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Resources Centre / Twins Tips Introduction / Twins Tips / Twin Pregnancy Week by Week Calendar
Twin Pregnancy Week by Week Calendar
If you've just found out you're pregnant with twins, here's our week by week guide to the key stages of your twin pregnancy, your twins development and guidance on what to expect during your 1st trimester, 2nd trimester and 3rd trimester.

Pregnancies are dated from the date of your last period, so for the first two weeks you are not actually pregnant! However, your babies will be conceived by the end of the second week. During the third week, you will actually be pregnant! You will not know that you are pregnant yet because you have not yet had a missed period. However, so much is going on inside of you at this time! Your babies are developing quite rapidly. During this time, the baby's brain, bladder, liver, kidneys, spine, extremities, reproductive tracts and heart are all beginning to develop. By week four, you should be expecting your period to arrive. If you take a test now, you might get a positive sign!

You are 4-8 weeks pregnant

You may just be finding out that you are pregnant. Congratulations! Many women are shocked to find out that they are carrying twins! By four weeks, your developing twin babies will show up on ultrasound as two little gestational sacs. Although you cant see it on ultrasound until around week 6, the amniotic fluid and embryo are inside the entire time. Your babies are developing quite rapidly. During this time, the baby's brain, bladder, liver, kidneys, spine, extremities, reproductive tracts and heart are all beginning to develop. The first time your twins are visible on ultrasound, they will be about 2-3 mm long-which is less than a grain of rice. However, by week 7 and 8, each baby is about the length of two grains of rice. Cardiac activity can also be seen by ultrasound although you may not have a scan until you are 12-16 weeks, unless you have received fertility treatment when you may have an early blood test and scan to confirm your pregnancy.

You might be noticing a great change in your appetite. This is one of the first signs of a pregnancy. Most women will experience an increase in their appetite between weeks 4 and 6. It is perfectly normal and may continue for the rest of the pregnancy. Because you are carrying twins, you should listen to what your body is telling you and eat accordingly, you dont have to eat for three but a woman expecting twins has about one and a half times the calorific need of those that carry single pregnancies, thats about 600 additional calories per day.

It is also very normal to feel tired, or just plain exhausted at this point. Your body is working overtime to produce two healthy babies. You should try to get extra rest at night and rest as much as possible throughout the day. Eating a healthy diet and participating in light exercise will help.

An increased frequency of urination is a common complaint early (and throughout) pregnancy for most women. The uterus is beginning to grow and put pressure on the bladder, therefore making it hold less urine than normal and sending you to the restroom more frequently. If you experience burning or pain during urination, contact your GP.

Morning sickness and nausea may be worse with a multiple pregnancy. Although it rarely becomes serious, it can be frustrating. Nausea and vomiting can happen at any time of the day. Eating frequent, small meals should help ease your stomach. Many women also experience a heightened sense of smell and may experience an aversion to certain smells and tastes.

A twin pregnancy seems to cause more heartburn, and does so earlier in the pregnancy. This is because your uterus is larger. Antacids will help with heartburn symptoms for most women. Rather than lying down after a meal, take a short walk or sit straight up for a while to aide in the digestion of your food. You may also notice that you feel constipated. Drink lots of water and increase your fibre intake.

Many women experience nosebleeds and stuffiness during pregnancy. This is because the mucus membranes in your body have an increased blood supply. The increase in blood can make the mucus membranes in the nose become swollen and secrete additional mucus. Many pregnant women also experience a sensation of breathlessness. The feeling will get worse as the pregnancy progresses. It is normal to have an increased heart rate. This is from an increase in blood supply and decrease in blood pressure.

Breast tenderness is a common symptom of early pregnancy. Breast tenderness and swelling seem to increase in women who are expecting twins. You may also notice a darkening of the areola-the circle around the nipple on the breast. Support your breasts properly during pregnancy.
<>First Visit to Doctor<>
During your first visit with your doctor you will normally be attending to confirm you are pregnant. Address any questions or concerns that you have, you may find it useful to write these down before your visit. They may also do some tests: including:

1.)Blood pressure and vital signs
2.)Physical exam-heart, lungs, breasts, abdomen, and pelvic
3.)Family history questionnaire
4.)Urine Sample
5.)Blood samples

You are 8-12 weeks pregnant.

