Double Trouble: Twins and How to Survive Them

ONE Twinshock

It may have taken an American to coin the phrase ‘twinshock’, but the sensation is felt the world over. There is no easy way to learn the news. It helps if your hand is being held by the man responsible (more possible if it’s your first pregnancy, less probable if it’s your second) or if you have a sympathetic sonographer doing the scan, but, once the word is out, the impact will take your breath away. Being told that you are expecting twins will resonate deep in your psyche, announcing that your life is about to change for good.

For this reason, sonographers doing the ultrasound often try and fudge the moment with comments such as: ‘There seems to be two. Let me check if there’s three’ (this happened to Joanne Pinkess, who heaved a huge sigh of relief that it was not triplets). Another girlfriend, Heather, was asked: ‘Would you like the good news or the bad news?’ With four children already, she asked for both. ‘The good news is that everything is fine,’ said the scanner, ‘the bad news is that you’re expecting twins.’

The other approach is to push the responsibility for the diagnosis on to you. The sonographer scanning Judy Collins, with her husband Jim beside her, turned to poor Jim to announce the news. ‘What’s the first thing you can see?’ she asked, turning the screen to the husband. Jim saw two blobs, so said ‘two eyes?’ ‘No,’ she corrected him, ‘two babies.’

However you learn, try and hang on to that initial moment and build it into a story for later. Not only will you be asked dozens of times before your life is over, but your twins will have to recount the moment, too. If only I had a pound for every time I’ve had to retell the story of my mother going into labour, and the midwife calling over the doctor to ask ‘Can you hear two heartbeats here?’ Sadly for my father, he was in the pub. My, how times have changed.

Tears and light blasphemy

From the mothers I’ve asked, the most common response to the news they were expecting twins seems to be tears and light blasphemy. I had my three-year-old with me for the 12-week scan, and he was ramming a Thomas the Tank Engine train into my thigh while the sonographer slopped gel on my stomach and swirled the scanner over my paunch for a good five minutes before choosing her moment. ‘Have you been experiencing anything unusual about this pregnancy?’ she ventured. ‘Oh, you know, a lot more tired than with the first,’ I answered, preparing for a moan. ‘Peep, peep,’ squeaked Thomas at my knee. ‘Well,’ she continued in her best breezy voice ‘there is something I have to tell you…’ (a line that never goes down well with pregnant mothers). I sat up immediately, expecting the worst unmentionable diagnosis. ‘You’ve got two babies in there!’ she blurted. ‘Ohmygod, Ohmygod, Ohmygod,’ I answered.

A few minutes later, as she helped me out of the darkened scanning room, I felt twice as pregnant as before I went in, suddenly more sow than goddess. I was directed around the corner for the next NHS appointment and for my next shock – that the hospital had no room for me. Even if they had told me that there was a Stannah Stairlift and a red carpet up to the delivery room, I would have burst into tears at that point. It was as if the initial shock was receding and reality setting in. I boo-hooed so loudly at the reception desk that a flurry of doctors suddenly poked their heads out of their doors and a kind female doctor came out to investigate. Seeing the waiting room full of anxious pregnant mothers, now massaging their bumps a little more nervously, she whisked me into her office. There she explained the relative merits of all the local hospitals, from how new their maternity units were to how many beds they held, to reassure me that if I couldn’t make it into my chosen Chelsea and Westminster there were others that would have me.

It was to be my first lesson about carrying twins and the National Health Service (make a noise to get help from anyone, blubbing loudly if necessary). I also learnt that from that day forward, and particularly when the twins were born, I was to be the entertainment for the waiting room.

Numb with no tears

Not everyone reacts with such drama. Triplet (heroine) mother Valerie Cormack had a variation on twinshock when she was told at her first scan. She sat in a daze at the news and described her reaction as ‘horror and worry’.

‘My first thought was “how will I manage this?”, and my second thought was “where are we going to put them?” – our house isn’t that big.’ Valerie, 34, had her mother with her because her husband Andy was away on business. When she told Andy, his reaction more than made up for her state of numbness. ‘He was thrilled. He said “Isn’t it great! We’ve always wanted a family and now we’ve got three children!”’ A week later, Valerie’s fears began to subside and she started to feel happy about it.

Preparing the siblings

Just as there is no perfect time to deliver the news to an absent spouse, there is also no perfect time to prepare other children.

I had my three-year-old little boy to tell, who had been vaguely aware of the histrionics in obstetrics, but was really far more interested in his Brio engine. Rather than sit him down and Have The Talk, I decided to prep him whenever he brought up the subject. A colleague at work, both of whose parents were psychologists, warned me against The Talk.

