9 Characteristics of a Twin (Multiple) Pregnancy

Posted on October 2, 2014 by fran pitre

CONGRATULATIONS! You’re Expecting TWINS!

This news can either be elating or devastating to you as the receiving parent-to-be, but either way, happy or traumatized, this news triggers the reality that life will from now on be very different!

Chances are that if you’re reading this article, you’ve recently seen an image resembling the one on the right show up on an ultrasound machine that you were attached to (and no, this is not one of my scan photos). Oftentimes, this news comes as a complete shock because there is no family history (that you know of) of twins “running in the family” as they say … (‘course they run all over my house). But lately, especially with Assisted Reproductive Technologies (ARTs) so prevalent today, more and more couples are half-expecting to learn that twins, even triplets or more, are ON THE WAY!

I’m not here, however, to discuss how this came to be. It’s a FACT, and when your head stops spinning, the crying eases, and you can finally see straight again, you and your husband need to know what you may expect and need to prepare for, from here on in your pregnancy.

If you’ve already been pregnant and delivered a single baby (aka singleton), you’ll note some similarities but also some differences.

What you may possibly experience while pregnant with twins

1. Prenatal Care: You’ll be advised to seek the care of a Board Certified Obstetrician as opposed to a General Practitioner. You can also expect more visits with your OB/GYN for careful monitoring of your pregnancy progression, especially if a complication develops. You can also expect more screening tests (i.e., blood glucose levels, and ultrasounds).

2. Pregnancy Nutrition: You’ll be asked to increase your intake of iron and folic acid, along with your daily prenatal multivitamin. As with any pregnancy, you should eat foods rich in calcium, iron, and protein. It’s also very important that you drink at least two quarts of water each day to prevent dehydration, which can quickly lead to preterm labor.

3. Morning Sickness: Pregnancy nausea is caused by the levels of the hormone human chorionic gonadotropin (HCG). It’s a fact that this hormone is higher with a multiple pregnancies, so the probability of or higher degree of morning sickness will exist. The good news is that this usually subsides between weeks 12-14. (But when you’re as sick as a dog at 7 weeks, you don’t think week 12 will EVER arrive!)

4. Spotting: Light to moderate spotting can occur in a multiple pregnancy, often due to multiple uterine wall embryonic implantation (which can cause slight bleeding). Some cases are due to the early miscarriage of one or more babies, which doesn’t necessarily mean a miscarriage of every fetus, and the remaining baby(ies) can be carried to full-term. If bleeding, however, is accompanied by cramping and heavy bleeding with clots, it is no longer “spotting”, and could indicate a more serious problem.

5. Weight Gain: Where it’s recommended to woman carrying a single baby to gain between 20-30 lbs., you can expect to gain approximately 35-45 lbs. with a twin pregnancy (and more with triplets and beyond).

6. Gestational Diabetes and Preeclampsia: The risk for these conditions to develop is higher in a multiple pregnancy. These two conditions (high blood glucose with diabetes, and elevated blood pressure with preeclampsia) can be very dangerous for both mother and baby(ies) if not detected and treated. With careful medical monitoring, both conditions can be managed.

7. Twin to Twin Transfusion Syndrome (TTTS): This is a complication that occurs in primarily identical twins because there is a higher likelihood that the two babies will share a single (monochorionic) placenta. This syndrome occurs when, due to blood vessel malformation and distribution the babies receive an imbalance of nutrients, meaning one twin becomes severely over-nourished, while the other becomes severely under-nourished. Careful monitoring and treatment is required with this condition. Twins possessing his or her own individual placenta (i.e., fraternal twins), will not develop this condition.

8. Preterm Labor: Labor generally comes early for a mother carrying more than one baby naturally due to the fact that the uterus cannot stretch any further toward the end of the gestational period, perhaps arriving between 1-4 weeks before the due date. But also commonly occurring in about 50% of twin pregnancies is much earlier preterm labor that occurs because of the faster rate of uterine growth, causing uterine irritability which causes cramping and contractions. Higher order multiples have a 100% chance of going into preterm labor, and with preterm labor, often comes the recommendation for bed rest which could be partial or complete, depending upon the degree of symptoms. Careful monitoring and sometimes medication is required to manage this condition.

9. Delivery: Although it is very possible to deliver twins vaginally if the pregnancy is far enough along (I did, for my 2nd set), and the babies are positioned just right, most often than not, twins are delivered via C-Section. It’s safer for both mother and babies if your gestation is 30 weeks or earlier, and probably much less risky from the standpoint of the delivering physician (and offers much lower medical liability).

