Sunday, January 22, 2006

Twin Pregnancy

I am not a doctor. I have no medical training. I am not an expert. I have been 18 weeks pregnant with twins and I have read all the twin pregnancy books. I have also done the research and spoken to dozens of women about their twin pregnancies. Based on my experience, theirs, and the reading I have done I want to give women an idea as to what a twin pregnancy entails.

I fully acknowledge that a woman can get pregnant with twins, work until her 35th week, have a vaginal delivery, and go home with 2 healthy babies without spending a day in the NICU. But this is not the norm.

I am writing this post to prepare you for the what-ifs, the crisis, the unfortunate. I feel it is best to be prepared and have a back up plan, just in case. The majority of OB's think that a twin pregnancy just means add 5 lbs of weight gain, but that is not the case. Twin pregnancies are high risk and you should make sure your OB has an agressive plan for taking these babies to 30-35 weeks.

Congratulations! You are pregnant. After months of trying you have finally peed on a stick or taken a blood test. Your whole world will change in 9 short months.

Around 6 weeks pregnant morning sickness will set in. This is not the queasy carousel tummy trouble. This is mind blowing sickness. All you want to do is throw up, but you can't. Your entire day is spent planning things around your stomach; you're queasy, you're hungry, you can only eat vanilla Haagen Daaz ice cream. You discover that sleeping is the best antidote to your condition. You have tried EVERY trick out there and you are STILL sick. You are wondering why you had sex . . . .
My tips: drink cranberry juice - because even if you throw it up it will taste better, don't eat chicken and rice - it doesn't come up well, suck on hard candies ALL THE TIME, avoid gagging - it triggers vommitting.

The doctor schedules an ultrasound around 6 to 7 weeks. Your first peak at your little bean! You see two flickers on the screen, what? Congrats. TWINS! The whole office is excited for you and your head is swimming. How will I handle two newborns? Well, let's get through the next 30 weeks first. That's right, 30 weeks. Your due date will be moved up to a 35-week gestation. Twins do not go past 35-weeks and the goal is at least 30-weeks. Start shopping now.

You will need to find a pernatologist - a high risk fetal doctor. He will not deliver you, but only acts as the babies doctor. You can take your OB's suggestion or contact your local multiples group and ask them for a recommendation. You will see the perinatologist at least six times, more if there are problems. He has a high level ultrasound - even better to see baby with. He only works with high risk pregnancies.

You will also start packing on the pounds. You need to eat an extra 600 calories a day. Start eating in the morning and do not stop. This will be hard with the vomitting. But it is necessary to put on at least 20 pounds by the 20th week. Since those babies will be coming out early you need to pack on the pounds early. Now is not the time to buy low-cal, low-fat, or no sugar. You will go to the store and wonder why there isn't a high fat section of the store. No, the cookie aisle doesn't count.
My tips: drink yogurt smoothies, protein shakes (Ensure makes one for mothers), lots of meat (my favorite was breakfast sausage), and meat with every meal. I would be sure to eat the majority of my calories before 4 pm, when the morning sickness got really bad.

Around 14 weeks I suggest you ask your OB to start checking your cervix for shortening and opening. Women with an incompetent cervix could have had a perfectly normal singleton pregnancy, but due to the extra weight and pressure with twins it could present itself only in a twin pregnancy. Often times doctors will discover it too late for a cerclage, cervical or abdominal, and will prescribe complete bedrest for the duration of your pregnancy. However, if it is discovered early a cerclage can be placed (stitching your cervix shut) and with modified bedrest you have a better chance of delivering healthy babies.

At 15 weeks I was fairly uncomfortable. I felt like I was in my 3rd trimester. I had to pee all the time, 3 times a night. I got tired and winded from taking a shower. I couldn't lift my 23 lbs son and walking into the store had become a chore. I spent the majority of the day laying on my left side. I was just too tired for anything else.
My tips: I got a handicap placard, ordered groceries online, and lined up childcare every evening because bathtime was too difficult for me.

You will go for a genetics appointment at 18 weeks. I am still not entirely sure what this entails as that is when it was discovered my twins hearts had stopped. I have been told that measurements are taken of major organs, TTTS is ruled out, you can also rule out other genetic syndromes like Down's. There are new techniques out there that are less invasive, but not widely practice yet like the Nuchal Translucency Scan.

At 24 weeks the experts recommend modified bedrest for at least 5 hours a day, that excludes the 10-hours a night. At this point your baby CAN survive outside the womb, although it is NOT recommended. If you suspect contractions at all, go directly Labor and Delivery to be monitored. Do not be a hero or convince yourself that you are wrong. Mother's instincts rarely are. Do not wait until it is too late. Labor cannot always be stopped and your babies lungs aren't fully developed yet. If you baby is born he/she will have severe disabilities.

26-weeks! A milestone. Pack that hospital bag. Buy the carseats. You will be seen by your OB and the Peri more often now. You should be counting kicks. If you don't feel the sufficient number of kicks, drink some juice or a soda with sugar and lay on your side. Then go to Labor and Delivery if the babies - both of them - aren't responding. Now is the time to be vigilant. I would rather be the fool in the hospital every day than the mother home grieving.

Do some research on the NICU, be sure you are delivering at a hospital with a high level NICU (level 3) so you and the babies can be together. Read up on Preemies and the special care they will require. Do not take risks. Be cautious, overly. Pretend you are a hyporchondriac and visit that Labor and Delivery room often.

You will need to rest more. You will be as big as a house - hopefully. Plan your baby shower, or if you incredibly high risk, plan a welcome home party for the babies. 30 weeks is the goal. But don't go past 35 weeks. You will probably have a c-section scheduled. Doctors just prefer high risk mommies be scheduled. It reduces the risk.

Of course, seek a doctors opinion. I am not the expert. A great book is "When you are Expecting Twins, triplets or more."

1 comment:

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