The embryonic period will be over after week 12 and the embryological structure is complete. Your developing twins still have a tremendous amount of developing to do. Their kidneys, intestines and extremities are developing rapidly. At 8 weeks each baby is approximately four centimeters long and weighs about one gram. By twelve weeks they will have more than doubled to be about nine centimeters long and has grown to about 20 grams!

During this time of your pregnancy you will still most likely notice changes within your appetite. You may be noticing more cravings or aversions to certain types of foods or smells. Many researchers believe that a craving is the body's way of trying to obtain something that you are lacking. Some women crave salt and need the sodium, while others crave spinach for the extra iron.

Mild anaemia is not uncommon during pregnancy, especially when carrying multiples. This is because your body's blood supply has increased dramatically to support the growing babies and your red-cell production has decreased.

Around this time of a pregnancy, many women report a change in sexual desire. Most women report a decrease in their libido during the first trimester. This can come from nausea, breast tenderness, and the increased pressure on the bladder. However, some women also report an increased desire for intimacy. Both partners should be reassured that sex is perfectly safe during a pregnancy with multiples. The babies are well protected and you cannot harm them.

You may also notice some changes in your complexion. Some women may experience the pregnancy "glow". The increase in blood creates a look of radiance, but also makes your skin more sensitive to skin care products. It is important to take care of your skin during pregnancy. Bleeding gums is a common complaint throughout the pregnancy. Again, this is due to an increased blood supply which will cause the gums to swell. The bleeding should not be cause for concern. Just be gentle when brushing and flossing.

Most pregnant women worry about stretch marks. Stretch marks are a natural and sometimes unavoidable consequence of skin that is stretching for the growing babies. It is best to accept the fact that stretch marks may occur. After delivery, the stretch marks will generally fade away and become less noticeable. You can keep your skin well moisturized and use Vitamin E creams to help with the marks and itching.

<>Typical Symptoms 1st Trimester<>

Breast tenderness
Breathlessness
Constipation
Fatigue
Frequent urination
Increase or decrease in saliva
Increased heart rate
Leakage from nipples
Morning sickness
Nasal stuffiness
Change in sexual desire
Bleeding gums
First Antenatal Visit

This may be your first visit to your consultant and/or midwife and at this stage they will be going over information regarding your pregnancy. You will go back to the midwife to start your routine prenatal visits. If you have any questions regarding your pregnancy, this is the time to bring them to your consultant/midwifes attention. Your consultant may classify your pregnancy as high risk, because you are carrying multiples. Some consultants will do an ultrasound assessment to check the babies well-being. You may also be offered certain tests which are optional and you can discuss the pros and cons with your consultant.

Your consultant/midwife may check the following during your visit:

1.)Weight gain or loss
2.)Blood pressure, pulse and respiratory rate
3.)Heart and lungs
4.)Breast exam
5.)External palpation of the uterus
6.)Measure the height of the uterus
7.)Check for fetal heartbeat
8.)Urine screens for blood, sugar and any bacteria

You are 12-16 weeks pregnant.

By twelve weeks, your once called embryo is now called a foetus. At twelve weeks each of your developing babies will weigh approximately 20 grams. At the beginning of week 13, each of your twins will resemble the familiar tadpole looking image! Although the babies do not have any obvious organization of movement yet, if seen on ultrasound you will notice reflexive motions. By 16 weeks the twins will each weigh around 120 grams! What amazing growth! They will also reach a length of about four inches long. By sixteen weeks, the developing twins can swallow and the kidneys begin to operate. The production of urine by the fetus contributes to the amniotic fluid. Your babies are now beginning to show some control over its environment.

