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Tandem Babywearing, or Carrying Multiples - Carrying Matters

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- supporting children, carers and society to be more connected through close contact.

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Wear My Baby has supported many parents and expectant parents of twins and multiples to carry their babies. Often parents of twins are happy to carry one each most of the time, or carry one and have the other in a buggy. But many parents LOVE having the option to carry both at once - especially when they are very small. We've tried lots of twin carrying options, so here are our top twin baby carrier choices.

Remember: carrying two babies - or just one baby! - can take some practice. It's always best to get some expert safety and carrying advice and try before you buy, to make sure you choose the best carrying option for your family.

BEST BUCKLED TWIN BABY CARRIER: THE TWINGO TWIN CARRIER

The TwinGo tops our list of purpose-designed buckled twin baby carriers.

It has the same design principles as most buckled carriers like the Ergobaby and Tula etc. The big advantage of the TwinGo over two separate baby carriers is that you only have one set of shoulder straps. You essentially have one carrier, worn on your back, with a second body panel (with it's own removable shoulder straps) that neatly clips onto the front. This makes carrying two babies or toddlers MUCH less cumbersome.

It can also be worn as two entirely separate carriers. Genius. It's easier to get on and off than you might imagine, though of course a little practice and guidance may be needed.

One baby will need to have good, consistent head control and be able to sit up with minimal assistance (around 4-6 months) before they can go on your back. Until then you can use the TwinGo is used as 2 separate front carriers (or use a stretchy wrap to carry two on your front - see below) You can wear babies on your front in the carrier from 10lbs upwards, or as little at 7lbs using the infant insert.The TwinGo has an upper weight limit of 40lb (18kg) if you're wearing one baby, or a combined weight limit of 70lb (32kg) when used as a tandem carrier.

The body panels have generous zipped pockets, easily big enough to store you keys, phone, wallet, baby wipes and a few nappies! Each half of the baby carrier folds in on itself like a pack-a-mac, leaving you with two neat little packages that can easily fit in a bag or under a buggy. At £185 this twin baby carrier is significantly cheaper than two top of the range buckles carriers. It's ideal for twins but works really well for little ones of different ages, too.

The Mini Monkey Twin Carrier is new for 2018, and the Wear My Baby team has just received our tester. Ideal for carrying one baby on each hip, it works as two connected, adjustable pouches, tightened and secured with buckles. It's billed as suitable from newborn to 12kg (26lbs) each, but is likely to best suit babies from couple of months old to 8-9 months. Full review coming soon!

The W eego Twin carrier is another purpose-designed twin baby carrier worth noting. This is suitable from newborn, and generally used until around 3-6 months. However, it cannot be used for back carrying and we tend to find it harder to get a comfy, safe ergonomically supportive fit for smaller babies. The Twingaroo is closer in design to the TwinGo but can't be easily worn as 2 separate carriers without purchasing an additional strap conversion kit, so offers less flexibility than the TwinGo & isn't ideal for babies under around 5-6 months.

USING SEPARATE BUCKLED CARRIER FOR YOUR TWINS

Another option for twin parents is wearing two regular buckled 'soft structured' carriers, one front and on back.

As an alternative to a single twin baby carrier, some twin parents do wear two Ergobaby carriers, two Tulas, two Manducas and so on. If you've already got a couple to hand then give it a whirl! It will likely feel very cumbersome with four padded shoulder straps and two passed waistbands, but it's not impossible.

If you're in the market for two carriers that will do a similar job to the TwinGo, using two Connecta baby carriers or 2 Izmi baby carriers can work particularly well. With minimal padding on the shoulders and none at all on the waistband, this combination offers a less bulky (and sweaty) ride than most double-up alternatives.

If you'd like to carry two newborns on your front, we love using stretchy wraps and woven wraps (see below).

BEST TWIN BABY CARRIER FOR NEWBORNS: STRETCHY WRAPS

Our top choice: The JMPBB Original

A stretchy wrap is an ideal way to carry two newborn twins, even premature and low birth weight babies.

Don't be put off by the generous size of the fabric wrap; with a bit of practice they really are easy to use. One of their best features is the ability to pre-tie them around you, so you can simply pop your babies in and out, whether you're at home or getting in and our of the car.

JPMBB's 'The Original' wrap comes top of our tried-and-test list. These wraps are high quality, 2-way stretchy wraps: soft, very easy and forgiving to use, but also very strong, slightly wider than most, and very supportive. The Boba Wrap are Lifft stretchy wraps are superb 2-way stretchy wraps that many of our parents enjoy carrying twins in. One-way stretchy wraps like the popular Moby can also be a nicely supportive option as they have rather less 'give,' though can require at first a little more technique to get an ideal fit.
Here is one of our favourite instructional videos for carrying twins in a stretchy wrap.
The one standard size will fit all wearers and can be used to carry one or two babies on your front. Stretchy wraps are safety-tested to withstand even a toddlers' weight, but tend to be used mostly for the early months. Many parents find they can carry twins in one stretchy wrap until they are anywhere from 2 - 5 months, depending very much on their babies' size and development; the JPMBB Original tends to last longer than most given it's unique fabric.

Some twin parents who have thinner and more lightweight wraps (such as the Hana Baby Organic) do wear 2 stretchy wraps at the same time, with 1 twin in each; though this quite a toasty warm option for the wearer!)

BEST TWIN BABY CARRIER FOR VERSATILITY: WOVEN WRAPS

Our top choice (for beginners): Didymos DoubleFace long woven wraps

If you like the idea of soft fabric and want a truly versatile carrying option for carrying one or two babies, then a woven wrap is a brilliant option. Two babies on your front, one of each hip, one on front and one on your back... so many possibilities!

It will take some practice to learn how to tie woven wrap well and quickly, but the slightly steeper learning curve (than, say, a buckled carrier) is well worth the effort!

A tandem Front Wrap Cross Carry (FWCC) is a great first 'carry' (way of tying a wrap) for newborns, whether carrying one or two babies - and we do recommend practicing with one baby first, until you're feeling confident. Amanda's Tandem Hip Carry is a great carry for babies with increasing head control (usually 2-5 months+). Tandem Trouble is a superb YouTube channel for twin wrapping tutorials, using one or two woven wraps at a time.

Woven wraps come in varying lengths (size 2 to size 8) to accommodated different tying methods ('carries') on the front, back or hip. Most people find a size 7 a good size to learn to wrap twins to begin with, with taller or broader wearers preferring a size 8+.

Our Didymos DoubleFace long woven wraps have contrasting colours on either side, making them ideal for those new to wrapping, and don't require any breaking in. But there are a vast number of woven wrap brands and designs to explore.

Here are a few options, demonstrated by some experienced twin-wrapping parents, to inspire you:

MORE TWIN BABY CARRYING OPTIONS

Vija Kangaroo care tops/ t-shirts for twins: Not a sling, but a fantastic piece of clothing for keeping your babies close to you, either for kangaroo care or general - highly beneficial - skin-to-skin contact. These are particularly brilliant for premature/ low birth weight babies and are used in some hospital settings.

A Close Caboo can be used to carry newborns twins.

Two pouch slings or rings slings, or one of each: Great for a carrying two newborn twins on your front or one baby on each hip (typically from around 2-4m+), this can be a very 'natural' feeling way of carrying for parents who hold their twins in-arms. We find the stretchy 'Little Wrap Without A Knot' ring sling from JPMBB super comfy, with no restrictions on your arm/shoulder movement.

