What to expect when you're expecting (164 page)

Pictures, pictures, pictures. Of your babies, that is. You’ll get extra ultrasounds to monitor your babies and make sure their development and growth is on track and the pregnancy is healthy. Which means extra reassurance, plus extra pictures for your baby book.

Extra attention. Good prenatal care also means extra attention to your health to reduce your risk of certain pregnancy complications (like hypertension, anemia, placenta abruption, and preterm labor, which are all more common in multiple pregnancies). With all that extra attention, any problem that develops will be treated quickly.

A multiple pregnancy can also impact the health of the mother-to-be:

Preeclampsia.
The more babies you’re carrying, the more placenta you’ve got on board. This added placenta (along with the added hormones that come with two babies) can sometimes lead to high blood pressure, which may in turn progress to preeclampsia. Preeclampsia affects one in four mothers of twins and usually is caught early, thanks to careful monitoring by your practitioner. For more on the condition and treatment options, see
page 548
.

Gestational diabetes.
Expectant multiple moms are slightly more likely to have gestational diabetes than a singleton mom. That’s probably because higher hormone levels can interfere with a mother’s ability to process insulin. Diet can usually control (or even prevent) this condition, but sometimes extra insulin is needed (see
page 546
for more).

Placental problems.
Women pregnant with multiples are at a somewhat higher risk for complications such as placenta previa (low-lying placenta) or placental abruption (premature separation of the placenta). Fortunately, careful monitoring (which you’ll be getting) can detect previa long before it poses any significant risk. Abruption can’t be detected before it happens, but because your pregnancy is being carefully watched, steps can be taken to avoid further complications should an abruption occur.

“Will I have to be on bed rest just because I’m carrying twins?”

To bed rest or not to bed rest? That is the question many moms-to-be of multiples ask, and many practitioners don’t always have an easy answer. That’s because there really isn’t an easy answer. The obstetrical jury is still out on whether bed rest helps prevent the kinds of complications sometimes associated with a multiple pregnancy (such as preterm labor and preeclampsia). So in the meantime, until more is known, some practitioners prescribe it in some cases. The more babies in a pregnancy, the more likely it will be prescribed, since the risk of complications increases with each additional fetus.

Be sure to have a discussion with your practitioner early in your pregnancy about his or her philosophy on bed rest. Some practitioners prescribe it routinely for all expectant mothers of multiples (often beginning between 24 and 28 weeks); more and more do it on a case-by-case basis, taking a wait-and-see approach.

If you are put on bed rest, see
page 571
for tips on coping with it. And keep in mind that even if you aren’t sent to bed, your practitioner will probably still advise you to take it easy, cut back on work, and stay off your feet as much as possible during the latter half of your pregnancy—so get ready to rest up.

“I’ve heard of vanishing twin syndrome. What is it?”

Detecting multiple pregnancies early using ultrasound technology has many benefits, because the sooner you and your practitioner discover you’ve got two (or more) babies to care for, the better care you’ll be able to get. But there’s sometimes a downside to knowing so soon. Identifying twin pregnancies earlier than ever also reveals losses that went undetected before the days of early ultrasound.

The loss of one twin during pregnancy can occur in the first trimester (often before the mother even knows she’s carrying twins) or, less commonly, later in the pregnancy. During a first-trimester loss, the tissue of the miscarried twin is usually reabsorbed by the mother. This phenomenon, called vanishing twin syndrome, occurs in about 20 to 30 percent of multiple pregnancies. Documentation of vanishing twin syndrome has grown significantly over the past few decades, as early ultrasounds—the only way to be sure early in pregnancy that you’re carrying twins—have become routine. Researchers report more cases of vanishing twin syndrome in women older than 30, though that may be because older mothers in general have higher rates of multiple pregnancies, especially with the use of fertility treatments.

There are rarely any symptoms when the early loss of one twin occurs, though some mothers experience mild cramping, bleeding, or pelvic pain, similar to a miscarriage (though none of those symptoms is a sure sign of such a loss). Decreasing hormone levels (as detected by blood tests) may also indicate that one fetus has been miscarried.

The good news is that when vanishing twin syndrome occurs in the first trimester, the mother usually goes on to experience a normal pregnancy and delivers the single healthy baby without complication or intervention. In the much less likely case that a twin dies in the second or third trimester, the remaining baby may be at an increased risk of intrauterine growth restriction, and the mother may be at risk of preterm labor, infection, or bleeding. The remaining baby would then be watched carefully and the rest of the pregnancy monitored for complications.

For help coping with the loss of a twin in utero, see
page 583
.

Multiple Childbirth

You’re probably spending a lot of time wondering (okay, maybe you’ve been obsessing) about the day you’ll actually give birth to your bundles of joy. Every delivery day is an unforgettable one, but if you’re carrying twins (or more), yours probably won’t be the typical birth story you’ve heard from moms who’ve delivered just one. Not surprisingly, things can get a little more complicated when you’ve got two babies or more heading for the exit—and a lot more interesting.

Will your labor and delivery be twice the effort? What will be the ideal way to deliver your multiple newborns into your two arms? The answers can depend on a lot of factors, such as fetal position, your health, the safety of the babies, and so on. Multiple births have more variables—and more surprises—than single births. But since you’ll be getting two (or more) for the price of one labor, your multiple childbirth will be a pretty good deal no matter how it ends up playing out. And remember that whatever route your babies take from your snug womb to your even snugger embrace, the best way is the one that is the healthiest and safest for them—and for you.

How will your labor differ from the labor of a mother-of-one? Here are a few ways:

It could be shorter. Will you have to endure double the pain to end up cuddling double the pleasure? Nope. In fact, when it comes to labor, you’re likely to catch a really nice break (for once). The first stage of labor is often shorter with multiples—which means that it may take less time to get to the point where you can start pushing, if you’ll be delivering vaginally. The catch? You’ll be hitting the harder part of labor sooner.

Or it could be longer. Because a multiples mom’s uterus is overstretched, contractions are sometimes weaker. And weaker contractions could mean that it might take longer to become fully dilated.

It’ll be watched more closely. Because your medical team will have to be twice as careful during your multiple delivery, you’ll be monitored more during labor than most moms of singletons. Throughout labor, you’ll likely be attached to two (or more) fetal monitors so your practitioner can see how each baby is responding to your contractions. Early on, the babies’ heartbeats may be monitored with external belt monitors; this could allow you to go off the monitors periodically so you can walk around or hit the whirlpool tub to help ease your pain (if you’re so inclined). In the latter stages of labor, Baby A (the one closest to the exit) may be monitored internally with a scalp electrode while Baby B is still monitored externally. This will put an end to any wandering because you’ll be tethered to a machine (but by this time, you may be well past the point of wanting to move around anyway). Be sure to discuss fetal monitoring and how it will affect your mobility with your practitioner.