1. What Makes a Twin Pregnancy Different?

A twin pregnancy comes with its own unique set of experiences. The most apparent difference is that two babies are growing simultaneously, which means your body has to support both. This can lead to a higher intensity of pregnancy symptoms or some that may present earlier than with a singleton pregnancy.

2. Top Symptoms That May Indicate You’re Pregnant with Twins

a. Excessive Morning Sickness

Morning sickness is a common pregnancy symptom, but it can be more pronounced in twin pregnancies. If you’re experiencing extreme nausea and vomiting, known as hyperemesis gravidarum, it might be one of the early signs of twins. This is often attributed to the elevated levels of the pregnancy hormone human chorionic gonadotropin (hCG), which tends to be higher when you’re carrying more than one baby.

b. Rapid Weight Gain

Gaining weight quickly in the early stages of pregnancy is another possible sign of twins. Since there are two babies developing, your caloric needs and overall body mass tend to increase faster than they would with a single baby. If your healthcare provider notices significant weight gain early on, they may recommend an ultrasound to check for twins.

c. Extreme Fatigue

While fatigue is common in all pregnancies, carrying twins can take an even bigger toll on your energy levels. Your body is working overtime to nourish two babies, which can result in feeling more exhausted than usual. If you’re struggling with extreme tiredness, even after getting plenty of rest, it might be an indicator of a twin pregnancy.

d. Higher hCG Levels

As mentioned earlier, hCG levels tend to be higher when carrying twins. Some women may have an earlier pregnancy test result or a darker positive line on their home pregnancy test. Your healthcare provider may order blood tests to check hCG levels, which could offer another hint of a multiple pregnancy.

e. Bigger Belly Early On

If you’re showing much earlier than expected, it could be due to the extra space needed for two babies. Many women with twin pregnancies report that their bump appeared more noticeable in the first trimester compared to friends expecting just one baby. However, belly size can vary and only an ultrasound can confirm whether you’re expecting twins.

f. Increased Appetite

With two babies growing, your body needs more energy. Some moms-to-be with twins notice a significant increase in appetite, often feeling hungry shortly after meals. This can happen as early as the first trimester and might be accompanied by stronger food cravings or aversions.

3. Medical Indications of a Twin Pregnancy

a. Elevated AFP Levels

Alpha-fetoprotein (AFP) is a protein produced by the fetus, and its levels are checked through a maternal blood test during pregnancy. When carrying twins, AFP levels tend to be higher than normal, which could be a red flag for your healthcare provider to look further into the possibility of twins.

b. Hearing Two Heartbeats

One of the most thrilling moments during a pregnancy is hearing your baby’s heartbeat for the first time. But what if there are two? If your healthcare provider detects two distinct heartbeats, it’s a strong indicator of a twin pregnancy. However, this can sometimes be tricky in the early stages, so it’s often confirmed with an ultrasound.

c. Ultrasound Confirmation

The only way to truly confirm a twin pregnancy is through an ultrasound. Most often, this happens during the first trimester, usually around weeks 10 to 12. In some cases, twins can be spotted even earlier during a routine dating scan. If you’re experiencing more intense symptoms than expected, your provider may suggest scheduling an early ultrasound.

4. Are You More Likely to Have Twins?

Certain factors increase the likelihood of having twins. These include:

• Family History: If twins run in your family, particularly on the mother’s side, your chances are higher.
• Age: Women over 30 are more likely to conceive twins, especially if they are over 35 due to higher levels of follicle-stimulating hormone (FSH).
• Fertility Treatments: Assisted reproductive technologies, such as in vitro fertilization (IVF), often increase the likelihood of twins due to multiple embryos being transferred.
• Previous Pregnancies: If you’ve had multiple pregnancies before, your chance of having twins is higher.

5. When to Consult Your Healthcare Provider

If you suspect you’re pregnant with twins based on any of the signs mentioned above, schedule an appointment with your healthcare provider. They can perform tests and ultrasounds to determine if you’re carrying more than one baby. Early detection is important as twin pregnancies often require closer monitoring due to the increased risks associated with carrying two babies.