In most pregnancy, nausea should be diminishing or may even be completely gone. You should be enjoying a hearty appetite. At times you may feel ravenous and that is okay. Follow the dietary guidelines that your caregiver has given you and enjoy nourishing your babies!! If you are still experiencing cravings, that is fine, but do discuss any extreme cravings with your doctor. You may need an additional supplement or vitamin.

Vaginal discharge that is white and creamy in texture is common and should not be cause for concern. Any discharge that is any color besides white or is associated with other symptoms should be reported to your caregiver.

You may notice that you are not getting as much sleep as you are used to. Your sleep can be disturbed by the need to urinate, increased dreaming, heartburn or other reasons. Find a comfortable position and try to get as much rest as possible. It is hard work to carry a twin pregnancy and you need to be fair to your body and let it rest often.

Many women complain of an increase in headaches. If you experience severe and/or frequent pain, you should report it to your caregiver. Do not take any type of pain reliever without the consent of your caregiver. Try a relaxing bath, calming music, eating and drinking often, rest in a darkened room or a soothing compress over your eyes. Hormone production may cause migraine headaches. Many environmental, food, hormonal and lifestyle triggers cause migraines. Avoid air pollution, smoke, fumes, bright lights, alcohol, aspartame, caffeine, chocolate, dairy products, fatty foods, MSG, nuts, and physical exertion. Depression, stress and anxiety can also lead to migraines.

At this point of the pregnancy, maternity clothes are probably a must. You may be outgrowing your pants as your waistline expands. Mums of multiples experience this earlier. Maternity bras are very important also. Purchase or borrow clothes that will last the entire pregnancy.

Swelling of the feet is a common complaint also. The extra weight in your abdomen has the effect of increasing the curve of your spine. Wearing athletic shoes and propping your feet up throughout the day should alleviate discomfort.

Ongoing Symptoms

Increase or decrease in saliva
Anemia
Food cravings
Increased heart rate
Constipation
Leaking from nipples
Nasal stuffiness
Breast tenderness
Bleeding gums
Heartburn
Breathlessness
Sensitivity to sun
Change in sexual desire
Fatigue
Stretch marks

Your doctor will be assessing many factors of the pregnancy at this checkup. Address any questions or concerns at this time. You may have an ultrasound to assess the babies condition. Your caregiver will most likely offer you the AFP test to check for abnormalities as well as carry out the routine tests outlined above.

You are 16-20 weeks pregnant.

Congratulations on the halfway point of your pregnancy! Your babies are continuing to grow at an amazing rate! By week 20, each baby will be a 7.5 inch person! This is a magical month for you as most women will feel the foetal movements now! Both babies are responsible for producing their own amniotic fluid now, whereas the placenta was doing it before. The membrane between the two babies is very thin but can be seen clearly on ultrasound. Although they can not see or hear yet, researchers believe that the babies have knowledge of each other at this point. Each foetus has the appearance of a very little baby and their movements are becoming more coordinated. Most of the development is now complete; however, the babies still need to grow and the systems will still mature. The lungs and brain will continue to develop throughout the pregnancy.

You more than likely can not hide the pregnancy anymore, even if you tried! Strangers can tell that you are obviously pregnant. Your uterus is much larger than a woman with a single pregnancy. This is because your uterus has to stretch more for the extra passenger(s)! If you have not bought maternity clothes, its time to do so or raid your husbands wardrobe!!

More than likely you are in the honeymoon part of your pregnancy. Nausea and vomiting are a thing of the past, your appetite is probably great, and you are likely to have more energy! But, you will also be experiencing new symptoms. Round ligament pain feels like a sharp pain in a precise location on one side of your stomach. It is usually between the hip and navel. The pain is generally brought on by movement, but can occur from nowhere also. It is caused by the stretching of the uterus and ligaments that support the uterus. It is a normal pain of pregnancy and will most likely resolve on its own within a few minutes.

