Friday 26 May 2017

What to expect with a twin pregnancy

Hearing the news that you are expecting twins can put you on an emotional roller coaster from disbelief to joy, from excitement to fear. Maura Reynolds, registered midwife at Mount Carmel Maternity Hospital, offers some advice

DISCOVERING a twin pregnancy nowadays is usually made at your first visit with ultrasound, which takes place at approximately 12 weeks. If you have conceived using fertility treatment the chances of having a twin pregnancy is higher. In fertility centres a check ultrasound is usually done routinely.

PREGNANCY SYMPTOMS

All pregnancy symptoms are more common in twin pregnancy, they can last longer and can be more severe.

MORNING SICKNESS

Due to the higher levels of hormones, nausea and vomiting can be worse in twin pregnancies. Morning sickness can start earlier and last longer.

TUMMY TROUBLE

Being pregnant with twins can cause more heartburn, indigestion and constipation. Being on a healthy diet can relieve some of the symptoms. But there are times when antacids are needed to help with the heartburn symptoms. Nowadays medication can be prescribed to help when antacids are not working.

FATIGUE

Growing two babies takes a lot of energy. Plus a pregnant mum- to- be of twins has twice the amount of increased blood. Sleep deprivation from discomfort can also wear you out so cat nap whenever you can. Also be prepared to go on maternity leave at a much earlier stage; this could be at approximately 30–32 weeks.

DIFFERENT TYPES OF TWINS

Twins can be either identical or non-identical. Identical twins are a result of one fertilised egg that splits and develops into two separate babies but are the same sex. Non-identical (or fraternal twins) are a result of two eggs being fertilised at the same time and can be different or the same sex. Diagnosing the type of twins is needed for the mum's care in the pregnancy.

MEDICAL CARE FOR THE MUM OF TWINS

Lots more clinic appointments are needed when carrying twins. We recommend that you see your midwife/doctor every four weeks.

As you are scanned to check the growth and development of the babies every two/four weeks, soon you will have a photo album ( or two) with all the pictures you receive at the scans.

In cases where the twins are identical these babies need to be scanned every fortnight from 16 weeks (due to the higher rate of twin to twin transfusion syndrome). With non- identical twins scanning every four weeks from 18–20 weeks is normal.

At all the visits to the antenatal clinic, the normal routine checks are carried out, such as blood pressure and urine checks.

Mums are encouraged to eat small amounts of nutritious foods ( little and often) and to continue exercising to keep fit.

Aqua aerobics is an excellent way to stay fit; the water takes away all the weight. Continuing the pelvic floor exercises is also advised because of the double weight on that muscle.

LABOURING WITH TWINS

For the majority of twin pregnancies labour may or may not start early, and they do not go to full term, ie 40 weeks. It can get pretty crowded for the little ones in the uterus!

Be sure to know the signs of pre- term labour and don't hesitate to call your hospital if you are experiencing any of them. The labour wards are open 24 hours a day every day of the year.

It is now recommended that identical twins and most non- identical twins be delivered by Caesarean section.

PLANNED CAESAREANS

A scheduled Caesarean is discussed with your doctor in advance and a date and time are set for your Caesarean section. With a planned C section, you will be given a spinal block. The babies will be born in a matter of minutes and with only one to two minutes between their births. Your partner can accompany you into the operating theatre.

EMERGENCY CAESAREANS

Do always remember that events may not go according to plan and you may end up having an emergency section. This can happen if the mum is not well, for instance with pre- eclampsia or has a bleed. The babies may not be growing well and it is better to deliver them sooner rather than later.

VAGINAL DELIVERY

If twin one is in the head down position ( cephalic) it is possible to have a vaginal delivery. The pushing stage can be shorter or longer than in a single delivery.

With twin two, the birth is usually 10– 30 minutes after the first. Sometimes the doctor may have to give assistance to twin two, getting the baby into a better position.

If you are having a vaginal delivery an epidural is strongly recommended just in case of an emergency Caesarean. Labour is watched more closely in twin labour and the babies' hearts monitored carefully. Best be prepared for all eventualities.

Maura Reynolds ( RGN, RM) is a registered midwife at Mount Carmel Maternity Hospital, Churchtown, Dublin 14. For more information about maternity packages at Mount Carmel, contact Samantha Langan on t: 01 4996397 or e: maternity@ mcm. ie

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