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Twins, Triplets, Oh My!

By Brenda Broussard APRN, CNM, WHNP-BC, MSN

Twins, Triplets, Oh My!

Expecting twins, triplets, or more? Being pregnant with more than one baby can happen spontaneously or from fertility treatments, like in-vitro fertilization (IVF).

Carrying more than one baby does change what experts expect will happen with your pregnancy, as well as some of the care you’ll receive.

Will pregnancy with multiples be the same?
The basics for having a healthy pregnancy still apply: Eat a well-balanced diet with a lot of fruits, vegetables, protein and whole grains to give your babies the nutrition they need to grow.

Take a daily prenatal vitamin and keep all of your scheduled prenatal appointments, including those with any specialists involved. Also, ask your healthcare provider if you need additional folic acid or other essential vitamins or minerals with your multiple gestation.

Just like any other pregnant mom, plan to attend prenatal, birthing and breastfeeding classes. But schedule yours a little earlier since you probably will not go the full 40 weeks of pregnancy—you could even end up with activity restrictions late in your pregnancy. Look for a hospital or birthing center that offers prenatal classes for moms carrying more than one baby.

Do I need to see a specialist?
You may begin your prenatal care with your nurse-midwife or doctor, but because multiple pregnancies do have more potential risk factors, you may also be asked to have at least one visit with a perinatologist, a doctor who specializes in high-risk pregnancies, or a maternal-fetal medicine physician. Also, expect to have additional prenatal checks including additional ultrasounds as needed to ensure your babies are growing well.

These specialists will give you an exam, review your chart and most likely do an ultrasound to monitor your babies’ growth, examine the placenta(s) and watch for any complications that the babies may be developing.

They will discuss any concerns that may arise about the babies’ growth and development, recommend any additional testing and monitor your pregnancy.

Will I go into labor early?
In general, women carrying multiples go into labor before the full 40 weeks of pregnancy. Most twins are born by 38 weeks; about half of all twins are born before 36 weeks.

Many prenatal care providers advise moms with multiples to shoot for at least 37 completed weeks of pregnancy. The greater the number of babies you’re carrying, the greater the risk you may go into labor and birth earlier.

If you’re carrying more than 1 baby, you’re also at higher risk for preterm labor as well as preeclampsia—a condition in which your blood pressure rises and you can become seriously ill if your babies aren’t delivered. Your healthcare provider will watch to see if you start to show any risks or signs of preterm labor or preeclampsia.

The earlier your babies are born, the higher the risk they may need to go to the Neonatal Intensive Care Unit for care before leaving the hospital. Babies born early often need assistance breathing, stabilizing their body temperature and eating.

Each week in pregnancy is essential to your baby’s health and development; the earlier your babies are born, the more likely they are to need additional medical help to mature and gain weight before they can come home.
Will I need to have a C-section?
About half of all twins are born vaginally and half via cesarean. Your risk of cesarean birth increases based on your age and the number of babies you’re carrying; older moms and moms carry multiples are more likely to have a cesarean even if one of the babies first emerges vaginally. Going into labor, only about 40% of all twins are both positioned head down in the womb.

Discuss your options for birthing with your healthcare provider and know that you may need to be flexible to get the best outcomes for yourself, and both babies. Many moms carrying multiples decide to write a birth plan that expresses their wishes for all possible ways of birthing.

How much weight should I gain?
Because you’re carrying more than 1 baby, you’ll gain more weight because of the extra weight of each baby as well as their amniotic fluid and placenta. Your body will also increase your blood volume to nourish your babies.
According to the National Academy of Sciences, how much weight you’ll need to gain when carrying twins depends on your pre-pregnancy weight and body mass index. Depending on where you fall on the standard BMI chart, you need to gain the following with twins:
 ►Healthy: 37-54 pounds
 ►Overweight: 31-50 pounds
 ►Obese: 25-42 pounds

For each baby beyond 2, add another 10 pounds to these recommendations. This is no time to “keep your figure”—weight gain with multiples is essential for the health of your babies.
What should I ask my prenatal care provider?

  • How often will I have prenatal appointments?
  • How much weight do you recommend I gain with this pregnancy?
  • Are there other specialists you will ask me to see during my pregnancy?
  • Are there any additional tests I’ll need during pregnancy?
  • What signs or symptoms should I watch for that may indicate a problem with one or both of my babies?
  • When should I start prenatal classes?
  • Will it be possible to birth my babies vaginally? What’s the likelihood that I may need a cesarean?
  • Does the hospital where I will birth have a Neonatal Intensive Care Unit?
  • If my pregnancy remains healthy for me and my babies,how long do you think I’ll carry them before labor begins?
  • How long do you think I can continue working?
  • Can my partner and I continue to have sexual intercourse?

Brenda Broussard APRN, CNM, WHNP-BC, MSN, is an instructor at the University of Louisiana at Lafayette College of Nursing and Allied Health Professions.


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