Two tie-on Meh Dai carriers, or one Meh Dai and one buckled carrier.

A buckle carrier on your back with a short woven wrap threaded through the front.
Interested in twin baby carrying? Book into one of our Twin Baby Carrying Workshops, book to see one of our Consultants or find a babywearing educator near you. Always seek advice from your medical practitioner if your babies have health considerations, and seek guidance on babywearing safety from an experienced babywearing Consultant if you would like help carrying two babies. It is typically recommended that you wait until babies are able to sit up well with support, before carrying them on your back. This applies particularly to buckled carriers, which tend to seat baby mid-low on your back and therefore do not offer a sufficiently easy view of smaller babies. The Twin Sling Facebook group is a great resource for advice and ideas.

A long woven wrap on your front and an onbuhimo on your back.

....or any other combination that works for you!

Oh - and for keeping twins dry when worn front-and-back, we highly recommend the brilliant BundleBean babywearing raincovers!

FOR MORE INFORMATION

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Best Twin Baby Carrier? | Wear My Baby | Babywearing Made Easy

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Wear My Baby has supported many parents and expectant parents of twins and multiples to carry their babies. Often parents of twins are happy to carry one each most of the time, or carry one and have the other in a buggy.

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Abigail's miracle birth story

“In September 2020, at my 12-week scan, I found out we were expecting twins. We were over the moon; it was a complete shock but such exciting news." Read Abigail's TTTS story...

Judi's story

Judi Linney tells us all about her experience of having twins in the 70's and how she became one of the founders of Twins Trust over 40 years ago...

Nichola's Story

“Asma saved our babies’ lives, there’s no doubt about that,” says Nichola Luther whose twin boys were born on April 4 2020, at the start of the Covid pandemic.

Eve's Story

The scar is a constant reminder for her that she has a sister and her life was saved by an amazing medical team

Tracey's Story

“Oh your twins are so cute” is an off-the-cuff comment by well-meaning strangers that still fills Tracey Kirby with sadness.

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twin pregnancy - Positive Birth Stories From Our Community

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DIGITAL COURSES All Courses YOUR JOURNEY Hypnobirthing SUPPORT Call the Midwife Podcast Positive Birth Stories Blog Village Hub Free Masterclasses Fertility Hub PBC Awards 2023 Healthcare Professionals Class What is it?

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A Natural Twin Hospital Birth: My Birth Story

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A Natural Twin Hospital Birth: My Birth Story

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A Natural Twin Hospital Birth: My Birth Story

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In this column, the author describes the vaginal birth of her twin daughters. Despite impending complications in the last weeks of her pregnancy that might have required a cesarean, this mother was committed to doing everything possible to give birth ...

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Is your MFM your BBFF? Let's see how an easy memory trick can help you remember the treatments you need every 2 weeks for twins.

MFM? BBFF? Let's start with the basics.

Updated 29 Sept 2020. You've just found out you're having monochorionic twins, and that's awesome. So you might be googling identical twins, and coming up with a lot of different information, and some contradictions. And a LOT of jargon. We want to make things simple and easy to remember for you.

Is Your MFM Your BBFF? The simple way to remember the testing you need.

We all have a BFF right? A Best Friend Forever. Someone who has your back, never tells you a lie, they follow the rules of friendship, and they take care of you, and don't let you down.

We think it's important to have a similar kind of relationship with the person in charge of your pregnancy. A Best BEST Friend For pregnancy, so to speak. Someone who's going to follow the rules for you, take care of you, tell you everything you need to know, and support you through it all.

Introducing your MFM.

Every monochorionic twin pregnancy needs to be referred to a Maternal-Fetal Medicine (MFM) Specialist, or as they're known in some places, Perinatologists. Most guidelines across the world agree this should be around 16 weeks, so it's important that you advocate for this. (You can see the guidelines here from RANZCOG, NICE, ISUOG as examples)

Your MFM-BBFF should check you at least every 2 weeks, but don't panic, some may want to check you a little more closely than that even without complications. It's more important that your new BBFF gets all the information they need to properly care for you.

Congratulations! It's twins - but what comes next?

So what tests do I need?

This is where your BBFF comes in handy. We use this as our reminder for what tests actually need to be done. Every 2 weeks, your MFM should be checking the following:

Brain

At every appointment, they should be doing Doppler readings on the middle cerebral artery (MCA) What this does is check the speed blood is going through the brain - if it's moving too fast, that's a sign of anemia, and if it's moving too slow, it's a sign of polycythemia. Your MFM-BBFF should be recording these, as this is a reliable indicator for (as well as some other complications.)

Bladder

Every appointment it should be checked that both babies' bladders are visible. Filling and emptying can take a long time to do, so it's rarely done. Instead, it should be noted what the status of the bladder is (empty/full/normal/enlarged, etc) because there are no actual measurements. A completely empty bladder is rare though, and if the fluid is also low for that twin, this should signal more checks.
Bladders are a huge part of diagnosing , so it's important to check them properly.

Fluid

Another big part of a TTTS diagnosis is fluid levels. Your MFM-BBFF should be checking the deepest, or max vertical pocket (DVP/MVP) of fluid on both babies and recording this in centimeters. Amniotic Fluid Index (AFI) isn't accurate for monochorionic twins. If one baby's fluid is below 2 centimeters, and the other above 8, then this is a sign of TTTS.

Flow

Umbilical arteries (UA) Dopplers are just as important as MCA Dopplers. They're an insight into the health of the two sides of your placenta. They help with detecting and monitoring its progress. The MFM-BBFF should be establishing how many blood vessels are present in each cord, and how the cords insert into the placenta. This can be in the center, on the edge, or even inserted in the membranes. This may have an effect on the growth of the babies.

We're not going to be mad if you right-click and download this to share on your favorite social media!

Recording this information

It's really important that your MFM-BBFF records all this information at every appointment. We also suggest writing it down yourself and getting a copy of your records. That way you can also keep track of it all. (Hint: we have a record sheet you can use here!)

You're looking for the following things on your report:

MCA-PSV (or some will record it as MCA PS or Vmax ) - a reading in centimeters/second, or sometimes as an MoM (brain)

Visible bladders with their status noted.

DVP / MVP - a reading in centimeters (fluid levels)

UA-PI - a number on the page, and the words normal, absent, reversed, intermittent (flow)

We know how overwhelming this type of pregnancy can be - so we wanted to make this as simple and transparent as possible. Your MFM can be a great resource and a definite BBFF if you get all the right testing done, and they watch you closely.

But just like in real life - if your BBFF does the wrong thing by you, or doesn't tell you the truth, or give you all the information you need - maybe it's time to find a new BBFF 😉

And don't forget - it's as simple as Brain, Bladder, Fluid, Flow. That's all you need to remember!
Want more information? Email us at hello@tapssupport.com, or if you've been diagnosed with TAPS, or want more information, join our active Facebook group. Information updated as of 29/09/2020. Many thanks to Prof. Dr. Dick Oepkes who took the time to fact-check and verify the details on this page. We are very, very grateful for your time. Further updated on 25/02/2021 - shiny new updated video inserted and fact-check performed.

