Q: |
We are expecting twins following IVF treatment. How will we manage?
| A: |
Although finding out that you will be the parent of two babies
rather than one can be a shock, the initial surprise will settle down
and you will soon start to get used to the idea. There are many
organizations that offer information and support to parents of twins, as
well as companies that make products for parents of two or more
children.
Your midwife and obstetrician will offer information and support and
may put you in touch with local multiple birth support groups. You will
also be going to more regular prenatal appointments and scans than if
you were having just one baby to keep an eye on the growth of your
babies.
As with all
multiple births there is increased risk of complications such as preterm
labor, and high blood pressure but with support and care you can have a
normal pregnancy and healthy babies
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Q: |
We're having triplets. Help! My wife is over the moon, but I feel numb. Where can we get advice?
| A: |
As having triplets is relatively rare—approximately 160 per
100,000 births—the majority of information and support for couples does
relate to having twins. However, more and more research is being done to
find out how to help and support parents having more than two children.
Your midwife and
obstetrician will be great sources of information and will be able to
put you in touch with other parents of multiple-birth children. There
are also several organizations that offer support and information for
parents having a multiple birth. As you and your wife learn more about having triplets, your anxiety will hopefully start to ease.
|
Q: |
How will I know if I'm carrying twins?
| A: |
It used to be that when a slightly smaller than expected baby
made her entrance into the world, a wise doctor or midwife would reach
for another baby coming close behind. Today, though, a multiple
pregnancy is suspected when parents have had fertility treatment or if
the uterus is larger than expected for the gestational age at the
initial visit. An ultrasound is requested and in short order the results
are known. Confirmation of the diagnosis of twins or a multiple
pregnancy can typically be done by 12–16 weeks but is often made as
early as 5–6 weeks by ultrasound when two embryos or two gestational
sacs are seen.
Midwives and
doctors are educated to be alert for signs and symptoms of twin
gestation. These include a uterine size that is larger than dates would
indicate; quad screen (4-marker screen) results that are higher than
usual or abnormal; two heart beats are being are heard with the doppler;
maternal weight gain is larger than expected; severe pregnancy-related
nausea and vomiting (morning sickness) is experienced; anemia (low iron)
is confirmed; or an exceptional amount of fetal movement (after 18
weeks or so) is detected.
|
Q: |
Does taking folic acid increase the incidence of twins?
| A: |
There has been some debate and conflicting studies about whether
taking folic acid pre-conceptually could increase the chance of having
twins. A study in Sweden found a higher incidence of multiple births
among women taking folic acid. However, this could be attributed to
factors such as a greater number of women undergoing fertility
treatment, which carries an increased probability of twins. Also,
subsequent studies have refuted these findings; in 2003, a large-scale
study in China found no significant difference in the number of women
carrying twins who had taken folic acid. Women undergoing assisted
reproduction should not exceed recommended doses of folic acid.
|
Q: |
Are all same-sex twins identical?
| A: |
No. Whether or not twins are identical depends on how they were conceived, not what sex they are (see How are twins conceived).
While identical twins are obviously the same sex, nonidentical same-sex
twins are as similar or different as any other nontwin siblings.
|
Q: |
How likely is it that our twins will be identical?
| A: |
One in 80 pregnant women carries twins and one-third of twins are
identical. Although there are factors that make you more likely to have
nonidentical twins, such as a family history of twins or being over 35,
having identical twins is not an inherited trait and there are no other
factors that make this more likely.
|
Q: |
Will I know after the birth if they are identical?
| A: |
The term “zygosity determination” means finding out whether
twins, triplets, or more are identical (monozygotic) or nonidentical
(dizygotic or fraternal). It is natural for parents to want to learn all
about their babies, and with twins this includes their zygosity. As
well as for reasons of natural curiosity, knowing whether twins are
identical can help parents determine the chance of having a multiple
pregnancy again, and also has implications on care during pregnancy,
since identical twins, especially if they share a placenta, are higher
risk, and so the pregnancy may be more closely monitored.
In two-thirds of cases,
the placenta provides the answer as to whether twins are identical. If
the babies have a single amniotic sac surrounded by one outer protective
membrane, known as the chorion, they are monozygotic. However,
one-third of identical twins whose egg split early, before the placenta
started to form, have two chorions with either a fused placenta, where
two placentas grow together, or two separate placentas. These placentas
are hard to distinguish from those of dizygotic twins.
|
Q: |
We don't know if our twins are identical. Will it be obvious after the birth?
| A: |
In a third of cases, twins are different sexes and therefore
obviously nonidentical. In same-sex twins, by the time the children are
around two years old, their “zygosity” is usually quite clear from their
physical features. Before this, there are many indications as to
whether twins are identical, such as the color of their hair and eyes,
the shape of their ears, the eruption and formation of teeth, the shape
of the hands and feet, and the pattern of growth. If there is doubt as
to whether twins are identical, the most accurate way to determine
zygosity is by the DNA probe method, when tiny amounts of DNA are
collected with a swab from inside each twin's mouth. A laboratory
examines specific markers present in the DNA and diagnostic targets are
compared. Although nonidentical twins may share some marker patterns by
chance, monozygotic, or identical, twins will have the same pattern for
all markers.
|
Q: |
Will I love one twin more than the other?
| A: |
Although this can be a concern, it is more likely to be the case
that rather than favor one child over the other, a parent gives more
love and attention to the baby who needs it most at that particular
time.
