Twice as nice: Need-to-know tips for mums expecting multiples
If you're having a baby, it's an exhilarating time, and if you're pregnant with two, even more so. Claire O'Mahony has some 'twinspiration' for multiples' mums-to-be
Finding out that you're expecting twins can come as a shock, albeit a wonderful one. We all know how much work goes into looking after one baby, so the thoughts of trying to juggle two might seem overwhelming for parents-to-be.
There's no question but that it's more work in comparison with raising a singleton, but it also means double the joy.
Twins are not as common as we have been led to believe. There's a popular misconception, because of the rise of fertility treatments, that twins are on the increase. This is not actually true, according to Dr Fionnuala Breathnach, Associate Professor in Obstetrics and Gynaecology at the Rotunda Hospital. "For certain over the last three decades there has been an increase in twin pregnancy incidence. That has levelled off over the last 10 years or so, if not fallen, as a result of fertility treatments now being more conservative when it comes to generating multiple pregnancies," she says. "In the 1990s, it wasn't unusual for us to see many triplet pregnancies generated through the assistance of IVF but you see a lot less of that now. It's now pretty steady at about 1.5pc of pregnancies here."
Developments in foetal pregnancy in Ireland means that the outcomes for twin pregnancies are very good. However, having twins is considered a high-risk pregnancy from the outset. The riskier of twin pregnancies are those who share a single placenta, or monochorionic twins (most, although not all, identical twins share one). Twenty per cent of twins are monochorionic and according to Dr Breathnach, most twin pregnancy complications that she sees tend to be represented in this group. The more common group of twins are those who have their own independent placenta (or dichorionic twins) and this is the case for all non-identical twins and some identical ones.
"Probably the most important thing is that the number of placentas has been correctly confirmed and that's achieved as early as possible. In ideal circumstances you really want for twins to have had an ultrasound done before 14 weeks and certainly before 16 weeks, so that you can be confident about the number of placentas," says Dr Breathnach. "Managing complications later in the pregnancy very much depends on how confident we are about how independent each twin is. After that, how frequently they need to be monitored depends on what group they're in." For those sharing a placenta, a scan is required every two weeks from 16 weeks until delivery and for dichorionic twins, if they're uncomplicated, it's sufficient for them to be scanned every four weeks.
The basic principles as to how you would manage a singleton pregnancy apply to twin pregnancies, such as sufficient amounts of exercise and a healthy diet. But what are considered to be minor pregnancy ailments are magnified with twins.
"Twin pregnancy takes its toll on people, particularly for someone for whom it's not their first pregnancy," says Dr Breathnach. "It's a tough pregnancy, in particular in their third trimester and just by virtue of the additional weight, a twin pregnancy has effects on the pelvis, uterus and supports, and back supports." For many women expecting twins, they don't manage to work beyond 32 weeks.
Many twin pregnancies don't go full term. A national study, lead by Dr Breathnach, between 2007 and 2009, asked what the optimal timing was for delivering twins that were uncomplicated, and that was found to be between 37 and 38 weeks for twins who don't share a placenta and sooner, between 36 and 37 weeks for those who do.
Beyond pregnancy, there's the practicalities of your new life as a multi-tasker with multiples.
Lorraine McCarthy is chairperson of the Irish Multiple Births Association (IMBA), which runs multiples clubs around the country, as well as providing information evenings for expectant parents, publications and a phone support line staffed by volunteers who deal with everything multiples-related. Her experience is that when parents are anticipating life with twins, they are probably not entirely prepared for how demanding it can be in comparison to having a single baby.
"They will have heard about all of their friends, who will have had one baby, being able to get out of the house in a short few weeks and going to the movie mornings with baby and so on. They'll suddenly find that once dad goes back to work from his paternity leave, it's very difficult to get out of the house with two or three babies," she says. "You nearly need to be accompanied everywhere when your babies are small if you want to do something like baby massage. All of these things have an extra dimension of planning that you wouldn't have with a singleton."
With most multiples being delivered before term, McCarthy says it can be a shock for parents who didn't anticipate that perhaps their babies will have to go to the intensive care environment, or to the special care nursery environment, or that mothers may leave hospitals before the babies do, and often times, one baby may be discharged before the other.
She advises new mothers of multiples to ask for help, and also to get as much sleep as they can, whenever they can. "Multiples are very intense in the early weeks when they're feeding and will usually feed every four hours when they're very young, but that's feeding two babies. When you've fed one, winded one and fed and winded another, you have one and a half to two hours left before the next feed starts. The sleep deprivation is absolutely chronic and debilitating in the early weeks," she says.
She also suggests that parents go to clubs specifically for multiples as it can really help them to talk to other parents.
There's no question but that having twins is expensive.
"We say beg, borrow although don't steal. There's a huge amount of barely-used stuff online, on places like donedeal.ie," McCarthy says. "Multiple pages on Facebook are good because, for some reason, when you have multiples you use stuff even less. It depends on the family. Often car seats are less used because it's just a bigger deal to go out and about with the babies." IMBA members can also avail of discounts from retailers around the country.
But however much work looking after twins might entail, multiples bring multiple benefits.
"It's fascinating to watch them develop and see their own personalities, it can be absolutely great fun. They have a very close bond and they always remain close and that's very special," McCarthy says. "The early days are intense but it's a great journey."