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Is Your MFM Your BBFF? - The Tests You Need Done For Twins

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Is your MFM your BBFF? Let's see how an easy memory trick can help you remember the treatments you need every 2 weeks for twins. Updated 29 Sept 2020. You've just found out you're having monochorionic twins, and that's awesome. So you might be googling identical twins, and coming up with a lot of different information, and some contradictions.

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RCOG Multiple pregnancy: having more than one baby

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RCOG Multiple pregnancy: having more than one baby

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This information tells you about:

A multiple pregnancy is the term used when you are expecting two or more babies at the same time (twins, triplets or more). It happens in about one in 60 pregnancies. Multiple pregnancy is more common as you get older or if you have fertility treatment.

Twins or triplets can be identical (monozygotic) or non-identical (di/tri-zygotic).

Identical twins or triplets have come from one egg, which has been fertilised by one sperm and has then split into two (or three) after fertilisation. Identical twins or triplets share identical genes, will look the same and be the same sex.

Non-identical twins or triplets have come from different eggs, which have been fertilised by different sperm. If your babies are non-identical, they will have different genes and will be no more similar than any other brothers or sisters.

Chorionicity refers to whether your babies each have their own placenta or whether they share a placenta. If your babies share a placenta (monochorionic) they are always identical. If they each have their own placenta (dichorionic/trichorionic) they are more likely to be non-identical but can still be identical.

Chorionicity is checked for at your first ultrasound scan. It is important to know about this because babies who share a placenta have a higher chance of having complications during the pregnancy.

Your first ultrasound scan also checks whether each baby is within their own amniotic sac or whether they share a sac. Babies who share a sac also have a higher chance of complications. Twins can be:

Dichorionic Diamniotic (DCDA) - This means each baby has its own placenta and its

own sac.This is the most common type of twin pregnancy.

Monochorionic Diamniotic (MCDA) - This means the babies share a placenta but they are each in their own sacs.

Monochorionic Monoamniotic (MCMA) - This means that both babies share a placenta and are within the same sac.This is a much rarer type of twin pregnancy.

Similarly, triplets can be trichorionic (each baby has a separate placenta), dichorionic (two of the three babies share a placenta and the third baby has its own placenta), or monochorionic (all three babies share a placenta).

Most women who are having twins or triplets have a healthy pregnancy and will give birth to healthy babies. However, complications are more common and you will be offered extra care during your pregnancy.

Problems that many pregnant women experience, such as morning sickness, heartburn, swollen ankles, varicose veins, backache and tiredness, are all more common in multiple pregnancies.These will get better after you have given birth but ask your healthcare professional if you are worried about any of these symptoms.

Additionally, you are more likely than someone having a single baby to experience more serious problems during your pregnancy.This may include:

Anaemia - this is usually caused by a shortage of iron because your developing babies use up a lot of iron.You will be offered regular blood tests to check whether you are becoming anaemic and you will be offered treatment with tablets if your iron levels are low. For further information see RCOG patient information Healthy eating and vitamin supplements in pregnancy.

Pre-eclampsia - this is a condition that causes high blood pressure and protein in your urine during pregnancy.Your blood pressure and urine will be checked regularly and, depending on your other risk factors, you may be advised to take aspirin tablets to reduce your chance of developing this. For further information, see the RCOG patient information Pre-eclampsia.

A higher chance of needing a caesarean birth or an assisted vaginal birth (forceps or ventouse) - your healthcare team will support you to create a birth plan and you should discuss your choices and preferences with your team. For further information see the RCOG patient information Assisted Vaginal Birth.

Post-partum haemorrhage - this means that you may bleed more than average after you have given birth.You will be offered medications at birth to reduce the chance of this happening. For further information see the RCOG patient information Heavy bleeding after birth (postpartum haemorrhage).

Prematurity

Overall around 8 in 100 babies (8%) are born prematurely (before 37 weeks).This is more common if you have a multiple pregnancy and can either be because you go into labour early or because your healthcare team recommend that the babies are born early.

If you are pregnant with twins you have a 60 in 100 (60%) chance of going into labour and giving birth before 37 weeks of pregnancy.

If you are pregnant with triplets you have a 75 in 100 (75%) chance of going into labour and giving birth before 35 weeks.

Babies born prematurely have an increased chance of health problems, particularly with breathing, feeding and infection. The earlier your babies are born, the more likely this is to be the case.

Depending on how early they have been born, they might need to spend time in the neonatal unit. Wherever possible your babies will be kept together however depending on their individual needs they may need to be cared for separately.

Problems with growth

Having a multiple pregnancy increases the chance that your placenta may not work as well as it should. This can affect the babies' growth and wellbeing during the pregnancy. Sometimes both babies may be small but more often only one baby is small. If only one baby is affected this is called selective fetal growth restriction (S-FGR).

You will be offered extra ultrasound scans during your pregnancy to check for growth problems:

if you are having DCDA twins you will be offered scans at least every 4 weeks from 24 weeks.

if you are having MCDA or MCMA twins you will be offered scans at least every 2 weeks from 16 weeks.

if you are having triplets or more you will be offered growth scans depending on your specific circumstances.

Twin-to-twin transfusion syndrome (TTTS)

Babies who share a placenta (monochorionic pregnancies) also share the blood supply from the placenta. In around 15 in 100 (15%) monochorionic pregnancies, the blood flow to the babies may be unbalanced. This is called twin-to-twin transfusion syndrome (TTTS).Triplet pregnancies can also be affected by this. One baby, the 'donor', receives too little blood while the other baby, the 'recipient', receives too much blood. It can be mild and may not require any treatment, or it can be serious, in which case you will be offered treatment in a hospital with specialist expertise. You will be monitored with frequent scans for signs of TTTS.

If you notice any of the following you should contact your healthcare professional immediately:

sudden abdominal pain and/or swelling

sudden breathlessness

change in the babies' movements.

You will be under the care of a specialist healthcare team throughout your pregnancy. This should include a doctor, a midwife and a sonographer who specialise in multiple pregnancies. You will be offered additional support as you need it from other team members, which may include dieticians, physiotherapists, mental health specialists, health visitors and infant feeding specialists. You will have an individualised plan of care for your pregnancy and birth that will include additional visits to the antenatal clinic and extra growth scans for the babies. You should be given information about what to expect from having a multiple pregnancy and a detailed plan of care at your first appointment with your specialist team. This should be by the time you are around 16 weeks pregnant. Sometimes referral to a specialised fetal medicine unit, which may be in a different hospital, may be recommended.

For further information, see Twins Trust: https://twinstrust.org/let-us-help/pregnancy-and-birth/ preparing-for-birth/antenatal-care/care-pathway.html.

Like all women, you will be offered screening for chromosomal conditions, such as Down's syndrome, at about 12-14 weeks. However, this is less accurate for multiple pregnancies. Should the result of the screening test show that there is an increased chance of a baby with a chromosomal condition it can be difficult to know which baby is affected. In this situation, you will be offered further specialist counselling and information from your health care team. If you would like further support to help you decide whether to have screening, please speak to your healthcare professional.

General information about these conditions and the screening tests available can be found in the UK National Screening Committee's (UK NSC) information booklet Screening tests for you and your baby.

You will also be offered another scan at around 20 weeks to look at your babies' development. The chance of these tests finding a genetic or structural condition is slightly higher than if you were pregnant with only one baby.Your specialist team will be able to offer you information and advice if the screening shows a higher chance of a genetic or structural condition.

You will be advised to give birth in hospital with midwifery and medical support.This may be at your local hospital or at a more specialist unit depending on how your pregnancy has been and whether or not you have gone into labour early.

