Te whānautanga māhanga Multiple pregnancy

If you are pregnant with more than 1 pēpi, it is called a multiple pregnancy. Every year in Aotearoa New Zealand, around 1,000 whānau find themselves expecting twins, triplets, and sometimes even more pēpi.

How multiple pregnancies happen

The 2 main ways a multiple pregnancy happens are:

  • 1 fertilised egg splits into 2 separate cells
  • 2 or more eggs are fertilised at the same time.

This will lead to either identical or non-identical siblings.

Identical twins 

Identical twins develop from 1 fertilised egg splitting into 2 separate cells. Identical twins are always the same sex. 

Non-identical twins

Non-identical twins result from 2 or more eggs being fertilised at the same time. They are more common than identical twins. The babies may be the same sex or different sexes.

Triplets or more

If your pregnancy results in 3 or more babies, they could be identical, non-identical, or a mixture of both. 

Who is more likely to have a multiple pregnancy

There are several things that could result in a multiple pregnancy, including if you:

  • are older — if you are in your 30s, you have a higher chance of a multiple birth because your body starts to release multiple eggs as you get older
  • are a twin yourself, or have twins in your whānau 
  • are having fertility treatment, such as in vitro fertilisation (IVF)
  • are taller than average, or have a higher body weight.

Signs of a multiple pregnancy

While the only way to know for sure if you are carrying more than 1 pēpi is an ultrasound, you may have more intense symptoms, including:

  • morning sickness (nausea and vomiting)
  • rapid weight gain in your first trimester
  • very sore or tender breasts
  • higher HCG levels
  • higher amounts of protein in your blood. 

Your midwife or doctor might also hear more than 1 heartbeat.

Complications of a multiple pregnancy

While anyone can experience complications during pregnancy, multiple births are considered a higher risk. This does not mean you will have problems. But your midwife or doctor will want to watch for possible complications. 

Talk to your midwife or doctor straight away if you have any signs of these complications. This is especially important if you go into premature labour, have bleeding or tummy pain, dizziness, headaches or swelling. 

Preterm labour and birth

The most common complication is preterm (premature) labour. This means you are more likely to go into labour before 37 weeks. Babies that are born preterm are at risk of low birth weight. 

High blood pressure (gestational hypertension)

Your midwife or doctor will watch your blood pressure carefully. This is to make sure you do not develop gestational hypertension. High blood pressure during pregnancy can lead to preeclampsia. 


Preeclampsia is caused by high blood pressure. It can affect both you and your unborn pēpi. It puts stress on your organs, and can cause swelling, dizziness, headaches and problems with your vision. If untreated, it can lead to more serious complications. 

Preeclampsia usually resolves after birth and your blood pressure returns to normal. 

Gestational diabetes

Due to an increase in hormones in the placenta, you can develop diabetes during pregnancy. Having more than 1 placenta increases your resistance to insulin (the hormone made by your pancreas that helps your body use sugar for energy).

Placental abruption

Placental abruption is when the placenta separates from the wall of your uterus before birth. It is more common if you are carrying multiple pēpi. Symptoms can include bleeding and abdominal pain, especially in your third trimester. This is an emergency situation. 

Fetal growth restriction 

Also known as intrauterine growth restriction, or small baby on board, this happens when 1 or more of your babies is not growing at the proper rate. This may cause preterm labour or low birth weight. 

Your maternity care

Having twins — or more — is considered higher risk.

If your lead maternity carer is a midwife or a general practitioner, they must:

  • recommend that you be referred to a specialist doctor
  • transfer the responsibility of your clinical care to the specialist doctor.

If you agree to having your care transferred, your midwife or doctor may be able to continue to provide some of your care. Discuss this with them and your specialist doctor.

If your maternity carer is a specialist doctor, there will be no change to your care.

Being prepared for the birth

You need to make a few extra preparations if you are expecting twins or more. As well as getting your whare ready, here are some things to think about.

Getting ready for your pēpi

An early birth

Twins and triplets are often born early. Pack your hospital bag early in your pregnancy – from around 26 weeks. Pack enough supplies for 2 (or more) babies.


It is possible to breastfeed more than 1 pēpi. Ask your midwife for advice.

Preparing for breastfeeding — Ministry of Health (external link)


This includes car seats, nappies, buggies, cots and clothes for each pēpi.

Safe sleeping

Talk to your midwife about safe sleeping for your babies.

Keeping yourpēpi safe in bed

Someone to help you in the weeks after the birth

Friends and whānau may be able to help, especially if your partner is working or you have other tamariki.

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