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On the double Prenatal Care

On the double

Surprise! If you’ve got two (or more!) buns baking in the oven, the news can be overwhelming, but there’s no need to stress. Here’s the lowdown on what to expect when you’re carrying multiples.

Are you still in “twin shock” after receiving the news? Or did you have an inkling that you might have two peas in your pod? Either way, you’re definitely not alone. The number of women giving birth to twins, triplets and quadruplets has increased 76 percent since 1980, according to the National Center for Health Statistics. While having twins is doubly exciting, there’s no doubt it differs from a singleton pregnancy. If you’re wondering what it’s like to birth babies, read on for answers (from both experts and moms who’ve been there) to some of the most common questions about multiple births.

Who is more likely to have multiples?
If twins run in your family, then it’s more likely you’ll see a duo, too. (Sorry, dads, it doesn’t matter how many twins were born on your side.) It’s possible you could have inherited a gene for hyperovulation, which means you release more than one egg when you ovulate. If both of those eggs are fertilized, then you’ll end up with twins.

Age and infertility treatments, however, are the biggest factors that up your odds of becoming pregnant with more than one. In your 30s and 40s, your cycle can become irregular, and you’re more likely to release two eggs during one cycle. Infertility treatments—including both in vitro fertilization and ovulation-stimulating drugs—dramatically increase the chance of having twins, triplets and quads due to multiple eggs being fertilized, as well as an inexplicably increased tendency for the eggs to divide and create twins.

What are some early clues that you might be pregnant with twins?
“The queasiness was worse, and it seemed like all my pregnancy symptoms were amplified,” recalls Lisa Higginbotham, a mom of three, including 6-year-old twins, and leader of the local chapter of Multiples of America in Livonia, Michigan. “It felt like I was pregnant twice—but at the same time.”

Because you have double the pregnancy hormones flooding your system, common first-trimester complaints like nausea, vomiting and fatigue can be more extreme when you’re having multiples. You’re also more likely to sport a bump sooner, which makes sense considering you’re housing a duo with limited space. “I popped out almost right away. At six or seven weeks my sister-in-law asked if I was pregnant because my stomach was so far out,” reports Higginbotham.

Other early indicators are feeling more movement than you did with a previous singleton pregnancy, higher levels of pregnancy hormones in your blood work and a larger uterus than expected. Around 10 weeks, your OB will be able to detect if there are two heartbeats using a handheld Doppler device. But if you or your OB suspects twins, an ultrasound can definitively spot them as early as five weeks.

Do twin pregnancies require special care?
“The most important thing to find out when you discover you’re pregnant with twins, or more, is [whether] they’re sharing a placenta … or each have their own,” advises Larry Rand, MD, director of perinatal services at the University of California, San Francisco’s Fetal Treatment Center. “It utterly changes how the medical care should be handled.”

When each baby has his own placenta, it’s like two tenants in the same building. They each have their own apartment and plumbing. But when babies share the placenta (the organ from which they get their food and nutrients), it’s like two people living in the same apartment. If one uses more of the common resources, complications can occur, warns Rand.

Two-thirds of twins are fraternal, meaning they come from two separate eggs and will have their own amniotic sacs and placentas. The remaining third are identical, meaning they come from the same egg that divided and can end up sharing a placenta and/or amniotic sac. Your OB should be able to discern from a first trimester ultrasound which camp your babies fall into.

Babies sharing a placenta are more likely to have gestational issues unique to twins. In those cases, it’s always best to see a maternal-fetal specialist who is well-versed in high-risk pregnancies. Ask for a referral from your gynecologist, family doctor or fertility specialist.

How will medical care be different?
“Pregnancy itself is a stress test for a woman’s body. When there are two babies at the same time, the mother’s body is under double the stress,” explains Rand. That’s why carrying multiples ups the odds of having gestational diabetes, preeclampsia and most commonly, preterm labor (before 37 weeks).

Your OB will want to keep a close eye on you and your babies through frequent exams and ultrasounds. Ultrasounds are the best way to monitor the growth of the babies and to check the length of your cervix.

If your cervix is getting shorter, it’s a good indication that your body might soon go into labor. If that happens before the 34-week mark, then your OB will give you a medication to speed the development of the babies’ lungs, explains Robert Resnick, MD, professor emeritus of reproductive medicine at the University of California, San Diego.

How much weight should you gain?
Being concerned about your shape—and how it will change over the course of your pregnancy—is totally normal. The good news? What you eat and how much you gain is primarily up to you.

Weight gain guidelines vary depending on your starting weight, but according to the American College of Obstetricians and Gynecologists, the average mom-to-be of twins should gain between 37 and 54 pounds. That requires about 500 additional calories a day, though the extra calories should come from nutrient dense foods, not pizza and ice cream sundaes.

It’s common to struggle with eating enough food because expectant moms of multiples are more likely to suffer from nausea, heartburn and feeling full faster. Barbara Luke, ScD, MPH, RN, RD, author of When You’re Expecting Twins, Triplets, or Quads: Proven Guidelines for a Healthy Multiple Pregnancy, emphasizes that you’ve got to make every bite count.

For expert guidance, Luke recommends asking for a referral to a registered dietitian who has worked with expectant moms. Multiples are not automatically born small. In fact, there are lots of 6- and 7-pound twins out there, she says. The moms who deliver the largest and healthiest multiples are, in general, the ones who were diligent about gaining an appropriate amount of weight based on a healthy diet.

What will labor and delivery be like?
Because most multiples are preemies, your biggest pregnancy battle will likely be trying to keep those babies in your belly for the full 40 weeks. On average, twins are born at 35 weeks, and triplets arrive at 32 weeks. “Delivering at 36 or 37 weeks is considered good, and going even later is best,” advises Resnick.

When delivery day comes, expect your OB to take every precaution to ensure the safe birthing of your babes, especially because moms of multiples are more likely to need a C-section. “I had to give birth to the first twin in the operating room ‘just in case,’” says Higginbotham.

If you get the green light for a vaginal delivery, labor could take longer than with a singleton. But, Rand assures, it isn’t as bad as you may think. The first child out “paves the way,” making it easier for his sibling to follow. Most twins are born about 10 minutes apart, but up to two hours can pass between deliveries.

“It’s always better for the mother and babies to have a vaginal delivery,” says Rand. “There are just more reasons to have a C-section with twins because of the complications that can arise. Prep yourself to do whatever it takes to deliver healthy babies.”

When you make it your M.O. to stay in the know, find a savvy medical team and eat right, you get the ultimate return on your investment: a double dose of healthy cuties. And when you have a bundle resting in each of your arms, you won’t be able to imagine it any other way.

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