The exact timing of birth in a multiple pregnancy will depend on your individual circumstances; however, even if your pregnancy has been uncomplicated, you should be offered a planned birth before your due date.This is because it has been found to be safer for your babies than continuing with the pregnancy to full term.The recommended timing of birth is usually:

Around 37 weeks of pregnancy if you are having DCDA twins

Around 36 weeks if you are having MCDA twins

Around 32-34 weeks if you are having MCMA twins

Around 35 weeks if you are having triplets.

Your health care team should start to discuss your birth plan with you from around 24 weeks. Your decision as to whether to plan for a vaginal birth (usually after an induction of labour) or a caesarean birth will depend on several factors including the position in which the babies are lying in your uterus (womb), how well the babies are growing and your personal preferences about the birth.

Twins
Both vaginal birth and caesarean birth have benefits and risks, which will depend on your individual circumstances.Your healthcare professional should discuss these with you to enable you to make an informed choice.

If the baby lying nearest to your cervix (the neck of the womb) is head-down and you have no other complications, then you should be able to plan for a vaginal birth if you choose.The position of the second twin can change after the first baby is born and should not influence how you choose to give birth. More than a third of women having twins who plan a vaginal birth will go on to need a caesarean birth.

If the baby nearest to your cervix is bottom-down (breech) towards the end of the pregnancy, a caesarean birth is usually recommended.

If you have planned to have a caesarean but go into labour naturally before the date of your operation, you should go straight to hospital.Your healthcare team will advise whether the safest option for you is to go ahead with your caesarean as planned or to give birth vaginally.This will depend on the situation at the time.

Monoamniotic twins and triplets
These babies are usually born by caesarean unless you are in very premature labour.Your own birth preferences are important and you will have time to discuss these with your healthcare team.

During labour extra measures will be recommended to look after you and your babies. You will be offered:

a cannula (a small tube) in your hand to give you fluids and medication if needed.
an epidural for pain relief while you are in labour. As well as providing good pain relief an epidural may also be helpful if your babies need to be born quickly by caesarean or by assisted vaginal birth. All options for pain relief should be discussed with you while you are pregnant and again when you are in labour. For further information on pain relief in labour see information from the Obstetric Anaethetists' Association: www.labourpains.com.
continuous monitoring of your babies' heartbeats using a machine called a CTG.This helps to show how your babies are coping during labour; however it may make it less easy for you to move around.Your first baby's heartbeat may be monitored by applying a tiny clip to their head, via your vagina.
The room may seem crowded when your babies are being born.There will usually be two midwives present. An obstetrician will be in the room or close at hand. Doctors and nurses specialising in the care of newborn babies may also be present.

After your first baby is born, the cord will be clamped and cut but the placenta will stay inside your uterus until your second baby has been born.

Your healthcare team will check whether your second baby is coming head-first or bottom-first by feeling your abdomen, doing an internal examination and by carrying out an ultrasound scan. The second baby is usually born within about 30 minutes to an hour of the birth of the first baby.

In a small number of cases you may need a caesarean for the birth of the second baby after the first baby has been born vaginally.This is only done if becomes unsafe for your second baby to be born vaginally.

After both your babies and their placenta have been born you will be offered medication to minimise the risk of having heavy bleeding (postpartum haemorrhage). See RCOG patient information on Heavy bleeding after birth (postpartum haemorrhage). If you do have heavy bleeding there is a chance that you may need a blood transfusion. If you think that you could never accept a blood transfusion, discuss this with your healthcare team as early as possible in your pregnancy. For further information see RCOG patient information on Blood transfusion, pregnancy and birth.

You should be offered advice about feeding your babies during your pregnancy and support with feeding after they are born. How you choose to feed your babies is a very personal decision. There are many benefits of breastfeeding for you and your babies but feeding more than one baby can be challenging. Extra help is available if you need it from your healthcare team and local support organisations.You can find further information from the Twins Trust: https://twinstrust.org/let-us-help/parenting/under-1s/feeding.html.

You may want to consider colostrum harvesting (expressing breast milk while you are pregnant so you have some milk ready to give your babies when they are born). For further information see Association of Breastfeeding Mothers: https://abm.me.uk/breastfeeding-information/ antenatal-expression-colostrum/.

Like anyone who has given birth you will have routine visits from your healthcare team when you get home. Having a multiple pregnancy and giving birth to more than one baby can be challenging. Having as much help and support as possible makes it easier and you may want to plan this well ahead. Activities and support groups are available for families having multiple pregnancies (see below).

Support is especially important if you have had complications in your pregnancy or if your babies have needed to go to a neonatal unit.

Your emotional wellbeing is also very important and you may experience anxiety or have low mood. If you feel that you need additional support you should talk to your healthcare professional. You can find further information from the Maternal Mental Health Alliance or Twins Trust.

The nature of obstetrics and gynaecology care means that intimate examinations are often necessary.

We understand that for some people, particularly those who may have anxiety or who have experienced trauma, physical abuse or sexual abuse, such examinations can be very difficult.

If you feel uncomfortable, anxious or distressed at any time before, during or after an examination, please let your healthcare professional know.

If you find this difficult to talk about, you may communicate your feelings in writing.

Your healthcare professionals are there to help and they can offer alternative options and support for you.

Remember that you can always ask them to stop at any time and that you are entitled to ask for a chaperone to be present.You can also bring a friend or relative if you wish.

Twins Trust: www.twinstrust.org

Tommy's: https://www.tommys.org/

Bliss: https://www.bliss.org.uk/

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Multiple pregnancy: having more than one baby

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This patient information leaflet provides advice on multiple pregnancy.

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RCOG Green - top Guideline No. 51 Management of Monochorionic Twin Pregnancy

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RCOG Green - top Guideline No. 51 Management of Monochorionic Twin Pregnancy

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BJOG: An International Journal of Obstetrics & Gynaecology

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International Council of Multiple Birth Organisations (ICOMBO)

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International Council of Multiple Birth Organisations (ICOMBO)

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A voluntary organisation whose aim is to raise awareness of the unique needs of multiple-birth infants, children, adults and their families promoting their health, education and welfare.

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The International Council of Multiple Birth Organisations (ICOMBO) is a voluntary organisation that champions the rights of multiples. We are passionate about ensuring the unique needs of multiple birth infants, children, adults and their families are understood and met.

Since 1980, ICOMBO (formerly COMBO) has brought together communities from around the world, with the common goal of benefiting twins, triplets and more, and their families, throughout their lives.

To learn more about what we do, who we are, and what drives us,

From the lastest updates from our members, to research news, be the first to know.

Research

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ICOMBO - International Council of Multiple Birth Organisations

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ICOMBO is a voluntary organisation whose aim is to raise awareness of the unique needs of multiple-birth infants, children, adults...

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Twins Trust is committed to undertaking research to better the lives of our families and improve the health outcomes from multiple pregnancies.

In 2013 we took an exciting first step into investing in clinical research.

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Twins Trust is committed to undertaking research to better the lives of our families and improve the health outcomes for multiples.

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The Human Multiple Births Database (HMBD) gathers the number of twin births and the twinning rates for countries with reliable statistics. The database also provides statistics on other multiple births (i.e., triplets, quadruplets, etc.) whenever possible. Although their frequency has increased even more than that of twins, they still constitute a minority, as most multiple deliveries involve twins. Links to research also.