For further descriptions and explanations, please visit: Pregnancy Help: What to Expect … Twins and Multiple Pregnancies, an article posted on Epigee ™ Women’s Health, and Expecting Twins? 11 Things You Didn’t Know About Twin Pregnancy, an article by Denise Mann, reviewed by Louise Change, MD for WebMD.com.

My personal twin pregnancy experiences …

… included excellent prenatal care for all three pregnancies; multiple screening ultrasounds (which I came to enjoy once the tech said that everything “looks great”); severe morning sickness for all three (requiring medication during twin set 2 and 3), which always ended by week 14 (glorious week 14!); light spotting that lasted a couple of weeks during my last pregnancy, but was of no consequence; the miscarriage of one of my triplets during week 11 of my second pregnancy (but which was not accompanied by any bleeding), and I went to on to deliver my (now-called twins) at 35+ weeks; I gained about 30 lbs with pregnancies 1 and 3, but about 41 lbs with pregnancy 2, because I carried them longer.

I experienced no gestational diabetes nor preeclampsia with any of my pregnancies, nor (because all of my twins are fraternal) did I develop TTTS. I did, however, experience preterm labor with each pregnancy beginning between as early as 18 weeks with my first, and starting as late as 22 weeks with my last. Each led me to 100% bed rest, and although I followed my doctors’ orders, I delivered twins 1 @ 31 weeks, twins 2 @ 35 weeks, and twins 3 @ 31 weeks (to the day as with twins 1!). As far as my deliveries were concerned, you may have heard of the term: V-BAC (standing for a Vaginal Birth After a prior C-section), well, I call my deliveries a “C-V-C”: a C-section, then a vaginal birth, then a C-section. Although my vaginal delivery was no picnic, it was much more rewarding and satisfying an experience, with a much shorter recovery period than either C-section.

If you’re reading this and expecting a set of twins or more, many congratulations to you, with wishes and prayers for a safe, healthy pregnancy, and safe healthy delivery for you!

Blessings ~

Preventing Preterm Labor from Becoming Preterm Birth

Posted on October 3, 2013 by fran pitre

With all pregnancies, it’s very important to become familiar with symptoms that could indicate the signs of early or preterm labor. This is especially important with a multiple pregnancy because preterm labor is much more common than with a single baby on the way.

The fact that your uterus is not only growing larger, but because of the double, triple or more babies growing and rapidly taking up space, the uterus is also growing at a faster rate than if you were carrying one baby. With a single pregnancy, as the uterus grows, it naturally contracts as part of the growth process. You’ll notice a slight pulling or tightening/hardening sensation in the lower abdomen that is completely painless and harmless, which may last for a few seconds. However, this more rapid rate of growth with a multiple pregnancy can cause the uterus to become irritable and you may notice normal growth contractions become more frequent as you reach about mid-point in your second trimester (approx. 20-22 weeks).

If the contractions begin to increase in frequency, and the tightness and temporarily hardening of the lower abdomen is accompanied by pain (mild to moderate), then your contractions may no longer be harmless. They may be becoming productive contractions, which means that cervical effacement (shortening) may be starting. Effacement occurs prior to cervical dilation during active labor, and you don’t wanna go there yet!

So, sit down, breathe deeply and relax. Stress and panic will only make the situation worse. Call your health care provider (at any time of day) and speak with an on-call nurse. She will immediately advise you to get off your feet (preferably lie down on your left side), and drink a full 8-10 ounces of water. Contractions may be brought on or worsened if you’re water intake is low and you’ve become even slightly dehydrated. Dehydration is the number one cause of muscle pain, tightening and cramping … ask any athlete or sports enthusiast. Your uterus is a big, powerful muscle and ligament-bound organ, and the muscles are very sensitive to dehydration, so DRINK A LOT OF WATER!

Are You in Preterm Labor? If your contractions continue for a good 30 minutes after hydrating yourself, call the nurse back, and she may suggest that you come into the office or go directly to the Labor & Delivery Unit at the hospital. The likelihood of actually delivering is low because of available medications that can be given to you to stop the contractions. An anti-contraction medication called Terbutaline (actually indicated for asthma treatment) may be administered first via injection after you are placed in a hospital bed. Fetal monitors are positioned on your abdomen (secured in place by velcro held stretchy belts) to keep constant tabs on the babies’ heartbeats to identify any fetal distress. Also attached to your abdomen is a contraction monitor to identify the frequency and intensity of your contractions. You can also expect a clear fluid IV to be started to quickly further hydrate you. Usually, when a bout of preterm labor occurs early in your pregnancy, some good hydration and one good dose of terbutaline may be all that’s needed to do the trick! Once the contractions have stopped and have not occurred for more than an hour or two, you can expect to be sent home.

