Pregnancy is glorious and amazing and joyful and wonderful. And don’t forget – terrifying. Truthfully, what expectant mother hasn’t stared down the months of her pregnancy with awe, wonder and more than a little fear? Certainly, most of us have. It completely normal and healthy to experience these feelings with any pregnancy, but when you’re looking at a multiple pregnancy, there’s a whole new level of complexity. A pregnancy with twins, triplets or more involve factors that most mamas of singletons don’t need to consider. That’s why we sat down with our friend Miami Valley Hospital’s Maternal-Fetal Medicine Specialist Dr. David McKenna to learn what to expect when you’re expecting multiples. And especially – what do you need to do differently to ensure a healthy pregnancy and birth?
Do twins really run in families?
Well, let’s take a closer look at twin pregnancies. Are they genetic? If you have twins in your family, you’ve probably heard a family member say something to the effect of, “Oh, Aunt S0-and-So had twins and it runs in the family, but it skips a generation, so you’ll have twins, too!”
Is that accurate? Well, according to Dr. McKenna, there is an increased probability if you have non-identical twins (twins that come from two different eggs) in the family. Non-identical twins can run in families and, in fact, there are entire populations where the twin rate is very high. Identical twins, however, do not run in families and are believed to be a random event that occurs equally as often in all places and populations around the world. The exception is when you’ve undergone fertility treatments as those can increase the likelihood of multiples.
What do I need to do differently if I’m pregnant with twins?
Knowing that you’re pregnant with twins as early as possible is extremely important. “The problem with twins is that if you don’t get the right amount of nutrition and weight gain early on in pregnancy, you can’t catch up,” Dr. McKenna said. For this reason, doctors recommend first-trimester testing to see if yours is a multiple pregnancy. You’ll also want to know if you’re pregnant with identical or fraternal twins since, interestingly enough, they require different types of customized care.
With a singleton pregnancy, even if you don’t find out you’re pregnant until later in the trimester, your baby will typically gain enough weight and develop normally, especially if you’re low risk. With twin and multiple pregnancies, gaining weight in the first half of the pregnancy is vital to the babies’ health. If you don’t do that, Dr. McKenna says, those babies will be smaller and are more likely to be born prematurely.
If I’m pregnant with multiples, will I end up on bedrest?
For centuries, doctors have prescribed bedrest during pregnancy to prevent prematurity and a host of other complications. In fact, Dr. McKenna says, years ago, they would admit pregnant moms to the hospital at 24 weeks for what was referred to as “twin-rest” in an attempt to ensure they didn’t deliver too early. However, this extended bedrest didn’t seem to help. Instead, Dr. McKenna says, “What we’ve found today is that bedrest really doesn’t prevent any of those things and actually has a lot of risk associated with it. We think that good healthy activity is the best in any pregnancy.”
Dr. McKenna goes on to say that customizing an activity plan to each pregnancy is vitally important. Especially with twins, triplets and more, you will need to modify your exercise, but in most cases, it can be done. Doctors might encourage you to try brisk walking, yoga or possibly swimming. All of those choices are great low-impact options for pregnant mamas.
Do I have to have a C-section?
For many years, doctors and patients alike have assumed that multiples meant an automatic Caesarean section. It’s just the way things were done. More recently, however, studies have shown that natural births are quite possible in many twin pregnancies. According to Dr. McKenna, in twins that weigh about three pounds or more, if Baby A (the first baby to be born) is in the head down position, it’s safe to have a vaginal birth, EVEN IF Baby B (the second baby to be born) is NOT head down. The risk of birth injury is not significantly decreased by having a C-section. If your doctor is comfortable and there are no other medical reasons you can’t, a vaginal birth could be attempted. Your plan of care, of course, may vary.
What are some resources available?
The specialists at Premier Health’s Multiple Miracles program will work with you to make sure you and your babies have the best outcome possible. Their program is designed specifically for the needs and risks for mothers carrying multiples.
“We really want to customize the program for mom and make her understand that this is a special pregnancy. All pregnancies are special, but twins are always high risk and we want to make sure that we cover all the basics.” Dr. McKenna said.
To this end, it’s critical to get to the doctor early, in large part so they can customize a diet plan for you. At Multiple Miracles, pregnant mamas will start by doing a 3-day diet log so the registered dietitian can get a look at what you eat and then tweak your diet for optimal nutrition. According to Dr. McKenna, twin gestation “requires an incredible amount of protein,” about 150-200 grams per day, which is more than double the protein required for single gestation. Since it can be difficult to eat that amount of protein on a regular basis, the dietitian will provide tips and suggestions for making that happen.
Specialists will also look at your activity level and make recommendations for any changes you need to make. And, if you want to keep your current exercise program, they’ll look at that, too. Multiple Miracles also has yoga classes available for moms who would like to take advantage of those!
Finally, childbirth classes specifically for multiples are available to prepare you for the unique situations that might pop up. And yes, twin pregnancies are higher risk and may present more complications, but Dr. McKenna says they try not to overwhelm moms with all of the possibilities at once, (DMB Mom Comment: Thank you! We’re overwhelmed enough.) but instead aim to address each trimester – and any complication that may arise – as it comes.
Would you like more information?
Click here to learn about available programs for moms of multiples.
