Expecting: Twins, Triplets and More, Oh My!

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What’s a parent to do with two? Or more? One is hard enough, so we gathered all of the knowledge you need to conquer your new journey!

That moment when you and your significant other are holding hands, anxious to find out the sex of your little peanut. The doctor says, “Congratulations, you are having a boy … and a girl!” Surprise! Two peanuts! How is that even possible? It’s not even in your family line! Although there is an increased probability you can have twins if it’s in your family history, or you are a twin yourself, it’s still possible to have twins even if it’s not linked to heredity.

“There are different types of twins,” says Dr. David McKenna, Maternal-Fetal Medicine at Miami Valley Hospital, “Twins can come from one egg or two eggs. If they come from one egg [identical], that is constant across ovulation but twinning from two eggs, that would be from family history.”

The chances of having identical twins is the same for every woman, no matter what your family history is. In fact, the chances of having identical twins is about 1 in every 89 births. However, the older you get, the higher your chances of having non-identical twins. Your height and the number of kids you already have are important factors, too.

BE AWARE OF HIGH-RISK COMPLICATIONS

Know that a multiple pregnancy (more than one) automatically puts you in the high-risk pregnancy category, since you are at a higher risk of having pregnancy complications than the mama who has a singleton pregnancy (one peanut). Although identical twins are more high-risk than non-identical, a mom carrying more than one bun in the oven will need more attention during and after pregnancy.

“In general, all complications of pregnancy are more common with twins gestations,” says McKenna.

It’s also important to know that there are two types of complications: maternal and fetal.

“Maternal complications that are quite common with twins include: hypertensive disorders such as preeclampsia [high blood pressure and protein in the urine], gestational diabetes and increased risk of cesarean delivery and the associated risks with that,” he continues.

When it comes to fetal complications, complications include increased risks for birth defects, growth abnormalities or preterm birth. Over 60 percent of twins and nearly all higher-order multiples are premature (born before 37 weeks). The higher the number of fetuses in the pregnancy, the higher the risk for preterm birth and the greater the risk it is going to occur at an earlier gestational age, according to McKenna.

DOCTOR VISITS & TESTING

Nonetheless, a mom carrying twins or multiples will have more checkups and doctor appointments throughout the pregnancy.

“There are definitely a lot more visits required with any kind of twin pregnancy,” says McKenna.

Moms will have more check ups with identical twins than non-identical. For identical, depending on how the pregnancy is going, it’s every two weeks up to 28 weeks, and after that is weekly, then twice a week at 32 weeks leading up to an early delivery of no later than 37 weeks. For non-identical, Mom is seen every four weeks for ultrasounds, testing at 32 weeks with a recommended early delivery date no later than 38 weeks, according to McKenna.

As for testing, starting at 28 weeks, non-stress tests are normally done for identical twins, and for non-identical twins, this begins at 32 weeks. Twins also require more frequent ultrasound appointments compared to singletons, as often as every 2 weeks for identical, and every 4 weeks for non-identical.

COPING WITH INCREASED DISCOMFORT

I think it’s safe to say that the further you get into any pregnancy, the more uncomfortable you are. That is a given. However, if you have a multiple pregnancy, that discomfort is a bit more, uncomfortable.

Trouble sleeping, constipation, swelling, back and headaches are some discomforts to expect, and although this is all completely normal, they can sometimes be warning signs. If you feel like something is abnormal, call your doctor right away. With a multiple pregnancy, these discomforts can happen earlier than a singleton pregnancy.

“At approximately 32 weeks, the combined weight of two fetuses is going to be around 7 to 8 pounds,” says McKenna. “So it’s not unreasonable to expect that around that point, you start feeling the way you did in your prior pregnancy if you went to full term, or [like] someone else has felt at the end of their pregnancy.”
Needless to say, none of this sounds enjoyable. The good news is, there is hope for some relief.

According to McKenna, it has been shown that a regular prenatal yoga routine is one of the best ways to relieve any discomforts, not only in singleton pregnancies, but doctors have every reason to believe it does wonders in multiple pregnancies, too. Positives include less of a need for pain medication during labor, a decreased chance of a cesarean delivery and moms generally feel better overall.

Other ways you can avoid discomforts is by participating in an active exercise or activity program such as swimming and getting into the pool, which takes the force of gravity off of the body; or wearing pregnancy support belts and hose which helps relieve any discomforts.

BABY’S ARRIVAL

It’s time for Baby’s grand arrival! Most of the time, twins are born in the operating room instead of labor and delivery due to the greater possibilities of having a cesarean delivery. That way a plan is in place to ensure a safer delivery and labor for Mom and Baby. Here’s what to expect – depending on the positioning of Baby ‘A’ and Baby ‘B’ (head-down or breech), this can determine a cesarean or vaginal delivery.

“Twins are higher risk for having a cesarean birth,” says McKenna. “The first thing you have to consider is the gestational age and also the presentation of Baby ‘A’ and Baby ‘B.’ At full-term, if the babies are close in size, within about 20 percent of each other [estimated ultrasound weight] and Baby ‘A’ is head down, a trial of labor is appropriate.”

If Baby ‘A’ is breach or having any other complications, (about 20 percent of the time) then a cesarean is recommended. If both babies are head down, a vaginal birth will be appropriate. If Baby ‘B’ is breach, there may be a risk for Baby ‘B.’

“Doing the cesarean deliveries does not decrease risk for Baby ‘B,’ says McKenna. “Therefore a trial of labor is still appropriate if Baby ‘B’ is now presenting. We encourage that because moms are going to have a better recovery after an easy vaginal birth, and it’s going to be a lot easier on her as opposed to having a cesarean.”

There are tons of classes to help prepare Mom and Dad for the arrival of their little ones. Many hospitals such as Miami Valley Hospital offer multiple childbirth education classes for parents to better prepare for labor and delivery.

“Going to the birthing education classes, they should go as a couple,” says McKenna. “It’s a fighting experience if you had no clue what to expect. That’s the whole goal of childhood education to give them an idea of what the possibilities are.”

Physically seeing and being at the place where your bundles will have their big debut at will help ease your mind and make you feel more comfortable overall.

FIND LOCAL SUPPORT!

WEST CHESTER MOTHERS OF TWINS & MORE CLUB; wcmultiples.org
Provides support, education and outreach programs for parents with multiples. They have a spring and fall clothing and equipment sale plus playdates and outings throughout the year.

NORTHEASTERN CINCINNATI MOTHERS OF TWINS & MORE CLUB; nemotmc.com
Offer support to moms of multiples living in or around the greater Cincinnati area.

NORTHERN KENTUCKY MOTHER OF MULTIPLES CLUB; nkmotc.webs.com
A local non-profit organization supporting families expecting or raising twins, triplets and more. Plus they have big Semi-Annual Sale!

TRISTATE MULTIPLES; tristatemultiples.com
Support group for families with triplets or more in the tri-state area.

TWIN MULTIPLES CLUB; twinmultiples.com
A free online international resource for families with twins or multiples.

Amanda Hayward is editor of this publication. She is from Cincinnati, Ohio, a military wife and mom of two. If you don't see her writing for Cincinnati Family, you'll find her running, juggling kids, teaching group fitness classes and cooking up healthy recipes.

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