Tuesday, December 6, 2011

Multiple Miracles

Every year I get more calls for information about pregnancy and delivery of multiples. Is it in the water? Mmmmmmmm, I don't think so. I think it's ovarian stimulation and IVF. When we start to stimulate ovaries to produce more eggs, we run the risk of multiple gestations. And we then harvest lots of eggs and fertilize them and then transfer two or three or four, knowing we may lose a few, we also know that we run the risk of multiples. Sometimes what turns out to be a miracle of conception turns out to be a multiple miracle.

There may be special problems and different care necessitated by the miraculous multiple conceptions. It is easiest understanding and most commonly occurring as twins. Fraternal twins develop from two separate eggs and sperms, creating their own placenta and amniotic sac. They are different, just like any other siblings and can be of either sex. Identical twins are the result of one fertilized egg splitting and developing into separate but equal fetuses, sharing genes and thus characteristics like blood type, coloring and sex. Each baby usually has its own sac even though they may share a placenta.

An ultrasound is the most common way of diagnosing twins. Two heartbeats can be identified at six weeks gestation usually at the first ultrasound done for viability at around that time in the pregnancy. A twin pregnancy is considered one pregnancy with two deliveries at completion.

Care is different with multiples. You will see in addition to your obstetrician, a perinatologist who is an expert in fetal growth, development and multiples. This doctor will administer extra prenatal care but your obstetrician will actually help you deliver the babies. You need more calories with twins. Probably about 2,700 calories per day. Maybe extra vitamins and iron, for sure ( anemia is common in women carrying multiples ) and extra folic acid, more than just in your prenatal vitamin. Instead of the twenty-five to thirty pounds expected weight gain with a singleton, you should expect to gain about thirty-five to forty-five pound; one pound per week until about twenty weeks and then probably a little over that during the second half of the pregnancy.

Naturally, your body gets bigger with multiples. You may ache more and require more rest. But extra precautions and bed rest are prescribed for women with complications, so don't put yourself to bed. The perinatologist and obstetrician will give you guidelines that are appropriate for you and it's one of the reasons that they see you so much, for extra exams and ultrasounds and monitoring.

The risk of many complications is higher with multiples: hypertension, anemia, preterm labor and growth problems sometimes caused by twins sharing a single placenta. Occasionally, one of the fetuses will expire in utero ( vanishing twin ).

Delivery of the multiples is dependent on many factors and there is a higher than average occurrence of cesarean section due to babies' positions and conditions. Many women are more than able to breastfeed both twins. Extra help is great and peer support from groups like Marvelous Multiples is wonderful, even way before delivery. As we see more and more multiples, more information and guidance becomes available for what we handle as common- place pregnancies these days.