Prescription: Partial or Complete Bed Rest. You might be sent home with the orders to start taking it more easy, to be mindful of your water intake, and perhaps you’ll be given a prescription for oral Terbutaline to taken as needed. If another episode occurs again soon after, you may be asked to greatly cut back on or eliminate all activities, which will include going to work. You may be placed on complete bed rest until you reach 34 weeks gestation, when you’ll be able to resume some light activities no longer at risk of delivering dangerously premature babies. In twins or with single births, 34 weeks gestation is the point at which all doctors strive to reach in regards to the baby’(ies) development and lowered risk of complications associated with prematurity.

Bed Rest Attitude? Gratitude! Because of the fact that your babies didn’t arrive profoundly early as a result of your 2 or more bouts of preterm labor, consider yourself extremely blessed and fortunate! Each day on bed rest is a challenge, especially if you have older children, but it is definitely a survivable, temporary situation. Count each day as a blessing and know that you are doing what is BEST for your babies: keeping them inside where they will grow stronger and healthier with each passing day, and giving them them the absolute HEALTHIEST start to their lives by committing yourself (and sacrificing) to reaching the minimum of 34 weeks. Anything past 36 weeks is “gravy” according the the health specialists, so keep focused, resolved, committed and try to keep the complaints to a minimum! 😉 And remember, this too will pass, and will be worth every minute of every hour of every day. For more info, advice and suggestions on coping with pregnancy bed rest, look for the article Surviving Bed Rest on this site!

Nature’s Timetable. You’ve followed your doctor’s orders to the letter, and only gotten off the bed or couch for bathroom trips, two to three quick showers per week, and been driven to and from your OB appointments. By following this strict routine, you are doing all that you can do to ensure that your pregnancy continues. Just be patient and take it one day at a time, because each day that you stay pregnant matters in the health and long-term wellness of your babies.

However, with all that you’ve done (or rather, not done) for now weeks or even months, labor begins again. Another (and perhaps final) trip to the hospital is in order again, and if your pregnancy gestation is prior to 34 weeks, your doctor will take all steps to stop labor. If two rounds of Terbutaline is no longer effective (your body will build up a resistance to it eventually), your doctor may start an IV drip of magnesium sulfate. This treatment is very effective in stopping labor contractions, but as it directly affects your uterine muscles, it also affects your other muscles. You’ll feel warm all over (even your tongue) and you may become very weak and sleepy. Magnesium sulfate therapy lasts between 24 and 48 hours, so hunker down and go with it. Unfortunately, side-effects do exist that are unpleasant. Nausea, vomiting and heartburn often accompany this therapy, but if your body is not tolerating the medication as these symptoms may indicate, your doctor may opt to discontinue therapy. Regular-interval blood is taken to monitor your tolerance to this drug therapy throughout this treatment, and your body may indicate intolerance to the “mag”, as it is affectionately called. Another medication that may be introduced at this point is called Procardia, (generically called Nifedipine, indicated for cardiac patients) which is being found as more effective than Terbutaline for labor-stopping purposes.

Birth Day! With all the measures taken to prolong your pregnancy, you may be looking at an extension of one to two more weeks or more! However, nature (God) has a way of sometimes overriding all the ways humanly possible to give your babies a later birthday. If your doctor sees that, despite all of the treatments, your labor is simply progressing, its time to accept that these babies are coming! If you are less than 36 weeks along, the best hands you and your babies can be in would be a hospital with a Level 3 NICU (neonatal or newborn intensive care unit). This is the highest level of infant care, and you’re in the best place. If your babies are under 30 weeks, a cesarean section (C-section) will be done. If, however, your babies are over 30 weeks (the skull bones are now firmer), and their positions are head down and engaged to enter the birth canal, you might be given the choice to deliver vaginally. If you are carrying more than two babies, however, you can count on having a C-section.

Congratulations ARE in order! Although you may have just gone through days of drama and trauma, and the unwanted and unexpected early births of your babies happened despite all your hopes, prayers, and actions taken by your health care team, your babies have arrived, and you need to know that this is (although bitter-sweet) an occasion for celebration! If your babies are very premature (arriving before 28 weeks), a high level of care and time will be needed, and there may be one or more short or long-term residual effects due to this level of prematurity.

