Prenatal Care for Twins

*This post was original published as a part of Prematurity Awareness Week 2013 on “How Do You Do It?” where Dory is a contributing author. You can find the original post here.*

Prematurity Awareness Week 2013: How Do You Do It?

World Prematurity Day November 17In the United States, 1 in 9 babies is born prematurely, 1 in 10 in Canada. Worldwide, over 15 million babies are born too soon each year. While not all multiples are born prematurely, a multiple birth increases the probability of an early delivery. Babies born prematurely, before 37 weeks gestation, are at a higher risk for health complications in infancy, some of which can have long-term effects. Full-term infants are not all free from their own health complications, of course.

In honor of November’s Prematurity Awareness Month, led by the March of Dimes, How Do You Do It? is focusing this week’s posts on The Moms’ experiences with premature deliveries, NICU stays, health complications, special needs, and how we’ve dealt with these complex issues.


 

 

I will start out by saying that I have never been pregnant before now. This is my first pregnancy and I have been thrown in head first with this new world of twins. So my experience is different. I didn’t know what to expect when going into it all. I had other friends that had been pregnant with singletons, and so I wasn’t completely naive, but I also really learned as I went. So, here is my experience with various aspects of prenatal care for our twins.

Prenatal Vitamins

I had wanted to be pregnant for a while, so I started taking prenatal vitamins very early on (well over a year before actually getting pregnant). I knew that the benefits were only going to help me, so I had no problem taking them long before we actually started trying for our baby. I have quite the sweet tooth, so I took the gummy prenatals with extra folic acid- two before bed- and it was quite the delicious pre-bed treat. Because I am also lactose intolerant, I also took a calcium supplement (gummy version) and a multivitamin (also gummy). After about a month of 6 gummies all right before bed, I started spacing them out a bit more and went with 1 of each vitamin at lunch and 1 of each before bed.

It ended up being a very good thing that I started this so early, because once I got pregnant, I had major trouble stomaching any vitamin supplements at all. I literally couldn’t do it. I felt so guilty to be denying my babies these added nutrients, and I talked to my doctors and nurses quite often about this. Thankfully, they said that I had done the right thing by starting so early, because my body had a built-up supply of the nutrients, and my babies would still benefit, even if I couldn’t take them every day.

Once the 2nd trimester hit and I started to get over the morning all-day sickness, I got some Flintstone vitamins, upon the suggestion of my doctors. I actually could take these just fine (2 at night before bed), and I felt like I could do something again for my babies. This didn’t last, however, and once I got to about 28 weeks, I had trouble with the nausea again, and I had to stop taking them. Thankfully, my pregnancy diet (and cravings) included lots of fruits and veggies and protein, so I knew that I was doing what I could. Plus, the babies were growing really well and the doctors were happy.

Moral of the story: start taking your prenatals EARLY, but listen to your body. It doesn’t help you to get sick after every vitamin, when it may be better to rely on those better vitamin-rich foods instead. And no matter what, talk to your doctor. I felt guilty each time they asked about prenatal vitamins, and I had to say that I wasn’t taking them. Then, they would respond that it was ok. I was doing well, and I shouldn’t worry. Oh, I love getting support like that from a doctor!

The First Appointment

Thankfully, I knew what to expect at my first appointment, so this wasn’t a surprise, but I can understand that some may have been taken aback if they weren’t prepared.

Because we had been seeing a doctor for a short time leading up to getting pregnant, my appointments were on the fast track. Please don’t worry if you don’t have all of these appointments right away.

I took a pregnancy test on April 5, when I was only 3 weeks 5 days pregnant. When it came back positive, I called my doctor immediately and he scheduled me to get a blood test done that day (a Friday). We went in the moment they opened the doors and I happily gave them my arm to draw the vial (and I hate getting blood drawn). They told me that they would fax the doctor the results in about an hour.

An hour passed, and we didn’t hear anything. Because it was a Friday, I knew our doctor would be closing early (a half day), so I didn’t want to have to wait to find out if we were going to be parents. I called and spoke to the secretary (whom I had become really close with due to our visits), and she was able to tell us the great news: it was positive! I asked about the HCG levels, and they were a good steady number. We set up an ultrasound date for 3 weeks later, and I dreaded having to wait that long for the final confirmation and heartbeat.

