Ovulation: Signs, Symptoms and How to Know

Are you feeling as if you’re extra pregnant? If you’re experiencing extremely strong symptoms, you may be wondering if it’s a sign that you are pregnant with twins. After all, we all know that nausea and fatigue are normal, but should you really feel this bad?

Although there’s only one way to be certain whether or not you’re expecting twins – by having an ultrasound scan  – there are some symptoms that could suggest there’s more than one baby in there.

Some mothers with a twin pregnancy say they had a feeling from the very start that they were expecting more than one baby. However, others are surprised to discover that they’re having twins.

Although there are some signs you are pregnant with twins, there can also be a lot of overlap with the symptoms and signs of a singleton pregnancy. It isn’t possible to know definitively whether you’re going to have more than one baby by just judging from the symptoms. Only an ultrasound scan can confirm whether you’re having one or more babies.

Nevertheless, it’s often exciting to wonder if the signs and symptoms you’re experiencing are clues that you’re having twins. So, let’s look more closely at the possible hints that you could be having multiple babies.

Increased Morning Sickness

Some women will never experience morning sickness, while others begin experiencing nausea and vomiting from as early as the fourth week of their pregnancy. It’s the increase in hCG or human chorionic gonadotropin (the pregnancy hormone) that contributes to the feeling of nausea, and it can occur at any time of the night or day, contrary to its name!

Some women who are pregnant with twins report that they experience more morning sickness than in a singleton pregnancy, or that their vomiting and nausea lasts for longer into the pregnancy. It’s hard to establish a morning sickness baseline, though, since it varies between individuals and even between pregnancies. So how can you identify for sure whether your sickness is more extreme?

If your morning sickness continues past your 14^th week, this could be a sign that you’re expecting twins, but it could also be a sign of something else. Prolonged or exceptionally severe morning sickness is also sometimes an indicator of a condition known as hyperemesis gravidarum. If you vomit several times daily, experience all-day nausea, or have lost weight, you should consult your doctor.

Twin pregnancies do have a higher risk of this condition, but not all moms expecting twins experience bad morning sickness. Some experience no sickness at all. Therefore, there’s no guarantee, even if your morning sickness is very bad, that you’re having twins.

If nausea strikes, there are a few things you can do to relieve the sickness:

• Eat healthily. Although it can be hard to stick to a balanced diet when you’re feeling nauseated, a mix of complex carbohydrates, fat, and protein at every meal won’t just nourish you and your baby, but it will also help to regulate your blood sugar levels – a possible cause of your morning sickness.
• Support your liver. Your liver processes the toxins and hormones in your body. Often, during your first trimester, it will be overburdened. Lemon water and raw apple cider vinegar can help with this.
• Boost your digestion. Ginger can help to relieve stomach upsets and nausea. Drinking ginger tea or eating some ginger biscuits can help to reduce the feelings of sickness.
• Avoid an empty stomach. When you wake up, eat some wholegrain crackers or ginger biscuits that you left by the side of your bed last night to eat before you even get up.

Severe Food Intolerances

Women with a twin pregnancy often notice that not only do they have worse morning sickness, but they also often have a stronger aversion to specific foods. This, again, is due to hormonal fluctuations. Some common aversions include:

• Fish
• Seafood
• Green leafy vegetables
• Meat
• Coffee

It could be that changes in the way you perceive tastes during pregnancy are the cause of food aversions. There is also a theory that suggests food aversions could be protective for developing babies. Whatever the reason you’re suddenly turned off by the idea of eating a tuna sandwich or drinking your usual cup of java in the morning, it’s probably a good idea to avoid those foods.

Instead, eat mild-tasting, healthy foods that you feel able to tolerate like avocados, broth, smoothies, bananas, and oats. There’s no need to be worried or stressed. These food aversions will usually pass in a couple of weeks, so you can eat plenty of nutrient-rich foods later in your pregnancy.

Extreme Fatigue

One of the earliest signs of pregnancy is fatigue. In fact, you may begin to experience exhaustion even before you’ve missed your first period. Higher hormone levels, together with increased urination and sleep interruptions can make it hard to get quality rest.

