• Rebekah Porter

I Just Found Out I Am Expecting Multiples! Now What?

Educate! Educate! Educate! Pace yourself. Don't learn it all today. You will have a wide range of emotions. All your plans are out the window with many changes in store for the next while. Here is some wisdom we have learned from many moms through the years. We hope our tips will help make your journey easier.

1. Get a book and learn about nutrition.

2. Next, interview your current care provider to learn about your OB's multiples experience. Change care providers if you desire.

Reach out to other mom's of multiples.

3. Find a support network that fits you and join it.



Resources:

Naturally parenting twins

Raising Twins

NashPOTATO -Nashville Parents of Twins and Triplets Organization: A chapter of the Natl Org of Mothers of Twins Clubs, which is headquartered in Franklin.

National Organization of Mother's of Twins Club: Support group for parents of twins or higher

Birthing Multiples Naturally

Murfreesboro Parents of Twins Club:

In Sumner County we have a private Facebook group for mothers of multiples.

Birthing Multiples Naturally group on FB

Baptist Hospital offers a "Marvelous Multiples" class


Books: Dr. Barbara Luke When You Are Expecting Twins, Triplets, Quads

Elizabeth Noble Having Twins And More: A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood (more natural minded)

*Find a balance between the two books above. One is more medical centered and the other is more natural focus.


Words of Wisdom:

Get chiropractic care every week in the 3rd trimester. Make sure that he is certified in Webster Technique.

Get an OB who you feel supports you.

Learn to stand up for what you need. It is ok to stand up for what you and your babies need.

Ask for help and accept help. This will help you find a true support network. Doing this pregnancy and postpartum alone will burn you out.


What doctors will deliver multiples vaginally?

Dr. Jabush at Summit

Dr. Mary Carroll (MFM) at Vandy

William J. Kellett or Dr. Lee at Vandy

Dr. Draughn at Centennial

Dr. McIntosh at Gateway


Can I change providers?

Yes. It is important to interview your doctor early in your pregnancy to make sure that they support your birthplan. If you disagree, ask around and find a new doctor who will support you. Try to settle on a doctor by 25 weeks in pregnancy


Questions to ask your provider:

Do you require both babies to be head down in order to deliver vaginally?

Will your be there for the birth or is it whomever is on call?

If you are unavailable, are your partners supportive of my birth plan?

Can I meet your partners?

Do you have a mandatory induction weekage (38 weeks)?

Do you require me to have an epidural?

Would I have to give birth in the OR or L&D?

Would I need additional testing? Do I get it in this office or do you refer me out?

Do I need to see an Maternal Fetal Medicine doctor?

Do you have in office fetal monitoring for twins (non-stress testing)?

How many twins have you delivered vaginally this year?

What % of your twin pregnancies are c-section?

Click here for a copy of these questions to take to your doctor appointment.


PREGN ANCY

Do I need to see a Maternal Fetal Medicine provider?

That depends. Some believe that you can see your OB the whole time. Some believe that you need to see MFM (Maternal Fetal Medicine) in the beginning or at least by 32 weeks. Most providers are trained in high risk pregnancies and will just consult with a MFM. If your baby is Di/Di, You might not need to see a MFM. If your twins are Mo/Di, then you should. Mo/Mo or conjoined you definitely need to see a MFM. There is the option of choosing an OB who has a great ultrasound machine that can assess you babies and then refer you to an MFM if needed. Be aware that some ultrasound techs are not good at assessing twin pregnancies whether in the office or in the hospital. They can measure and get inaccurate results. This can cause unnecessary alarm in the mother and Doctor. MFM groups are very skilled in scanning twin pregnancies and reading the results accurately.


What is the zygosity of my multiples?

In a twin pregnancy there are 2 zygotes. Either your egg split or you ovulated 2 eggs. Dizygotic: 2 separate fertalized embryos, own amniotic sac, own placenta: least risky situation

Monozygotic: One embryo that split in two after conception, (identical twins), separate sacs, separate placentas: least risky.