6. Caring for a Twin Pregnancy

Once twins are confirmed, it’s important to follow specific advice for managing a multiple pregnancy:

• Regular Check-ups: You’ll likely have more frequent prenatal visits to ensure the health of both babies.
• Balanced Diet: Proper nutrition is crucial, as your body needs extra calories, vitamins, and minerals to support two growing babies.
• Rest: Expect to need more rest throughout your pregnancy, as twin pregnancies can be more physically demanding.
• Monitoring for Complications: Twin pregnancies can carry a higher risk of complications such as preterm labor, gestational diabetes, and preeclampsia, so close monitoring is essential.

Ready to take the quiz?

While experiencing more intense pregnancy symptoms doesn’t always mean you’re having twins, it can be a clue to consider. If you notice any of the signs mentioned above, it’s always best to consult your healthcare provider for an accurate diagnosis. Whether you’re having one baby or two, early care and attention are key to ensuring a healthy pregnancy for you and your little ones.

Note: This quiz is for fun and informational purposes only. It’s not a medical test and should not replace professional medical advice. For accurate pregnancy information, please consult a healthcare provider.”

The post Wondering if you’re pregnant with Twins? Take the Quiz! appeared first on TWINS Magazine.

.

While vaccines are one of our great success stories in modern medicine, saving millions of lives over the past several decades, they remain a topic of uncertainty for many parents. You are not alone if you have questions about vaccinations for your growing family. This article will guide you through the most up-to-date newborn-vaccination recommendations to help keep you and your newborn twins safe.

Highlights:

Newborns have a high risk for severe complications from vaccine-preventable illnesses.

All babies should receive the first hepatitis B vaccine within 24 hours of birth.

The CDC recommends COVID-19 vaccines for everyone ages six months and older, including people who are pregnant and breastfeeding.

Pregnant women should also receive a Tdap (whooping cough) and flu vaccine.

.

Family members and caregivers should be up-to-date with immunizations and boosters, including whooping cough and influenza vaccines.

Why are vaccines so important?

The simple answer – getting vaccinated is better than getting the disease. Those quick little pokes have saved many children from dying from diseases like meningitis, diarrheal infections, and many more. Since a newborn’s immune system is not fully developed, they are at an even higher risk for severe complications from vaccine-preventable illnesses.

.

Are vaccines effective?

Yes! Vaccines do an outstanding job. Many diseases affecting children have been reduced or eliminated thanks to vaccines. Most childhood vaccines are 90% to 99% effective in preventing disease, and if a vaccinated child gets the disease, the symptoms are less severe than the illness of a child who did not get the vaccine.

.

Are vaccines safe?

Millions of children safely receive vaccines each year. The most common side effects are pain or swelling at the injection site. Serious side effects from vaccines are rare. For every 1 million vaccine doses, 1 to 2 people may have a severe allergic reaction. Your doctor’s office is well-trained to treat any severe allergic reactions that may occur.

Why do vaccinations start at such a young age? Do I have to stick to the recommended vaccination schedule?

Changing the recommended vaccination schedule is not a good idea. The CDC’s recommended scheduling for each vaccine is based on age and factors like immune response and likelihood of exposure to the disease. There is no research to show if a child would be equally protected with a very different schedule.

.

Tips for vaccinating twins

Most new parents cringe at the idea of their newborn receiving their first shot, and this can be double as tough for parents of twins. Here are a few tips to help make the injection go as smoothly as possible:

.

Enlist some help: Having an extra pair of hands to help undress, dress, and comfort the babies after the injection can be incredibly helpful. If no one is available to help, ask if a staff member, such as a medical assistant, is available to help during the vaccinations.

Ask for something sweet. A sweet solution of sucrose or glucose (often called sweet-ease) a minute before the shot can help reduce your little one’s discomfort with the injection.

If you are breastfeeding, this can help soothe them after the vaccination. Have your helper hold them during the vaccination and get them dressed, so you can take them afterwards.

For triplets or more: Consider having them vaccinated at different times, especially if you do not have a helping hand.

Vaccines for newborns

Hepatitis B Vaccine

Brand Names: Engerix-B and Recombivax HB (3-dose vaccine series); Pediarix, Vaxelis (4-dose vaccine combination series)

.