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The unprecedented increase in the twinning rate

The frequency of twin births has significantly increased in developed countries, doubling since the 1970s (see Figure 1). Two main factors have contributed to this development, namely the rise in the use of medically assisted reproduction techniques, as well as a substantial increase in the mean age at childbearing (Pison et al., 2015). This ’boom’ in the birth of twins constitutes a public health challenge, in that twins tend to have frailer health than singletons, at least during their early years. Compared to singletons, twins have lower birth weight, they tend to be born prematurely, and the deliveries are more complicated, all of which can potentially lead to long-term health problems. It is therefore important to understand better the causes of the increase in the twinning rate, as well as the variations across countries.

The Human Multiple Births Database (HMBD) gathers the number of twin births and the twinning rates for countries with reliable statistics. The database also provides statistics on other multiple births (i.e., triplets, quadruplets, etc.) whenever possible. Although their frequency has increased even more than that of twins, they still constitute a minority, as most multiple deliveries involve twins.

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The frequency of twin births has significantly increased in developed countries, doubling since the 1970s (see Figure 1). Two main factors have contributed to this development, namely the rise in the use of medically assisted reproduction techniques, as well as a substantial increase in the mean age…

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Welcome to Twins Trust twin growth charts. In twin pregnancies assessment of fetal growth is an essential component of antenatal care. The portal has been developed as an aid to clinicians caring for twin pregnancies and features downloadable customised twin growth charts as well as tools to help calculate centiles for estimate fetal weights. The data has been developed using almost 10,000 ultrasound examinations from more than 2,000 UK twin pregnancies and the aim is to provide safer evidence based care for twin pregnancies worldwide.

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Welcome to Twins Trust twin growth charts. In twin pregnancies assessment of fetal growth is an essential component of antenatal care. The portal has been developed as an aid to clinicians caring for twin pregnancies and features downloadable customised twin growth charts as well as tools to help calculate centiles for estimate fetal weights.

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Twin and triplet pregnancy - NICE guideline

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Twin and triplet pregnancy - NICE guideline

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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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Jodi Carol Photography | Orlando Birth and Family Stories

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Sometimes birth doesn't go how we'd hoped or planned. But, birth can be beautiful in all of it's forms. Below, one mother shares her story of hoping for an unmedicated vaginal twin birth, and the emotional journey she experienced as she ended up having a gentle c-section. Thank you, Lauren, for sharing your journey!

Our journey to parenthood was a long rocky road where the end seemed dark and illusive. It started with unexplained infertility, took a sharp turn when we became foster parents, and became a mountain full of switchbacks when we found ourselves in court petitioning for the adoption of our three foster kids. They were in our care over 3 years before the adoption was granted. In the meantime, we still wanted to get pregnant and tried everything from years of tracking our fertility, ovulation assistance, intrauterine insemination, and eventually two rounds of IVF. We took frequent breaks to balance the demands of our court case, being foster parents, and graduate school for both my husband and I. On February 6th, 2018 I met with our fertility specialist to plan our second round of IVF, on the 12th a standard court date turned into the surprise adoption of our three kids, and by April 16th we knew we were pregnant. 4 weeks later it was confirmed it was twins due in December. After seemingly endless waits in courtrooms and doctor's offices, we were well on our way to becoming the parents of five beautiful children before the year was out.

From the first moment we saw our twins on a monitor, they were one on top of the other. Sometimes they would shift a bit filling me with hope that they would turn head down and allow me to do a natural delivery. I am a VERY healthy person as is my husband. I wanted desperately to have these girls via an un-medicated vaginal delivery. I invested in Hypnobabies, the Bradley Method, and Spinning Babies in hopes of their turning. I did headstands in our pool and laid upside down on an ironing board. None of it worked. Finally, my doctor, Terrance Peppy, insisted I be scheduled for a "gentle" c-section at 38 weeks. I was devastated, cried, and grieved the experience that would never be.

On December 4th, Ben and I woke up to get to Winnie Palmer Hospital by 4am. Amazingly, I had slept great and didn't feel at all anxious. Driving to the hospital we recorded a video talking about our fertility journey and soon enough we were there. Rather than being nervous about the procedure and the birth, I channeled my energy into fretting about the one thing immediately in my control, whether our birth photographer, Jodi Severe, would be allowed in the operating room to document the actual procedure. Despite not being the birth I envisioned, I still wanted the miracle documented. But the hospital procedure allowed only one support person in the operating room with me. Doctor Peppy was on board for the additional photographer but we also needed approval from the head anesthesiologist. From the moment we walked into the hospital, this was all I could think about. I blocked out the impending surgery and focused on the photos.

After we checked in, we were brought to an upper floor. I sent Ben back to meet up with Jodi and already began talking to everyone I could to get her approved for the OR. I was brought back to prep and was helped out of my clothes and into the operating gown. My humongous belly made this all quite difficult. The night before, I had sterilized in the shower with a special soap and now had to brush my teeth and have all sorts of areas scrubbed and sterilized to prevent infection after the c-section. Once I was sufficiently sterilized, I was brought into a cubicle and laid down on a rolling bed. Monitors were placed on me. An IV was placed in my arm. After three failed attempts at placing the IV, the nurse got her boss to do it. I had three good sized bruises from the tries. Eventually, the anesthesiologist came in and I immediately told her about my photographer and Dr. Peppy's approval. She said she would need to check about the extra person with her boss. She came back and the answer was no. I was devastated. I think I may have been focusing on this to avoid focusing on the actual c-section. But in my mind, having those first moments of the girls captured seemed more important than anything.

Now, with the photography issue behind me, I had no choice but the address the situation right in front of me. The epidural was being placed. My body was going numb. There were monitors on my belly, tubes in my arm, and beeping all around me. I began to quietly cry. This was not how I had hoped to bring these girls into the world. This was not the experience Mother Eve had. This was all too medical and all wrong. I wanted to be alert, not drugged. Seeing my emotions, our anesthesiologist asked if I had a camera. She explained that her job in the OR was simply to watch and wait in case of an emergency. She would be happy to take pictures as long as everything went well. Then, when the incision was closed, the photographer could come in and capture the girl's first moments. This felt like a tender mercy.

Soon enough, I was brought into the operating room with Ben. A sheet with a covered plastic window was placed between my face and the medical team. All the doctors were in good moods. Doctor Peppy joked that he hoped they were really girls in there. I joked back that they had better both be white . . . since these were IVF babies there was always room for a mix up! It was nice to feel that the medical team all knew each other and enjoyed what they were doing. I didn't feel anything as the incision was made and before I knew it the plastic window was uncovered and Zorah was being held up, fresh out of the womb. I could pinch the plastic and feel her tiny new hand. I was in tears, completely overwhelmed by the process that brought her here. Suddenly the photos, and delivery, and the planning didn't matter. What mattered was seeing this girl and being her mom. I was awestruck. It took a few minutes before Phoebe was brought to the window. She had been high up in my ribs and doctor Peppy had to push her down from the outside. She was covered in blood from the incision which had now been open a few minutes. Still . . . tears. I was completely overwhelmed. Doctor Peppy quickly stitched my abs back together for smoother healing and closed the incision. I could see the girls to my left getting cleaned up and wrapped before they were placed on me for the remainder of the operation. They were beautiful.

