20 to 23 weeks pregnant with twins or multiples

If you were carrying a singleton, this is probably around the time when you’d be having your second trimester ultrasound. Since you’re carrying twins or multiples, you’ll probably have been having more frequent ultrasounds already, and if you have one coming up, it may not feel quite as out-of-the-ordinary as it would have otherwise.

Over the next month, your babies, who are already practicing breathing with amniotic fluid, may start to produce the meconium that will fill up their first dirty diaper, and will be starting to store fat under their skin to help them regulate their own temperatures once they’re born. During this time, it can be helpful to check in with your healthcare provider to make sure that you’re hitting your weight targets, since multiples are often born early, and having an on-track birth weight can help make them healthier and stronger as they come into the world.

Tips for twins or multiples in the twentieth week

As your bump continues to grow, you may want to look into getting a support band if you start to experience pain in your back or groin. The band will help redistribute the weight more evenly, which can be helpful in any pregnancy, but can be especially useful with the extra weight that comes with a twin or multiple pregnancy. Another way to get some relief from this extra weight is to find opportunities to spend some time in the water. Swimming, or just relaxing and floating in a pool or natural body of water, is a great way to take a break during the coming weeks.

Planning ahead

It’s always a good idea to think about a birth plan that will make you feel as comfortable as possible as you move toward delivery. When you’re carrying twins or multiples, it’s also helpful to go into delivery knowing you may need to be flexible. While it is possible to deliver twins vaginally in some cases, there is a much higher chance that a C-section will be medically necessary in a twin or multiple pregnancy because of complications. Complications may also mean that an early delivery is the safest option, so it can be helpful to talk through possible complications with your healthcare provider ahead of time.

Sources

• American College of Obstetricians and Gynecologists. “Multifetal gestation: Twin, triplet, and higher order multifetal pregnancies.” National Guideline Clearinghouse. U.S. Department of Health and Human Services, May 2014. Retrieved January 25 2018. https://www.guideline.gov/summaries/summary/48025/multifetal-gestations-twin-triplet-and-higherorder-multifetal-pregnancies.
• Stephen T. Chasen, Frank A. Chervenak. “Twin pregnancy: Labor and delivery.” UpToDate. Wolters Kluwer, December 2017. Retrieved January 25 2018. https://www.uptodate.com/contents/twin-pregnancy-labor-and-delivery.
• Richard A. Ehrankranz, Mark A. Mercurio. “Periviable birth.” UpToDate. Wolters Kluwer, December 2017. Retrieved January 25 2018. https://www.uptodate.com/contents/periviable-birth-limit-of-viability?search=viability%20milestones&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2.
• William Goodnight, Roger Newman. “Optimal nutrition for improved twin pregnancy outcome.” Obstetricians & Gynecologists. 114(5): 1121-1134.
• Atsushi Kuno, Masashi Akiyama, Toshihiro Yanagihara, Toshiyuki Hata. “Comparisons of fetal growth in singleton, twin, and triplet pregnancies.” Human Reproduction. 14(5): 1352-1360. https://academic.oup.com/humrep/article/14/5/1352/766210.
• http://www.mfmsm.com/media_pages/MFM-Optimal-nutrition-for-improved-twin-pregnancy.pdf.
• Kenneth J. Leveno, J. Gerald Quirk, Peggy J. Whalley, Robert Trubery. “Fetal lung maturation in twin gestation.” American Journal of Obstetrics and Gynecologists. 148(4): 405-11. March 1984. Retrieved January 25 2018.
• Mayo Clinic Staff. “Twin pregnancy: What multiples mean for mom.” Mayo Clinic. Mayo Clinic, December 13 2014. Retrieved January 25 2018. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/twin-pregnancy/art-20048161.
• “FAQ: Multiple pregnancy.” American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists, July 2015. Retrieved January 25 2018. https://www.acog.org/Patients/FAQs/Multiple-Pregnancy.
• “Tracking your weight, for women who begin a twin pregnancy at a normal weight.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Retrieved January 25 2018. https://www.cdc.gov/reproductivehealth/pdfs/maternal-infant-health/pregnancy-weight-gain/tracker/twins/normal_twin_weight_tracker__508tagged.pdf.
• “Twin pregnancy obstetric care guidelines.” Brigham and Women’s Hospital. Brigham and Women’s Hospital, June 28 2016. Retrieved January 25 2018. http://www.brighamandwomens.org/Departments_and_Services/obgyn/Services/twin-pregnancy/twin-pregnancy-obstetric-care-guidelines.aspx?sub=6.