Hepatitis B is a contagious liver disease caused by the hepatitis B virus. The vaccine is vital in your newborns because approximately 90% of infants who become infected with hepatitis B will become chronically infected (compared to only 2%–6% of adults). Chronic hepatitis B can lead to chronic hepatitis, liver cancer, and death.

All babies should get the first hepatitis B vaccine within 24 hours of birth. The hepatitis B vaccine may be given as a 3-dose vaccine series or as part of a 4-dose vaccine combination series (a vaccine that combines more than one vaccine into one shot). Both series start at birth and are completed by 6-18 months.

Some newborns will have a mild reaction, such as pain at the injection site or a rash. If you are concerned about symptoms, call your pediatrician for guidance. Here are a few tips for comforting your twins after the injection:

.

A cool, damp cloth can help reduce any redness and swelling at the injection site.

Some newborns will want to eat slightly less the 24 hours after getting a vaccine and may prefer smaller and more frequent feedings.

.

If a pregnant mother tests positive for hepatitis B, the babies will get their first shot of the hepatitis vaccine within 12 hours of birth and receive a hepatitis B immune globulin (HBIG) along with the vaccine to help prevent the disease.

What is the recommendation for the hepatitis B vaccine in premature babies? If your twins were premature and weighed less than 2000g at birth (about 4lbs., 6oz.), the American Academy of Pediatrics (AAP) recommends the hepatitis B vaccine be given at one month of age or when discharged home from the hospital (whichever comes first).

___________

.

Vaccines for family members and caregivers

Family members and other caregivers can protect newborns by staying up-to-date on all their vaccinations.

.

Whooping Cough Vaccine (DTaP for children and Tdap for preteens, teens, and adults)

Whooping cough can cause severe and life-threatening complications in babies, especially those under six months. About half of babies who get whooping cough will end up in the hospital, about 1 out of 4 will get pneumonia, and 1 out of 100 will die. Whooping cough is very contagious and is transmitted through respiratory droplets. The best way to protect newborns from whooping cough is to ensure pregnant women get a whooping cough shot (called Tdap vaccine) during each pregnancy between 27 and 36 weeks. It’s also crucial that siblings and anyone around the babies are up-to-date.

Influenza Vaccine

Influenza (commonly called the flu) can also cause severe complications like dehydration, pneumonia, and even death in babies less than six months. Because flu vaccines are not approved for use in children younger than six months old, protecting newborns from the flu is especially important. The CDC recommends that all pregnant women get the inactivated flu vaccine (the injection, not the live nasal flu vaccine). All caregivers and household members six months and older should also get the influenza vaccine.

COVID-19 Vaccine

We still have a lot to learn about the risks of COVID-19 in newborns; however, it appears most newborns who test positive for COVID-19 are asymptomatic or have only mild symptoms. The CDC recommends COVID-19 vaccines for everyone ages six months and older, including people who are pregnant and breastfeeding. Booster shots are approved for everyone five years of age and older.

.

Helpful resources for parents

To learn more about vaccine ingredients: What’s in Vaccines?

Centers for Disease Control and Prevention (CDC): Vaccines & Immunizations

American Academy of Pediatrics: Conversations About Vaccines

Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website or call 1-800-822-7967. VAERS is only for reporting reactions, and VAERS staff do not give medical advice.

.

References

Kempe A, Saville AW, Albertin C, et al. Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey. Pediatrics. 2020;146(1):e20193852. doi:10.1542/peds.2019-3852

Child and Adolescent Immunization Schedule. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Published 2022. Accessed September 3, 2022.

Hepatitis B Foundation: Hepatitis B Vaccine Schedules. Hepb.org. Published 2022. Accessed September 5, 2022.

The post Newborn Vaccinations: a pediatrician’s guide to keeping your newborns safe appeared first on TWINS Magazine.

Once you have twins, you find yourself in the company of twins, twin parents, or family members of twins more often than you expect. I wish that had been around more often before ours arrived because though I read all the articles, many books, and listened intently as my doctor spoke, I never fully knew what to expect. That’s my goal here: to give those who are in my 2019 shoes today a clearer picture of what it’s like to carry, birth, and begin life with twins. 

