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Boyle: TWIN SET

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Pregnancy

Finding out that you’re having twins is the double surprise of a lifetime. Whether you’ve conceived them spontaneously or with some medical assistance, it’s a big leap to go from longing to have one baby to knowing that you are going to be responsible for two. You are suddenly initiated into a very special club of mothers, one that seems to be expanding steadily. If you live in Connecticut, Massachusetts, New York, or New Jersey, you may feel like you see a lot of twins, and you’d be right. These states are known to have higher twin populations than the rest of the country. The twin trend is on the rise in Canada, the United Kingdom, and Australia as well.

Experts attribute the rise in twin birth rates to several things: moms are having babies later (after thirty-five), which means they ovulate differently and may produce two separate eggs during a cycle; moms are relying more on fertility medications (such as Clomid, which can increase your chance of having twins to one in ten); and moms are often using assisted-reproduction technology such as in vitro fertilization (IVF), which commonly transfers more than one embryo. (About 60 percent of the moms who took our survey used some sort of fertility treatment to get pregnant.)

But no matter how prepared—or unprepared—you were for the possibility of twins, you now have several months of lead time to take care of yourself properly, get the bare basics for their nursery, educate yourself on what’s unique about having twins, and get excited about the babies you are going to have.

As both of us know from experience, a twin pregnancy is hands down way more demanding than a singleton pregnancy. Physically, you may be gaining more weight, carrying more baby weight, and experiencing the side effects of hormonal turmoil, such as heartburn (which can start as early as 20 weeks). Mentally, you may be riddled with practical worries (“Are their car seats going to fit in our car?”) or forced to switch from a languid, easy-going mind-set to breaking down your life into weekly components. Emotionally, your moods may shift from bliss to panic, depending on how you feel physically or what twin thing you are thinking about. It can be even more nerve-racking if it’s your first pregnancy. Luckily, the Twin Set Moms have some hard-won advice on how to keep your pregnancy feeling more blessed than stressed, even when the emotional stakes are high.

First Time, Double Time

Being pregnant for the first time is an unbelievably special period in a woman’s life. Everything is new, and there’s a lot to learn and get excited about. If you are pregnant with multiples for your first pregnancy, it’s a big deal and deserves to be cherished, celebrated, and respected. Blood tests, sonograms, and screenings can all bring you happy news, but they may also present an element of uncertainty as to the health of your developing babies. It’s normal for any newly pregnant mom to freak out about a questionable or confusing test result, and probably even more so for a woman carrying multiples. Remember, you have a great reward waiting for you at the end of this marathon pregnancy, and that is two sweet babies who have nothing but love in their hearts for you. Still, it’s important not to keep your worries bottled up inside; it’s not good for you or your babies. Rather, share your concerns with your partner and your obstetrician. Sometimes, all any pregnant mom needs is a reassuring word to put your mind at ease and to help your body get the rest you require.

Are You Automatically Defined as “High Risk” When You Are Pregnant with Twins or More?

Dr. Roger Newman’s opinion is yes. “Twins can have various complications that increase the risk of something going astray.” According to Dr. Newman, virtually every potential obstetrical complication is magnified with multiple pregnancies. For instance, the average birth weight for twins is 5 pounds, as opposed to 7 pounds with singletons. Some general OB/GYNs prefer to follow their patients’ twins themselves and watch them carefully for the development of such potential complications, referring them to a “high risk” specialist or perinatalogist for additional care. Cathy’s OB managed the beginning of her twin pregnancy just as he did her singleton ones until she was about sixteen weeks. Then he had her visit a perinatalogist for monthly ultrasounds (sonograms). At the beginning of the third trimester, Cathy had sonograms every two weeks until thirty weeks, and then weekly ones until she delivered at thirty-seven weeks.

Nurse Shirley Griffith says that most perinatalogists work for hospitals and run a small department for consultation and ultrasounds. “Very few do deliveries,” according to Griffith. “The most common reason that a patient is referred to a perinatalogist is for a level two ultrasound and possible chromosome testing, due to advanced maternal age (thirty-five and older),” she adds. If you would like more information on being seen by a high risk specialist, talk to your OB about it.

How to Deal: What’s Different About Twin Pregnancy

“Different” doesn’t necessarily mean bad in the context of twin versus singleton pregnancy. Some differences are awesome, others not so much. For us, these were the biggies:

•More doctor’s visits and sonograms. Addictive! Both of us were fortunate enough to have obstetricians who were exceptionally familiar with multiple pregnancies and births. Even though our doctors and nurses had seen their fair share of multiple mommas, our radiologists still oohed and aahed with us during our sonograms, and our nurses laughed as we groaned about getting on the scale. If you are a working woman, you may need to give your boss a heads-up that you’ll probably have to duck out of the office a bit more frequently; if you are a stay-at-home mom, you may need to figure out what to do with your kids. You can plan for the frequency of both your doctor visits and sonograms to escalate as your pregnancy progresses. Dr. Newman breaks it down:

First trimester. The first sonogram is usually when the radiologist figures out that there are two babies in there instead of one.

