Having Twins

     Being pregnant with more than one baby is called multiple pregnancy.  A multiple pregnancy can be twins (two babies), triplets (three babies), or more.  Today, twins are born once in about every 41 births.  Having twins can bring great joy and rewards to a family.  Sometimes, however, it can also pose a risk to the mother and her babies.  Complications can occur that require special care.  This section discusses twins and explains some of the problems that can occur during a twin pregnancy.

 

 

   

FACTS ABOUT TWINS

     Twins can be either identical or fraternal.  Most are fraternal twins-each develops from a separate egg and sperm.  Fraternal twins each have their own placenta and amniotic sac.  Because each twin develops from the union of a different egg and a different sperm, these twins may not look alike.  The twins can be boys, girls, or one of each.  Identical twins are more rare.  They occur when one fertilized egg splits early in the pregnancy and develops into two fetuses.  Identical twins may share a placenta, but each baby usually has its own amniotic sac.  Identical twins are the same sex and have the same blood type, hair color, and eye color, and they look very much alike.  Some families are more likely than others to have twins.  Women who take fertility drugs also have a higher chance of having twins.  Since these drugs can cause more than one egg to be released from the ovaries at once, multiple fertilizations become more likely. 

 

 

DIAGNOSIS

     Most twins are diagnosed before delivery.  Your doctor may tell you that you are carrying twins if:

	Your uterus grows more quickly or is larger than expected.
	More than one fetal heartbeat can be heard.
	You feel more fetal movements than you did in any pregnancies you had before.
	An ultrasound exam done for other reason detects twins.

     Some twins are found when other prenatal tests are done.  If a twin pregnancy is suspected, an ultrasound may be done to confirm it.  The test also may be able to tell if the twins are identical or fraternal. 

 

 

PRENATAL CARE

     You will need special prenatal care with twins.  You will need to see your doctor more than often and you may have more medical tests.  Plan to take childbirth classes during your 4th to 6th month.  Ask about special classes for parents expecting twins.  If there isn't one convenient for you, talk to your doctor about getting one started.

 

 

NUTRITION

     When pregnant with twins, you will need to eat more than if you were carrying one baby.  Eating well and gaining weight are important for your health and the health of your twins.  Your body must nourish the babies and meet your energy needs as well.  You will need to eat about 2,700 calories every day.  Your doctor will prescribe extra vitamins and minerals to help your babies grow.  Anemia (iron-poor blood) is more common in women pregnant with twins, so it's especially important to take your prenatal vitamins and iron as prescribed.  Folic acid is also important for twins.  It is hard to get all the folic acid you need just from your diet, so you should take folic acid along with the prenatal vitamin.  You should gain more weight when carrying twins than if you were having only one baby.  Plan to gain 35-45 pounds.  In the first half of pregnancy, you should gain about 1 pound a week.  In the second half, aim for a little over 1 pound each week.  If you are underweight, you may need to gain more. 

 

 

REST

     Twins can make you more uncomfortable than usual during pregnancy because the uterus becomes much larger.  Resting during the day will help give you energy.  Avoid standing for long periods and lifting heavy objects.  Talk with your doctor about your job or your work at home.  Some women will be told to restrict their activity because of pregnancy complications.  You may even need to stay in bed for several weeks.  Talk to your doctor about what kind of activity is right for you. 

 

 

COMPLICATIONS

    The risk of certain complications is higher in a twin pregnancy.  The mother is more likely to develop high blood pressure or anemia, and the babies are more like to be born small.  The mother is also more likely to go into preterm labor.  Sometimes these problems can be prevented with early detection and care.

 

 

PRETERM LABOR

     Preterm labor is labor that starts before the end of 37 weeks of pregnancy.  This can result in preterm birth, the most common problem of multiple pregnancy.  About half of all twins are born preterm.  When babies are preterm, they often have problems breathing or eating.  They will have to stay in the hospital nursery longer than usual.  Extremely preterm babies can die, even with the best of care.  In others, problems can occur as they grow and develop.  If preterm labor is found early enough, delivery can sometimes be postponed.  This will give your babies extra time to grow and mature.  Even a few more days can make a big difference.  Because of the risk of preterm labor, you should be alert to the early signs of preterm labor.  If you have any of these signs, don't wait.  Call your doctor or nurse or go to the hospital right away. 

 

 

PREMATURE RUPTURE OF MEMBRANES

     The membranes that hold the amniotic fluid rupture (break) at the start of labor.  Sometimes the membranes rupture or leak before labor.  This is called premature rupture of membranes.  When one or both of the sacs rupture early, the mother is at high risk of preterm labor and infection.  If you have premature rupture of membranes or preterm labor, you may be given injections of a steroid medication.  This can help the babies' lungs work better. 