Looking back, it was a very wild journey from the moment we found out we were expecting to life with our babies today. Even as I sit here organizing my thoughts around isolated events, I am in awe. 

As I attempt to share the most memorable and unique parts of our experience, I want to preface here that I am not a medical professional—I am simply a mother trying to care for two babies at once—and that there were many other symptoms I experienced while pregnant and thereafter, but those outlined here were specific to having twins, or at least I was told they were. 

Carrying Twins 

Extra doctor appointments were part of the package. 

I had standing appointments with my regular doctor, appointments with an MFM, and regular nonstress tests—sometimes all on the same day, and often on different days within the same week. We developed really great relationships with the staff. 

37 weeks was the goal. 

A twin pregnancy is different from a singleton pregnancy. Everything is measured gestationally, meaning a full-term twin pregnancy hits sooner than a singleton. It’s as if I was “at capacity” sooner, which makes sense since there are two occupying the space, not just one. Needless to say, we didn’t make it to 37 weeks. 

On that note, I had this irrational fear that my stomach was going to turn into the shape of a watermelon on its side, but our bodies are absolutely amazing. Worrying about these silly things is so not worth the stress, especially when you’re about to welcome two beautiful babes. 

My doctor requested I work from home after a certain point in my pregnancy.

It’s a high-risk pregnancy, and though it’s easy to lump that into one big bucket, the term can actually mean a lot of things. In my case, I worked in downtown Chicago, and my fear was that, if my water was to break while downtown, surrounded by traffic, chaos, and spectators, it would be an emergency, and they worried I wouldn’t make it to the hospital in time. Once I hit 34 weeks, my doctor requested that I no longer make the trip downtown, though she wanted me to start this sooner. My doctor was very laid back and had a cool approach to everything, so I trusted her request was strategic. This did not sit well with my employer at the time though, and I was asked at the tail-end of my last day in the office to “reconsider” working from home, being told that I was one of the many women who have had a “high-risk pregnancy” and that I was still six weeks out from a full-term 40 weeks. “We’ve all been through it” were her exact words. Her lack of understanding that a full-time singleton pregnancy is different from a full-term twin pregnancy proved how unqualified she was to request such a thing from me. Bottom line: your doctor knows what’s best for you and your babies. 

The chance of developing preeclampsia is higher with multiples—and it happened. Twice. 

I kept hearing the word “preeclampsia” knowing it was a concern. But, until this time in my life, I didn’t really have a lot of knowledge about this condition—minus the fact that Kim Kardashian had it. Honestly, it’s a bit of an anomaly. They don’t really know everything about why it happens, but it’s believed to be related to the condition of the placenta. In the case of our mono-di twins, we had two babies sharing one placenta (hence identical!), and you can imagine the amount of stress that puts on one support system. 

Once I was in my third trimester, I experienced preeclampsia without knowing it. I had a pounding headache, and when I went to pee for the 100th time while at the doctor’s office, I saw silver flecks floating all around me. I didn’t realize these were the “spots” everyone was constantly asking me about, so I chalked it up to being hungry and low sugar. I ate some cookies, and we went home and carried on. A few weeks later, I’m 35 weeks pregnant, at a nonstress test appointment with my husband, laughing casually about nothing, when a nurse walks in and says they’re calling a doctor in because my blood pressure is elevated—the most telling sign of preeclampsia. They delivered our babies the next day. 

Delivery is typically the solution to preeclampsia, but occasionally it rears its ugly head again. Days after I delivered, I was planning my release from the hospital, and my blood pressure began to rise again. After monitoring it for a while, they resorted to their last resort: magnesium. For 24 hours, I was bedridden as magnesium was pumped into me via an IV and exited through a catheter. This is less than common, and waiting nearly a year to welcome your two babies shouldn’t be out shadowed by the fear of this happening. 

Delivering Twins 

I planned for a natural birth, but mentally, I prepared for a C-section. 

Let me first say that I didn’t picture myself having a C-section or a natural birth in a chair with my feet planted in stirrups; I actually found the most comfort in the idea of water birth. But once I found out I was having twins, I knew that was out of the question. 