However, there’s no way of knowing for certain whether the fatigue you’re experiencing means you’re pregnant with one or two babies. If you feel extra tired, you should try to get plenty of rest, perhaps by taking more naps, making your bedtime earlier, or by making your sleeping environment more restful.

When women are pregnant with multiples, they often report extreme fatigue. Lethargy, exhaustion, and sleepiness in the first 12 weeks are often greater since the body is working extra hard to nurture two babies. Sometimes, the exhaustion is due to other factors such as poor nutrition, stress, working, or having to care for other children, but it could also indicate a multiple pregnancy.

It is, though, hard to assess whether the fatigue you’re experiencing is especially extreme. Even singleton pregnancy causes tiredness. If you’re a first-time mom, you won’t have a reference point of what a “normal” amount of tiredness during pregnancy is. While second-time moms may think they’re feeling more tired, they may attribute it to the demands of caring for other children while pregnant. So, like nausea, fatigue is quite a subjective symptom with several potential culprits.

If you’re feeling exhausted, here are some tips to try:

If you’re at work, try to take a nap in your lunch break

• Try going to bed earlier at night, even as early as 9 pm
• Try deep breathing if you’re struggling to sleep
• Eat a healthy diet to boost your energy level
• Stay well-hydrated. Lack of fluids can make you feel extra tired
• Take a walk. You should try to walk for 20 minutes each day to boost your energy levels

Increased Need to Urinate

It’s relatively common to need to urinate more frequently during early pregnancy. However, with a twin pregnancy, you’ll experience an even greater need to use the bathroom because of the larger amount of hormones in your body. The increased urination symptom is caused by the increased hCG levels in the body, which are higher in a multiple pregnancy.

If your increased urination is causing a problem, try these tips:

• Try drinking fluids earlier and stop drinking a couple of hours before you go to bed
• Avoid drinking any diuretic beverages. These include coffee, seltzer, and tea. Instead, try to drink more electrolyte hydrating drinks such as plain filtered water, broth, or coconut water
• With every pee, learn forward to completely empty your bladder. Also, wait for a few seconds before getting up off the toilet to ensure your bladder has been completely emptied

A Higher Resting Heart Rate

In pregnancy, your basal metabolic rate will increase so your baby can be supplied with nourishment. This also causes your rest heart rate to increase too. The normal heart rate when resting is about 70 beats per minute. In pregnancy, that usually increases to around 80 to 100 beats per minute.

In a twin pregnancy, your heart rate may become even higher. If your heart reaches over 100 beats per minute, you may be diagnosed with tachycardia. This is frequently considered to be normal when you’re pregnant, so you don’t have to worry, however you should get it monitored by your doctor or midwife.

Although you can’t really do much to prevent your heart from beating so fast, you may find it helpful to add stress-reducing measures into your life.

Some ways of keeping your body calm can include:

• Not allowing your body’s blood sugar levels by snacking regularly and eating well-balanced meals
• Practicing meditation, visualization, or deep breathing
• Avoiding any high-stress environment such as traffic jams, walking in busy streets, or rock concerts
• Using therapeutic herbs like lavender to help you stay calm

Mood Swings

As soon as your fluctuating hormones kick in, you’ll find mood swings aren’t far behind! When you have a twin pregnancy, you may find that you are even more moody because of the huge biological changes your body is going through.

If pregnancy moodiness strikes, there are a few things you can do:

• Try journaling your thoughts and feelings. You may be able to write things down that you don’t feel you could say out loud. Vent your feelings safe in the knowledge that you aren’t being judged
• Get some support from someone you trust. This could be a friend, a family member, or your partner
• Practice spirituality. This may help you to connect with peace and keep a higher perspective That can mean different things to different people. Perhaps for you, it means doing yoga or meditation, or perhaps it means going to a place of worship. Whatever makes you feel more peaceful
• Try to bear in mind those intense emotions and feelings will eventually pass, so there’s no need to be worried

Extreme Breast Tenderness

Another common indicator of pregnancy is breast tenderness. In a twin pregnancy, though, the tenderness can be extreme. This is, yet again, because of the high hormone levels in a multiples pregnancy, and because your breasts will be working overtime because they’ll soon need to support two babies instead of one.

