Am I Having Twins?

Signs and Symptoms of a Twin Pregnancy

twin pregnancy ultrasound - it's twins!

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Many people find the idea of having more than one baby at a time fascinating. Parents of multiples are probably familiar with comments like, "Oh! I always wanted twins!" and questions like "Are they natural?", "Are they identical or fraternal?", and "How did you get them?"

The desire for a twin pregnancy can lead some people to wonder what they can do to increase the chances of having twins. If already pregnant, a person might wonder if they are pregnant with twins, triplets, or more.

You can learn that you are pregnant with multiples in many ways, from signs and symptoms to the revelation on an ultrasound—or even at birth (although this is very uncommon if you have had routine prenatal care).

Pregnancy Symptoms

If you are pregnant with twins you might wonder what pregnancy symptoms you will have. Many people who have been pregnant with twins report having typical pregnancy symptoms—only multiplied. Many people who are carrying multiples report increased nausea and vomiting (morning sickness) especially in the first trimester of pregnancy.

Some people who have been pregnant with twins complained that the feeling of fatigue and sleepiness in the first several weeks of pregnancy was significantly worse than previous pregnancies or what they expected from pregnancy.

These are common complaints in the first trimester of most pregnancies and are caused by increasing hormonal levels. These symptoms can be increased in multiples because the hormone levels are also increased in these pregnancies.

You could still be having twins even if you don't have increased pregnancy symptoms.

A person who is pregnant with multiples can be completely surprised by the diagnosis if they haven't experienced anything out of the ordinary.

Size Matters

You (and your health care provider) might wonder if you could be carrying multiples if your abdomen or pregnant belly begins to grow more quickly than normal. Your doctor or midwife will check the growth of your uterus at every prenatal visit starting at about 12 weeks.

If your belly seems to be bigger than expected, you might be having twins but it's also possible that you've got your dates wrong.

Increased growth isn't always apparent in the early weeks of pregnancy. Health care providers sometimes explain that, depending on the position of the fetuses, it might be 20 weeks before they would notice an increase in size that is different than what would be expected (as both fetuses are still small at this point in pregnancy).

Fetal Movements

Some people say they felt like they had an octopus in their abdomen when they were pregnant with multiples. They claim that they felt near-constant movement in all directions. This can be a sign that you are having more than one baby. This sign is typically reported more midway through pregnancy than at the beginning or end.

Lab Work

Your provider might order a blood test to confirm your pregnancy or to evaluate first trimester bleeding. Following your hCG values in early pregnancy can help your provider determine if your pregnancy is developing appropriately.

Unusually high levels of HCG (human chorionic gonadotropin) can be a sign that you are carrying more than one baby.

Another routine prenatal test called AFP (alpha-fetoprotein) is often ordered in pregnancy to screen for possible neural tube defects or other genetic disorders.

A person might be told that their AFP level could indicate a problem with the fetus. In fact, it might be that the AFP value is elevated because two or more fetuses are present.

Confirmation Procedures

You can't rely on physical exam, symptoms, or lab values to be certain that you are carrying more than one baby. The most definitive way to confirm the presence of twins or more is an ultrasound.

A first-trimester ultrasound is sometimes done if there is a possibility of a problem, such as bleeding, questionable dates, suspected ectopic (tubal) pregnancy, or other health concerns. However, if an ultrasound is done too early (at less than 6 weeks), it's possible that one of several fetuses might not appear on the screen.

If there is no indication for a first-trimester ultrasound, your 20-week anatomy scan will confirm if you are having twins or more.

Ultrasound can be used to follow your multiple pregnancy and screen for potential problems like vanishing twin syndrome, twin-to-twin transfusion (TTTS), and growth problems. Usually, you will be scheduled for one ultrasound per trimester, but this number will be increased if you have complications.

A Word From Verywell

If you have multiple reasons to believe you're carrying multiples, talk to your midwife or doctor about confirming your suspicions. Sometimes, a person's intuition proves to be the best way to tell they are having twins!

Gone are the days (for most) when twins go undiagnosed until birth. Just keep in mind that there are plenty of other explanations for intense pregnancy symptoms that have nothing to do with twins or other multiples. Your health care provider will make sure you have the tests necessary to determine if you're having a singleton or multiple pregnancy.

By Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.