<>Ongoing Symptoms 2nd Trimester<>

Change in sexual desire
Fatigue
Sensitivity to sun
Constipation
Breathlessness
Hearty appetite
Sleep changes
Heartburn
Swelling feet
Vaginal discharge
Nasal stuffiness
Spine curving from added weight
Bleeding gums
Anemia
Increased heart rate
Pregnancy glow
Larger abdomen
Headaches
Stretch marks
Decrease in urination

To Think About This Month

  • Birthing options
  • Finding out sexes of the babies
  • Work plans after pregnancy
  • Discuss travel options with your consultant
  • Antenatal Clinic 2nd Trimester
As always, discuss any questions or concerns with your consultant/midwife at this time. Your consultant will be discussing the results from any prior screening tests. You will be discussing the ultrasound process and amniocentesis, if needed. They will also be checking:

1.) Weight gain
2.) Blood pressure, pulse, respiratory rate
3.) Heart and lungs
4.) Breast exam
5.) External palpation of the uterus
6.) Measure height of fundus
7.) Check fetal heartbeat
8.) Urine screen for blood, sugar and bacteria
9.) Ultrasound assessment
10.) Pelvic exam

You are 20-24 weeks pregnant.

At 20 weeks, each of your babies will weigh approximately one pound! By 24 weeks, they will have gained another half pound and will be approximately 12 inches long! The babies are continuing to grow and have produced some fat under the skin. Lanugo-soft, furry hair-covers their skin and you will most likely notice this at birth. The babies are also starting to be covered with a cheesy substance called the vernix caseosa coating. The twins are in constant contact and kick and nudge at one another for space. The membrane that separates them still is amazingly elastic! Every joint in their bodies are flexed. The chin is at the chest and their elbows are tucked at their sides. Their legs are often brought up to their chest and the feet are tucked under their bottoms. On ultrasound, you will often see that they like to have their hands up near the face. During periods of awake time, they will stretch out and move around.

You should be feeling your babies move around every day. You might not be able to tell which one is which though. You may only be able to feel it one side occasionally and that is OK. It may be that both sets of legs are stretching out in the same direction.

Edema is not uncommon during any pregnancy, especially when carrying multiples. Sometimes the extra accumulation of fluid can cause carpal tunnel syndrome. This is a tingling or numbness in part of the palm and fingers caused by excessive compression of the bones and nerves. If you are experiencing this, try to rest as much as possible and drink lots of water. Symptoms usually go away after delivery.

You may be noticing that you are warmer than everyone else in the room. Your resting metabolic rate is increased during pregnancy and causes you to feel overheated. It does not mean you have a fever. Drink extra fluids to replace any fluids that you are losing through perspiration.

Many pregnant women also begin to experience leg cramps at this point of their pregnancy. It can be a sudden and extremely painful feeling. Because you are carrying multiples, you are at increased risk for experiencing leg cramps. You are carrying extra passengers and they can be very greedy when it comes to getting the mineral they need for good nutrition. You may be suffering from a shortage of calcium. Ask your midwife to help you find a way of getting enough for your and your babies.

It is not uncommon for mothers of multiples to go into premature labour. Pay close attention to any changes in your pregnancy and inform your midwife at once if you experience any signs or symptoms of early labour.
Ongoing Symptoms

Nasal stuffiness
Sensitivity to sun
Bleeding gums
Constipation
Round ligament pain
Leg cramps
Anemia
Leakage from nipples
Glow of pregnancy
Change in sexual desire
Hearty appetite
Sleep changes
Expanding uterus
Fatigue
Headaches
Heartburn
Swelling feet
Stretch Marks
Spine curving
Vaginal discharge
Decrease in urination

To Think About This Month

  • Obtaining baby care essentials
  • Birth preparation classes (multiples-specific if possible)
  • Birthing options and plans
  • Work arrangements if not already done
  • Childcare arrangements if needed
  • Antenatal Clinic
You should be very comfortable discussing concerns with your doctor at this point. It is important to share your feelings and questions with them. Make sure to keep your doctor informed on your lifestyle and any changes that are occurring. If you have not had a 20 week diagnostic ultrasound performed, you will most likely be receiving that as well. Your doctor will be reviewing the results of any tests you have had performed. Your doctor will probably be going over the signs of preterm labour and giving strict instructions on when to call if needed.

