Twin and Multiple Births

If you are expecting twins or multiples, then you are probably extra-excited and want to share your pregnancy with everyone! Going through a twin or multiple pregnancy can be an incredible experience, but it does mean that your pregnancy may not be exactly the same as if you were only carrying one baby. Twin and multiple pregnancies often involve a few differences, particularly when it comes to prenatal health care, nutritional needs, and the labor and delivery process. Here is some information to help you become more familiar with what to expect with twin and multiple pregnancies.

Prenatal Care
As with a single pregnancy, it is important that you see your health care provider regularly if you are expecting multiples. Regular prenatal care appointments will help to ensure that your pregnancy is progressing just as it should. However, there will be some differences in your prenatal health care if you are carrying multiples

Your Health Care Provider
If you are carrying twins or multiples, it is likely that you will be encouraged to see a board certified obstetrician (instead of your general practitioner) throughout your entire pregnancy. Some women who are experiencing complications with their multiple pregnancy may also see a perinatalogist, a board certified obstetrician with special training when it comes to dealing with pregnancy complications. Though you may not have to attend appointments more frequently, it is likely that you will be offered more tests during your prenatal appointments. In particular, you will need to undergo a few more ultrasound tests than women who are carrying single babies. Ultrasounds will probably be provided at every prenatal appointment in order to check on the growth and development of each baby. Your health care provider will also perform more screening tests, particularly to check on your blood glucose levels.

Pregnancy Nutrition
It is essential to work hard to meet your nutritional needs during pregnancy; after all, your baby is relying on you for all his vitamins and nutrients. If you are expecting multiples, you may need to increase the amount of certain vitamins and minerals in your pregnancy diet in order to satisfy the needs of all of the babies. In particular, your health care provider will probably recommend that you increase your intake of folic acid and iron in order to prevent neural tube defects and anemia. Water consumption is also essential with multiple pregnancies. Try to drink at least two quarts of water a day. This will prevent dehydration which can cause contractions leading to preterm labor.

Pregnancy Weight Gain
It can sometimes be difficult to know exactly how much weight you should gain during your nine months of pregnancy. Weight gain becomes even more complicated with multiple pregnancies. If you are expecting twins, it is generally suggested that you gain between 35 and 45 pounds over nine months, with the bulk of this weight gain occurring in the second and third trimesters. If you are pregnant with triplets, you should gain at least 45 pounds, slowly and constantly over the three trimesters. If you are carrying higher order multiples, you may need to gain more weight in order to reduce your risk of pregnancy complications. Be sure to speak with your health care provider about what a safe and healthy weight gain would look like for you.

Pregnancy Complications

It is especially important that you be aware of possible complications that may occur during a twin or multiple pregnancy. Unfortunately, complications affecting both mother and baby are more likely to occur in multiple pregnancies.

Preterm Birth
Preterm labor is one of the main complications associated with twin and multiple pregnancies. Labor often occurs early because there is simply not enough room inside of your uterus for the babies to grow any bigger. Preterm labor occurs in more than 50% of twin pregnancies and in more than 90% of triplet pregnancies; women expecting higher-order multiples are almost 100% likely to go into preterm labor.

Because of these risks, you may be required to engage in bed rest for a short period throughout your pregnancy, particularly if you are expecting triplets or more. However, regular prenatal care throughout your pregnancy will help to reduce your risk of preterm labor by as much as 10%. Try to become as familiar as you can with the signs of labor, so you will know exactly what to do should labor begin early.

Preeclampsia and Diabetes
If you are carrying multiples, you are also at increased risk for developing preeclampsia or diabetes during your pregnancy. Preeclampsia occurs three to five times more often in twin pregnancies, and occurs in more than 50% of all triplet pregnancies. On average, gestational diabetes occurs 10% more often in multiple pregnancies than in single pregnancies. These complications can be very dangerous to both you and your baby if left untreated. Your health care provider will be sure to screen you for these illnesses at each of your prenatal appointments. With appropriate care, preeclampsia and gestational diabetes can be managed safely.

Twin to Twin Transfusion Syndrome(TTTS)
If you are expecting twins, it is important to get checked out for TTTS. This syndrome sometimes occurs in twins that are sharing a single placenta (known as a monochorionic placenta). In TTTS, abnormal blood vessels form inside of the placenta, disrupting the proper flow of blood, oxygen, and nutrients. As a result, one twin can become severely undernourished while the other becomes over-nourished. TTTS is a very dangerous syndrome that requires immediate medical attention. Your health care provider will monitor you for TTTS if you are expecting twins.

Labor and Delivery

Labor and delivery will also be a little different when you are expecting multiples. In particular, the method in which you give birth might be different than what you had outlined in your birth plan.

C-Section or Vaginal Birth?
If you are expecting twins or multiples, you may be wondering if you will be able to have a vaginal birth. It is often rumored that all twins and multiples are delivered by cesarean section, but this is not the case. In fact, about 50% of twin births occur vaginally. However, if you are expecting two or more bundles of joy, you should know that you are at increased risk for having a c-section. This is because multiple births are often difficult to predict, and can become complicated much more quickly than a single birth.

Typically, the most important factor in determining whether or not your multiples will be delivered vaginally or through cesarean section is the presentation of your babies. Depending upon the position of your babies in the uterus during labor, vaginal birth may be tricky or even impossible. You may have to change your birth plan slightly if you are experiencing certain complications if one or more babies appears to be in distress.

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