Friday, January 7, 2011

Twin Pregnancy

I approached pregnancy just like everything else, with tons of research. When we found out I was having twins I had to do even more research.

I read about nutrition in multiple pregnancy, exercise, how to prevent common problems, etc. I also looked at the survival/disability rates for multiples in many other countries. The countries with the highest rates of living, healthy multiples did many things differently than the standard of care in the U.S.

In the U.S. most women are told to take a prenatal vitamin every day and that's the extent of the nutrition advice. However, the better a woman's nutrition the healthier the babies. Weight gain in a multiple pregnancy is extremely important. The more weight you can gain earlier, the better. I interviewed multiple providers before finding one (with a team) that I knew would lecture and provide me with research on things like nutrition at every appointment. She also was available by email, text, and phone all the time.

I struggled with weight gain. I had all day sickness (not just feeling nauseous) every day for 5 months. I ended up in the hospital with severe dehydration because I couldn't even keep down a sip of water. I tried every cure out there. When we would go out, my husband often carried lemon slices in a baggie in his pocket. Smelling and biting into one would often give me enough time to get to a trashcan or bathroom.
4 months pregnant

About the time that ended, we went on our last big vacation before having kids. It was an incredible trip to Hawaii. I was limited to just walking and swimming for exercise, so we hiked and swam every day. It was beautiful, though I will have to go back another time when I can swim with sharks and do a few other things I wasn't able to do that trip. I remember thinking I was huge and looked so bad in everything I wore. Little did I know how much bigger I would get.
 Hiking - 6 months pregnant
6 months pregnant - I thought I was huge.
Another thing I learned from other countries, is for the best chance of avoiding early labor (other than tons of water and staying hydrated) is to stop working at 30 weeks. This is enforced by doctors in other countries because it is so much safer! While I did stop working at 30 weeks, a situation/opportunity  presented itself and I did work a few more months. However, I worked with my legs up and kept drinking tons of water.

In the U.S. most multiple pregnancies are over by 36 weeks. The OB has often scheduled the c-section early in the pregnancy to prevent any problems. In the countries with the highest success rates multiples are usually born vaginally between 38-42 weeks. This was my goal. While I did make it to 38 weeks, I ended up with a c-section.
38 weeks - I gave up on maternity clothes fitting
While pregnant (and huge) people would often comment on having twins. Most people said things about how wonderful it is, how lucky we are, and how they have always wanted twins. People who had multiples would say they are thinking of us, wish us luck, and offer condolences. My favorite response at the time, and looking back, still the most accurate, came from a young 2 year old. He is a twin and was usually a happy, silly, bouncy boy. When his mom told him I was having twins he stood still, looked very serious, and very slowly said, "Ha. Ha." He then walked away. That pretty much sums it up.

I made some very unusual decisions for a multiple birth in the U.S. Many people thought I was crazy and should just do what an OB tells me without question. However, when I had to go to the hospital at 38 weeks, the nurses assured me I never would have made it that long with an OB. I did end up with a c-section and looking back would absolutely do some things differently. Choosing a care provider (midwife) who had the same goals I did would not be something I would change. My kids were born at just over 5 pounds each. If they had been born any earlier, they would have spent time in the NICU. Instead they spent their time with us, in our arms, and bonding from the moment I was awake.
1 day old
Most people don't realize how dangerous it is to carry twins. Fetal deaths per 1000 births is 26% for twins (7% for singletons). Everyone knows premature birth is dangerous, however most don't realize that 62% of twins in the U.S. are born early - usually through an induction or c-section. 82% of twins are born with low birth weight. 70% of low birth weight babies have a disability diagnosed before age 11 and 30% within the first year. There are also serious risks for the mother trying to grow multiple babies at one time.

I spent the entire pregnancy thinking things like, if they were born now they have a 5% chance of survival. If they were born now, they have an 80% chance of survival, but a 98% chance of disability. When I made it to 36 weeks I finally breathed a small sigh of relief. I was still waiting for their weight to go up. Knowing that most ultrasound weight estimates are off by +/- 2 pounds I wanted them to measure at least 7 pounds before I would feel safe. At my last ultrasound, 2 days before they were born, they measured 7lb 5oz and 6lb 15oz. Almost there and I felt relief. I am so glad I didn't believe they would be born the size they were estimated.

19 comments:

  1. Wow what a great story and great info for expectant mothers of twins/multiples. I love all the stats you shared. We just got done watching 'The Business of Being Born' on Netflix and I was totally blown away by the US stats vs. other countries!

    I'd love to hear more about your experience working with a midwife. :)

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  2. Shellie,

    I'm luck to live in an area with a lot of midwives. There are a few that work out of hospitals, many local birth centers, and a ton that support home births. I browsed web sites and ruled out any that clearly weren't my style. I selected a few to interview and narrowed it down from there.

    All of my appointments were either at my house or at the sonogram place. It was nice not having to drive or wait when it was uncomfortable to sit. I did most of the traditional testing and had extra sonograms because of the twins, but those were all optional.

    It was a wonderful supportive relationship. She listened to me. She always had time for me. My appointments would be more than an hour long and I never felt rushed. I know she had other clients, but she treated me as her priority. I've spoken with other women she worked with and they all say the same thing. There is no way I would have had any of that with most of the OBs in this area.

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