You are 24-28 weeks pregnant.

You have encountered a magical point in your pregnancy. Around 24 weeks, the babies will enter the stage of viability. If born now, there is a 90% chance of survival with medical intervention. During these four weeks, the babies will double their weight and by week 28 each baby will weight around 3 pounds and will be around 15 inches long. Fat is developing rapidly under the skin and the babies are beginning to get more pigment in their skin. Hair continues to grow and facial features are becoming more distinct. During this month your babies' eyelids will become unfused. If observed on ultrasound, you can see your baby opening and closing their eyes. Each baby is already very individual and has their own cycles of sleep and wakefulness. Babies will begin to respond to sound during this month. Turn on the music and read to your babies each day.

By 28 weeks you are likely to feel the affects of pregnancy. You will be feeling very heavy and the weight of the pregnancy is probably starting to affect your back and legs. The pressure of your growing uterus can also cause backaches. You may experience relief when the babies change their positions. As the babies move down into your pelvis, you will experience pelvic pressure and increased pressure in your rectum. You will notice an increased urge to urinate more frequently. This urge will remain for the rest of the pregnancy.

You should be feeling movements from each baby every day. The intensity of their kicks and movements may be changing around this time. There is not room for them to move around as much anymore, so you may not feel as strong of movements.

Because you are carrying multiples, expect to experience a lot of Braxton Hicks contractions. A Braxton Hicks contraction is a contraction of the uterus and feels similar to a menstrual cramp. Typically, they are not painful but will make your belly feel hard. Sometimes a change in position will trigger a Braxton Hicks contraction. Unlike true labour contractions, there is no pattern to a Braxton Hicks contraction.
<>To Think About This Month<>
  • Be aware of symptoms of preterm labour
  • Obtaining baby care essentials
  • Finding care for your other children
  • Limiting physical activity
  • Accepting help from others
  • Antenatal Visit
You will probably be visiting the doctor every two weeks by this point. Make sure you address any questions or concerns to your caregiver. Make sure that you have asked your doctor about any physical activities and sexual intercourse at this point of your pregnancy. You will be screened for group B streptococcus around this time. You will also have a glucose tolerance test at this visit. The glucose tolerance test will check to see if you have gestational diabetes. In addition to these tests, your caregiver will be checking:

1.) Weight gain or loss
2.) Blood pressure, pulse and respiratory rate
3.) Heart and lungs
4.) Breast exam
5.) External palpation of the uterus
6.) Measure height of fundus
7.) Fetal heartbeat
8.) Urine screens for sugar, blood and any bacteria
9.) Possible ultrasound assessment

You are 28-32 weeks pregnant.

By the end of the 32nd week, each baby will weigh approximately four pounds. Actually, twins are tracking along the same rate as singletons at this point of the pregnancy. You should be familiar with their patterns of movement, although it is not as strong. It is difficult to determine which baby is which. Some mums can feel when their babies have the hiccups. This is very normal and should not be a concern. The babies are putting on a lot of fat now, which is necessary after birth to regulate temperature. During this month, the head will be more in proportion to the body. With the exception of the lungs, all organs and systems are operational.

At this point, fatigue is very pronounced. Listen to your body and rest when you can. Even if you can not actually sleep, try to prop your feet up and allow your body to rest. Breathlessness may also be worse now. Your uterus is taking up an incredible amount of room in your diaphragm. Sitting up straight may help some with this problem.

Backache is becoming worse also. Pay attention to any new or unusual aching in your back-it could be a sign of preterm labour. A nice, warm bath can help soothe the discomfort of a backache. Do not sit in a Jacuzzi or use hot water, though.

If you spend a lot of time standing up or sitting down, hemorrhoids are likely to be a problem. To avoid constipation that could make the hemorrhoids worse, continue to eat a balanced diet and drink plenty of water. Cold packs and sitz baths may offer some relief.