Baby A called the shots here because her position ultimately determined what kind of birth it would be. And for me, with every ultrasound, Baby A was in a different position, making it hard to get comfortable with one birth plan over another. To know her today is to realize how fitting this fickle behavior was (God, I love her).

A C-section is actually a pretty peaceful experience. Don’t let the fear of it muddy the experience of welcoming your beautiful babes. I wondered where my thoughts would go while I was laying on the table, conscious during surgery. My husband gently rubbing my hand kept me present and focused on him instead of what was going on behind the curtain. I highly recommend this. 

Life with Newborn Twins 

Preemies and time in the NICU. 

Our babies arrived at 35 weeks and 2 days. One came home after 7 days in the NICU and the other spent 10 days there. We were lucky to bring Baby A home on the same day that I was discharged, but it was certainly tough leaving our sleepy Baby B behind. The wonderful nursing staff took amazing care of her though, and it helped me retain my sanity throughout the entire process. Now, who do I blame for all of the extra energy this kid has today because I’m starting to think there’s a connection between her wildness and her extended stay in the NICU. I’ve got a bone to pick with someone. 

A visit with a lactation consultant was so worth it. 

Breastfeeding and pumping were difficult and often painful, but we got there. I often felt like I was ready to throw in the towel (and it’s ok if you do), but a visit with a lactation consultant made all the difference for me, especially because she herself was a mother of twins. Everything changed for the better after one hour with her. Ah, the power of empathy. 

There are no two-for-one deals, especially with insurance and diapers.

We are still paying off medical bills today, and we hit our deductible before our babies were born. 

On the diaper front, Costco is king, and I encourage any mom expecting twins to ask for as many diapers in various sizes as possible before their arrival. 

Sleeping together was encouraged. 

We were encouraged to have our babies sleep in the same room, whether that was our room or their own. In consideration of SIDS, we opted to have two bassinets in our bedroom until they were old enough to move to their own room with a sound machine. Living in the city, we had limited space, and though we had two mini cribs set up, they ended up sleeping in one side-by-side since they were so itty bitty and barely moved throughout the night. Now that they’re older, we recognize that they’re very different sleepers; we joke that one sleeps to rest, and the other sleep to recharge. One is up with the sun and the other needs a little more time. Regardless of their sleeping style though, it’s common for them to sleep through each other’s outbursts, but it’s also common for them to wake one another up when they’re being silly at odd hours. This has led to us separating them at nap time and often in the early hours of the morning. 

Nighttime is a nightmare in the beginning.

It’s no secret that a newborn baby keeps new parents up all night. Well, take that singleton schedule and double it because the nights are doubly terrible. Sorry, sometimes the truth hurts. The good news is that things will normalize. For us, routine started taking shape around month 6, and though we met a few sleep regressions over time, extended sleep was eventually a regular thing. 

Structure is everything. 

We utilized Babywise to try to establish some routine in our home, but no matter how organized (or borderline OCD in my case) we were, two new babies brought two new layers of chaos to our home. They don’t care if you were up twenty minutes ago with their sibling, they’re hungry now! Stick with the routine, and order will follow. Sort of. 

It’s ok to ask for help. 

All parents have their own personal arrangements, so caring for the babies will obviously look different for everyone. I am fortunate to have a partner who went into this chapter fully expecting to do half (oftentimes more) of the work, including middle-of-the-night feedings. Ultimately, we worked out a schedule. He got up with the babies until around 3 a.m., after which, I took over; moving myself and the babies into the nursery, handling the remaining wakeups, and allowing my husband to get some sleep. This worked for us because, in the end, we both felt like we were getting extended sleep. My best advice is, if your partner is getting parental leave (and I sincerely hope they do), experiment with sharing the middle-of-the-night responsibilities. Your body is going through so much after delivering a human—physically, mentally, emotionally—and you deserve a little break here and there. Even if this shared time is temporary, the extra help and rest will be invaluable as you recover. 

It’s also ok to ask for space. 

