Getting ready to deliver twins, triplets, or more

Dr. Horsager's twins
Dr. Horsager's 24-year-old twin daughters, Alex (left) and Katherine (right).

You’ve made it out of the first trimester safely. You’re feeling better – the nausea isn’t as bad, and you aren’t as sleepy. The shock has started wearing off. You are expecting twins, triplets, or more – so what comes next in your care?

More ultrasounds

Around 18 or 20 weeks, you will have an ultrasound specifically looking for abnormalities in the babies. Twins are at higher risk for congenital anomalies, so we’ll want to closely examine the development of major organs, including the heart.

Ultrasounds will continue to be used to track the growth of the babies. Measuring the size of your abdomen with a tape measure isn’t very accurate with twins.

If your twins are identical and sharing a placenta, we will look even more frequently with ultrasound. In some cases, the shared blood vessels can cause one baby to get more blood, which can affect growth and the amount of fluid in each baby’s sac.

Risk of early delivery

The uterus just isn’t very smart. It can’t tell that two 4-pound babies are different from one 8-pound baby. For this reason, women carrying multiples frequently deliver early.

We know half the women carrying twins will go into labor before they reach 37 weeks of gestation – the table with this article shows how the rate of preterm birth increases with twins, triplets, and more. Three-fourths of the women carrying triplets will experience preterm labor, as will 90 percent of women having quadruplets. It’s one my biggest concerns, especially when it happens before 28 weeks, since babies born that early may have a higher chance of permanent complications related to prematurity.

Gestational age and birthweight characteristics, by plurality

Many treatments have been proposed to prevent premature delivery in twins. Doctors have tried putting patients on bed rest or placing a stitch in the cervix to keep it from dilating. Our Obstetrics and Gynecology department participated in a national research trial that studied progesterone shots in twins and triplets. Unfortunately nothing has worked to prevent preterm delivery.

Since patients carrying multiple gestations are at increased risk for preterm delivery, we’ll watch for those signs. You may have extra ultrasounds to measure how long your cervix is or frequent vaginal exams, depending on your doctor. If you have contractions and there is heightened concern about the possibility of early delivery, you may also receive corticosteroid shots to improve the lung development of the babies and reduce the risk of other complications in preterm infants.

Sometimes, we will recommend an early delivery. Women carrying twins have a higher chance of developing high blood pressure than women with one baby. If your blood pressure is very high, early delivery may be necessary – both for your health and that of your babies.

Time to have these babies!

Frequently women with twins will ask about the possibility of having an early delivery because they become increasingly uncomfortable as their babies – and bellies – grow bigger. We like to get women as close to term as possible to reduce newborn complications and increase the chance that the babies will be ready to go home with you when you’re released.

To ease discomfort and help you get enough rest, I recommend (based on personal experience!) trying a recliner for sleeping or napping in the third trimester. Many women find it more comfortable to rest in the recliner with their feet elevated, rather than lying flat on their back or side. This has the added benefit of helping reduce swelling in your feet or legs that can worsen over the course of the day. Other patients have told me that using a body pillow has helped them rest more comfortably.

When it’s time for your delivery, the method is going to depend on many factors, including:

  • How far along in the pregnancy are you?
  • How big are the babies and are they similar in size?
  • Are they coming head or feet first?

You’ll want to talk to your doctor about their experience and comfort level with delivering twins. Of course, you may not end up having a vaginal delivery. The likelihood of having a cesarean section is much higher than if you were carrying just one baby.

We expect more blood loss when delivering twins, regardless if you have a cesarean section or vaginal delivery. So, even if you were really good about taking your prenatal vitamins, you may end up being a little anemic. You’ll need to continue taking iron pills after delivery so you can quickly get your blood count back up to normal.

Once the babies arrive

If your babies were born prematurely, they may need to spend extra time in the NICU. This can be difficult for you and your family, especially if you are home recovering from a C-section or if one baby comes home and the other needs to stay a little longer.

Accept offers of help with housekeeping, meals, or driving you back and forth to the hospital. Use this time to catch up on sleep because both babies will be home with you soon. And seek advice from doctors and lactation consultants about providing breast milk for your infants, even if they aren’t ready to breastfeed.

Helping you manage the risks

Our team, which includes high-risk specialists who work closely with our general obstetricians, is equipped to manage all pregnancies. For more information about our services, request an appointment online or call 214-645-8300.

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