If you’re experiencing sore breasts, here are some top tips to help reduce the discomfort:

• Stop wearing underwired, tight bras, and switch to softer, non-wired ones. A sports bra may be a good choice
• When you go to bed, wear a cotton bra to sleep in. This will help avoid the discomfort of moving in bed
• Avoid jarring your breasts, bouncing, or running until the pain and sensitivity have subsided
• If it hurts to touch your breasts, ask your partner to avoid touching them for a while

Higher hCG Levels

We’ve already mentioned that the body produces hCG during pregnancy. When you take a home pregnancy test, it is this hormone in your urine that the test detects in order to give you your positive result. Although your home pregnancy test won’t tell you precisely how high your body’s hCG level is, a blood test can.

If you’re going through fertility treatments, you might have blood taken to check your hCG levels. Your doctor will use these blood tests to establish your baseline level, and will then use those figures to see whether your numbers double in the way that they’re expected to.

Women who have a multiple pregnancy will often have an hCG count that is higher than usually expected. Although you may have a better chance of distinguishing a twin pregnancy with this kind of blood test, it’s still not an exact science. Other factors could cause a higher-than-normal blood hCG level, such as a molar pregnancy or an inaccurate due date. Also, most women don’t have these levels checked frequently anyway.

Although it isn’t possible to distinguish between a single or twin pregnancy simply from looking at your pregnancy test stick, it’s possible that your positive test may come earlier if you’re carrying twins. If you use a standard pregnancy test (rather than the super-sensitive varieties) and it shows up immediately as positive with a very dark positive indicator even before your period was due, you may have a greater chance of being pregnant with twins. Remember, though, that a dark result or early positive may just mean you’ve had less water to drink before taking the test.

An Abnormal AFP Test Result

The AFP (or alpha-fetoprotein) screening test is carried out on mothers-to-be in their second trimester. This blood test is sometimes known as multiple marker screening or maternal serum screening. It is used to identify whether there is a higher risk of some birth defects. If you have a twin pregnancy a positive, or unusually high result, can be produced. If you get a positive result, your doctor will usually schedule an ultrasound scan as an additional assessment measure.

A Second Fetal Heartbeat

When your doctor or midwife uses a fetal doppler, they may be able to hear the heartbeat of your baby from as early as 8 to 10 weeks of pregnancy. If they believe they’ve detected a second fetal heartbeat, they’ll probably arrange an ultrasound scan so they can get a clearer idea of whether you’re expecting twins.

The Doppler system uses harmless sound waves to amplify the sound of the fetal heartbeat. Usually, this can be distinguished from later in your first trimester. An experienced midwife or physician can usually detect if there is more than one heartbeat, and this would indicate a twin or multiple pregnancy.

It’s important to note, though, that listening to your baby’s heartbeat at an early stage of pregnancy can be misleading. Sometimes, what may appear to be a heartbeat from a second baby is actually the heartbeat of the same baby but heard from a different angle, or heard as an echo. It’s rare for the mother’s heartbeat to be mistaken for that of their baby, as it’s usually half the speed of a fetal heart rate. However, it can create additional background noise that makes it harder to determine whether there is only one fetal heartbeat or two.

Measuring Large for Dates

Measuring large for your due date isn’t one of the earliest signs of expecting twins, since your doctor or midwife will probably not measure your stomach until after the 20^th week of pregnancy. Usually, you’ll already have had an ultrasound scan or have one scheduled at that stage.

Some women report that they begin to show earlier when they’re experiencing a twin pregnancy. However, the stage at which a pregnancy starts to show will vary depending on the pregnancy and the woman in question. A lot of women tend to show earlier in a second or subsequent pregnancy.

During your pregnancy, your midwife or doctor will measure the fundal height. This is the length between the top of your pubic bone to the top of your uterus. This is an effective way to estimate your baby’s growth and gestational age.