I was warned about people touching my belly without my permission, but I never expected half the attention having twins would bring me. In fact, I can’t recall a time when a stranger touched my pregnant belly, but I can certainly recall every time someone approached to gush or peek at our newborn twins. It certainly makes you feel a little extra special, but the discomfort quickly set in for my husband and me. Before we knew it—without our permission—people were in our personal space, pushing back the covers that shielded our babies’ faces for a better look. 

Other than your new babies, you don’t owe anyone anything immediately following birth. Texts can wait, work emails can absolutely wait, and visits from family and friends can wait. This time is precious and short-lived. Soak it in. 

“Everybody falls in love differently.” 

This was exactly what I needed to hear during the weeks following the birth of my twins, and I was fortunate enough to have a close friend (already a momma) who checked in on me often, especially my mental and emotional state. Not just that, she asked questions that allowed me to simply answer yes or no, rather than having to explain myself. I thought I would have this instant connection the moment I saw my babies, as they do in the movies—my husband did—but all I experienced was exhaustion. As a new mother, you give and give and give. Having someone reach in rather than having to reach out made all the difference when I was experiencing the baby blues. My best advice here is to assign someone close to you to check in on you post-delivery, especially someone who can empathize with what you’re going through. They know what you need to hear and how little effort you want to put into explaining yourself. 

Babies change everything. x2. 

This is nothing short of an understatement. 

General Ah-ha’s! 

The million-dollar twin question. 

No, they don’t run in either of our families because identical twins are not genetic. 

I’m not the exception. 

My pregnancy was rather uneventful (thankfully!), and I had a lot of natural exercises built into my years of living in the city and taking public transport, but that didn’t stop me from experiencing some Braxton Hicks around week 25, and preeclampsia before and after delivering, or the baby blues. I thought I would be able to withstand more, especially early on, but by week 14, I was feeling winded by a simple walk. 

For those expecting, it’s okay to be honest with yourself and others about how you’re feeling—physically, mentally, and emotionally. PPD is a real thing, and I hope you’ll talk to your doctor if you think you may be experiencing symptoms of it. Shoutout to those helping to normalize the conversation around mental health. 

No one knows what it’s like to have (or be pregnant with) twins except for the parents of twins. 

There’s a lot of unsolicited advice that comes your way no matter what you’re having, but having this phrase said to me when I was roughly 7 months pregnant was so profound, and it’s lived in my mommy brain ever since. It’s a solid motto to replay in your head when someone says the wrong thing to you. 

Fostering individuality is important. 

It’s cute to dress twins alike—we’re certainly guilty of this—but we always try to keep in mind the two different people we’re helping to shape. From the very beginning, we could tell a difference in personality, and though they’re very yin and yang, I always try to keep in mind the people they will grow into and how I, myself, felt when I was an adolescent and teenager. I want to make sure that when they get there, neither one feels like they’re simply part of a matching set. 

Little efforts go a long way when you’re feeling overwhelmed as a new parent. I hope this snapshot of my experience helps to provide some insight and perspective into what it’s like welcoming multiples, and that it offers those expecting, and those adjacent to those expecting ideas for how to support new twin-parents-to-be.

The post What I Wish I’d Known Before My Twins Arrived appeared first on TWINS Magazine.

“When I was breastfeeding my twins, I felt like I had my shirt off 24 hours a day,” recalled Jean Dosdos, a breastfeeding support volunteer through the West Palm Beach Mothers of Twins Club in West Palm Beach, Fla. “I know how frustrating it can be for new moms of twins, and that’s why I volunteer. I know it’s a tremendous help to have that support and encouragement. Otherwise, new moms would quit trying after two or three weeks.”

Find support
The first steps to successfully nursing twins are to seek out supportive family, friends and an encouraging pediatrician; get accurate information; and turn a deaf ear to negative remarks. Talk to other mothers who are nursing twins a couple of months older than yours. Join a Mothers of Twins club and attend La Leche League meetings before your delivery. A lactation consultant can administer a healthy dose of facts and the wisdom of experience.

Carol Huotari, accredited La Leche League leader and an international board certified lactation consultant, said that commitment is essential to successfully breastfeeding twins. “A migratory field worker pumped her milk three times a day in the bus and the other workers laughed at her, but her commitment was strong and her twins were the healthy ones who didn’t have ear infections.”

