Twin Pregnancy

by Amy E. Tracy

Nothing was easy about Desiree Childress’s third pregnancy. Soon after she and her husband, Will, learned they were expecting identical twin boys, she experienced severe nausea. Having trouble holding anything down, she became dehydrated and IV lines for fluids were placed.

At about 18 weeks, preterm labor began and strict at-home bed rest prescribed. With two young daughters at home, Tiffany, 9, and Victoria, 5, Desiree found staying off her feet and reducing stress nearly impossible. Five weeks later, she was hospitalized.

Both nurses, Desiree and Will knew that these early complications and a twin pregnancy increased the likelihood of a premature delivery. Over 50% of multiples are born prematurely (before 37 weeks gestation), or weigh less than five and one-half pounds. Many preemie multiples require weeks of hospitalization and special medical attention.

By getting expert care in the hospital, Desiree hoped her babies would arrive close to term, but she also wanted to be prepared for the unexpected. David and Isaiah were born eight weeks early, each weighing a little over three pounds. “You really can’t prepare for the reality of delivering preemies, but knowing what to expect made it a little less overwhelming,” she says.

Julie Medas, a clinical neonatal nurse specialist at MetroHealth Medical Center in Cleveland, Ohio, agrees. She says that learning about the neonatal intensive care nursery (the NICU) and what a preemie looks like “won’t provide comfort, but it will give parents a sense of familiarity should their babies arrive early and need special care.”

Taking a Tour

Medas recommends that parents experiencing pregnancy complications ask for a tour of the NICU and visit a baby of comparable gestational age. “The perception is that seeing a preemie will overwhelm parents, but sometimes the imagination is far worse,” she says.

A neonatologist or a neonatal nurse can explain some of the medical equipment and common problems of preemies. Your hospital may also offer a video or booklet about the NICU. If information becomes stressful, cut your visit short and come back another day.

“The NICU can seem like a foreign land with an unfamiliar language,” says Medas. Take your time to absorb this new world, and don’t be afraid to ask questions. Some suggestions:

* What are visiting hours, and who can visit?
* Will my babies be placed near each other?
* How can I participate in my babies’ care?
* Does the NICU encourage skin-to-skin contact, music therapy, or infant massage?
* Are multiples co-bedded (placed in the same bed)?
* What resources are available to parents of premature babies and multiples?
* Is there a developmental program (occupational and physical therapy) for preemies?
* Is there a place for parents to spend the night?
* Is CPR training offered?

Researching Resources
On bed rest and with time on her hands, Desiree created a notebook of resources she’d need after the twins’ birth: “I made a list of dependable support systems, those who I could really count on like my church to provide meals and sitters my girls really liked.” She also included important names and phone numbers, such as her insurance provider and pediatrician, and she rented a pager so the NICU could reach her.

To find out what services and help you may need following your babies’ birth, talk with your hospital social worker or a nurse. Also, ask if there are any local preemie parent or mothers of multiples support groups: A parent of preemie multiples can offer first-hand advice. Mothers of Supertwins (631-859-1110) and The Triplet Connection (209-474-0885) offer programs and literature to support expectant mothers of multiples.

Desiree joined a mothers of multiples club in her third trimester. “At first, it was scary because all of the mothers of twins in the group had delivered prematurely,” she says, “but it also gave me hope to see that their children were okay, and they offered great support.”

Breastmilk Basics
When you’re coping with pregnancy complications and the risk of premature babies, thinking about breastfeeding can be daunting, to say the least. But learning about breast milk and how it can help your babies is something important you can do for your babies.

“Some doctors consider breast milk a medicine for preemies,” says Medas. Research shows breastmilk is less stressful on a preemie’s digestive system and kidneys, provides important antibodies that fight infection, and protects against allergies.