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The Birth of Zorah and Phoebe: A Gentle Cesarean Twin Birth after IVF - Jodi Carol Photography | Orlando Birth and Family Stories

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Our journey to parenthood was a long rocky road where the end seemed dark and illusive.

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Coping with multiple births, several children under five, or bringing up a lot of children in a high rise flat with no lift? You'll need more than an extra pair of hands.

Our volunteers provide just that: for the mum who struggles to get a pushchair and her toddlers down three flights of stairs to the parents of triplets who need a volunteer to help get the whole family to the park or to do the food shopping, Home-Start provides tailor-made help to give your children the best possible start in life.
"With twins you just need about ten pairs of hands. And then I got postnatal depression", says Emma. This is her family's story:
Other stories like this:
Kris: "I had five children under five. It was tiring and hard. Carrying two children at a time was normal"
To find out if Home-Start has a volunteer available to help you, contact your local Home-Start.

Also, look at our how we help and common questions pages for more information.

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It's the little moments that make the biggest difference . Donate to help power those little moments. Donate now because childhood can't wait.

Donate here to support Home-Start UK's work around the country. To support a local Home-Start, you can find their details here. Read more
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Double delight or triple trouble? Multiple births can bring both...

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AIMS -  Twins and Multiples: More Babies, More Decisions, Same Rights

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AIMS -  Twins and Multiples: More Babies, More Decisions, Same Rights

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Journal Vol. 29, No. 4 - Twins and Multiples: More Babies, More Decisions, Same Rights

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Journal Vol. 29, No. 4 - Twins and Multiples: More Babies, More Decisions, Same Rights

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Everything you need to know about woven wraps

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Wrapping twins - woven wraps are great for wrapping multiple babies because they are so versatile and offer so much possibility, and so much customization.

Keep in mind that US regulations require baby carriers to be tested and that testing does not cover multiple children. However, woven wraps have no weight bearing seams, and no plastic buckles or other parts that can give way. That's why woven wraps are the safest kind of carrier to use for improvisation or any babywearing.

Use these common sense safety tips when wrapping twins:

Learn to wrap competently with one baby before attempting to wrap two.

Familiarize yourself with safe newborn positioning so that you can ensure both your babies maintain safe positioning in your wrap.

Wrap snugly so babies cannot turn, sink, or slouch into a dangerous position.

Sling rings are often used with tandem carries - use quality rings and watch for wear in your wraps.

Ensure there is no one spot that is continuously bearing undue weight in your wrap, including spots where one wrap may be threaded through another.

Keep an eye on the fabric you wrap with to ensure that it is in good condition.

Tandem Babywearing with a Woven Wrap

When wrapping twins that are teeny, tiny, you can wrap them together in a single front carry. You can do a Front Wrap Cross Carry, Front Cross Carry, or Pocket Wrap Cross Carry (as in the video below) and tuck one babe under each cross.

Wearing one on the front and one on the back in one long woven wrap as demonstrated here by LaKeta of TandemTrouble and her twins. Do not try this with a stretchy wrap such as the Moby.

Once babies have head control and are sitting up, a tandem hip carry in a single wrap is an option. Because you have a baby under each arm, this carry is not going to help you to get housework done, but it does work great for going out together. Demonstrated by Payal of TwinMommy101 and her girls.

Two babies can also be worn in a single wrap on front and back. If your children are two different ages/sizes, you will likely find it most convenient to have the older baby or toddler on your back and it's a good idea to secure the back carry with a knot before adding the front carry passes so that the heavier child's weight does not pull the wrap too tight around the smaller baby. Any wrap carry that has rucksack straps and ties a the waist can be finished with a Tibetan finish that creates a cross for second baby to sit in. Or a carry with Rucksack straps that would usually be tied at shoulder can also be done with a front cross variation to add room for a baby on the front as in this video:

Often, wearing two is most convenient in two separate wraps because this way you can take one baby down without disturbing the other so you can switch from wrapping one to wrapping two seamlessly throughout your day as your needs (and theirs) change.

One great combination for using two wraps is to tie on a Front Cross Carry (a poppable carry so you can take the little one out if he or she needs to potty or be changed, then pop baby back in without retying) and then put your toddler in a rucksack carry on your back. The baby can be inserted into the Front Cross Carry after you are done wrapping toddler so you don't end up bending over with baby on the front.

When you are not wearing two, you will likely find many occasions to wear one twin while:

nursing the other

changing a diaper

pushing one in a shopping car

using a single stroller

Here are a couple more sites of interest about babywearing twins:
Tandem Trouble Babywearing Tutorials Tandem Babywearing Group on Facebook for questions/discussions Twin Babywearing and Twin Nursing Positions
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Wrapping twins - woven wraps are great for wrapping multiple babies because they are so versatile and offer so much possibility, and so much customization. Keep in mind that US regulations require baby carriers to be tested and that testing does not cover multiple children.

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Baby Sleep Information Source

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While a vast amount of research has been done concerning the sleep of single babies, much less has focussed on multiples. Here we summarise the research which has been done.

Whilst Sudden Infant Death Syndrome (SIDS) is extremely rare, the rate is two- to four-times higher in twins, compared to singleton babies. This is likely to be because many more twins are born premature and/or at a low birth weight; factors which are associated with increased SIDS risk in all babies.

It is important that parents are aware of how the sleep environment of twins can affect SIDS risk, as well as its effect on babies' sleep, and ease of night-time care.

Twins Trust, a charity focused on twins and multiple births, provide information for sleeping twins and multiples.

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How to keep all babies - including multiples - safer when sleeping

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How to keep all babies - including multiples - safer when sleeping

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Sleep study - Tamba with Prof Helen Ball

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Sleep study - Tamba with Prof Helen Ball

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NHS information

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Problems getting twins to sleep

There are several reasons why 2 or more babies may be more difficult to get into a good sleeping routine.

Twins and triplets are more likely to be born prematurely and spend time in neonatal care, where they're used to being touched and nursed frequently.

They may miss this contact and find it hard to settle when they come home.

If you're still visiting 1 baby in hospital, it can be hard to establish a good routine with the other baby at home.

Other things to note:

Newborn babies, in particular premature babies, have tiny stomachs and need to feed frequently.

It may take longer to get into a routine with 2 babies to care for.

More than 1 person may be caring for your babies, and they'll take a while to get used to being handled in different ways by different people.

You may want to comfort a restless twin faster than you would a single baby, as you're worried they may wake up their twin.

But there are plenty of ways to encourage a good sleeping routine so everyone gets enough rest.

Can my twins sleep in 1 cot?

You can put your twins to sleep in a single cot while they're small enough. This is called co-bedding and is perfectly safe.

In fact, putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe them and their twin.

If you put your twins in the same cot, follow the same safe sleeping advice as for a single baby.

They should be placed on their backs with the tops of their heads facing one another and their feet at opposite ends of the cot, or side by side on their backs, with their feet at the foot of the cot.

Use a single cot for co-bedding, but not a Moses basket, as it'll be too small for 2 babies.

Co-bedding means you can keep your babies with you in your room for longer.

With triplets, you can place them next to each other across a cot while they're still small enough to fit.

They should be laid on their backs with their feet touching the side of the cot.

When your twins are older, you may choose to put them in separate cots placed close together so they can continue to comfort each other.

If older twins are disturbing one another, you may think about giving them separate rooms if you have enough space.

It's recommended that babies sleep in the same room as their parents for the first 6 months, as this is known to reduce the risk of cot death.

