Q&A: What can I do to reduce the risk of delivering my twins prematurely?

First off, congratulations! Twins are exciting and special. Twins are so prevalent nowadays, and we all know so many sets of healthy twins, a lot of people forget that twin pregnancies are intrinsically higher risk, especially for preterm labor and birth. While the length of pregnancy in general averages 39 weeks, twins' average birth age is 35 weeks, and some come a lot earlier than that. About 60 percent of twins are born early, and are at risk for the health issues that can accompany prematurity.

So what's a mother to do? Number one is to get good prenatal care. Your doctor is the best person to give you advice on your health and the health of your babies-to-be. Here are some guidelines to consider as well:

• After mid-pregnancy, watch for signs of preterm labor:
  
  -Keep alert for uterine contractions, a sensation of balling up or tightening that can be the first sign of preterm labor. Contractions can sometimes feel like diarrhea cramps or menstrual cramps, or repetitive back pains. Leaking of fluid and ANY vaginal bleeding before 36 weeks can also be signs of preterm labor. If you notice contractions, leaking of fluid, or any bleeding, call your doctor!
  
  -Your doctor may also follow your cervix with ultrasound or vaginal examinations.

• Be as healthy as you can be. Normal weight moms should gain extra weight when carrying twins—as much as 37 to 54 pounds total. Underweight women need even more weight gain, while overweight women can get away with somewhat less. Iron supplementation is usually necessary in twin pregnancies, and prenatal vitamins are more important than with singletons.

• Watch your activities. While bed rest has never been shown to prevent preterm birth (despite its widespread use for that purpose) many doctors will recommend decreasing activities that tend to cause contractions as you get to mid-pregnancy. Talk to your doctor about exercise, sex, and your daily responsibilities.

• Ultrasound examinations:
  
  -Certain knowledge of gestational age is critical, since that is how you know if labor is preterm or on time. Ultrasounds done in the first trimester are more accurate than later ultrasounds at estimating gestational age.
  
  -Most twin pregnancies are followed with fairly frequent ultrasounds, to look for fetal growth (since measuring your tummy doesn't tell us about each baby separately), fetal well-being, and signs of impending preterm birth.

While twin pregnancies are at higher risk than most singletons, most twins do well. Even when they come early, they are often close to full term. Remember to ask lots of questions, and follow the advice you receive from your doctor. Parents of twins report that it is amazing to have two babies at once. It can be fascinating to see how they are similar and how they differ. Raising twins is truly special. I wish you all the best.