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Pamela Brawer
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What's Different About a Twin Pregnancy?
Obviously, the main difference between a twin pregnancy and a regular pregnancy is the presence of two fetuses. At the end of a twin pregnancy, a mother will give birth to two babies, rather than just one.
The experience of a twin pregnancy can also be very different for some women. In some cases, women who are pregnant with twins experience enhanced or increased pregnancy symptoms, such as nauseau, fatigue, or edema (swelling). While it's not quite accurate to say that these symptoms are doubled in a twin pregnancy, the increased levels of hormones do exacerbate them for some women.
In addition, a woman who is pregnant with twins is at greater risk for some medical complications, such as preterm labor, preeclampsia, pregnancy induced hypertension (PIH) and gestational diabetes. Women who are pregnant with twins should be encouraged to receive proper medical care, follow a healthy diet, take in ample fluids, and minimize any activity which puts the pregnancy at risk.
Prenatal Care
You will need special prenatal care with twins. You should see your doctor more often and you may need special tests. Plan to take childbirth classes during your 4th to 6th month of pregnancy. Ask your doctor about classes for parents expecting twins.
Nutrition
When pregnant with twins, you will need to eat more than if you were carrying one baby. Eating well and gaining weight are important for your health and the health of your twins. Your body must nourish the babies and meet your energy needs as well. You will need to eat about 2,700 calories every day, if you are of average weight.
You should gain more weight when carrying twins than if you were having only one baby. Plan to gain 35–45 pounds. In the first half of pregnancy, you should gain about 1 pound per week. In the second half, you should aim for a little more than 1 pound each week. If you are underweight, you may need to gain more. If you are overweight, you may need to gain less.
In addition to a prenatal vitamin, your doctor may prescribe extra vitamins and minerals to help your babies grow. Anemia (iron-poor blood) is more common in women who are pregnant with twins, so it's especially important to take your prenatal vitamins and iron as prescribed. Folic acid also is important for twins. It is hard to get all the folic acid you need just from your diet, so you should take a prenatal vitamin that contains folic acid.
Rest
Twins can make you more uncomfortable than usual during pregnancy because the uterus becomes much larger. Resting during the day will help give you energy. Talk with your doctor about your job or your work at home. Some women may be asked to restrict their activity.
Growth Problems
Twins are more likely to be smaller than average. Ultrasound is often used to check the growth and the amount of amniotic fluid of each baby.
Monitoring a Twin Pregnancy
Many techniques are used to check the well-being of your babies. Your doctor may use some or all of these techniques to monitor your babies:
- Have you count your babies' movements, called kick counts, at home
- Examine your cervix by physical exam or ultrasound exam for changes that may show early signs of preterm labor
- Repeat ultrasound exams to check the babies' growth
- Measure the babies' heart rate in response to their own movements (nonstress test)
- Perform a biophysical profile, which includes checking the babies' heart rate, body movement, muscle tone, and the amount of amni-otic fluid by ultrasound
Delivery
In some cases, twins can be delivered by vaginal birth. In others, a cesarean birth, in which the baby is delivered through a cut made in your abdomen and uterus, may be needed. How your babies are born depends on certain factors, including:
- Position of each baby
- Weight of each baby
- Your health
- Health of the babies
Labor, especially the pushing stage, may take longer with twins. Babies usually are born several minutes apart in a vaginal delivery, but it can take longer.
Twins usually can be born vaginally if they both are in the head-down position. A vaginal birth also may be possible when the lower twin is in the head-down position but the higher twin is not. Once the first twin is born, the other twin can sometimes be turned or delivered with feet or buttocks first. When this can't be done, the second twin is delivered by cesarean birth. When the lower twin is not in the head-down position, both twins are delivered by cesarean birth.
Caring for Your Newborn Twins
Most twins do well at birth and can be cared for like any other healthy babies. However, caring for twins is stressful at times. Get as much rest as you can. You may feel overwhelmed, or even sad sometimes. If this occurs, let you doctor know.
If the babies are born early, they may need special medical care to breathe, eat, and keep warm. Preterm and small twins may be cared for in a special nursery called a neonatal intensive care unit at the hospital.
Many women wonder if they can breastfeed more than one baby. The answer is yes. Mother's milk is the best food for any infant. It has the right amount of all the nutrients the baby needs. When you breastfeed, your milk supply will increase to meet the amount needed by your babies. You will need to eat healthy foods and drink plenty of liquids. If your babies are premature, you can pump and store your milk until they are strong enough to nurse from the breast. You may find it helpful to talk with a lactation specialist who is trained to teach women about breastfeeding.
Having twins can be an exciting time. You can give your babies the best possible start by taking good care of yourself. Learn the warning signs of problems, and talk to your doctor or nurse about your questions and concerns.
It also is helpful to talk with others who have twins. There are organizations and support groups that provide services for parents of twins.
Resources
Manhattan Twins Club
Twiniversity
Multiple Birth Pregnancy Overview - NYP Hospital
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