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There are several reasons why 2 or more babies may be more difficult to get into a good sleeping routine. Twins and triplets are more likely to be born prematurely and spend time in neonatal care, where they're used to being touched and nursed frequently.

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video demo of twin sling wearing

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People carry twins for the same reasons anyone carries their children - usually to get somewhere and/or for cuddles!

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It's A Sling Thing - More Than Just Slings

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It’s A Sling Thing is currently moving....

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Our wonderful new website will be available again soon over at our new home - calmfamily.org! Come back later on... If you have any queries please email us on hello@calmfamily.org

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EXPECTING TWINS, TRIPLETS OR MORE?THE HEALTHY MULTIPLEPREGNANCY GUIDE

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EXPECTING TWINS, TRIPLETS OR MORE?THE HEALTHY MULTIPLEPREGNANCY GUIDE

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TAMBA

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early.

Vaginal delivery of more than one baby

People often assume that if you are expecting more than one baby they must be born by caesarean section. In fact, almost half of all twins are born vaginally and the process is similar to having a single baby.

If the first baby is in a head down position, it's usual to consider having a vaginal delivery. However, there may be other medical reasons why this would not be possible. For example, if you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

If planning a vaginal delivery, it is usually recommended that the mother has an epidural for pain relief. This is because if assistance with delivery is needed, it's easier and quicker when the mother already has an epidural in place.

If you have a vaginal birth, you may need an assisted birth, when a suction cup (ventouse) or forceps are used to help deliver the baby.

Caesarean section for multiple births

If you are expecting more than one baby, you may choose to have an elective caesarean section from the outset of your pregnancy. Alternatively, your doctor may recommend a planned caesarean section later in the pregnancy as a result of potential complications.

Your babies' positions may determine whether they should be delivered by caesarean section. If the presenting (first) baby is in a breech position (feet, knees or buttocks first) or if one twin is lying in a transverse position (with its body lying sideways), you will have to have a caesarean section.

Some other conditions might also mean you will need a caesarean section, for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.

If you have previously had a very difficult delivery with a single baby, you may also be advised to have a caesarean section with twins.

Even if you plan a vaginal delivery, you may end up having an emergency caesarean section. This could be because

the babies become distressed,

the cord prolapses (when the cord falls into the birth canal ahead of the baby),

you have high blood pressure,

the labour is progressing slowly,

an assisted delivery doesn't work.

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if the baby becomes distressed. This occurs in less than 5% of situations when twins are born.

Special care

As multiple pregnancies are generally less likely to carry to full term, parents expecting more than one baby should be prepared for the possibility that their babies may come early and spend some time in a neonatal intensive care unit. These can sometimes be quite upsetting places to begin with, and parents can think their babies look small and vulnerable amongst all the technology. It may be a good idea to try to visit the neonatal intensive care unit on a hospital tour during your pregnancy to prepare yourself for the possibility that your babies may spend some time here.

Although the thought of having premature babies may be worrying, studies have shown that premature multiples mature more quickly than single babies born at a similar time and multiples are often better equipped for early starts. Some premature babies may only need a short stay with little medical treatment.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

The Twins & Multiple Births Association (Tamba) provides support and information to parents expecting twins, triplets or more babies. They publish a Healthy Multiple Pregnancy Guide, which is available free on Tamba's website if you register.

NHS choices also provide information on delivering twins.

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early. People often assume that if you are expecting more than one baby they must be born by caesarean section.

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The Multiple Births Foundation

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Giving birth to twins - Pregnancy and baby guide - NHS Choices

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Giving birth to twins - Pregnancy and baby guide - NHS Choices

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It's important to understand your birth options if you're expecting more than 1 baby.
Twins and triplets are more likely to be born early and need special care after birth than single babies.

Your birth choices with twins

It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

You'll normally be advised to give birth in a hospital, as there's a higher chance of complications with twins.

There are usually more health professionals at a multiple birth - for example, there may be 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).

You'll already have met your obstetrician and midwives to discuss your baby's birth beforehand, so they will not all be strangers.

For more information on who's who, read about the antenatal team.

The process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.

This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.

Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.

You'll be offered a drip in case it's needed later - for example, to restart contractions after your first baby is born.

Triplets or more babies are almost always delivered by a planned caesarean section.

Can you have a natural birth with twins?

Lots of women think they have to have a caesarean section with twins. In fact, more than 40% of twin births are vaginal.

If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.

If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.
Find out more about the signs and stages of labour
You're more likely to have a vaginal birth if the first twin is in a head-down position.

But there may be medical reasons why a vaginal birth is not recommended.

If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.

As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.

Once the first baby is born, your midwife or doctor can check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.

If the second baby is in a good position, it should be born soon after the first, as your cervix is already fully dilated.

If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.

Caesarean section and twins

In the UK, more than half of twins and almost all triplets are delivered by caesarean.

You may choose to have a planned caesarean, or your doctor may recommend a caesarean, if:

the first baby is lying feet, knees or buttocks first (breech)

1 twin is lying sideways (transverse)

you have a low-lying placenta

your twins share a placenta

you have had a difficult delivery with a single baby before

As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.

In very rare cases, some women deliver 1 twin vaginally and then need a caesarean section to deliver the second twin. This happens in less than 5% of twin births.

Finding out if your twins are identical

After the birth, your midwife will examine the placenta to check that it's all there and look at the membranes.

If your babies have a single placenta with 1 outer membrane (chorion) and 2 inner membranes (amnion), they must be identical (monozygotic).

Otherwise, the only way to tell if they're identical is through DNA testing. This is not available on the NHS.

For advice on how to find out if your twins are identical, you can phone the Multiple Births Foundation on 020 3313 3519 or email them at imperial.mbf@nhs.uk.

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It's important to understand your birth options if you're expecting more than 1 baby. Twins and triplets are more likely to be born early and need special care after birth than single babies. It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

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Different babies, different needs - best beginning

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Different babies, different needs - best beginning

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Breastfeeding Twins - Association of Breastfeeding Mothers

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Breastfeeding Twins - Association of Breastfeeding Mothers

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs. With two babies, more milk is removed from the breasts, so more milk is made. The best way to make sure you establish a good supply is to feed your babies often in the early weeks and to ask someone knowledgeable to help you check that they are attached and breastfeeding correctly.

During the first few days and weeks, babies send signals to your milk supply and may sometimes feed more frequently. This frequent feeding is sometimes perceived as a sign of a lack of milk but, if feeds happen responsively, milk supply will swiftly increase, and feeding will settle into a pattern again. Your babies' weight gain and their nappies will reassure you that they are getting the milk they need.

"I found out at an antenatal scan that I was expecting twins. I asked if I could breastfeed them and was told that I would have to give bottles as well. This upset me as I'd really enjoyed breastfeeding my other two children. The twins were born at 36 weeks (though I nearly had them earlier than that). They never had bottles. I'm glad I found out in advance that it's possible to breastfeed twins."
How can I breastfeed two babies?
Confidence and the belief that it can be done are important. Attend a breastfeeding support group or workshop while you're pregnant to increase your confidence and find out where to get support locally. If you have any questions after your babies are born, you'll know who to ask. Perhaps you can be put in touch with someone who has breastfed twins (or see the Facebook group mentioned below).