Apparently, when she was little and her parents had tried to prepare her for the arrival of her brother, she had nodded all through their explanation of forthcoming family life. At the end, they asked if she had any questions. She replied earnestly: ‘Mummy, will it have a head?’

When my son Humphrey showed any interest in my stomach, I would say proudly ‘Mummy’s got two babies in her tummy.’ One day, as I was continuing to reinforce the message, he stuck out his stomach and said ‘Humphrey’s got two babies in there, too.’

I have to say that Humphrey’s reaction was a little better than four-year-old Jake, the elder sibling of non-identical twin girls in Lewisham, south-east London. When Jake was taken along with his mother and father to the 12-week scan to share in the excitement of his new brother or sister, there were even more tears. ‘It soon became obvious that the scanner was on to something,’ said Paul, his father. ‘The first we knew was when she turned to my wife and asked whether we had a history of twins in the family.’ Jake asked his father what ‘twins’ meant. ‘It’s very special,’ said Paul, in twinshock himself but choosing his words carefully, ‘there’s not going to be one baby, but two!’ Jake promptly burst into tears, howling: ‘But Daddy, I don’t want two babies, I only want one.’

Telling the office

There is only one good rule when it comes to the office: tell them as late as you can get away with (which won’t be that late on with twins). If you are someone who likes to be the centre of attention, then blurt the news out as early as you like. However, the rest of us will find a twin pregnancy a rude awakening. It is the equivalent of dressing up in a clown outfit and wearing a big red nose.

From the moment everyone knows in the office, you will spend the rest of the run-up to maternity leave answering questions on whether you have chosen names, found out sexes, or, worse, how cousin Ethelberga had twins and was committed to a psychiatric hospital shortly after. Nobody will be interested in how well you gave that presentation, or took the minutes of the meeting, only in the gusset of your elasticated trousers. If you want to be taken seriously, don’t let on until the most tactless person finally asks. Then you know that you can hide it no longer, and the truth will out. By then you will have your handbag ready on the desk to swat the next person who makes a bad joke. Go in hard to deflect the more cautious jokers out there.

Scans, scans, scans

It is well worth making friends with the staff in the ultrasound department because you are going to see a lot of them by the end of your pregnancy. A box of Quality Street never goes amiss. Once they have spotted twins, they’ll probably expect you to come in every fortnight after 28 weeks (just when you don’t feel like moving far), as well as having the usual 12-week and 20-week scans. What they are checking for is how the twins are growing and whether they are lying head down or head up, which will make a difference to the birth. Particularly with identical twins sharing a placenta, they are looking to see whether one of the twins takes the lion’s share of the food (twin-to-twin transfusion, a great name for a ’70s rock band). In the unlikely event that there is a dominant and greedy twin, they may suggest delivering the babies ahead of time. One friend of mine was told by the sonographer that she could continue with her identical-twin pregnancy without being induced because the twins were exactly the same weight at around 5lb. When born, one twin was over 7lb – two pounds heavier than the original estimate. It turns out that they measured the same twin twice.

So, scans may look like a precise science, but they aren’t. Sexes are wrongly reported, anomalies not picked up, and suggested birth weights are often wildly inaccurate. All this human error is further confused by giving you probability equations to do in your head, when everyone knows pregnant women can’t do maths.

‘Excuse me, is a one in 500 chance in the Nuchal Translucency test a good result or a bad result? Does that mean that if I have 499 children, the 500th may have Down’s syndrome? Or will it mean that one of my twins will have it, and the next 199 sets of twins I produce won’t? But won’t I be given another nonsensical probability equation at those subsequent pregnancies? Why can’t someone just say “yes” or “no”? Anyway, we’ve already decided that if we do have a Down’s baby we are carrying on with the pregnancy. Which begs the question: why are you scanning me in the first place?’ This is what I would like to have said to the sonographer. Instead, like thousands of pregnant women, I just nodded and felt a little scared.

If you do feel anxious at the prospect of a scan, take your partner, mother or girlfriend with you. They can listen while you feel fearful. And, if you are unhappy about any scan diagnosis, ask to be scanned again by the head of ultrasound in the hospital. Scans are so often wrong, they are not worth losing sleep over.

TWO What Flavour Are They?

Okay, I promised in the Introduction that I wouldn’t befuddle you with words like ‘monochorionic’ and ‘dizygosity’, but the time has come to get the dictionary out. You may as well get a handle on what flavour your twins are, because throughout your and their life, plenty of people will try to tell you differently. You will be amazed at how many intelligent people were obviously sound asleep during their biology lessons.