Finally, the big day arrived (6 weeks 3 days), and my husband and I nervously went in to the office. I got undressed (waist down) as I knew that they would be needing to do an internal ultrasound. This is because the baby/babies are too small at this point to be seen using the stomach ultrasound. They need to get closer, which is why they have to make it internal. If you aren’t prepared for this, I can understand how this would be scary and uncomfortable. Prepare yourself, though, because it really isn’t painful if you are ready for it. They insert a stick-like wand “up there” right against your cervix. There may be moments of being uncomfortable, but they really try to make it as pain-free and quick as possible. I promise that, once you actually see your baby/babies heartbeat(s), you will totally forget about anything else except this miracle that is happening to you.

People have asked us if we were surprised it was twins. In a short answer, yes. Although my doctor wasn’t. When we went in, I was joking with him in order to cover up my nerves. I was convinced that something had happened in the past 3 weeks and I had lost the baby. I didn’t have any proof to confirm this, but I just was worried. 3 weeks felt like a long time to wait in between the blood test and the ultrasound! So as we were joking, I told him that I hoped I was still pregnant. He told me that he knew I was, and it was just a question of how many. I asked him if he would buy us dinner if it was just one. He happily agreed (knowing through the HCG numbers that it would be two). Well, he was right, and we didn’t get a dinner from him. Oh well!

When he was looking at the ultrasound, he quickly (within seconds of any image on the screen) said, “Yes, there they are.” We were shocked. My jaw hit the floor. Thank goodness I was already sitting/laying down. The nurse turned to my husband a few times to ask if he needed to sit down, but he was frozen to his place. Two heartbeats. Two strong heartbeats. Twins.

At our office, we got lots of pictures and even a flash drive with all of the pictures and a video of the heartbeats. We went home to share the news with our parents via Skype (they already knew we were expecting, but they had no idea about the next doubly exciting chapter to this story).

Perinatal (“High Risk”) Appointments

When you are expecting multiples, you are categorized as a “high risk” pregnancy. Many people, upon hearing this, get scared or confused. To someone not facing these appointments themselves, they may wonder why it is “high risk.” After all, there are so many more twins born now. So is it really “high risk?” Yes, it is. Now, this is not to say that you will definitely have problems with your pregnancy. I didn’t have any complications after the first trimester.

Those of us blessed to carry multiple babies at once are considered high risk because bodies simply weren’t made to carry more than one baby at once. We can do it and be successful at it, but we do need to be carefully monitored.

Be prepared to see a perinatal specialist, a “high risk doctor.” They will focus on your babies’ needs throughout the pregnancy. For us, once we got in the groove of appointments, these were our ultrasound visits. We started by going once a month (plus a couple of additional appointments due to scheduling issues). They did a full tummy ultrasound (no more internal ultrasounds unless they had trouble seeing your cervix), where they would focus on measuring the size of the babies, the amniotic fluid amount, the length of my cervix, the cord and placenta placement/size, and check the vitals of the babies.

Then, once we hit the third trimester, we went in for a couple of appointments every 2 weeks. They still only did the measurements once a month, but they just wanted to check and see the babies a bit more often. They also wanted to make sure I wasn’t going into pre-term labor.

At 32 weeks, we started our weekly perinatal appointments. They scheduled the measurement ultrasound for every 4 weeks still (32 and 36 weeks), but I would be getting additional ultrasounds each week as well. During these, they would check the amount of amniotic fluid (to make sure it wasn’t leaking out). They would check the stomach cavity and diaphragm. They would also look at and measure the heartbeat and heart chambers. Finally, they would look to see that the babies were practicing breathing. Now, they don’t actually breathe when inside the womb, but they do pretend to do this. After 3 weeks of this, I realized that Baby Girl A would pass this part of the test with flying colors, as she would always show this. Baby Boy B, however, would get jostled a bit to wake up and show us something. I asked our doctor about this- should I prepare myself for issues after they are born with his breathing? She told us not to worry. They give themselves a window of 45 minutes per baby to watch for signs of breathing practice. If the baby hasn’t shown it in that 45 minute time, then we would worry. Baby Boy always took longer than his sister, but never more than 5-7 minutes, so there is nothing to fear. In addition, there are many other aspects that they look for during these ultrasounds, not just breathing. All of the results as a whole are much more important than just any one part.