Set goals
Knowing your goals is part of the commitment. “Are you going to nurse exclusively for six months? A working mother may supplement with bottles. Think it through and decide what will work in your life,” Huotari advised. Success is defined differently for every mother.

It takes time to learn
While still in the hospital, talk to your lactation consultant about your goals, concerns and lifestyle. Ask that she be there when you first nurse and ask for a home visit if you have preemies. She will guide you through the first sessions; they are the learning times for you and your babies. Your newborns are trying to latch on and you are establishing your milk supply. “With twins in the football hold position, you can really watch what they are doing with their mouth,” Huotari explained. As they grow you may find more comfortable positions.

Preemies may take a little longer to latch on since their sucking instinct may not be fully developed. In that case, you may need to pump your breasts to get the milk flowing.

You will have milk
When your twins latch on well and nurse effectively, your milk supply will quickly build. It is a case of demand and supply. The greater the demand, the more milk you supply. Expect to nurse your newborn twins about 10 to 12 times in a 24-hour period.

Until your twins learn to latch on, it may be a good idea to nurse them one at a time. “It really helps mothers to individualize their twins and see who’s who. Each baby has a different nursing style,” Huotari said.

Know who nurses when and where
Whether you continue to nurse them individually or simultaneously, you do it you need to be organized about it. Keeping track of who nursed first and at which breast helps you know how they are feeding.

“I breastfed my 30-month-old triplets, Sammy, Hope and Emma. One of the three is still breastfeeding, one weaned at 13 months, the other at 24 months,” said Sheri Ingalls of Port St. Lucie, Fla. “To keep my milk supply up, I nursed the babies on demand through the night. It also alleviated some of my concerns over the babies getting enough to eat. During the day, the babies had to be on a schedule so that I could ensure that each one had the opportunity to be first–which was the easiest let-down–and last, which was the longest time on Mommy. If I allowed them to nurse on demand all the time, Hope would have nursed all day and left the smaller ones with nothing.”

Sleep when your twins sleep
Allison Berryhill of Atlantic, Iowa, found nighttime nursing to be a way of life during her twin boys’ most milk-dependent months. “With newborns, I reclined in a pillow-piled Lay-Z-Boy, each boy to a breast, attached for the night. I did not get long, uninterrupted hours of slumber, but I was no more sleep-deprived than during the final months of pregnancy when few positions were comfortable.”

Sleep becomes the top priority–after establishing your milk supply and feeding your twins. The rule for mothers of twins is to sleep when your twins sleep.

You’ll get more rest if you can learn to nurse lying down in bed and if you set up a comfortable “nursing station” for the days. Whether it is a Lay-Z-Boy or a comfortable sofa, you need room to prop plenty of pillows and a footstool for your feet. On a table within easy reach have a telephone, diapers, a notepad for jotting down who nursed first and where, and a snack and a beverage. A well-arranged nursing station means you won’t have to hop up once you’re settled and you will be more rested.

Nurture yourself
If you become fatigued your ability to keep a positive outlook while coping with the ups and downs of nursing twins diminishes. You must take care of yourself. That means sleeping as much as possible, eating right, and drinking quarts of fluids each day.

The number one piece of advice new mothers of twins offer expectant mothers is to get help with the household chores and cooking.

But housework may have to wait. Cooking is something others do for you. Only you can nurse your twins.

Sleep deprivation and neglecting your basic care just opens the door to depression. About 10% of women have postpartum depression the first year, but with mothers of twins the figure jumps to 25%, according to Huotari. When you are home and alone with your babies, you can quickly feel isolated and overwhelmed. Be sure you have a friend to talk with, one who understands the special demands of multiples.

Don’t give up
Regardless of how much support you have and how well you prepare mentally, the reality of your new job can be an emotional seesaw and the adjustment definitely takes time. Huotari offered some sage advice: If you feel like giving up, stick with what you’re doing for three days and then see how you feel. Remember, tens of thousands of nursing mothers say joy does come out of the early chaos.