All twins are identical (not)

People desperately want to believe that all twins are alike. There is some deep-seated desire in the human soul that needs to believe this. It is not a rational thing. Perhaps it is steeped in our ancient tribal belief that we must hunt in identical pairs. Or maybe it’s a more modern, narcissistic view that when we die, a clone of ourselves will continue to carry on our important genetic heritage and be available for medical science when needed. Some people will even argue with you that ‘your twins are not proper twins’ unless they are identical.

This means that if you have fraternal (non-identical) twins (another misnomer to make all twins sound like brothers), you will often be asked ‘are they identical?’ Even if you have boy and girl twins, and the girl is standing in pigtails and a dress and the boy is brushing mud off his football kit, the same stupid question will be asked again and again. And don’t be fooled by the intelligence of the interlocutor. My headmaster asked my brother and I the very question in front of the whole school when we went up to receive two different awards at an end-of-term ceremony. In this instance I refrained from my stock answer (‘No, he has a willy and I don’t’). However, I highly recommend this one for closing the subject quickly.

If you have non-identical girl twins, or non-identical boy twins, you may need to engage in a brief biology lesson, particularly when your answer of ‘No’ will be met by disbelief. ‘No, they came from two separate eggs and two separate sperms,’ is usually pitched at the right level. Most people’s eyes will glaze over at the mention of zygosity.

The truth, however, is a little more complicated. And if you only read the following once in your life, it will give you some insight into why twins are so endlessly fascinating to the medical establishment.

Boy/Girl Twins

Girls and boys cannot be identical. Nobody mistakes a brother and sister for each other, so why do people mistake boy/girl twins? Statistics1 show the national average for boy/girl twins to be 33 per cent of all fraternal twin births. Expect around 100 per cent of the population to ask you ‘Why don’t they look the same?’ Women are more likely to have fraternal twins if there is any incidence of twins on their mother’s side (not their father’s).

Non-identical Girl/Girl or Boy/Boy twins

Statistics also show that 33 per cent of all non-identical twins are two-egg girl/girl combinations, and the other 33 per cent are two-egg boy/boy combinations. These twins will show the normal sibling differences in temperament, intelligence, social interests and choice of pop music. Unlike their identical counterparts, where studies have shown twins to co-operate more with each other, fraternals are, if anything, more competitive than other siblings. This is not a given – again it’s back to temperament – but it is worth preparing for, especially in toddlerhood (where buying two identical ride-on cars will save you having to shout constantly ‘SHARING, for God’s sake!’). Competitiveness among twins is not that surprising when you consider they have to compete for everything from day one, from mother’s milk to parental attention.

Nor should acquiring a competitive edge be considered a downside. My twin brother went on to win a bronze medal at the Olympic Games in modern pentathlon (running, riding, swimming, fencing and shooting). I am sure he honed his skills in the back garden while running away from me in my nurse’s outfit.

Identical twins

Identical twins are sometimes described as ‘a freak of nature’, because there is no genetic reason for producing them. Unlike fraternal twins, that follow the mother’s hereditary line, identical twins are theoretically a one-off occurring in one in every three twin births.

Not all 20-week scans, when you can tell the sex of the babies, can diagnose for sure whether the twins are identical or not. Sometimes with identical twins the egg splits later in the pregnancy, between day 7 and 14, resulting in separate placentas and separate sacs. To confuse matters further, non-identical twins can sometimes be misdiagnosed by ultrasound scans when their two placentas have fused into one.

There are now two types of test done at birth to confirm for sure whether the twins are identical or not – a blood test to compare blood factors, and the more recent DNA fingerprinting. Parents of identical twins usually want to know the results, not only to establish their birthright, but also for medical reasons. If one child shows susceptibility to allergy, asthma or any childhood illnesses, they will be better informed to protect the other.

One good thing about identical twins is that when people ask you: ‘Are they identical?’ You can answer ‘Yes!’ (and so can your twins). However, be prepared for fresh idiocy. Caroline Watton, who has identical twin girls, was stopped by an old lady in the supermarket as she was pushing the girls around in a trolley. ‘Ooh, aren’t they sweet!’ cooed the old woman. ‘Are they identical?’ Before Caroline could answer ‘Yes’, the woman contradicted her. ‘Of course they’re not!’ she said. ‘Look, one’s fast asleep and the other’s awake.’ The nation’s biology teachers have a lot to answer for.