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 born early.

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.

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