Babies who are born very small and very sick will not have the ability to breastfeed during their first days or weeks of life, but they can receive breast milk through a feeding tube placed in their nose or mouth. This means mothers have to pump and store their milk. A lactation consultant with knowledge of a preemie’s special needs can provide instruction. Ask your pediatrician, the hospital staff, or the La Leche League (800-525-3243) for a referral. Many NICUs have lending libraries that include breast-feeding books and videos, too.

“Even if you can’t or choose not to breastfeed, you can still provide your babies with the best nutrition possible,” says Medas. And it’s something only you, a mother, can do.

Preemie Parenthood
“I was prepared for the monitors and technology in the NICU, but it was still overwhelming to see those two tiny little babies,” says Desiree. “I couldn’t see their faces because of the wires and tape. I couldn’t hold them or feed them. I felt like I had really lost out.”

If your babies’ birth can’t be delayed and you become a parent of preemie multiples, like Desiree and Will, you’ll face many emotions: guilt, anger, sadness, and fear, to name a few. Having more than one baby adds to the stress: You may have two sets of medical complications to cope with, maybe even two sets of healthcare providers.

Making arrangements for help before your babies’ birth is a good idea (whether or not you delivery prematurely). You’ll need time to take care of yourself so that you’ll have the energy to take care of your babies and family.

After a difficult pregnancy, you’ll also need time to reflect on your losses. To help you cope with your feelings before and after delivery, consider starting a journal, or find someone who listens well (another parent, a social worker, a mental health expert, an Internet chat room (such as the TWINS™ Magazine Message Board), or a clergy member).

“Remember, feeling is healthy,” says Mara Stein, a Chicago clinical psychologist who delivered twin girls ten weeks early. “But if your feelings start getting in the way of your life, affecting your marriage or other relationships, or you find yourself constantly feeling sad, you may need professional help,” she says. Consult a trained therapist, such as a psychologist, psychiatrist, social worker, or family counselor.

“Becoming a parent of preemies is the hardest thing you’ll ever have to do,” says Desiree, whose twins are now eight months old. “But when I look at David and Isaiah and see them smile, I know it’s all been worth it.”

Amy E. Tracy is the author of The Pregnancy Bed Rest Book (Berkley Trade, 2001), and the co-author of Your Premature Baby and Child (Berkley Trade, 1999). Visit her Web site at www.pregnancybedrest.com.

Who’s Who in the NICU

Neonatologist: a doctor who is specially trained in the care of premature and sick babies
Registered Nurse: has graduated from an accredited school of nursing; these nurses provide much of the daily care of preemies.

Neonatal Nurse Practitioner: a registered nurse who has advanced training in neonatal care.

Clinical Neonatal Nurse Specialist: a registered nurse who has additional neonatal training in patient and nurse education.

Social Worker: can provide information on nonmedical care, such as insurance coverage, emotional support, and transportation.

Respiratory Therapist: a specialist who provides the respiratory needs of ill babies.

Developmental Therapists: help enhance a baby’s physical development.

Medical Specialists: doctors with further specialized training in such areas as the eyes, heart, lungs, and brain.

NICU Baby Books
NICU Notebook: A Parent’s Journal
Available from:
Mothers of Supertwins
PO Box 951
Brentwood, NY 11717
www.mostonline.org
877-434-MOST (6678)

Women carrying twins are five to six times more likely to experience preterm labor, says Dr. John Elliott, a specialist in maternal-fetal medicine and partner with Phoenix Perinatal Associates, in Phoenix, Arizona. “And women are only able to self-diagnose about 15% of those contractions,” he says.

Experts think this may be because many of preterm labor’s signs, such as a backache and pelvic pressure, are what women carrying multiples expect to experience. “There’s also so much activity inside their womb, mothers might not recognize contractions,” says Dr. Elliott.

Knowing you’re at risk and not a good monitor of contractions means you should immediately discuss any concerns with your doctor. You may need to wear a belt with electronic sensors that detect contractions around your abdomen. Several times a day, the monitor is hooked to a telephone and relay graphs of uterine activity to a nurse.