It is also possible
that the strain of having two new babies in the house may increase the
likelihood of delayed bonding, although this can also happen if the
birth has been traumatic; if the mother or indeed the father is
exhausted; or if one baby has taken time to establish feeding, or is
more fussy than the other. This does not mean that bonding will not take
place over time, but if this is worrying you, you should mention it to
your midwife or doctor, since they may well be able to offer some
helpful advice.
In every family, there
are bound to be ebbs and flows of love between parents and children,
which is normal and not a cause for concern. When a parent has two
children born at different times, that parent may love one child
differently than the other, but this does not mean that the love a
parent has for one child is to the detriment of the other.
|
Q: |
Will the side effects of pregnancy be much worse with a multiple pregnancy?
| A: |
Although in some cases the side effects of pregnancy may be the
same when you are expecting two or more babies, the likelihood is that
many pregnancy symptoms will be exaggerated. Symptoms such as morning
sickness, fatigue or exhaustion, disturbed sleep, and swollen hands and
feet are often worse with a multiple pregnancy. Unfortunately, women
with multiple pregnancies also tend to suffer more from varicose veins.
In addition to these increased side effects, weight gain is greater and
more rapid for mothers carrying more than one baby and the uterine
measurement is often increased for the gestational age. This extra
weight and size caused by carrying two or more babies may also cause
more constipation, hemorrhoids, urinary tract infections, and vaginal
yeast infections.
Although there may be
more exaggerated symptoms with a multiple pregnancy, the majority of
these problems can be monitored by your midwife or doctor, and they may
be able to offer advice and treatment to ease these symptoms.
|
Q: |
Will my weight gain be much greater than for someone who is having just one baby?
| A: |
Mothers of twins or triplet pregnancies are likely to gain more
weight than women having one baby. Indeed, in the first trimester, rapid
weight gain may be an indicator of a multiple pregnancy. The increased
blood volume and size of the uterus, as well as each baby's weight,
possibly two placentas, and the amniotic fluid for each baby, will
continue this pattern of greater weight gain during pregnancy.
Although on average a
woman having a multiple pregnancy is likely to put on around 10 lb (4.5
kg) or more than a woman having one baby, this is not double the weight
gain. If you are having twins, you should raise your calorie intake by
only 500 calories per day, compared to 200 calories more for a single
pregnancy.
|
Q: |
I'm only 24 weeks, expecting twins, and already I've got high blood pressure. What can I do?
| A: |
Unfortunately high blood pressure is more likely to start, or
worsen if you already have the condition, in a twin pregnancy since the
rates of pregnancy induced hypertension (PIH) and preeclampsia
are increased in multiple pregnancies. There is little that can be done
to prevent PIH. General lifestyle changes, such as reducing your salt
intake, avoiding alcohol and tobacco, getting gentle, regular exercise,
and getting enough rest, are thought to help. You should also ensure
that you get to all your prenatal appointments and contact your midwife
or doctor if you experience headaches or visual disturbances such as
flashing lights or there is reduced movement from your baby.
|
Q: |
What can go wrong if I have a vaginal delivery?
| A: |
If both twins are head down, a vaginal birth is usually possible.
Sometimes, the first twin may be head down and born vaginally, but the
second twin may be breech. Sometimes, the second twin will turn and be
head down after the birth of the first twin, and you are then more
likely to deliver both twins vaginally. Studies suggest that there has
been a significant increase in combined vaginal-cesarean births of twins
and a decrease in vaginal only births, which may be due to the fact
that there is a greater willingness nowadays to allow women carrying
twins to try for a vaginal delivery, which also increases the likelihood
of this scenario. If you have a vaginal delivery, there is a greater
chance of one or both twins having an assisted delivery by vacuum extraction or forceps
, either because one or both twins is positioned in a tricky way,
for example facing the mother's back, or because the labor may be longer
and weaker because of the amount of work involved in pushing two babies
out. Fetal distress can also occur more commonly in a multiple birth.
|
Q: |
Why might the doctors decide to deliver my twins by cesarean?
| A: |
An elective cesarean
might be recommended for a twin delivery for several reasons, but
ultimately it is your decision. The optimum time for delivering any baby
is at term (37–40 weeks' gestation) and this remains the case for
delivering twins since they may well be smaller than a singleton baby,
having had to share your supply of nutrients. However, if one or both of
the babies are compromised, possibly due to twin-to-twin transfusion syndrome or raised blood pressure in pregnancy, there may be a need to deliver the babies preterm.