Typical Symptoms 3rd Trimester
Nasal stuffiness
Bleeding gums
Breathlessness
Changes in appetite
Change in sexual desire
Leg cramps
Edema
Overheating
Fatigue
Carpal tunnel syndrome
Sensitivity to sun
Constipation
Increased heart rate
Leakage from nipples
Fetal movements
Heartburn
Stretch marks

To Think About This Month

  • Childbirth classes
  • Obtaining baby care essentials
  • Celebration - Baby Shower
  • Packing necessary hospital items

At The Doctor

Many women wonder what position their babies are in at this point of the pregnancy. This is the time to find out how your babies are positioned and make any necessary corrections or arrangements. Babies still can turn at this point, but they are running out of room to do so. Talk to your doctor about any Braxton Hicks contractions you may be experiencing. Your doctor will also make sure you are getting an ample amount of rest. Your doctor may find it necessary to do a pelvic exam to check for any dilation of the cervix. Some caregivers do a biophysical profile to assess the babies condition. Aside from answering any questions or concerns you have, your doctor will also be checking:

1.) Weight
2.) Blood pressure, pulse and respiratory rate
3.) Heart and lungs
4.) External palpation of uterus
5.) Measuring the fundus
6.) Fetal heartbeat
7.) Breast exam
8.) Urine screens for sugar, protein and any bacteria
9.) Possible ultrasound assessment

You are 32-36 weeks pregnant.

This is the month that a multiple pregnancy will be so much different than that of a single pregnancy. The babies are not able to grow as much now as there is simply not enough room. However, they are relying on their mother's nutrition to help them put on the final layer of fat. Each baby will weigh around 5 pounds by the 36th week. If your babies are born now, they may need to spend a little bit of time in the intensive care unit until they reach a healthy weight to go home. Babies that are much smaller than 5-6lb may have a hard time regulating their own body temperature and will have to stay warm inside special baby beds called incubators. While still in the womb though, the babies lungs are beginning to produce surfactant, which will help the babies lungs to expand for their first breath. The placenta is still functioning well and nourishing the developing babies.

Your babies will be checked to make sure that they are in the head down position, which is needed for optimal delivery. The positions that the babies are in at this point are not likely to change before delivery. Your hips may feel like they are spreading and the diameter of your pelvis has probably increased a little by this time. The cramped uterus does not allow for intense fetal movements, but you should still feel subtle movements. Your extremities may swell more at this time, so it is important to get your feet up as often as you can.

Braxton Hicks contractions may be very frequent now. If you are experiencing more than four contractions in an hour, call your practitioner. Even if the contractions are not painful or intense, you could be experiencing preterm labour. Due to increased urination, vivid dreams, anxiety and difficulty finding a comfortable position, you may be having a hard time sleeping. It is important that you rest as much as possible during these last few weeks. Appetite may decrease because your uterus is increasing and your stomach is left with limited space. Make sure that you are drinking lots of fluids.

To Think About This Month
  • Packing necessary hospital items
  • Obtaining baby care essentials
  • Install car seats in car
At The Doctor
Your doctor may set a date for your delivery if you need a caesarean section delivery. Otherwise, you will wait until your water breaks or you start dilating and having contractions. Your doctor will be doing pelvic exams to see what type of progress your cervix is making. As any questions about the upcoming delivery. Many women will deliver their babies around this time, while others will remain pregnant a little while longer. Your doctor will be checking the same things he has previously checked. At this point you will be monitored for any labour signs-dilation, effacement, contractions, water breakage, etc.

You are 36-40 weeks pregnant

If you make it this far, WELL DONE! Almost all mothers carrying multiples will have delivered by this time as it is a fact that mothers carrying more than one child generally do not remain pregnant as long as those women carrying one child. If you're still hanging in there, at this point of the pregnancy, you probably are feeling a great sense of being "done" with the pregnancy. Try to enjoy the last week or so, as you will soon miss the feeling of being pregnant...no really, you will!

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