Triplets: common to have Dizogotic and monozygotic embryos. Monozygotic // Dichorionic/ Diamniotic (Di/Di): fraternal twins from two eggs that share a placenta and outer sac, but have separate inner sac.

Monochorionic/ Diamniotic: Share placenta: Very risky with twin to twin transfusion. Monochorionic/ Monoamniotic (Mo/Mo): Rare: Share the placenta and the same inner sac. Risky: can become entangled. 20% survive. Born with c-section due to risk. Conjoined twins: Rare: Eggs splits at 10 days or after. Zygote is not able to completely split. Always born by c-section.



Is my diet different than with a singleton pregnancy?

Yes, it is not just about gaining weight. You need to eat better and consume a higher amount of protein.


Will this pregnancy be vastly different than a singleton pregnancy?

No, some women don't even know they are expecting twins til 20 weeks. They get surprised at an ultrasound.


How much weight should I gain?

It is not a set amount for everyone. It is based on your pre pregnancy weight and BMI. A general rule is 20 pounds by 20 weeks. Front load your pregnancy in case the babies come early. Plus, it is hard to eat a lot at the end of the pregnancy and keep up the weight gain. Gain reserves on your body to be able to nurse them. Don't diet!


Will I have more tests than with a single pregnancy?

Typical testing includes non-stress test (NST), Biophysical Profile (BFP), and more ultrasounds to check growth.You always have the right to ask why the test is being given and to refuse the test. Ask what the medical indication for it is. Is the OB just covering their behind? Most OB's don't have moniotors that trace both babies for a NST (non-stress test), therefore you will be sent to the hospital. Learn as much as you can and become your own best advocate. What is best for you and your babies?


Will I have more complications?

Some women have no problems at all. Common complications: Higher risk of prematurity, Gestational Diabetes, Hypertension, preeclampsia, and Intrauterine Growth Retardation (IUGR). These are not guaranteed for everyone. Better nutrition, rest, and moderate exercise can reduce your risks.

Know what type of twins you are carrying and learn about risks specific for your pregnancy. Mo/DI twins: are identical at risk for twin to twin transfusion. Some issues are placental sharing and size restrictions.


Should I have an ultrasound?

Yes. If you are carrying multiples, you need to know what kind of twins you have. That way you can assess if your care provider is being aggressive enough in your care. You need to know the risks to your babies. Do they share a placenta? Are they fraternal Are they identical?

Please ask to learn if the ultrasound tech skilled in assessing twin pregnancies. Ultrasound techs are great at what they do often, so find a tech that assess alot of twin pregnancies. She will know what to look for and be able to get all the "tricky" pictures of the babies.


What is full term for multiples?

There is not an agreed upon weekage for "full term" in multiples. The Dr's believe that twins develop faster than a singleton pregnancy, but there is not proof of this theory. One thing to consider is that preterm babies (no matter the weekage) still can have breathing and breastfeeding problems.


Should I stay pregnant longer?

Stay pregnant as long as you can and you and your babies are healthy. Remember to maintain good nutrition so that you and the babies are healthier. Full term babies eat better after birth.


Will my babies be premature?

50% of multiples are born at 36 weeks or before. 50% are born after 37 weeks. In both of these categories many are born by elective c-section or induction, not by spontaneous labor. How many wait for their body to do it? We just don't have good statistics to answer this question well.


Will I have to go on bedrest?

Whether you are put on bedrest depends on many factors and also your care provider. Recent studies have shown bedrest to not be effective. There are many levels of bedrest from complete (you are upside down in the hospital) to rest (2 hours up and 3 hours down). Most mothers quit work by 32 weeks. Remember to slow down and get help.


BIRTH

Should I make a birth plan? How is it different than for a singleton pregnancies?

Yes! Please make a birth plan. This helps the parents learn and preplan for birth. Share your birth plan with your doctor to make sure that they support you. You are free to change providers if you find that they do not approve of your birth plan. Click here for a sample birth plan.


