Multiple Pregnancy: Twins or More

Home Treatment

A multiple pregnancy can make morning sickness worse during the first months of pregnancy. You can treat your symptoms at home, unless you have become dehydrated or are not getting enough to eat because of vomiting.

Pregnancy: Dealing with morning sickness

Learn the signs of early labor. They include:

• Cramping similar to menstrual cramps.
• Abdominal cramps, possibly with diarrhea.
• Contractions of your uterus that don't go away, about 4 or more in 20 minutes or about 8 or more within 1 hour.
• Pressure in your lower back, especially if it comes and goes.
• An increase in your usual amount of vaginal discharge.

Call your health professional immediately if you have symptoms of early labor.

Call your health professional or go to the hospital if you begin bleeding from the vagina or if your water breaks.

Self-care for multiple pregnancy

If you are pregnant with twins or more, you will be advised to:

• Make sure that you are taking in enough nutritious calories, folic acid, iron, and calcium to nourish you and your fetuses.
• Avoid alcohol, smoking, caffeine, most medicines, chemicals, X-rays, some cosmetic products, getting too hot, and eating contaminated food. All of these precautions are advised for any pregnancy. For more information, see the topic Pregnancy.
• Reduce your physical activity. Most doctors will recommend that you stop physically demanding exercise after 24 weeks of a multiple pregnancy. Talk to your doctor about walking or swimming.
• Get plenty of rest, especially after the 24th week of pregnancy. Studies show that strict bed rest does not prevent early (premature) delivery in multiple pregnancies.⁶
• Consider whether you need to change your daily work activities, based on how well your pregnancy is going. Be sure to follow any advice to reduce your activity level.
• See your health professional often. Beginning in the 20th week of pregnancy, you may be checked every other week. Beginning at the 30th week, you may be checked more often.

For more information on what to expect during pregnancy, labor, and childbirth, see the topic Pregnancy.

After the babies are born

Coping. Having a multiple pregnancy and caring for two or more infants at the same time can be overwhelming and exhausting. Lack of sleep, the increased amount of work, less personal time, and difficulty maintaining the home are common sources of frustration for parents of multiple infants.

With multiple newborns to care for, it is common to feel frustrated or guilty about not managing your life as easily as before. This is normal. Get extra help for as long as possible after your babies are born. Rest as often as you can during the day. Accept help from friends and family. They can bring meals, go grocery shopping, do household chores, or care for your children while you take some time for yourself.

Feeling sad or depressed (postpartum blues or postpartum depression) is more common after delivering twins or more.⁷ If you feel depressed for longer than 2 weeks or if you have troubling or dangerous thoughts, see your health professional. It is important that you get treatment. For more information, see the topic Postpartum Depression.

Depression: Managing postpartum depression

Consider joining a support group for parents of twins or more. Sharing your experience with other people who are in a similar situation may help you with the demands of caring for your babies. For more information, see the Other Places to Get Help section of this topic.

Breast-feeding?Breast-feeding more than one baby can be challenging, but it helps to build the bond between you and each baby. It gives your babies excellent health benefits. Breast-feeding also saves you hundreds of dollars that you would otherwise spend on baby formula. If you plan to breast-feed your babies, seek out support and information from your health professional, the hospital, or a lactation consultant before and after the birth. For more information, see the Other Places to Get Help section of this topic and the topics Breast-Feeding and Bottle-Feeding.

Parenting. Look for your new babies' personality differences and help them build their own identities over time. Give each of your children time alone with you. If you have an older child or children, schedule regular individual time with them.

Loss and grieving

Multiple pregnancy increases the risk of fetal death. Whether early in pregnancy or after birth, if one or more of your infants die, you and your family will need time to grieve.

Your hospital can help you contact support groups for grieving parents. Talking about your loss with friends, a spiritual advisor, or a counselor may also help. For more information on grief support, see the Other Places to Get Help section of this topic and the topic Grief and Grieving.

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Author:	Debby Golonka, MPH	Last Updated: July 24, 2007
Medical Review:	Adam Husney, MD - Family Medicine Gregory A L Davies, MD, FRCSC, FACOG - Maternal-Fetal Medicine
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