What to expect if you’re expecting… more than one baby


by Sofia Lieser, MD

Mar 22, 2022

The moment you find out you’re having a baby is life-changing and maybe a little scary—even more so if you find out you’re having twins, triplets or more. First, take a deep breath and focus on your joy and excitement. After all, your family is growing! That’s something to celebrate.

If you’re feeling nervous, don’t worry, your OB-GYN and care team will help you prepare and make sure you know what to expect. There are no silly questions when it comes to pregnancy and parenthood.

Here are a few of the most common questions I get from parents-to-be who are expecting multiples.  

How is pregnancy different with multiples?

A pregnancy with multiples is different from a singleton pregnancy in many ways. Multiples are automatically considered a “high risk pregnancy” due to the many complications that may arise, but don’t let that alarm you. Most of the time, these complications do not arise. We take every precaution we can to make sure mom and babies are healthy.

If you’re having multiples, your doctor’s visits will be more frequent and may involve more regular ultrasounds. A maternal-fetal medicine specialist may be involved in your care. Your delivery will also probably be planned prior to your due date.

Your pregnancy is unique and your OB-GYN knows you best. Together, you’ll put together a care plan that you both feel confident in.

How much additional weight should I expect to gain with multiples?

The amount of weight recommended to gain in pregnancy depends on the pre-pregnancy body mass index (BMI), which takes into account a person’s weight and height. Someone who is a “normal” weight based on her BMI should expect to gain 37-54 lbs. Someone who is “overweight” by BMI should expect to gain 31-50 lbs. Keep in mind, this will vary from woman to woman.

When will I find out if my twins are identical or fraternal?

First, let’s clear up the difference between the two. Identical twins result when one egg that is fertilized by one sperm splits into two during the development process. Fraternal twins result when two separate sperm fertilize two separate eggs.

Ultrasound done in the first trimester and early second trimester can usually help determine if the babies are fraternal or identical. If the babies are different genders, they are definitely fraternal.

Many identical twins share one placenta. However, some have separate placentas depending on when the embryo split into two. Sometimes, it may not be clear until birth. 

Is it more difficult to determine gender with multiples?

Fortunately, it is not more difficult to determine gender with multiples. Ultrasounds during the second trimester can usually determine gender. Of course, this is dependent on the baby’s position (this goes for single infants, too).

A noninvasive blood test will help detect the baby’s DNA to screen for Down syndrome and other chromosome abnormalities. It may also check the X and Y chromosomes and help determine gender.

What precautions should I take for a healthy pregnancy?

The risks of high blood pressure, diabetes and early delivery are higher with multiples. This means it is even more important to stay healthy during your pregnancy.

To support a healthy pregnancy, make sure you:

  • Eat well balanced meals.
  • Stay hydrated. Women who are pregnant or breastfeeding require more water to stay hydrated.
  • Exercise regularly.
  • Minimize stress and take time to relax.

Are multiples more likely to be born prematurely?

Yes, multiples are at higher risk for premature delivery. This could be due to preterm labor or a medically indicated preterm delivery. For example, twins may be delivered early due to growth problems with the babies or maternal high blood pressure (aka pre-eclampsia). Even when completely healthy, multiples are often delivered a few weeks early to increase the odds of a healthy delivery.

That said, keep in mind that most pregnancies, multiples or not, end up with healthy pregnancies and healthy deliveries. Talk to your OB-GYN about any worries or concerns you have about your upcoming delivery. Also, make sure you’re familiar with these abnormal signs you should call your doctor during pregnancy.

How do I prepare to take care of two (or more!) babies at once?

Taking care of a newborn baby can be challenging, especially for first time parents. Multiply that by two or three, and it may feel overwhelming.

Start preparing now—learn and prepare as much as you can ahead of time.

  • Read books about parenting. There are so many resources out there and your OB-GYN may have recommendations.
  • Attend parenting education classes near you.
  • Speak with friends and family who have lived through the experience.
  • Find maternal and lactation support groups near you or online.
  • Consider hiring a helper to come into the home at night or during the day for the first few months until the babies are on a regular schedule.

Hopefully you feel a little better prepared to welcome your little ones into the world! If there are still questions on your mind, talk to your OB-GYN or find an OB-GYN near you.

About the Author

Sofia Lieser, MD, is an OBGYN on the medical staff at Baylor Scott & White Medical Center – Grapevine.

We make it easy.

Healthcare doesn't have to be difficult. We're constantly finding ways to make it easy so that you can get Better and stay that way.

Better tools make it easier

We all have different healthcare needs. Handle them your way with the MyBSWHealth app. Download the app today and take a hands-on approach to your healthcare.

Text Better to 88408