Being told you are expecting multiples is a big surprise! Clinical Practice Development Co-ordinator Ann Bowers at The Coombe explains what to expect.
Discovering you are pregnant with more than one baby can lead to a roller coaster of emotions: surprise, fear, joy, bewilderment to name but a few. You may feel daunted by the extra risks and responsibilities that come with a multiple pregnancy and birth, however it is important to remember that you are not alone. There are lots of people who have been through a multiple pregnancy and healthcare professionals who have cared for parents of multiples will be there to support you on this amazing journey. Use the time before the arrival of your babies to research all you need to know about caring for yourself for your infants – especially the practical issues such finding out what happens at a multiple birth to sleep routines and feeding.
Mother of twins Catherine Rafferty shares her tips.
Forget about the housework; if someone offers help…take it! Just concentrate on feeding your babies; you won’t have time for much else especially at the start. Try get into the swing of feeding tandem and you will soon learn babies that feed together sleep together! Invest in a twin pillow can be used to tandem feed both by breast. Tap into local support groups even on Facebook if you cannot get out. Cuidiu and Irish Multiple Births Association (IMBA) are great.
Types of multiples
All pregnancies begin when a sperm fertilises an egg to form a zygote. Sometimes two eggs are fertilised by two different sperm forming two zygotes, in other words ‘twins’. These twins are called fraternal or dizygotic twins (meaning two zygotes). Each fraternal twin will have their own umbilical cord and own placenta. Fraternal twins are like having two pregnancies at the same time. They may look similar or completely different.
A single fertilised egg (zygote) that splits in the days after conception forms genetically identical twins known as monozygotic. These twins are of the same sex and will usually look very similar to each other. There are different types of identical twins. Some identical twins split soon after fertilisation and will have their own individual placentas. Some will split after they attach to the wall of the womb therefore they share a placenta. A very small number of twins who split later will share a placenta and an inner sac, called an amnion – however they will have separate umbilical cords and are called monoamniotic twins. Triplets and quadruplets may develop as a result of combinations of fraternal and identical twinning.
Looking after yourself
1. Diet and nutrition:
Taking care of yourself during your pregnancy starts with good nourishment. Eating a healthy, varied diet rich in iron, protein, vitamins and minerals is vital. Anaemia, in particular iron-deficiency anaemia is more common in multiple pregnancies. This can cause tiredness, fatigue, pale complexion as well as shortness of breath. Your doctor or midwife may recommend a pregnancy supplement. Keep well hydrated by drinking water, as this helps you feel more energised and is important for keeping a healthy urinary system. Slow burning foods such as wholegrain rich foods like vegetables, beans, oats, brown rice and pasta will help to keep you feeling full for longer and keep your blood sugar levels stable. Eating your meals slowly and while sitting upright may aid digestion and reduce heartburn.
2. Keeping active:
When you are expecting more than one baby, you will also be carrying extra weight in the form of placentas, amniotic fluid and extra maternal fluid. A multiple pregnancy will put more pressure on your joints, which may cause discomfort and backache towards the third trimester. Gentle exercise can ease tension and aid your muscle tone. You may find that exercise may help to relieve backache and constipation, while also helping you to sleep better.
Low-impact sports such as walking and swimming can be enjoyed by most women. Remember to start slowly and if you feel unwell or if you are in pain, stop! Due to the added weight of pregnancy, your pelvic floor muscles get weaker. Weakened pelvic floor muscles can lead to urinary incontinence and reduced sensitivity during sex. Pelvic floor muscle exercises can keep your pelvic muscles strong. Try to attend a physio class in your hospital to learn how to do pelvic floor muscle exercises correctly. Do these exercises daily throughout your pregnancy and beyond to maintain a healthy pelvic floor.
3. Emotional wellbeing:
A multiple pregnancy can cause a mixture of emotions from fear of the unknown to joy at the prospect of seeing your babies. Added to this are the extra pregnancy hormones and physical changes that can leave you feeling overwhelmed. These are normal emotions. Do not be afraid to discuss your feelings with your partner, they may be feeling a bit overwhelmed too. Support groups such as the Irish Multiple Births Association (IMBA) provide guidance and information for parents during pregnancy and after the arrival of your babies.