A multiple pregnancy may cause your uterus to grow beyond the usual range of a single pregnancy. Yet, there are other factors that can increase the measurement too. It’s more difficult to take this measurement accurately at an early stage of the pregnancy when compared with later on, and by then, an ultrasound scan will probably have already detected that you’re expecting twins.

There may be other reasons too why you’re showing sooner or measuring larger than expected. If you’ve had a baby before, showing earlier is more common. Also, you may be carrying a large baby or may have an inaccurate due date. All of this adds up to the fact that just because you think you’re larger than you should be or are showing at an earlier stage, you may not be having twins after all.

Early Fetal Movement

One of the most exciting moments of your pregnancy will almost certainly be when you feel your baby (or babies) move for the first time. Known as the “quickening,” the first time you feel your baby’s movement may happen between 18 to 25 weeks of pregnancy. Usually, it will be felt earlier in a second or subsequent pregnancy, perhaps from 16 weeks. However, when women experience movement in the early stages of pregnancy, it can be deceiving and inconsistent.

Although some moms-to-be of twins and multiples do experience earlier or more frequent fetal movements, medical professionals disagree on this subject. For some women who are pregnant for a second time, they already know what a baby’s movement feels like and so are aware of it at an earlier point in their pregnancy. For others, what may appear to be fetal movements could actually be an upset stomach or gas.

Since the majority of mothers don’t report experiencing fetal movements until about 18 weeks, you can’t take this as an early sign of twin pregnancy either. Your baby will be moving around in your uterus from the very early days of pregnancy, but you probably won’t feel a thing until you reach your second trimester.

Of course, if there are two or more babies in your womb, it’s possible that you’ll experience movement at a slightly earlier stage than you would with a single baby, but even so, it’s unlikely to occur before you reach your second trimester.

Extra Weight Gain

Another sign that probably won’t appear until later in your pregnancy is extra weight gain due to a twin pregnancy. In the first 12 weeks of pregnancy, you’re likely to have a fairly low level of weight gain. It’s recommended that you gain around 1 to 4lbs in the first trimester. When you reach your second trimester, weight gain will occur more rapidly, whether you’re expecting one baby or multiples. If you’re experiencing weight gain more rapidly in the first trimester, you should take to your midwife or physician about possible concerns or causes.

There are some official weight gain guidelines that could help you to determine whether you’re gaining weight at a rate consistent with a twin pregnancy. These are based on your pre-pregnancy BMI (body mass index):

• If you have a BMI under 18.5 you should expect to gain around 50 to 62lbs
• If you have a BMI of 18.5 to 24.8 you should expect to gain around 37 to 54lbs
• If you have a BMI of 25 to 29.9 you should expect to gain around 31 to 50lbs
• If you have a BMI of 30 or higher you should expect to gain around 25 to 42lbs

If you’re suffering from morning sickness, though, you may not gain weight, or even lose some, during your first trimester. If you’re worried for any reason about your weight during pregnancy, it’s advisable to speak to your doctor to alleviate your concerns.

A Gut Feeling or Hunch

Although the other items we’ve already mentioned are all relating to visible evidence such as an abnormal test result, exaggerated symptoms, or increased morning sickness, it’s fair to say that the mother’s intuition shouldn’t be completely overlooked. Some mothers-to-be have a dream that they’re having twins, while others just have a gut feeling that they simply can’t explain. It’s true that, in some cases, women know they’re having twins long before they have it confirmed by their doctors.

Which Characteristics Increase the Chance of a Twin Pregnancy?

Although sometimes twin pregnancies just happen naturally, there are a few characteristics that make it more likely that you’ll become pregnant with multiples. These include:

• Undergoing fertility treatment – with the arrival of effective hormonal fertility treatments like IVF (in vitro fertilization), more twin births have taken place. This is because of the stimulation of the ovaries that is part of the process that encourages them to release multiple eggs at once.
• A greater maternal age – once you reach the age of 30, you become more likely to release multiple eggs during each ovulation.
• A family history – if you have the twin gene in your family, you are more likely to give birth to fraternal twins (when two eggs are released at one time during ovulation). No gene exists to cause an identical twin birth which involves a single egg splitting in two, so that is purely down to chance.
• A higher BMI (Body Mass Index) – if your BMI is over 25, you may have a greater likelihood of giving birth to twins.
• Conception during breastfeeding or while on birth control medication – fluctuating hormones due to taking birth control bills or lactating can affect the chance of having a twin birth.

