Having Twins And Multiples (Including Sleep And Settling Tips)

Key Points:

1. Expecting twins or multiples increases the likelihood of pregnancy complications and demands more from the mother's body.
2. Carrying twins or multiples poses an increased risk of prematurity, low birth weight, and potential breathing, feeding, and temperature regulation issues at birth.
3. Feeding twins or multiples offers choices between breastfeeding and formula feeding with considerations for their nutritional needs.
4. Practical sleep and settling tips for twins and multiples include establishing a support system, synchronizing feeding and sleep schedules.

Expecting twins or more can be a very different experience than a ‘normal’ pregnancy when carrying one baby. Apart from the obvious, like increased size and movements, there’s also more stress on the mother’s body and greater likelihood of her developing pregnancy complications.   

Pregnancy with multiples

It’s essential to receive good antenatal care and do what you can to maintain your health. Speak with your maternity care provider about the timing of your pregnancy checks. These may need to be more frequent depending on how your pregnancy is progressing.    

Although most women experience a healthy pregnancy with twins and multiples, there is an increased risk of complications: 

1. Your body will have an increased demand for quality nutrition and extra kilojoules to support your babies’ growth. It’s not so much the amount of food you eat, but the type of foods which are important. Be mindful of what constitutes a healthy weight gain during pregnancy.
2. Make time to rest where possible and maintain good sleep hygiene. Remember, side sleeping is important when you’re pregnant to maintain healthy blood flow to your babies.
3. If you’re experiencing insomnia, think about changing your sleeping environment. Stop using your phone and computer for a few hours before you go to bed. De clutter your bedroom so it’s a calming and restful environment. Ideally, stop all sources of caffeine which can have negative health consequences during pregnancy.
4. Be mindful there is an increased risk of pregnancy complications when carrying twins/multiples e.g. miscarriage, twin to twin transfusion, pre eclampsia and high blood pressure as well as gestational diabetes.

Birth

Where you give birth will depend on what maternity services are available to you.  Private hospital fees are only covered by private health insurance and there are often ‘out of pocket’ expenses. 

Public maternity hospitals are covered by Medicare. Speak with your maternity care provider about what options are the most suitable for you and your babies.

At birth, there is an increased risk of:

1. Prematurity – twins are more likely than singleton babies to be born before 37 weeks of gestation.
2. Having babies with a low birth weight – being small for gestation age (SGA).
3. Babies having breathing and feeding issues.
4. Babies with problems maintaining their temperature and/or blood sugar levels.
5. Babies needing special or intensive care.

Feeding

You have choices about how you feed your babies. Although breastfeeding is the preferred and most natural way to feed babies, it’s not suitable for all women. If you can, offer your babies at least some breastfeeds, at least in the first few weeks of life. 

Colostrum, the first milk produced by a mother’s breasts is very high in fats and has important immune properties. This helps babies to build immunity and establish their own gut microbiome. 

If you choose to formula feed your babies, it’s important you follow the manufacturer’s recommendations exactly and sterilise all bottles, teats and feeding equipment to prevent your babies becoming unwell.  

Speak with your babies’ healthcare professional who will be able to estimate your babies’ quota (the amount of milk they need) based on their age and individual weight.

You may need to offer your babies a special formula if they were born premature or have gut or digestion problems.

Practical tips for settling twins and multiples to sleep

Nat is a sleep and settling expert at Nourish Baby and sister organisation Safe Sleep Space and has supported families with babies for the last 15 years. Amongst her many specialties, Nat’s an expert when it comes to settling multiples. Read on to learn some of her insights into what helps when settling multiple babies. 

Nat’s top ten sleep and settling tips  

1. Make sure you’ve got a support system set up with your partner and family/friends.  Creating clear communication within this support network will be significantly helpful. Organise a communication pathway with apps or a communication book, especially in the early days to record feeds and sleep.  This will help other caregivers to know what your babies are up to.
2. In the early days especially, focus on getting your babies’ feeding schedule sorted. Work out which is the more sensitive or trickier twin to settle. Aim to feed within 30 minutes of each other - this will help you and your partner to get more continuous, unbroken sleep.
3. Once you’re home, always follow the safe sleeping guidelines when settling your babies.  
4. Try working around the more sensitive twin’s schedule, but be prepared for this to change. If your babies are going into the same room, allow your calmer baby to have some more quiet time so you can focus on the more unsettled baby.
5. Aim to synchronise your babies’ feeds and sleeps. Have this as a goal even if, in the early days, there’s lots of flexibility. Go gently, especially in the first six weeks or so and be realistic. Aim to feed your babies within 30 minutes of each other and settle them to sleep within 15 minutes of each other.
6. At night when one twin has woken and fed, gently wake the other one for a feed. This can help with the same timed care.
7. If you have a more settled twin who is napping well and is settled overnight, it could work to separate your babies briefly so you can focus on the one who’s more wakeful and unsettled. Move the settled twin into your room and focus on the more wakeful one who’s in their existing room. Check here for information about room sharing.
8. Provide consistent sleep messages so your babies know it’s sleep time. Use swaddles, sing a song, darken the room - provide your babies with two or three messages so they learn when it’s time for sleep.
9. Aim to create small changes over a longer period of time than big changes quickly.  Creating neural pathways takes time, sensitivity and gentle consistency.
10. Importantly, look after your own needs -from this everything else will follow. Be kind to yourself, your partner and your babies and remember, you’ll all be learning together.

Key messages about twin and multiples

1. There’s an increased risk of mental health issues, such as depression and anxiety, for women who did not expect to conceive with more than one baby. Self care is important.
2. Twins and multiples are more likely to be born premature and need intensive or special care.
3. Synchronising multiple babies’ cares can be very helpful with their management.
4. It’s more realistic to aim for small changes at a time, rather than big changes quickly. Consistency and persistence can make a big difference when it comes to feeding and settling management. 

For more information check Nourish Baby or to book a sleep and settling phone consultation visit Safe Sleep Space.   

About the Author: Jane Barry - Your Health Content Expert

Jane Barry is a registered nurse, midwife, and child health nurse with a passion for combining clinical expertise and writing. She has nearly 30 years of specialist experience in child health nursing and holds a Bachelor's Degree in Applied Science (Nursing). Jane specialises in women’s health, parenting, pregnancy, babies and maternity care, child health, nutrition, feeding, teething, and dental health issues.

An active member of AHPRA, The Australasian Medical Writer’s Association, Health Writer Hub, and the Australian College of Children and Young People’s Nurses, Jane Barry delivers health content with professionalism and clarity.