Babies arriving between 30-34 weeks stand a much better chance at simply growing with careful care and monitoring before being sent home with you. Generally, the protocol standards neonatologists use to decide that a baby is ready for hospital release would be weight, overall health, and gestational age. Rarely do preemies go home before they reach 37 weeks (what would have been) gestational age. The weight goal doctors like to see reached is between 1800-2000 grams (4 to 4.5 pounds). Some doctors like to see closer to 5 lbs. Other circumstances may also factor in, however, such as illness and surgery recovery, and apnea/bradycardia (referred to as “A’s & B’s”) episodes, which are very common heart/lung/breathing maturity conditions, may be occurring too frequently. Another alternative to staying hospitalized after 4.5-5 lbs. is reached and A’s &B’s are the only issue, may be to take the babies home but with the security of portable monitors that can alert you as you that an episode has occurred so you can quickly stimulate the baby to take that breath and thus prevent any further problems. SIDS (Sudden Infant Death Syndrome) occurs much more frequently and the risk time is longer with preemies.

Welcome to the world of parenthood! Buckle your seat belt and prepare now for the craziest ride of your life! Be encouraged and take comfort that despite your baby(s)’s premature arrival, and the challenges it may have presented or may still present, you will find the strength through love, devotion and commitment to be the best mother for your baby(s). Trust me, you will find the strength, and YOU’LL DO GREAT!

For other resources on premature labor’s signs, causes, treatments and prevention, please visit American Pregnancy Association and The National Institute of Child Health and Human Development.

Premature Babies. Due to the many medical complications that can develop as a result of premature birth, please refer to Premature Infant – Frequently Asked Questions, a resource on WebMD.com for a comprehensive report on what can be expected after the delivery of your premature baby(ies). Another source to check out is a research review that I co-wrote with a fellow student in a nursing school prerequisite class that I took a couple of years ago on the Developmental Interventions that can be done to improve chances of healthy growth in premature infants. Here is the link: Premature Infants/Developmental Intervention.

REMEMBER that an ounce of prevention is worth a pound of cure.

So, let’s keep those babies cookin’ inside as long as possible!

My personal preterm labor and delivery experiences …

… are basically described in the above article. I went on complete bed rest with all of my pregnancies somewhere between weeks 18-22. I, more or less, experienced each of the steps listed above, with some slight variations with each pregnancy. My second pregnancy was stretched to 35 weeks, due to, I believe, the fact that I went home with a subcutaneous intravenous line inserted in my thigh, which was attached to a little computer remote that administered regular doses of Terbutaline into my bloodstream. A visiting nurse came once per week to check my and the babies’ vitals, and alternate my I.V site from one thigh to the other. Along with this treatment came a monitoring system that I was required to use. Two to three times per day, I was required to belt myself to a contraction monitor and leave it on to read any contraction activity for one hour. Immediately afterward, I remotely transmitted the data via my telephone to an OB nurse who would read the data and call me back with the results. I was allowed five or so mild contractions per hour. One early morning just past my 35th week, the contractions numbered 27, and I was sent to the hospital. Trust me, I knew how bad I was feeling and predicted what my off-premises nurse’s instructions would be! My son (the trail blazer) arrived via vaginal birth at 4 lbs, 13 oz, and my daughter (who was out in 2 pushes) weighed 4 lbs, 6 oz. Neither had any health problems and stayed in the NICU for one week to grow a bit and overcome some mild jaundice, and are now very active, happy 11-yr-olds.

My first and my third pregnancies’ preterm bouts, however, were different. At 30 weeks with my first set of twins I went into preterm labor for the 3rd time, and although hospitalized and on treatments, my water broke at 30 weeks and 5 days. My daughters (born weighing 2 lbs., 14 oz and 3 lbs, 1 oz), were hospitalized for 6 weeks and had some health issues, but nothing long-term. They are now strong, smart, healthy 16-year-olds.

My water broke (after 2 hospital-stay bouts of preterm labor placing me on oral Terbutaline) one afternoon with no warning when my third set were 30 weeks and 5 days along, coincidentally and ironically the exact gestational age as my first set of twins. Although a vaginal birth was preferable, I was advised to go ahead with a C-section in case the babies were just too small. They were born at 4 lbs, 1 oz and 3 lbs., 11 oz. … much bigger than my daughters. Perhaps (and it s suspected) I was off my conception date a week or so. My now 3-yr-old sons are typical, healthy, and BUSY little boys!