Second trimester. Usually between eighteen and twenty weeks’ gestation, you’ll be given an ultrasound to check if the twins are developing properly. Dr. Newman adds, “At this scan we also check for the mother’s cervical length measurement to try to assess her risk of preterm delivery. There is a significant direct relationship between cervix length and gestation length.” Around twenty-four weeks, “we scan the patient again, and repeat the transvaginal cervical length measurement.”

Third trimester. “We will usually follow the twins’ gestation on a monthly basis with ultrasounds in order to assess growth.”

•More glimpses of babies’ personalities. Awesome! The extra sonograms meant that we had the added bonus of seeing Baby A and Baby B interact. You may find that Baby A hogged more room in the beginning, yet Baby B kicked his or her way into position two weeks before delivery day. Some of the personality traits you notice in vitro may be consistent with what you see after your twins are born. For example, Christina’s sonograms showed that Baby A was her son and Baby B was her daughter. Baby A was born first and almost a pound bigger. Baby B was often scrunched up on the sonogram and harder to see. Baby A is currently a loud and friendly child, and Baby B is a bit shyer and snuggly. Cathy’s Twin A was dominant in utero, taking up the majority of space and literally pushing Twin B into a small corner. True to form, Twin A pushed out first and has been running the show ever since.

•More pampering. Awesome! Despite the growing twin birth rate, people tend to be in awe of a woman doing double time. You may get a pass on making side dishes for Thanksgiving and instead be brought second helpings by your grinning father-in-law. You may look more pregnant than you really are, but the visibility of your belly may mean that folks you don’t really know are more courteous (holding doors for you and giving up seats on the bus). Trust us, you’ll miss this after you give birth and you are out and about by yourself (probably doing a drugstore run) and the people treat you just like everyone else!

•More pressure “down there.” Uncomfortable. In her seventh month of twin pregnancy, Christina felt as though her uterus was just going to drop out, especially at the end of a long day caring for her active preschooler. Despite all the pressure, the medical advice of her doctors was a laid-back “take it easy.” When the pressure got too intense, she’d try to sit down for a few minutes and elevate her feet (she’d usually have to park her daughter in front of the television first). Other moms are more proactive about the intense pressure: they wear maternity belts, which come in a variety of styles and have an adjustable waist secured by Velcro and a back-support panel (look for them on amazon.com or fitmaternity.com). Sizing is often based on your pre-pregnancy hip or pants size, so you may want to upgrade a size or two to accommodate your twin belly.

•Less comfortable sleeping positions. Annoying. When your belly starts getting really big, typically around six and a half months (which is earlier than for singleton moms-to-be), you start fantasizing about sleeping on your belly (or on your back) again. To maximize her sleeping comfort, Cathy bought a body-size pillow (you can get them in The Company Store catalogue), slept on her left side, and wrapped her arms and legs around it (she was desperate for leg support at the end of a long day). These big, long pillows help stabilize you and keep you from teeter-tottering in bed.

•More digestive issues. Gross. The combination of more hormones whirling around in your body and more babies taking up room in your belly can mean you can’t tolerate foods you’d normally eat with no problem. Christina experienced bad heartburn in her last trimester of her singleton pregnancy, but that was successfully combated with Tums and Pepto-Bismol. However, as early as her twentieth week of twin pregnancy, the heartburn showed up with a vengeance. By her third trimester, she was mixing prescription heartburn meds with over-the-counter products and eating her last meal of the day no later than three-thirty or four in the afternoon. Cereal and milk was about as spicy as she could take it.

•More physically strenuous. Exhausting. If only we’d known that we were going to be pregnant with twins, we would’ve gotten ourselves in much better shape first. Our doctors cut us off from moderate exercise by twenty weeks, whereas we exercised into our ninth month with our singletons. To deal with the physical strain, we asked for more help with our other kids. You do what you have to do to keep your strength up and get your rest.

Twincidentals: When Your Expanding Butt and Belly Are a Hot Topic There’s something about being pregnant with twins that turns you into the subject of public discussion, like it or not. You may be asked questions about how much weight you are gaining or hear comments like “Oh, wow, you’re bigger than a barn!” Despite the fact that the twin birthrate is on the rise, people are still in awe of the size of the belly. Don’t let these comments bring you down. Remember, it’s good for you and the two babies you are growing when you pack on pounds. The attention can be fun if you have the right attitude. And after your twins arrive, conversations will be more focused on their appearance than yours. In fact, we bet you’ll be hearing lots of “Wow, you just had twins? You look great!”

Tackling Your Biggest Pregnancy Worries

There is potentially more to worry about with a twin pregnancy than with a singleton pregnancy. For one thing, it’s more of a strain on a mom’s body, especially on her cervix, and there are increased chances of early delivery. Experts say that about 50 percent of twins are born before thirty-seven weeks (which is considered full term, versus forty weeks for singletons). Our survey results were consistent: almost half of the moms said that their twins were born before thirty-seven weeks. Our purpose in sharing these statistics is not to scare you, but rather to let you know that no matter what you do right, the outcome may be out of your hands.