Also, ask your doctor about tests to predict preterm labor, including frequent pelvic exams, checking cervical length by ultrasound, and measuring hormones in the saliva, and ways to postpone delivery, including medication. Listen to your body carefully and look for these early labor signs:

• increased uterine contractions that are painful or painless (do not write them off as “Braxton Hicks” (false labor); let your doctor evaluate you)
• menstrual-like cramps (these can come and go or be constant)
• a low, dull backache
• diarrhea
• pelvic pressure (it feels like the babies are pushing down)
• increased frequency of urination a change in color, amount, or consistency of vaginal discharge.

by Amy E. Tracy

Sherene Silverberg, a marketing consultant, who lives with her husband, Marc, in Norfolk, Virginia, was thrilled to learn one August that she was pregnant for the first time and carrying twins.

Then the stories started.

“It seemed every person I met insisted on telling me a horror story about twin pregnancy, about someone they knew who had a long bed rest, terrible complications, or a premature delivery,” says Silverberg. “I became very fearful that my babies would end up in the neonatal intensive care nursery.”

In fact, multiples are often born prematurely (before 37 weeks’ gestation). “For every additional baby inside the womb, you can deduct three and a half weeks off of your due date,” says Dr. John Elliott, director of maternal-fetal medicine at Good Samaritan Hospital and a partner with Phoenix Perinatal Associates, in Phoenix, Arizona. Twins typically arrive at 36-1?2 weeks, triplets at 33 weeks.

Babies born prematurely are at risk for medical and developmental problems, but “the majority of babies who are born between 34 and 37 weeks have fewer and milder problems,” Dr. Elliott says.

Besides premature birth, “any complication that can happen with a singleton is two times as likely to happen with twins,” says Dr. Elliott. Of primary concern is preterm labor. Mothers carrying multiples are also at increased risk for preeclampsia (high blood pressure that only occurs during pregnancy). Twins are at higher risk for birth defects, too.

The Power of Positive Thinking

Though these statistics are disheartening for mothers-to-be, like Silverberg, Dr. Elliott and other perinatal health experts say there is much a woman can do to increase her chances of delivering healthy babies. One of the most important of these is having a positive attitude: “If you tell a woman that she is not going to succeed, it can negatively affect the outcome,” says Dr. Elliott. “But if you give a woman confidence that she will succeed, you’ll see better results.”

A case in point is Silverberg’s experience. “Hearing those awful stories and reading books about all the bad things that could happen during my pregnancy really messed up my mind,” she says. At sixteen weeks, Silverberg began experiencing mild contractions, which she believes were caused by all the worry and stress. She began seeing a therapist, who helped her focus on the positive and less on the negative, and the contractions stopped.

Silverberg continues to keep her spirits up throughout her days in waiting by listening to relaxation tapes and meditating several times each day. You can also keep a diary of your pregnancy progress, or a journal of your feelings. To stay upbeat, some women practice saying frequent positive affirmations, such as “My babies will arrive healthy and strong.”

Deciding on a Doctor

Finding the right doctor is critical. “Women carrying multiples need to make sure their pregnancy is being treated as a multiple pregnancy, not a singleton pregnancy, and that their practitioner is aware of the special issues concerning multiples,” says Dr. Gila Leiter, assistant clinical professor at Mt. Sinai School of Medicine, in New York City, and author of Everything You Need to Know to Have a Healthy Twin Pregnancy (Dell, 2000). “It’s a warning flag if your doctor says he or she is not going to treat your twin pregnancy any differently.”

You may choose an obstetrician/gynecologist (look for one with experience in multiples) or a perinatologist, a doctor who primarily focuses on high-risk pregnancies. Midwives typically do not care for twin pregnancies. Ask your doctor or hospital if there are any prematurity prevention programs in your area. Some larger communities offer clinics that specialize in multiple births, too.

