Thriving in a Twin Pregnancy: Choosing a Doctor and Prenatal Tests


Excerpted from Double Duty: The Parents’ Guide to Raising Twins, from Pregnancy through the School Years (2nd Edition) by Christina Baglivi Tinglof Copyright © 2009 by Christina Baglivi Tinglof. Excerpted by permission of McGraw-Hill. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

“When I went in for a routine visit at 16 weeks, I was sporting a decent bump at that point. But my first child was big, so I didn’t think much of it. The doctor took a look at my tummy and said, “You’re looking a little big.” She got out the stethoscope and listened a few minutes. Then she left the room in search of an ultrasound machine. On her way out the door she asked, “Do twins run in your family?” I thought she was kidding, but sure enough, a few minutes later we were looking at two babies on the screen. The first thought that went through my head? Minivan.”

Forget the old saying, “You’re eating for two.” You’re eating for three—a sometimes awesome task. And while most women can expect to gain 25 to 30 pounds with a singleton pregnancy, the American College of Obstetricians and Gynecologists recommends gaining at least 35 to 45 pounds if a woman is carrying twins. In fact, research shows that the more weight a woman expecting twins gains—especially during the first two trimesters of her pregnancy—the less likely she’ll run the risk of a premature birth. Twin pregnancies at any age are considered high risk, a term that often sounds worse than it is. Remember, most mothers-to-be breeze through a twin pregnancy without a complaint. Unfortunately, others are confined to bed rest early on due to complications stemming from an engineering glitch in the human body—women were designed to carry only one fetus at a time. But there’s plenty that you can do to help ease your anxieties about your pregnancy—educate yourself on multiple births, increase your protein and calorie intake significantly (more on that later in this chapter), take frequent rests, and follow the advice of your physician (but always ask questions if you don’t agree). This chapter focuses on your pregnancy and what you can do to help bring healthy babies into the world.

Prenatal Care

You dream that the birth of your children will be a day of joy with few, if any, complications. Yet you can’t ignore that little voice in the back of your head that keeps whispering, “What if there’s a problem?” While no one can guarantee smooth sailing, good prenatal care provides the best chance for a healthy outcome for both you and your babies. Keep all scheduled doctor’s appointments. And to get the most out of your visits, keep a written list of questions that you want to remember to ask your doctor. With so much information exchanged during a typical prenatal exam, you should think about taking a small tape recorder with you, too, so you can review your doctor’s advice later when you have a chance to take it all in.

Choosing a Doctor

Your relationship with your obstetrician is an important one. Since you’ll be asking him or her many questions throughout your pregnancy and deciding on a host of important issues, including which prenatal tests to undergo, you should feel a strong sense of trust and comfort. To find a qualified obstetrician, call your local hospital’s doctor referral service, ask other moms of twins in your area, or contact your local Mothers of Twins Club for a list of recommendations. Try to choose a health care provider with experience in multiple births and high-risk pregnancies. You and your doctor should have similar views on pregnancy and birthing as well. Does he or she routinely perform cesarean sections on all multiple births, while you feel strongly about trying to have a vaginal birth? What treatment does he or she prescribe if problems do arise? Many tests and techniques involving a multiple birth vary widely, and a few are considered controversial. Do you agree with your physician’s point of view? If not, you might want to interview another obstetrician. You might want to also consider signing on with a perinatologist, or maternal-fetal medicine (MFM) specialist, an obstetrician who specializes in high-risk pregnancies. You can use a perinatologist as either your primary-care physician or as a consultant (think of this doctor as a second pair of eyes trained to spot potential problems or complications associated with a multiple pregnancy).

“I think if I were to do anything differently, I would have stayed with the high-risk OB/GYN instead of my regular OB. Maybe the high-risk doctor would have caught the problem that caused my preterm labor. I would have also pushed to see my doctor after our last ultrasound when the technician said one baby was head down. I delivered four days later.” (Ashlyn and Taylor, fraternal girls, were delivered at Week 28. Ashlyn weighed 2 pounds, 1 ounce while Taylor came in at 2 pounds, 7 ounces.)

Hospital Affiliation

Even if you take excellent care of yourself and follow your doctor’s advice to the letter, twins sometimes show up early (three weeks on average), and in some cases very early, requiring an extended stay in a neonatal intensive care unit (NICU). Neonatal intensive care units are ranked as follows: Level I is a basic care unit for uncomplicated births; Level II (specialty) cares for infants who come into the world with moderate problems such as apnea but are expected to recover quickly; and Level III (subspecialty) focuses on comprehensive care for extremely high-risk newborns such as those born in critical condition. When searching for your obstetrician, try to find one affiliated with a Level III hospital with a top-notch NICU. Otherwise, if your newborns do need to be placed in the NICU and your hospital doesn’t have one, your babies will be transported to a better-equipped facility, away from you. Chances are that your twins won’t need the NICU. Of the 39 surveys completed for this book, 12 sets of twins spent some time in the NICU. Two of those sets required only a day, and one pair stayed two days (enough time for their moms to recover from the rigors of childbirth). But one set of fraternal girls stayed for 10 long weeks. The median time (excluding the highest and lowest scores) for all, however, was only 10 days.

“My girls were in the NICU for 10 days. The hardest part was being transferred to my room and hearing all the mothers and their babies and knowing mine wouldn’t be coming. I cried a lot. But looking back, I was given the opportunity to recover before I took on the daunting task of more than one. I visited every chance I got, even after I was released. Somehow knowing they had each other when I wasn’t there gave me some feeling of peace.”