Many doctors
recommend a cesarean for a breech baby, where the baby is bottom down
inside the womb, because there are more risks associated with a breech
vaginal delivery. In a twin pregnancy, if the first baby is breech, this
puts the second twin at risk too. Also, if the first twin is breech and
the second is head first (cephalic), a cesarean is recommended due to
the rare complication of “locked” twins, when the babies' chins get
locked together.
If both babies are
head down and appear to be thriving, many midwives and doctors will
encourage a vaginal delivery. Your doctor and midwife will discuss the
risks and benefits of both as you get closer to delivery time.
|
Q: |
Will my triplets need to be delivered before 40 weeks?
| A: |
Yes, it is very likely that your triplets will be delivered
before 40 weeks. Although most twins are born at around 37 weeks, which
is considered to be a term pregnancy, it is rare for triplets to reach
term, and most are delivered at around 32–36 weeks' gestation.
As a woman's body is
designed to carry one infant at a time, carrying more than one increases
the risks for both mother and babies, and the decision to deliver your
triplets will be made when one or more of the babies is not coping well.
To improve the chances of a good outcome, get plenty of rest and eat a
healthy diet .
Although premature deliveries do carry a risk to the infant, if the
baby's well-being is compromised an early delivery is necessary. If you
go into premature labor, you may be given medication
to try to stop labor long enough to administer steroids, which
will help to mature the babies' lungs before delivery—as long as this
does not put the babies at risk.
|
Q: |
How likely is it that my twins will have a lower than average birth weight?
| A: |
Almost half of all twins are born weighing fewer than 51/2 lbs
(2500 gms) and are therefore considered “low birthweight.” this may be
the result of preterm delivery or insufficient fetal growth. These
babies are at increased risk for complications during birth and for
life-long disabilities such as cerebral palsy as well as neurological
and sensory impairment.
|
Q: |
Do twins run out of room to turn in the womb?
| A: |
It does tend to be the case that, in the third trimester, twins
find a position and settle there at an earlier stage of pregnancy than
if there was just one baby. Generally, with twin pregnancies there seems
to be a lot less change in presentation from about 32–34 weeks.
However, how your twins are likely to be delivered depends largely on
the direction that the twin who is lowest in the pelvis is facing. If
twin a is head down, then a vaginal delivery could be possible and the
second twin may be able to be gently coaxed into a favorable position,
or may need to have an assisted delivery.
|
Q: |
I've been told that one baby isn't developing as well as the other. What will the doctors do?
| A: |
Although it is common for twins to grow at a different rate in
the womb, if there is a significant difference in size, it may be that
one baby is getting a greater proportion of the nutrients than the
other. It is important to check that your babies are developing in line
with their gestational age. However, if your doctor is concerned about
the development of one baby, they will probably refer you to a fetal
medicine specialist: an obstetrician with additional training in caring
for the unborn baby. He or she may do blood tests and perform an
ultrasound to assess the growth of each baby and investigate why there
is a difference.
You may continue to
have additional scans, known as growth scans, which will help the
doctor assess if one baby is small or growing slowly. These usually
start around 24 weeks and continue every 2–4 weeks until your babies are
due. They look at a number of areas including the head, abdomen, and
thigh bone measurements; the amount of amniotic fluid around the babies;
the babies' levels of activity; the blood flow in the umbilical cord
and the position of the placentas. Your doctor should explain the
findings of the scans and if there is a concern you will be closely
monitored. An early delivery may be planned if one of the babies is
compromised.
|
Q: |
What is twin-to-twin transfusion syndrome?
| A: |
This is a rare but serious condition that occurs only in
identical twins who share a placenta. It is caused when there is an
abnormal blood supply and a blood vessel directly connects the twins.
One twin pumps blood around his own body and that of his twin and, as a
result, he does not grow properly. An early delivery is usually needed
to save the smaller twin.
|
Q: |
Am I likely to lose one or more of my babies?
| A: |
There are increased risks for both mother and babies associated
with multiple pregnancies and sadly there are occasions when one or more
of the babies dies in the uterus. This occurs in around 2.5–5 percent
of twin pregnancies most commonly after in vitro fertilization and
transplant of several embryos. In some circumstances if there is a fetal
abnormality in one twin the doctor may suggest that one or more of the
babies is terminated in the very early weeks to allow the normal healthy
development of the other baby or babies. However, many doctors believe
that this is unnecessary since the procedure itself carries the risk of
losing all the babies. Although incredibly hard, this is ultimately your
decision, so you should spend time discussing the options with your
doctor.
Unfortunately,
the death of a baby in a twin pregnancy can sometimes cause problems for
the surviving twin, although the degree and type of problem depends on
whether the twins were identical or nonidentical. If identical, the
doctors will assess whether it was a monochorionic pregnancy (in which
the twins share the same placenta) or a dichorionic pregnancy (in which
they have a different placenta). When the placenta is shared, there is a
30 percent risk of death or a neurological problem to the surviving
twin if the other dies; if there are two placentas, there is a lower
risk, of 5–10 percent, of death or disability occurring in the surviving
twin. |
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