When choosing your doctor, consider these questions:

• Is it a solo or group practice? Weigh the pros and cons. You’ll get one-on-one attention in a private practice, but your doctor may cancel appointments during deliveries, or even be on vacation when you go into labor. In a group practice, you probably won’t see your primary doctor at every appointment, but all the physicians who may deliver your babies will know your medical history.

• What access does your doctor have to sonography?

• Twin pregnancies typically require frequent ultrasounds.

• How will your doctor monitor this pregnancy? Ask for specifics regarding frequency and content of appointments, and what tests and procedures may be needed.

• What hospital is your doctor affiliated with? You may need a hospital with a nursery that can handle very premature babies?

• Will you be able to call your doctor with concerns and questions (not just emergency calls)? Make sure your doctor welcomes you as part of your medical team.

A Change of Pace

Experts say reducing the stress in your life can also help you carry your twins longer. “I tell women that if they are going to have successful pregnancies, their first job is to be an incubator; anything else they can fit into their lives is a bonus,” says Dr. Elliott.

One of the first things Jennifer Shearin, an automotive engineer, in Rochester Hills, Michigan, did when she found out she was expecting twins at 19 weeks was reduce her workload and notify her employer that she’d probably be going on temporary disability (which she did at 24 weeks).
“I was concerned about how we’d handle finances when the disability payments ran out, but I also knew I needed to eliminate some stress in my life for my babies,” says Shearin. She and her husband, Will, managed money concerns by eliminating “recreational shopping,” delaying the purchase of a new car, and cutting back on dining out.

When her blood pressure went up late in her pregnancy, Shearin rested more, napped frequently, and avoided anything strenuous, such as grocery shopping. Her babies, Emma and Olivia, were born four and a half weeks before their due date, but without any long-term health problems.

Most doctors do not prescribe bed rest as preventative treatment; however, bed rest at home or in the hospital may be prescribed if you experience complications, such as preterm labor. “A lot of studies say bed rest doesn’t work to prevent preterm birth, but bed rest is useful in high-risk situations in helping to decrease uterine activity and to get pressure off the lower uterine area,” says Dr. Leiter. (For more on bed rest, see What To Do If You’re Sent to Bed.)

Nutritional Needs

Since twins often arrive preterm, it’s important for you to gain weight early in your pregnancy. “It’s been well studied that a mother’s good nutrition and proper weight gain increases the birth weight of a baby, and the higher the weight at birth, the better a baby does,” says Dr. Leiter, who gave birth to twin girls more than a decade ago.

But gaining weight can be a challenge for multiple moms who often experience excessive nausea and vomiting. To reduce nausea, Dr. Leiter suggests consuming products with ginger (ginger ale, ginger tea, and ginger preserves) in small amounts (too much ginger may be harmful). Also, try eating dry crackers and cereal and drinking flat noncaffeinated soda. Consult your doctor about other methods to reduce nausea, including hypnosis, “relief bands” that stimulate acupressure points on the wrists, and medication. To maintain calories, eat frequent small meals throughout the day and stay hydrated by drinking water and juice.

You’ll also need to make sure you get the most nutrition from the food you do consume. Two essentials in your diet should be protein (red meat, rice and beans, nuts, and dairy products) and calcium (four glasses of milk per day or the equivalent). Ask your doctor or a dietitian for nutritional guidelines and if supplements might be needed. “Nutrition is not a minor issue during a multiple pregnancy,” says Dr. Leiter. “Women need to seek the advise of an expert.”

Silverberg knows the importance of eating well for her babies. She avoids soda and artificial sweeteners, and prepares all meals from scratch. “I believe that everything I eat and do impacts these two little souls,” says Silverberg. “It’s such an awesome responsibility, and I plan on doing as good a job as I possibly can.”

Amy E. Tracy is the author of The Pregnancy Bed Rest Book(Berkley Trade, 2001). Visit her Web site at www.pregnancybedrest.com