By Kelly Whitehead
Author of Why Me? Understanding and Managing a Potential Preterm Pregnancy
"Two heartbeats? Two babies? Two cribs, two car seats, two college tuitions..." These may have been the first panic-stricken thoughts you had when you first found out you were carrying more than one baby. There are many ‘things' to consider when carrying multiples to make sure you not only enjoy this amazing experience, but to help you have a healthier pregnancy with plump babies.
Multiples Equals the Risk of a Preemie
Almost 60% of twins arrive too soon (or prior to full term, i.e. 37 weeks gestation). Only about 8% of twins are born before 32 weeks (or very preterm), while 48% are born between 32 to 36 weeks, and 44% at term or later. The good news is that even though they're coming earlier, they have a higher chance of surviving today than they did 20 years ago.
Three month premature twins at 4 months old (1 month adjusted).
Of Special Concern for a High-Risk Multiple Pregnancy
Know the Signs of Preterm Labor (PTL)
PTL is when you experience regular contractions of the uterus AND changes to your cervix before 37 weeks. Since we know that twins sometimes want to make their entrance early, it's important to pay attention to your body and recognize the possible early signs of labor. These contractions differ from Braxton Hicks (BH) contractions, as BHs tend to be irregular and do NOT cause changes to the cervix. It can be hard to tell the difference between the two, so I suggest that if you have any concerns, call your doctor. Never be embarrassed to ask, even if it's only to seek reassurance.
Preterm contractions show themselves in many different ways. They may not always be painful, and can feel like just a tightening or even a tingling sensation in your stomach. Other signs are: more trips to the bathroom (increased "number twos" and diarrhea), period-like cramping, lower back pains (which can easily be confused with normal pregnancy pains), heaviness or pressure in your stomach, "lady area," or butt, or a change in your discharge. You may even just feel a bit off. These can be very hard symptoms to pinpoint, so be on the lookout, and tune into your body. Even if you sense something is not right -- have it checked out!
Understanding Cervical Length -- A Preemie Predictor
The shorter your cervix, the greater the risk. Length should be determined using transvaginal ultrasound (TVU), not via finger guessing. A cervical length of 2.5cm or less is considered short and puts you at risk for a preemie. A measurement of 2 to 3 cm with a positive Fetal Fibronectin result (FFN, a swab test used to help "predict" the likelihood that you will deliver within 7-10 days) also puts you at an increased risk. (Using both FFN results AND cervical length are best.) Even if you are having contractions, but your cervix is staying nice and long, you should feel reassured that you get more time to sleep before night feedings start.
For women carrying twins AND who have a prior history of preterm birth, they should consider getting 17 Alpha-Hydroxyprogesterone Caproate (aka 17P or progesterone) injections. This is a hormone which is shown to reduce early birth by 33%. It is NOT recommended for every pregnant woman who is carrying multiples.
For women without a past history, i.e. low-risk women, who show cervical shortening of ≤2.5 cm, vaginal progesterone has been shown to reduce the rate of babies coming before 34 weeks by 45%. Even with a shortening cervix, vaginal progesterone can extend pregnancies and help us to have healthier babies.
Note: Cerclages (transvaginal) are not recommended as a standard for women carrying multiples, but should be considered if the woman has a history consistent with an incompetent cervix, such as second trimester loss(es), LEEP or other cervical surgeries, etc.
Multiples ≠ Automatic Bed Rest
Many people think that just because you are carrying multiples, it means you're automatically confined to bed jail. (I spent 4.5 months on bed rest and it was awful.) This is not true. Routine bed rest has actually been shown to cause harm and babies coming earlier. For those of you who do get put on bed rest due to preterm labor, preeclampsia or other reason, hang in there! You can do this. (Note: As the benefits of bed rest have not been proven, many doctors are now limiting the use of bed rest during pregnancy.)
Twin-to-Twin Transfusion Syndrome
This very serious condition affects identical twin pregnancies. This syndrome happens when the blood flow is uneven and goes through one twin, the donor, then to the other twin, the recipient. The donor twin typically has very little amniotic fluid and often doesn't grow well. The recipient twin has lots of fluid, causing a swollen bladder among other issues. A bladder that is bigger in one baby on ultrasound is an early sign. The risk of death for both babies without treatment is very high. Fifteen weeks is considered an important time to get checked in order to predict, with accuracy, whether your babies will suffer from this. The most severe cases typically develop between 16 and 18 weeks. ALL women carrying identical twins must be screened at around 15 weeks. Laser surgery has shown great promise in saving TTTS babies. Amnioreduction is another treatment commonly used.
Flaunt Your Stuff
Even though your skin is stretched beyond belief, your back hurts all the time, you're stressed and fear the early arrival of your babies ... you must try to enjoy this time. Flaunt what you got, girls! Enjoy this amazing time.
About the Author
Kelly Whitehead is a scientist-mom who lost a son at 23 weeks, then went on to have two high-risk pregnancies to have her children today. During this time, in which she struggled to make medical decisions and manage her feelings, she realized there were no books that covered what she needed -- so she wrote one herself in order to help others (www.hrpwhyme.com). She is a spokesperson for Sidelines and a birth doula. Her passion is to help families through the journey to reach parenthood.