Finally, in these weekly visits, they do the Non-Stress Test (NST). After the ultrasound (and they’ve figured out where the babies are), they hook you up to these monitor belts. They will put some jelly on these discs and place them on your stomach where each heart would be located. Once they find the heartbeat and can hear it clearly, they will attach the disc to an elastic belt, wrapped around your waist. Then, they find your second baby and do the same thing with another disc and belt. Finally, they will put an additional disc on the top of your uterus to measure contractions. You will be hooked up to this for 20 minutes.

During the NST, they are looking for changes in your babies’ heartbeats. They want to see them rise and fall, as the babies move around. If they don’t see much variation, they may do a few different things to get a reaction. First thing is they will ask you to drink some cold water. Cold liquids and foods often get those babies jumping. Jumping babies = rise in heartbeats. I also tried eating some apples that I brought with me, as that often got them moving and shaking. When that didn’t work, they brought in the buzzer. It is a mini airhorn of sorts that they put against your stomach. It vibrates and emits a buzzing sound. When they did it, both babies jumped and started kicking like crazy (and I started laughing because it was so funny to witness. Well, for me, they jumped but Baby Girl didn’t show a change in her heart rate. That’s when Daddy stepped in to the rescue. He came over to me and put his hand over Baby Girl. As she always does, she jumped to life at his touch. Then he started talking to her and coaxing her into getting excited. It finally worked, and both babies passed this test.

Regular OB Appointments

In addition to your perinatal appointments, you will still see your OB, who will actually do the delivery. If they are in the same practice, you may schedule these on the same day. For us, however, we didn’t have this luxury, so we had extra appointments. We made the decision that we would both go to all of the high-risk appointments, because that was when we could see our babies. My husband didn’t want to miss that! For the OB appointments, they focused on my care, and he really didn’t need to be there for them. He came to a few early on to meet our OB and discuss her thoughts on twins and twin deliveries. As I started going more often (and more quickly) to these visits, I gave him permission to save up his doctor time for the other appointments.

During the OB visits, they will take your weight (to make sure you are growing at a good rate) and blood pressure. They will also have you pee in a cup to check your protein levels (to check for signs of preeclampsia). Then you will go back and meet with your OB. She will ask about how you are doing. Sometimes you will get a cervix check (be prepared for this to be a little uncomfortable, as your lady parts are a bit more delicate when you are pregnant). She will also order blood tests and your gestational diabetes test.

Gestational Diabetes Test

I documented my experience (and nerves) about this test here. It really wasn’t bad, but I worked myself up to a bundle of nerves.

Dealing With It All

It all has to do with attitude. I loved going to the doctor so often, because it meant that they were really thorough in making sure that we were all okay. Because I had stopped working after the first trimester (I was a teacher and I finished the school year and didn’t return for the upcoming year), I could be flexible with my appointment times. I also didn’t mind if they took a while. Having this laid-back attitude definitely made a difference in what could have been a very stressful situation. I looked at my appointments as adventures. After all, I got to see and talk about my babies. I got to express fears or concerns and get to know what was going on in my body. I took advantage of the Do-you-have-any-questions? section of my visits. I stayed positive. I listened to their advice and did what they said to the best of my ability. I kept a smile on my face. It really helped.

We had one ultrasound tech that we kept getting that would rush through our ultrasounds. This meant that we got poor pictures and felt like we couldn’t appreciate the experience during those weeks. After the first time this happened, I left the office in tears. I just wanted to see my babies, and I hated that I had to wait another month to get the chance. Well, after a few times of this with her, I realized this was just her style. So, one day I went in and told her, “We aren’t in ANY rush today! I’m feeling great (a lie). It’s beautiful outside, and we don’t have anywhere to be! We are at 34 weeks, and who knows how many more of these appointments we will have left. So, feel free to take your time during this ultrasound!” It did the trick. She commented that she couldn’t take forever because they had a very hectic schedule during the rest of the day. BUT I noticed that she took a little longer on their faces, even though it wasn’t medically necessary. AND we finally got two more pictures of our beautiful babies (which we hadn’t gotten for a few weeks). We didn’t have to be rude or spiteful or call her out on her previous rudeness. Just a upbeat, passive comment was all it took to win her over and get what we wanted in return.

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