeo.com/11739595 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.