When will my babies come?

Multiples have a larger range of expected delivery dates than a singleton pregnancy, so the delivery day is hard to predict. One thing is certain; either the babies will come early or late.


Can I have a home birth?

There are some homebirth midwives that are trained in twin births. Be aware that they will not do a homebirth if you go into labor before 36 weeks, but will go with you to the hospital.



What is this 38 week cutoff?

Women do carry and deliver healthy babies past 38 weeks. Most OB's believe that the placenta starts to erode and 38 weeks and created this cutoff to help insure healthy babies. This is something you need to discuss with your provider.


What if they want to induce me?

Don't be a victim of you desires or your doctor's fears. Make an informed choice after you have correct information. If the induction is not an immediate medical emergency, there is time to ask questions and to make a decision. Here are some questions to ask: Why do you think I need to be induced? What are the benefits? What are the risks? What are my other choices? What induction methods can I choose? Will I be mobile? What about herbs? Chiropractors? Acupuncture? Listen and decide what you feel is right.

Advice: Make the most of the induction. Explore alternative therapies.


What if my babies are not head down?

Babies change position often. Visit the Spinning Babies website for ways to belly map and to learn about getting your babies to change positions.


What is the typical labor pattern?

The birth tends to be faster and a stretched uterus makes contractions less painful. After baby A labor can vary and the Dr. might use more interventions. Be educated before labor about your choices so that you can make an informed decision in labor.


Do I need to go to a special hospital to have my babies?

Many community hospitals are not well equipped. Find out if they have 24/7 anesthesiologists. What level nursery does your hospital have? At what weekage will they allow you to deliver without transferring you to a more skilled hospital?

Your local hospital probably has only a level one nursery. If you deliver before 34 weeks, they might transfer you to another hospital due to not being able to take care of your babies.

Advice: Go to a better hospital with a level 3 nursery. If you choose a community hospital, tour the higher level hospital in case you get transferred. Also, know what hospital chain it is connected to.


If I have a vaginal birth, will I need an epidural?

Not necessarily. Plenty of women have had a vaginal birth without an epidural. Talk to your care provider. Some feel it is mandatory, in case there is an emergency. If an emergency happens, they will probably put you to sleep for a c-section. If baby A comes out and baby B shows signs of distress, they can place a spinal. Question your provider as to why you would need an epidural. Question your provider on the likelihood of needing anesthesia for a vaginal birth. Make a decision and get the support you need for your birth. This might mean changing to a different doctor or having a homebirth. Be informed of your options.


Should I just plan a c-section?

No, just because you are expecting multiple does not mean you need a c-section. Many women give birth to multiples vaginally. You can do it too! Learn about your birth choices. Get the support you need for the birth you want.


Do I have to give birth in the Operating Room?

It depends on the facility, provider, and pregnancy situation. For emergency situations, you would be in the OR (Operating Room). More often than not they will push for the OR. You can ask for a delivery bed to be in the OR. Another choice is to labor in L&D, but be moved to deliver in OR. Remember to ask how many people can be in the OR for a vaginal birth?


Will I have a c-section?

Some expecting moms do have a c-section for medical reasons. Others have a great chance of a vaginal birth. The decision will be based on the position of the twins at the onset of labor. The position of the presenting twin needs to be head down by the cervix. If the second baby is breech, it depends on your provider's experience on whether you can continue with a vaginal birth. Some will do an external version if the presenting baby is not head down. Word of advice: Find a skilled experienced OB with multiple births because they won't require both babies to be head down and can help you deliver both babies healthily.


POSTPARTUM

Can I get in home help?

Yes! We have helped many moms with multiples adjust to life after birth. We can help you with feedings or other household duties. Hire a postpartum doula. Click here to learn more.


Can I breastfeed multiples?

Yes, many mothers do it. You are more likely to be successful if you get support. Join La Leche league or find a lactation consultant. To find a list visit Nashville Resources.



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Nashville, TN 37221

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