Monday, August 7, 2023

Healthy Habits: Pregnancy with Twins


National Twins Day was August 5th. Twins account for 
3% of live births in the US. When parents first learn they’re having twins, they may have many questions about the difference between singleton vs. multiple pregnancies: How much more should I eat? Do I require a C-Section? Is there an increased health concern?


OBGYN and Maternal Health Expert “Rural Doc” Alan Lindemann, M.D., author of the forthcoming book "Pregnancy Your Way," has over 40 years of experience delivering over 6000 babies, and provides answers to common questions about having twins.


1) When Will I Know If I’m Carrying Twins? An ultrasound at 20 weeks will identify multiple births. But it can be sooner because you and your doctor will most likely question why you are so big.


2) Do I Need Extra Care? Yes. All multiple pregnancies require an increased level of care and attention. Be sure to ask your doctor how often you will be scheduled, but from my experience (and with exceptions of course) it would probably begin with every two weeks at 26 weeks, and then every week at 32 weeks. This would be 6 or 7 more visits than needed with a singleton pregnancy.


3) Do Twins Always Require a C-Section? No. In most cases it is possible to deliver twins without a C-section and even without an episiotomy. Despite the fact that today many obstetricians prefer to deliver twins and even breech babies by C-section, it is not unreasonable to ask your doctor to deliver your twins vaginally. You at least deserve a discussion of the pros and the cons.


4) Are There Increased Health Concerns? Yes. Nausea, lack of interest in food (anorexia), and risk of miscarriage are high in the first trimester. In the second trimester, risk of preterm cervical dilation and hypertension are greater than for a single baby.


5) How Much More Should I Eat? My experience with twins indicates you should eat about 40% more than with single pregnancies, but you need an absolute amount of protein. If you are carrying one baby, I recommend 130 grams of protein per day in six meals, but for twins you will need another 20 or 30 grams of protein per day.


6) Can I Nurse Twins Simultaneously? Yes! Nursing twins can be done. The babies can be held like a football under each arm, with a head on each breast and the body and legs to the mother’s sides and back. Until your milk production catches up, you may need to top off your twins’ feedings with formula.


7) Are Twins Always Delivered Around the Same Time? Not always! I have had twins deliver on separate days, weeks,months, and even separate years (I’m not sure what the parents did about birthday parties or schools!).


For more information, visit and


About Dr. Lindemann:

An obstetrician and maternal mortality expert, “Rural Doc” Alan Lindemann, M.D. teaches women and their families how to create the outcomes they want for their own personal health and pregnancy. A former Clinical Assistant Professor at the University of North Dakota, he is currently a clinical faculty member available to serve as preceptor with medical students in rural rotations. In his nearly 40 years of practice, he has delivered around 6,000 babies and achieved a maternal mortality rate of zero! Learn more at and

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