Nevertheless, many cases of twin births are random, with no obvious characteristics or causes. At the end of the day, it could all be down to luck!

How Soon Will I Know if I’m Having Twins?

While the signs and symptoms may all indicate that you’re having twins, at the end of the day, you’ll need to wait until it can be confirmed by having an ultrasound scan. This will need to be after the sixth week of pregnancy since transvaginal sonograms before 6 weeks gestation have been shown to be unreliable when it comes to identifying two gestational sacs.

Also, if you find out at too early a stage that you’re pregnant with twins, it may end up that you lose one of them. It has been estimated that up to 30% of twin pregnancies end up with “vanishing twin syndrome”. This occurs when the twin pregnancy has been confirmed by ultrasound scan at about 6 weeks gestation but then, but the time the next scan appointment comes round at about 12 weeks into the pregnancy, one of the twins has been reabsorbed or “vanished”. Many women would prefer not to be aware that they were carrying twins until they know that both are relatively safe. However, others would prefer to know, even if there are high chances of losing one.

Are Hidden Twins Possible?

With early ultrasound scans available these days, it’s very rare for a hidden twin to occur. One twin can, in theory, hide behind the other during a scan, but this is only at a very early stage. It is also more likely if your twins are identical. By the time you reach your 20-week ultrasound scan, you’ll know for sure if you’re expecting multiples.

What Should I Know About Ultrasounds to Detect a Twin Pregnancy?

An early ultrasound test may be scheduled by your doctor to confirm your pregnancy or to check for any possible issues, especially if you’ve had problems in previous pregnancies or have an underlying medical condition. This will be scheduled for around 6 to 10 weeks into your pregnancy. If you aren’t scheduled to have an early scan, you will be given an anatomy ultrasound scan later in the pregnancy at around 18 to 22 weeks. Once your doctor sees the sonogram images, they’ll be able to tell you for sure precisely how many babies you’re expecting.

What Are the Chances of Being Pregnant With Twins?

The rate of twin births is 32.6 twins for every 1,000 births according to 2018’s CDC figures. However, there are a number of factors that contribute to the number of twin births every year. Elements such as genetics, fertility treatments, and age can all make it more likely that you’ll become pregnant with multiples.

Although a twin pregnancy can be exciting, it can be worrying too. It carries a few risks when compared to a single pregnancy, so you need to focus especially on your health and well-being and get good prenatal care if you’re having twins.

What Can I Expect From a Twin Pregnancy?

If you’re pregnant with twins, you can expect your pregnancy to be a more complicated one when compared with a standard single pregnancy. Therefore, you’ll probably be advised to have specialist prenatal care. This will ensure that any possible complications can be spotted early by a specialist and treated before they get out of hand.

You may need to see an obstetrician who specializes in providing care for moms-to-be with twin pregnancies. You will also probably be advised to give birth in a hospital instead of at home or in a birthing center since hospitals have more facilities and specialist staff on hand to manage the possible complications of twin pregnancy such as premature birth.

You will also require a higher level of prenatal care throughout your pregnancy, with more tests and more appointments. While you probably won’t be given extra blood tests, you will require additional ultrasound scans.

If your twins have two separate placentas, you’ll need to have an ultrasound scan at 12 to 13 weeks, then again at 20 weeks before having one at 4-week intervals right up to the birth. Some women will be given scans more frequently than this.

If you have a twin pregnancy where your babies share a single placenta, your pregnancy could be even more complex, so you should have an ultrasound scan every couple of weeks from the end of your first trimester.

You will also require more frequent prenatal visits during a twin pregnancy. This will give you the opportunity to get support with your lifestyle and health should you require it as well as advice and information about parenting, birth, labor, and pregnancy.

