Nadine had no clue she was carrying twins until she was on the delivery table. That was 35 years ago. When her daughter Toni gave birth last year, she’d had nearly eight months’ notice about her own “double happiness.” (Yes, twins—fraternal twins, that is—do run in families!)
Thanks mostly to routine ultrasound testing, 9 in 10 women who are pregnant with twins, triplets (or more) are well aware of it long before Nadine was. And it’s a good thing, says Toni. “My husband and I had a chance to prepare the nursery and get two of just about everything,” she says. “Even more important, it gave us time to get used to the idea. I can’t imagine how my mom and dad handled the surprise.”
Although the frequency of twin birth is typically quoted as about one in every 80 pregnancies, the use of fertility drugs and other assisted reproductive techniques is making multiple birth a far more common event. And because the odds of conceiving twins increase as a woman gets older, the growing number of over-30 women giving birth has also contributed to the rise.
What can a woman carrying twins or more expect? Here’s a look.
Knowing about a multiple pregnancy long before delivery can reassure expectant moms who may wonder why they seem to be experiencing double-strength doses of morning sickness, heartburn, insomnia and other pregnancy woes. It’s not their imagination: These “super-symptoms” tend to go hand in hand with multiple pregnancy and are usually no cause for concern. Less room in the abdomen to accommodate the growing fetuses increases shortness of breath and digestive trouble, and more pressure on the pelvic area exacerbates back pain, constipation and hemorrhoids, especially as the pregnancy progresses. Mom can minimize symptoms by getting plenty of rest and cutting back on strenuous activity. Working moms-to-be may have to take their job leaves sooner rather than later (around week 24 of the pregnancy). Bed rest may be recommended in some cases to decrease the risk of premature labor, commonly associated with multiple pregnancy.
Like all expectant moms, women carrying more than one fetus affect their babies’ development with every bite they eat. To ensure healthy babies, a woman expecting twins should increase her food intake by about 450 calories a day. (By comparison, a woman carrying just one baby should eat 300 extra calories a day.) But “multiple moms” shouldn’t take that as a cue to indulge a sweet tooth or to butter their bread on both sides. Instead, the extra calories should come from wholesome sources of protein, calcium, vitamin C and other nutrients. If heartburn is a problem, it may help to spread the day’s calories among several small meals rather than three large ones.
Good sources of protein include egg whites; lean beef, pork or veal; skinless poultry; fish; and soy products. Calcium is found in skim milk, yogurt, cottage cheese, collard greens, kale, broccoli, mustard greens, and salmon and sardines with bones. Tomatoes, oranges, cantaloupe, strawberries, tomatoes and peppers are good sources of vitamin C.
A multiple pregnancy also takes a toll on a woman’s iron stores. To guard against anemia, expectant moms should take a daily supplement that contains 60 to 100 milligrams of iron.
Women carrying twins should expect to gain 40 to 45 pounds; women carrying triplets, 51 pounds; and those carrying quadruplets, 58 to 68 pounds.
Amid all the excitement, it’s easy to forget that carrying more than one fetus is considered a complication of pregnancy insofar as it increases risk for:
- preeclampsia—pregnancy-related high blood pressure that tends to occur earlier and more frequently in multiple pregnancies.
- intrauterine growth retardation (IUGR)—slow fetal development. Smoking and drinking alcohol raise the risk of IUGR. Most babies born with IUGR catch up with normal babies by 18 to 24 months.
- birth defects—twins are twice as likely to have a birth defect than single babies.
- preterm labor—twins generally are born at about 37 weeks compared with 40 weeks in a single pregnancy. Premature delivery used to pose the greatest risk to twins’ well-being, but today’s sophisticated neonatal intensive care units and specialized medical staff make it possible for most premature babies to thrive as well as any baby.
Fortunately, keeping a watchful eye on developments helps ensure that 9 in 10 moms safely give birth to perfectly healthy twins. If you’re pregnant with twins or triplets, you should expect to see your physician about every two to three weeks in the first and second trimesters and even more frequently in the third trimester. Ultrasound exams may be done periodically to ensure the babies are growing according to schedule. Starting at around 28 weeks, twice-weekly nonstress testing may be performed to assess the babies’ well-being. You may also be asked to monitor the babies’ growth at home by keeping track of their kicks and other movements.
Moms carrying triplets or more generally give birth by cesarean section. Twins are another story, with cesarean sections performed in about one in two twin births. The twins’ position in the uterus during labor is often the deciding factor. If you’re expecting more than one, you’ll discuss childbirth options with your physician as delivery approaches.