One of the most common complaints during a multiple pregnancy is extreme tiredness. Your body works extremely hard during a pregnancy and during a multiple pregnancy it must work even harder. In a singleton pregnancy, blood volume increases by nearly 50%, however, in a twin pregnancy your blood volume will increase by nearly one 100%. This means that your heart will need to work much harder to pump all of this blood around your body. As a result, your blood pressure will generally drop and your pulse rate will rise during a multiple pregnancy.
It is common for pregnant women, in particular women expecting multiples, to feel faint when lying down due to the pressure of the uterus. Most women will find it more comfortable to lie on their side. This may be necessary for scans and any other procedures requiring a pregnant woman to lie down for a considerable amount of time.
Deborah Hughes-Mulcahy, mother of twins Emma and Anna shares her experience and advice.
I found out I was pregnant at five weeks after ten years of trying for a baby. To say my husband and I were overjoyed is an understatement! I suffered from morning sickness the whole way through my pregnancy and I had bleeding (caused by a subchorionic hematoma) up until 20 weeks of pregnancy. Apart from all this, my pregnancy was problem free. I had a planned C-section at 36 weeks plus five days, which went very well and my two daughters were born – Emma 4lbs 12oz and Anna 4lbs 9oz. They are 14 months now and doing really well.
Anna is deaf in one ear, which was found at her newborn screening. But she seems to be okay and is picking up speech very well, so she’ll be continually assessed. I would recommend that parents with multiples join the IMBA Facebook page. You can ask anything at any time, no matter what time of the night and you’ll get an answer! Also, accept help from any one that offers, even if you think you don’t need it! And I know it’s hard, but do look after yourself. I recently attended an emotional wellness course that was run by IMBA and I learned some great tips on how to stay on top of my mental health.
In 2011, the latest figures available from the ESRI, Ireland reported the highest fertility rate of any of the 27 EU countries, at 16.2 births per 1,000 population. The twinning rate for 2011 was 18.1 per 1,000 maternities, compared with a twinning rate in 2010 of 16.7 per 1,000 maternities. Multiple births in 2011 included 1,319 sets of twins, 28 sets of triplets and 1 set of quadruplets.
Patrica Allen-Garrett, mother of two and a half year old Daniel and Alannah shares her story.
Daniel and Alannah were born on the 28th of December – 10 weeks early. Daniel was 3Ib 4 oz, while Alannah was an even tinier 1Ib 9 oz. We had been monitored very closely from 21 weeks, as there was a big growth deferential between the two babies. My team at Holles street discovered at a routine antenatal appointment that the blood flow had reversed for Alannah, so I had to go up to theatre that day for a C-section.
My consultant had warned me from 23/24 weeks that I could be faced with an early delivery – so I was somewhat prepared for this. The team in Holles Street were amazing, Daniel was in NICU for five weeks while Alannah was in for seven weeks. Luckily, they were born with no complications – the only issue was that they were small. I expressed milk for them as they were too tiny to latch on. In terms of the early days with the twins, I would recommend that support is key. I was lucky to have my husband at home with me to help out. I also have some great friends who were a brilliant support to me during those early weeks.
I developed postnatal depression but I managed to come through it – it’s important for mothers to know that if they feel like they are dipping and can’t cope that the help is out there. Take all the assistance that you are offered and make sure you look after yourself. Eating well and getting enough sleep are vital and reaching out to people is important too. I kept a big white board up on the kitchen wall, which outlined all of babies’ feeds and sleeps. This really helped me to stay on top of things. And one great tip is to give your visitors a job. Let them make their own tea! The twins are now doing really well and are a pair of happy little chatterboxes!
Is it possible to breastfeed twins?
Breast milk is made on demand, the more you feed the more milk you make. By feeding your babies on demand, your babies will get enough milk. In the beginning, you may find it easier to breastfeed one baby at a time. Once you gain confidence with positioning and latching your babies to the breast, you can try feeding them at the same time. Take any help that is offered from family and friends to allow you to get rest and concentrate on feeding your babies.
Find out more about breastfeeding twins.
For further information:
The Irish Multiple Births Association (IMBA) is a charity that was founded in 1996 by parents of multiples. IMBA is managed by volunteers who are all parents of multiples themselves.
Tel: 01 874 9056
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