"The twins were our first children and I thought I'd like to try to breastfeed. I read a little and a friend invited me to watch her breastfeed her baby. Most of the mums I met at a twins' club hadn't tried, but I decided to give it a go. Our babies were born at 37 weeks after a straightforward labour and the hospital staff were generally encouraging. I wish I'd known a bit more about growth spurts though and how to let the babies increase my milk supply at these times. I also wish I had known about antenatal hand expressing."

Twins can be fed separately or together. Many mums find that they do both in different situations and when their twins are at different stages of development. Feeding babies together can be a good way to establish a plentiful milk supply quickly and can save time. While mum and each baby are still learning about breastfeeding, it may be easier to spend some time feeding separately. As the babies grow and their head control develops, it will be easier to breastfeed them together. Later still, the babies will be able to position themselves. Decisions like when to swap breasts and which positions work best, will vary from family to family.

"Don't be afraid to ask for help positioning the second twin in the early days, so you can have a go at feeding two babies together."

Rugby hold, Parallel and Crossover holds
Breastfeeding cushions designed with twins in mind are more likely to enable a mum to tandem feed and even feed hands-free. However, some mums find they prefer to use V-shaped or normal pillows or cushions or use positions where no cushions are needed. If you have someone to assist you in the early days, they can help you position a second baby after the first one has started feeding.

"After a couple of weeks, I got the hang of feeding lying down and that made things a lot easier at night. When they were a little older, I managed to find a way of feeding both lying down. You get inventive about using different positions and doing things like answering the phone while breastfeeding."

"Our girls are now 17 months old and I'm still enjoying breastfeeding them. Now they are toddlers, I tend to feed them separately, but I used to do a mixture of breastfeeding separately and together."

What if my babies are born early?
Twins are more likely to be born early than single babies. If babies are born early, their mother's milk will be different to full-term milk and have specific advantages for pre-term babies. Breastmilk reduces a baby's chances of becoming ill and some conditions can be particularly serious in a pre-term baby. If twins are born very early, they may need to be fed by tube or special cup until they are able to breastfeed. Expressing breastmilk for premature babies will mean a mother is making a valuable contribution to her children's welfare, especially as hospital staff are responsible for other aspects of their care. Donor milk can also be an option.
Won't I be too tired to breastfeed?
Tiredness is sometimes given as a reason not to breastfeed twins, but there's no evidence that breastfeeding in itself is tiring. In fact, breastfeeding mums can make the most of opportunities to sit or lie down. It's important to eat a balanced diet and to rest when your babies sleep.

Once breastfeeding is established, it gets easier to go out or travel with twins, because breastmilk is available immediately and at the right temperature. Imagine the sheer number of bottles to be washed, sterilised, made up with hot water then cooled down for bottle-fed twins, and the cost of formula.

Breastfeeding involves the release of specific hormones that help a mother to feel relaxed. This is particularly beneficial for mums of twins who are likely to have an even busier time than other mothers. Also breastfeeding will help your uterus (particularly enlarged after having twins) to contract back to its pre-pregnancy shape and size and will help you lose weight more quickly.

If families feed their babies at the same time, they may choose to wake the other twin at night to minimise the number of night feeds. Breastfeeding at night can be done lying down and can help to establish a good supply of milk.
But my family and friends want to help
Grandparents or others might ask if they can help by giving a baby a bottle, but if bottles are introduced early on, this may make breastfeeding more difficult to establish and reduce a mother's milk supply. Dummies may also mean the demand on your milk is reduced so the supply reduces. However, some mothers of twins do find that expressing breastmilk can be useful and allows someone else to feed the babies occasionally.

There are lots of other things that family and friends can offer to do to help parents of newborn twins e.g. cuddling a baby, changing a nappy, offering mum a drink or sandwich, helping at bath time if needed, or hanging out washing. The support and encouragement of friends and family is an important aspect to breastfeeding twins successfully.
More information:

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Many new mums worry about whether they will have enough milk, but in fact there are very few women who don't have enough.

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MULTIPLE BIRTHS -A PARENT’S GUIDETO NEONATAL CARE

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MULTIPLE BIRTHS -A PARENT’S GUIDETO NEONATAL CARE

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TAMBA

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Postnatal Depression - a guide for mothers of multiples

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Postnatal Depression - a guide for mothers of multiples

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Feeding twins, triplets and moreA booklet for parents with advice and information

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Feeding twins, triplets and moreA booklet for parents with advice and information

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Multiple Births Foundation

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Lullaby Trust

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You may like to sleep your twins in their own Moses baskets or cots from birth, or you may decide to co-bed them in the early weeks and months.

Co-bedding means siblings share the same sleep surface during any sleep period, for example by being in the same cot together.

Whichever you decide, all The Lullaby Trust advice for safer sleep should be followed for each baby, for each day and night time sleep.

This includes, for example:

Please have a read of our other safer sleep guidance for information on sleeping babies as safely as possible.

Safer sleep for twins: FAQs

Can I bed-share/co-sleep with my twins?

The safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. Sharing a bed with an adult is a significant risk for babies born prematurely or at a low birth-weight, which is common in multiples.

Co-sleeping is particularly dangerous if either you or your partner smokes (even if you do not smoke in the bedroom), has drunk alcohol or taken drugs (including medications that may make you drowsy), or are very tired.

If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

You can find further information on our co-sleeping page.

If my twins were slept close together on the NICU, shouldn't I be continuing this at home?

Premature or low birth-weight twins are often slept in close proximity on the Neonatal Intensive Care Unit to model the intrauterine environment and improve the development of vital functions like heart rate and breathing.

Once your babies are discharged, they should be ready to be slept according to the safer sleep advice for all babies. You can also phone our information line with any queries on 0808 802 6869.

My health visitor told me it's better for twins to sleep in the same cot together than to sleep separately. Why is this?

At The Lullaby Trust, we often will promote co-bedding your twins so that you can share a room with them, if you have restricted space. Sharing a room with your babies is a really important measure you can take to reduce the chance of SIDS.

However, there are other reasons you might want to co-bed your twins that you might want to look into. Various areas of research have suggested that putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe them and their twin.

I've read that babies need separate sleep spaces once they can roll and move about the cot. What is the best thing to do if I don't have space for two cots in my room?

Sometimes it can be tough in a practical sense to adhere to all of the safer sleep messages, particularly if you are short on space.

If you can't fit two cots in your bedroom for your twins, make the advice work for you - you may like to leave doors open between your rooms, or perhaps take in turns with a partner to sleep with the twins in a nursery room.

If possible, you may even be able to borrow something smaller than a second cot for a couple of months, such as a crib. Give our information line a call to have a chat about any further options.

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You may like to sleep your twins in their own Moses baskets or cots from birth, or you may decide to co-bed them in the early weeks and months. Co-bedding means siblings share the same sleep surface during any sleep period, for example by being in the same cot together.

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A vital resource to professionals and families alike, it aims to improve the care and support of multiple birth and twins families through the education of all relevant professionals.

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Sprogcast is a podcast about pregnancy, birth and parenting by midwife Mark Harris and Childbirth Educator Karen Hall, this one features independent midwife Virginia Howes talking about risks and possibilities for normality when giving birth to twins and doula Mars Lord discussing her experiences as a mother of twins and specialist twin doula

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Sprogcast - Episode 11 - Twins (March 2016) by Pinter & Martin

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Hosted by Karen Hall and Mark Harris, with midwife Virginia Howes and doula Mars Lord