Delivering More Than One Baby
How multiple fetuses are delivered often
depends on how babies are lying in your uterus. Possible complications
include abnormal presentation of one or more of
the babies, the umbilical cord coming out ahead of the babies,
placental abruption, fetal stress or bleeding after delivery.
Because risk is higher, safeguards are
taken during labor and before delivery. These include an I.V., the
presence of an anesthesiologist, the ability to perform an emergency
Cesarean delivery and the availability and/or presence of pediatricians
or other medical personnel to take care of the babies.
With twins, all possible combinations of fetal positions can occur. Both babies may come head first (vertex). They may come breech, meaning bottom or feet first. They may be lying sideways or oblique, meaning at an angle that is neither breech nor vertex. Or they may come in any combination of the above.
When both twins are head first, a vaginal
delivery may be tried and may be accomplished safely. It may be
possible for one baby to deliver vaginally. But the second one could
need a Cesarean delivery if there are problems. Some healthcare
providers believe delivery of multiples is more safely accomplished
with a Cesarean delivery.
After delivery, healthcare providers pay
close attention to bleeding in you because of the rapid change in the
size of the uterus. It is overdistended with more than one baby.
Medicine, usually oxytocin (Pitocin), is given by I.V. to contract the
uterus to stop bleeding so you don’t lose too much blood. Heavy blood
loss could produce anemia and make a blood transfusion or long-term
treatment with iron supplementation necessary.
4. Changes in You
Until this week, your visits to the
healthcare provider have probably been on a monthly basis. At week 32,
most healthcare providers begin seeing a pregnant woman every 2 weeks.
This continues until the last month of pregnancy, then you’ll probably
switch to weekly visits.
By this time, you probably know your
healthcare provider fairly well and feel comfortable talking about your
concerns. Now is a good time to ask questions and to discuss concerns
about labor and delivery. If there are complications or problems later
in pregnancy or at delivery, you’ll be able to communicate better and know what’s going on. You’ll feel comfortable with the care you’re receiving.
Your healthcare provider may
plan on talking to you about many things in the weeks to come, but you
can’t always assume this. You may be taking prenatal classes and
hearing different things about labor and delivery. Don’t be afraid to
ask questions. Most healthcare providers are receptive to your queries.
They want you to discuss things you’re concerned about instead of
worrying about them unnecessarily.
5. How Your Actions Affect Your Baby’s Development
Do you wear contacts? You may want to
wait until after baby is born to refill your contact-lens prescription.
You may experience eye discomfort and irritation during pregnancy
because of hormonal changes that change the curvature of the cornea.
Hormones can also alter your vision slightly and dry your eyes. Don’t
use any products for dry eyes until you talk to your healthcare
provider about it at a prenatal visit.
If you have problems, one solution is
disposable contacts that correct for the changes. You might also try
your old glasses if your contacts don’t seem to work. Wait until after
baby’s birth to make any permanent changes. It can take up to 6 weeks
before your vision returns to normal.
Tip for Week 32
Your requirements for
calories, protein, vitamins and minerals increase if you carry more
than one baby. You’ll need to eat about 300 calories a day more per baby than for a normal pregnancy.
6. Your Nutrition
If you’re expecting more than one baby,
your nutrition and weight gain are very important during pregnancy.
Food is your best source for nutrients, but keep taking your prenatal
vitamin every day. The vitamins and iron in prenatal vitamins are still essential to your well-being and the well-being of your baby or babies.
Iron supplementation may be necessary. If
you’re anemic at the time of delivery, a low blood count could have a
negative effect. You might need a blood transfusion.
If you don’t gain weight early in pregnancy, you have a higher chance of developing pre-eclampsia. Your babies may also be tiny.
If you’re on the go and want a salad,
buy a prepackaged bowl that contains dressing and toppings. It’s a
healthy choice on days you may be tempted to buy fast food.
Don’t be alarmed when your healthcare
provider discusses the amount of weight he or she wants you to gain.
Studies show if you gain the targeted amount of weight with a multiple
pregnancy, your babies are often healthier. In addition, gaining half
of your weight by week 20 can help your babies, especially if they’re
How can you gain the amount of weight you
need to gain? Just adding extra calories won’t help you or growing
babies. Avoid junk food because of empty calories.
Get your calories from specific
sources. Eat an extra serving of a dairy product and an extra serving
of protein each day. These will provide you with the extra calcium,
protein and iron you require to meet the needs of your growing babies.
Discuss the situation with your healthcare provider; he or she may
suggest you see a nutritionist.