Twins? What to Expect from a Multiple Pregnancy

There is a certain romance about twins. We envision the double stroller; inside, two babies wear identical outfits accentuating their likeness. We admire the parents for surviving such a grueling period of infancy. The proud mother and father project a certain glory because twins are special, and as parents they have been doubly blessed.

Common Complications

But with this blessing comes a need for caution. While twins are delivered successfully every day, carrying twins makes for a high-risk pregnancy, and an obstetrician must watch the mother very carefully.

Complications that arise with any pregnancy can have an earlier onset in twin gestations since the mother-baby physiologic relationship clearly differs from that of a single pregnancy. For example, if a woman carrying a single baby feels like there is no more room inside her at eight months, imagine what a mother carrying twins must feel like after only six months. The body is overloaded and tends to want to deliver twins prematurely because it believes it is carrying a single, mature baby. Doctors need to remain vigilant in their attempts to prevent premature labor.

If you're expecting twins, it can help to be prepared for some of the common complications that come with efforts to delay premature labor. Here are just a few things to discuss with your doctor:

• Medication: You may be required to take steroids to help strengthen the lungs of your yet-to-be born babes in preparation for possible preterm delivery.
• Hospitalization: You may be required to spend the latter part of your pregnancy in a hospital to better track your and your unborn babies' health.
• Bed Rest: Many doctors suggest bed rest (from just keeping your feet up and taking it easy to staying in bed as much as possible) for women experiencing multiple pregnancies. Quite simply, bed rest can prolong your pregnancy.

Risks

Premature deliveries aside, there are other risks as well. Here are some common conditions to be aware of. I point these out not as a cause for fear, but simply to raise awareness and encourage pregnant mothers of twins to be conscientious in their care.

The first condition, discordancy, occurs when one twin gets more than its share of oxygen and nutrition at the other twin's expense. As a result, one twin grows too much and the other not enough. Ironically, this puts both babies in danger because the overload on the larger twin can be just as hazardous as the deprivation to the smaller. Ultrasounds ensure that the babies are growing at roughly the same rate.

Ultrasounds are also used to confirm that identical twins are not sharing the same amniotic sac; with identical twins there is a chance that the membrane will not divide, and cord entanglement, which can be dangerous, is a real possibility.

Another condition that can arise in twin gestations is preeclampsia (or toxemia), which causes high blood pressure, swelling, kidney problems, and possibly seizures.

Placental accidents are more likely, too. Placenta previa, when the placenta lies over the opening of the womb blocking vaginal delivery, can occur because there is more placenta but less space for it to occupy.

Placental abruption, a premature tearing away of the placenta, is also more likely than in single pregnancies. This event can cause significant blood loss, the need for a transfusion for the mother, and poses real danger for the babies.

Birthing Twins

Once gestation is complete, new risks are presented as twins can be difficult, if not dangerous, to deliver. The lack of space and jumbling of little bodies frequently causes abnormal positioning of one or both twins. Two such positions are transverse presentation, when a baby is horizontally positioned instead of vertically positioned, and breech presentation, when the baby is positioned buttocks first rather than head first. In both these cases it is very difficult to deliver, and a C-section can be the safest option.

Prolapse of an umbilical cord, which can pinch the cord and cut off oxygen to the baby, is more frequent with abnormal presentations and is therefore more common with twins.

But carrying twins need not be a frightening experience. It is important to remember that while there is more potential for complications, modern obstetrical care and careful surveillance of two babies usually results in successful delivery.

Today we have at our disposal tools to closely monitor pregnancy and birth and intervene when necessary. Carrying twins is one of the strongest arguments, and best incentives, for good prenatal care. In this case, prenatal care is crucial for a healthy outcome. Twins occur in slightly more than one in one hundred pregnancies, but this number grows as the use of infertility drugs increases.