Women who are pregnant with twins will be more prone to pregnancy-related complications and health issues such as pre-eclampsia, gestational diabetes, bleeding, and premature labor. If your twins share a placenta, they may have an unequal share of the blood supply that can result in health problems for both of the babies. If the placenta itself isn’t equally shared, one twin may fail to get sufficient nutrients to grow properly.

It’s not possible to prevent all of these complications from occurring. However, it’s possible to reduce your risks of experiencing them or preventing them from worsening by attending your prenatal appointments regularly and telling your physician, midwife or OB-GYN if you’re experiencing any unwanted physical symptoms, or even if you feel something isn’t quite right.

Not every pregnancy-related health problem will be physical. Sometimes, pregnancy – especially a twin pregnancy – can take its toll on your mental and emotional health. If you’re experiencing emotional upheavals that continue for 2 weeks or longer, or that are impacting negatively on your everyday life, you may be suffering from depression or another mental health problem. You should discuss this with your doctor or midwife, or even call a helpline if necessary to get support.

Body Changes With a Twin Pregnancy

If you’re expecting twins, you may find that not only do you experience more severe pregnancy symptoms when compared with a single pregnancy, but your body changes are also considerably more obvious. You will gain more weight, and other common pregnancy complaints such as stretch marks, varicose veins, hemorrhoids, and bloating are all more likely to occur with a multiple pregnancy.

Such changes can have a negative effect on the way you feel about yourself and your body. You should discuss the way you’re feeling about your changing body with your midwife or doctor, especially if it’s affecting your self-esteem or mental well-being.

Eating Healthy in a Twin Pregnancy

Every mom-to-be knows that she should be eating healthily when pregnant, and when you’re expecting twins, it’s extra important to take care to eat a balanced diet that is packed with nutrients, minerals, and vitamins. Your midwife or doctor will probably recommend that you take expert advice about the number of carbohydrates, protein, iodine, calcium, iron, folate, nutrients, and fats you consume each day. A dietician will be able to help you by giving you expert dietary advice.

When you’re pregnant with twins, your doctor or midwife might recommend that you get expert advice about your dietary intake of protein, fat, carbohydrates, folate, iron, calcium, iodine, and other nutrients. Dietitians have qualifications and skills to give you expert nutrition and dietary advice.

Are Twins Always Born Early?

Usually, health professionals will aim for twins to be born at around 37 to 38 weeks after gestation unless a problem develops at an earlier stage or there is a good reason for delaying the birth. Around 60% of all twins are born before this 37-week target, while single babies are typically born at about 40 weeks of gestation. However, if you’re aware that your twins are likely to arrive early, you can prepare for a premature birth.

Will I Be Able to Give Birth to Twins Naturally?

You will need to discuss the type of birth you want with your midwife, OB-GYN, or doctor. Your babies’ health and your own health will both be taken into account when determining whether a cesarean or vaginal birth would be the best option for you and your babies. Note, though, that twins are around twice as likely to be born by cesarean section. You can talk to your obstetrician to determine the best way and time to give birth to your twin babies.

How Do I Prepare to Parent Twins?

It can be very rewarding to be a parent of twins, however, it can also be twice as challenging as parenting a single baby. There are some ways you can help ease the transition, though.

Communicate effectively with your partner. This is a vital part of maintaining a healthy relationship through the challenges of parenting. During your pregnancy, you should take the time to share your expectations and thoughts for the future so you can both be on the same page when the babies arrive.

It’s possible to breastfeed twins, and it can offer both you and your babies’ great benefits. However, it is also harder than breastfeeding a single baby. This can be made easier by using breast pumps specifically designed to be used with multiples, and your doctor may be able to recommend a lactation consultant who can help you to learn how to do this more effectively so you can get your babies off to the best start in life.

You can also get a lot of extra support as a parent of twins. There are many organizations and groups out there that have been established especially to support parents of twins. Many are made up of other twin parents who have their own advice based on experience. You will certainly need some support, particularly during the early days after taking your babies home, so don’t be afraid to ask friends and family for help whenever necessary. They’re sure to want to help with your beautiful new bundles of joy.