But I Don’t Feel High Risk

Even if you feel great throughout your pregnancy, multiple births are more likely to run into medical complications than singleton deliveries and, therefore, earn the term high risk. For this reason, moms carrying twins are monitored more closely than those carrying singletons. You’ll visit your doctor more often—usually once a month for the first trimester, every two weeks during your second trimester, and then weekly during your final trimester.


Prenatal Tests

In addition to more doctor visits, you’ll also undergo more prenatal tests. Even healthy twin pregnancies require more poking and prodding than singleton pregnancies. However, some doctors prescribe more tests than others. Following is a brief list of standard tests that you’ll encounter. Each has its benefits as well as its risks and should be discussed at length with your obstetrician.

Ultrasound

What? One of the most widely used prenatal tests, ultrasound (or sonogram) uses high-frequency sound waves and takes only a few minutes to perform. It’s relatively painless and one of the least invasive prenatal procedures. The doctor or technician rubs a thin layer of lubricating jelly across a pregnant woman’s lower abdomen and then moves a transducer across the area. As the sound waves bounce off the babies, an image appears on a television screen. (If you’re in the very early stages of pregnancy, however, your doctor may perform a transvaginal ultrasound instead during which a lubricated probe is gently inserted into the vagina. This type of scan is even more accurate than a traditional ultrasound as the device can come into closer contact with the fetal sac.) Why? Ultrasound is extremely important for a mom expecting twins. Not only can it confirm a multiple pregnancy, but it accurately predicts the babies’ due dates and gestational age. It’s also used to identify intrauterine growth restriction (IUGR) in which one or both fetuses’ weights rank in the less than 10 percent range for gestational age. For those moms expecting identical twins, ultrasound can determine the number of chorions (outer membranes or placentas) and amnions (inner membranes or amniotic sacs), which is helpful in diagnosing the presence of twin-to-twin transfusion syndrome (TTTS). Ultrasound can also recognize possible maternal problems such as placenta previa as well as fetal malformations such as spina bifida, Down syndrome, or abnormalities of the brain, heart, liver, or kidneys. Later in pregnancy it’s used to show the position of the babies to determine the best mode of delivery and to monitor fetal growth and weight. It also measures cervical length (a strong predictor of preterm labor especially prior to Week 30) and the amount of amniotic fluid surrounding the babies. Ultrasound can determine the sex of the fetuses, though not with complete reliability. When and How Often? For women expecting multiples, an ultrasound is routinely given about Week 7 to confirm a multiple pregnancy. It’s performed again near Week 18 to check the structure of the placenta and to detect any fetal abnormalities. Following Week 24, ultrasounds are given every few weeks to ensure the babies’ continued growth and to monitor for possible complications. (Please note: These figures are average; your doctor may have you  undergo more ultrasounds depending on your circumstances.) Pregnant mom getting an ultrasound

Pros and Cons.Considered a safe procedure since no harmful x-rays are involved, ultrasound is one of the least invasive prenatal procedures. Parents’ concerns about the health of their babies are immediately put at ease without lengthy waits for lab results. The benefits in safely accessing the fetuses in a multiple pregnancy make ultrasound a commonly recommended test.Amniocentesis What? Amniocentesis, generally considered a safe procedure, involves removing a small amount of amniotic fluid from the amniotic sac, the bag of liquid that surrounds the fetus (or fetuses). The genetic material found in the fluid is then studied in a laboratory. With the help of ultrasound, a safe insertion spot away from the fetus is established and then a needle is inserted through the abdominal wall and into the uterus. The procedure takes about 30 minutes to perform, and the patient may feel a small amount of discomfort. A mom-to-be carrying twins may have two amniocenteses performed—one for each amniotic sac. Why? Amniocentesis is used most often to detect chromosomal abnormalities such as Down syndrome in fetuses of women older than age 35 (age 33 if the mom-to-be is expecting multiples). The test can also recognize autosomal recessive diseases like sickle-cell anemia, cystic fibrosis, and Tay-Sachs disease. It can confirm the baby’s sex and, therefore, is important for a family with a history of sex-linked diseases such as hemophilia. During the third trimester, amniocentesis is invaluable in determining the maturity of a baby’s lungs if premature delivery seems inevitable. When and How Often? Although amniocentesis is usually performed once between Weeks 16 and 20, the clinician may order a second toward the end of the pregnancy to establish the maturity of a baby’s lungs when a woman is experiencing problems in her pregnancy and premature delivery is unavoidable. Pros and Cons. Waiting the required week or two for amniocentesis results can put a strain on any couple, but the peace of mind that follows after hearing that the test results are negative helps families relax and enjoy the remaining months of pregnancy. On the other hand, a major downfall to amniocentesis is the relatively late time in the pregnancy it is performed, making it difficult for those waiting for genetic analysis and who may be facing the decision of whether to abort. Furthermore, amniocentesis is more difficult to perform on a twin pregnancy since both sacs must be evaluated and on occasion the second sac can’t be located; it’s very expensive (about $1,500 for each test, usually covered by insurance); and there’s a small chance of spontaneous abortion (less than 0.06 percent, but 2.7 percent in women with multiples) or infection. [Next page of article…] A copy of the book Double Duty.