New Zealand Multiple Birth Association

General pregnancy issues

Growing two or more babies results in huge changes to our body and many of the systems within our body. You are at least three times more likely to have the ‘normal’ problems of pregnancy, such as reflux, severe morning sickness, haemorrhoids, varicose veins and constipation—and many of these problems feel worse when you are having multiples.

Most pregnancy complications are more common in multiples, such as Gestational Diabetes Mellitus, Pre-eclampsia, bleeding and placenta previa, and there are some specific conditions related to identical twins. The issues that are more specifically related to multiple pregnancy are discussed below, and you can find out about the rest in general pregnancy-related materials. Any concerns should be discussed with your LMC.


Backache can be caused by weight gain, incorrect posture and the hormone, Relaxin, which softens ligaments in the spine. Tips to manage backache include:

  •  Using correct posture. For example, stand upright—don’t slouch!
  •  Practice pelvic tilting when sitting, standing, or lying
  •  When lifting, bend your knees
  •  A stomach support might be suitable, e.g. Belly Bra.


Fatigue, or extreme tiredness, is common due to the huge amount of energy it takes to grow (and tow!) two babies. Sleep disturbances, due to hormonal changes, are also common. The main strategy is REST! That means lying horizontal when you get tired during the day—and not doing tasks around the house!! The stop-work recommendation for twins is at 28-32 weeks. Also check that your diet and water intake is adequate.

Pregnancy induced insomnia and sleeping problems

There are a number of sleep issues women experience in any pregnancy and which may be related to hormonal changes, physical discomfort, and anxiety—these can be significantly worsened by a multiple pregnancy!

Women often report:

  •  Vivid, unusual dreams—if these dreams worry you, talk to your midwife
  •  Waking in the night and not being able to return to sleep—this can be very frustrating and exhausting
  •  Discomfort lying or turning
  •  Hunger at night
  •  Active babies when you are lying down. This is often due to an increased blood supply going to the uterus. It is not uncommon for babies in utero to wake at a similar time each night. Little can be done about this, so try to relax and use this as a time to get to know your babies.

Tips for dealing with simple sleep problems include:

  •  Go to bed earlier
  •  Talk about your anxieties
  •  If you are getting too hot, sleep naked or use a fan
  •  Avoid synthetic materials
  •  Use pillows to provide support (between the knees, stomach, and back)
  •  Have a warm bath.

More severe than being slightly uncomfortable at night, pregnancy induced insomnia can cause distress and worry. It can also continue after the babies are born and contribute to exhaustion. Talk to your LMC and ask for advice. If you cannot get to sleep, or wake in the night for long periods of time and cannot return to sleep, the following may help:

  • Try not to worry about not sleeping—insomnia is frustrating, but normal
  • Have a bedtime routine that helps you prepare psychologically and physically for sleep
  • Get up, do something quiet, e.g. read or watch TV until you feel sleepy
  • Have something to eat if you are hungry—but again, make sure it is a sleep-inducing food (something high in complex carbohydrates and calcium, and low in protein).