Although there are no preparatory exercises you can do to strengthen your cervix, you can take your pregnancy week by week. Crossing one week at a time off your calendar is a good way to get accustomed to compartmentalizing so the thought of having twins doesn’t seem so overwhelming and so you don’t find yourself worrying too far into the future about things beyond your control. The women in our survey shared some of the things they worried about most. If any of these things are keeping you up at night, check out our coping strategies:

Worry: How am I going to recover from a C-section while caring for two babies?

Solution: Just because you are having twins doesn’t mean you are having a C-section. This is something you need to talk about with your doctor throughout your pregnancy. According to Dr. Newman, a vaginal birth is possible for mothers of twins when both twins are positioned head down, which is about 40 percent of the time, or when one twin is head down and the other is breech or transverse, which is about another 40 percent of the time. And miracles do happen. Christina, whose first child was delivered vaginally, was told during her third trimester of twin pregnancy that she might have to have a C-section. Around her thirty-sixth week, one twin was upside down and the other was sideways. By her thirty-eighth week they’d moved: both twins were head down and ready for a vaginal delivery. But this isn’t always the case, and obviously, if you’ve had C-sections before, your chances of having one for the birth of your twins is very hig. If it looks like you are going to have a C-section, you have to plan ahead and get some help for a few weeks so you can recover.

Worry: How am I going to deal with sleep deprivation when they’re here?

Solution: It’s brutal, but moms of multiples have all gone through it. You can survive alone, but having help is always better. As one of the moms in our survey shared, “I wish I knew enough to get help lined up ahead of time.” That is one thing you can do. You should also read our “Sleep Strategies” chapter, page 93, to see what it takes to get twins on a predictable sleeping schedule and our “Good Help” chapter, page 171, for tips on finding the right help for your budget and needs.

Worry: How am I going to feed two babies at once?

Solution: Read our “Chow Time” chapter on page 71 for tips on breast- and bottle-feeding. You can also look into breast-feeding classes before and after you have the twins. You may even want to line up a lactation consultant to visit you at home after your babies are born.

Worry: How am I going to get the rest I need during pregnancy if I am up at night worrying about everything?

Solution: Keep a stash of boring reading next to your bed (golf supply catalogues, second-language books, and tax laws should do it). Or keep a pad and pen nearby to jot down your fears or items for your to-do list. Sometimes, writing stuff down frees your brain and allows you to start to relax again. If you still can’t sleep, talk to your OB about homeopathic or medical remedies.

Eating Right—For Three

Eating as well as you possibly can is something you can control and a direct way to take care of yourself and your incubating babies during your twin pregnancy. It’s true, good nutrition correlates to higher birth weights and good intrauterine growth. But pregnancy is a nutritionally challenging period for your body in any case, and even more so when it needs to provide good nutrition to more than one fetus, so we’ve asked nutritionist Soniyu Perl to share her expertise.

Eat a balanced diet. Aim for a mix of whole grains, fruits and veggies, fats and oils, and quality protein foods that contain all the essential amino acids (meat, fish, poultry, eggs, and dairy products). If you can’t stomach meat at your meals, combine beans or lentils with grains instead. Aim for at least six servings of full-fat dairy (8 ounces of milk or a 1-ounce slice of cheese) and four servings from the protein group. If you are on the go, pack snacks in the morning (such as nuts, dried fruit, cereal, and granola bars) and carry them in your bag.

Eat enough calories. There are recommended dietary allowances (RDAs) for pregnant women with singletons; however, no guidelines have been set for women carrying multiples. Perl says an average non-pregnant woman needs 1,800 calories a day, and a good goal for a woman pregnant with twins is 3,000 calories a day. That means three meals and three snacks a day. If you are underweight, you first need to gain enough weight to take you to the normal range for your height, then put on the amount recommended for your twin pregnancy. The normal-weight mom should aim for 40 to 56 pounds. If you are overweight, go for 38–47 pounds.

Drink enough water. According to Perl, water consumption is especially important when expecting multiples because dehydration can trigger contractions. Aim for at least eight 16-ounce glasses of water every day. Develop a system to make sure you get what you need: lay out the bottles of water you need to drink at the beginning of the day, or drink a tall glass at the beginning of every hour. Try flavoring the water with lemon, cucumber, or a dash of fruit juice if it gets boring or if you are having a hard time keeping it down.

Fight morning sickness. When pregnant with twins or higher multiples, you’re more likely to have morning (or in some cases all-day) sickness than a woman pregnant with a singleton. This may be from the higher levels of hCG, estrogen, or other hormones in your system. If you are vomiting, you may need to use sports drinks such as Powerade or Gatorade to replace lost electrolytes. To minimize nausea, eat saltines or toast before you get out of bed. During the day, try ginger, an alternative remedy thought to settle the stomach and help quell queasiness. See if you can find ginger ale made with real ginger (most big-brand ginger ales aren’t), or grate fresh ginger into hot water to make ginger tea. Some women find temporary relief with Preggie Pops and Preggie Pop Drops (available at threelollies.com). Vitamin B6 has long been thought to ease morning sickness, which is the premise behind B-natal Green Apple Lozenges or B-natal Cherry-Flavored TheraPops (both available at ladytobaby.com).