 

 

HYPERTENSION

     High blood pressure that occurs for the first time in pregnancy is called pregnancy-induced hypertension.  A sign of hypertension is swelling.  Many women have some swelling, especially in their feet and legs, at the end of the day.  Too much or sudden swelling may be more serious.  If it is not treated, hypertension can cause seizures and threaten your life.  It is important for you to learn the warning symptoms of hypertension and to call your doctor right away if you notice them:

	Severe or constant headaches
	Swelling, especially of the face
	Blurred vision
	Pain in the upper right part of the abdomen
	Sudden weight gain of more than 1 pound a day

Warning Signs of Preterm Labor   Call your doctor or nurse right away if you notice any of these signs: Discharge from your vagina -Change in type (watery, bloody, or mucous) -Increase in amount A feeling of pressure in your lower abdomen or pelvic area Constant, low, dull backache Mild abdominal cramps like a menstrual period, with or without diarrhea Regular contractions or tightening of your uterus Ruptured membranes (your "water breaks")

 

     When blood pressure goes up during pregnancy, bed rest may be recommended.  Some women are hospitalized and given medication.  The babies may need to be delivered early if blood pressure becomes too high.

 

 

GROWTH PROBLEMS

     Twins are more likely to have growth problems.  Intrauterine growth restriction (IUGR) is the term for slow growth of babies during pregnancy.  Ultrasound is often used to check the growth of each baby.  Sometimes, all the babies will be smaller than normal.  Twins are called discordant if one is much smaller than the other.  This may be due to one twin getting more blood and having more amniotic fluid that the other, poor functioning of the placenta, or birth defects.  The smaller baby is more likely to have problems during pregnancy and after birth.  Ultrasound will be used to check each baby's growth and the amount of amniotic fluid.  Early delivery may be needed if either baby shows signs of having problems before term.  A  condition that can cause one twin to be smaller than the other is twin-twin transfusion syndrome (TTS). TTS can develop when twins share a placenta.  The blood passes from one twin to the other through their shared placenta.  This can be dangerous for both twins.  The twin that gives the blood will be very small and have too little amniotic fluid.  The other twin can have too much blood and amniotic fluid and becomes too large.  Your doctor will use ultrasound to check the amount of amniotic fluid.  Some of the extra fluid may need to be removed.  If TTS is severe, the twins may have to be delivered early.

 

 

FETAL LOSS

     In some twin pregnancies, one of the babies dies.  In early pregnancy, this is called vanishing twin.  If this happens, you may have some spotting or bleeding from your vagina.  This does not harm you or the other baby.  Death pf one of the babies is more serious in later pregnancy.  Losing a baby when you are still pregnant with another can be very hard for you and your family.  it can help to talk with your doctor, nurse, or a counselor about your feelings.

 

 

MONITORING TWIN PREGNANCY

     Many techniques are used to check the well-being of your babies.  They may be done to confirm other test results or to provide further information.  When problems arise, these tests can help to find them early.  Your doctor may use various ways to check your pregnancy:

	Repeat ultrasound to check the babies' growth
	Examine your cervix for changes that may show early signs of preterm labor
	Count your babies' movements, called kick counts
	Examine the babies' heart rate, body movements, muscle tone, and the amount of amniotic fluid by ultrasound
	Measure the babies' heart rate in response to their own movements (called a nonstress test)

     Sometimes, amniocentesis is needed.  Amniotic fluid contains a substance that shows the maturity of babies' lungs.  In the late months of pregnancy, amniocentesis may be used to decide if the babies' lungs are developed enough for them to be born safely.

 

 

DELIVERY

     In some cases, twins can be delivered by vaginal birth.  In others, a cesarean birth may be needed, in which the baby is delivered through a cut made in your abdomen and uterus.  How your babies are born depends on certain factors:

	Position of each baby
	Weight of each baby
	Your health
	Health of babies

    Labor may take longer with twins, especially the pushing stage.  Babies are usually born several minutes apart in vaginal delivery, but it can take longer.  Twins can usually be born vaginally if they are both in the head-down position.  A vaginal birth also may be possible when the lower twin is in the head down position but the higher twin is not.  Once the first twin is born, the other twin can sometimes be turned or delivered with feet or buttocks' first.  When this can't be done, the second twin is delivered by cesarean birth.  Cesarean delivery may also be needed when either of the babies is having problems.

 

 

CARING FOR YOUR NEWBORN TWINS

     Most twins do well at birth and can be cared for like other healthy baby.  However, if the babies are born early, they may need special medical care to breathe, eat, and keep warm.  Preterm and small twins may be cared for in a special nursery called a neonatal intensive care unit at the hospital.  Many women wonder if they can breastfeed more than one baby.  The answer is yes.  Mother's milk is the best food for any infant.  It has the right amount of all the nutrients the baby needs.  When you breastfeed, your milk supply will increase to meet the amount needed by your babies.  You will need to eat healthy foods and drink plenty of liquids.  Women who breastfeed need at least 500 extra calories a day.  If your babies are premature, you can pump and store your milk until they are strong enough to nurse from the breast.  You may find it helpful to talk with a lactation specialist who is trained to teach women about breastfeeding.  Caring for twins can be stressful at times.  get as much rest as you can.  Let others take care of the daily chores while you care for yourself and your new babies.  Enjoy the special time you have with each one. 

 

 

FINALLY...

     Having twins can be an exciting time.  You can give your babies the best possible start by taking good care for yourself.  Learn the warning signs of problems, and talk to your doctor or nurse about your questions and concerns.  It is also helpful to talk with others who have twins.  There are organizations  and support groups that provide services for parents of twins.  Ask your doctor or nurse to recommend one. 

 

 

 

ACOG PATIENT EDUCATION