Sheri summed up: “Don’t listen to other people, not even doctors when they tell you it can’t be done. You can make enough milk. You can get some sleep. You can have a life! Don’t give up if it’s tough at first, because after your babies are bigger and getting more milk in a shorter period of time, it’s a breeze.”

BREASTFEEDING FAQs
How can I tell if my twins are nursing effectively?
Most newborns breastfeed 10 to 12 times per 24-hour period. They nurse for 15 to 30 minutes at a feeding and swallow after every one or two sucks. A baby who is having difficulty getting enough to eat will not latch on properly may want to nurse inordinately long and will not swallow often.

How do I know if my babies are getting enough to eat?
After the first couple of days, they saturate six to eight diapers per day and have from three to five bowel movements. With multiples, it is helpful to keep notes on who nursed at which breast, for how long, and the number of wet and soiled diapers. An electronic scale helps your confidence. Once your milk and their weight gain are established, tracking the nursing schedules and diapers is not essential.

Why are my twins suddenly starving all day and night?
Growth spurts occur periodically; the first may come as early as 10 to 14 days after birth. The next one may surface around four to six weeks and another one around three months. Prop your feet up and nurse, nurse, nurse on demand. Your milk supply will quickly catch up with your twins’ needs. If, however, you respond with supplemental bottles, your milk supply may not increase to meet the rising demand.

Can I nurse my preemies in the NICU?
Babies develop the ability to swallow when they are 11 to 16 weeks in utero. The ability to suck follows a few weeks later. The ability to coordinate both actions and breathing comes later still. If your babies are very low birth weight, you may have to express your breast. Expect to pump for a total of 100 to 120 minutes a day. The NICU will watch for signs that your preemies are ready for nutritive sucking.

The post How to Succeed in Nursing Multiples appeared first on TWINS Magazine.

Now, fast forward to the moment you find out you are expecting twins (or more), and that idealistic vision you had just created for you and your one baby has now suddenly changed. Now you are facing the real possibility that you may have to forget about all your home-birth plans and you may even be told you will have to have a cesarean or C-section delivery.

Having twins can definitely take its toll on your body and then add this to having a C-section surgery, and you will soon discover that it may be more challenging and take longer to recover than you initially thought! Here are some tips to help you speed up your recovery process so you can spend less time sore and tired, and more time bonding with your new twin babies:

1. Walk, walk, walk

You will be encouraged to get out of bed at least a couple of times the day after your surgery – or even on the day of surgery – to walk. Don’t try getting up by yourself. The nurse should be at your side the first few times you do get up and walk. In the meantime, get the blood going in your legs by wiggling your feet, rotating your ankles, and moving and stretching your legs.

Personally, I have had three C-section deliveries and I can remember that even walking to the bathroom seemed almost impossible at first, but moving around is important for your recovery, so you need to push through so you will be ready to take on caring for infant twins. It will also help your circulation and make it much less likely that you develop blood clots. What’s more is that it will make your bowels less sluggish, which will help you feel a whole lot more comfortable a lot sooner. For these reasons, you’ll be encouraged to walk each day. Try to take your walks a short time after you’ve taken pain medication – when you’re likely to feel more comfortable.

2. Get plenty of rest

A C-section is major surgery. Just like with any other surgery, your body needs time to heal afterward. Expect to stay in the hospital for three to four days after your delivery (longer if there are complications), and give your body up to six weeks to fully heal. This is where you need to enlist lots of family and friends to help you with chores and laundry when you and your babies come home. I am sure you have already heard people say, “Rest when your babies rest!” This is so important, especially if you are recovering from surgery. The household “to-do’s” can wait, and even taking just a few moments to rest throughout the day can be extremely helpful for you and your postpartum body.

3. Manage your pain

Ask your doctor what pain medicines you can take, especially if you’re breastfeeding. Depending on the level of your discomfort, the doctor might prescribe a pain reliever or advise you to take an over-the-counter NSAID (Advil, Motrin) or acetaminophen (Tylenol). In addition to pain medicine, you can use a heating pad to relieve discomfort at the surgical site. In any case, don’t be shy about asking your nurse for more medication if you’re uncomfortable. You don’t need to suffer in silence, and the longer you wait to ask for the medication you need, the harder it will be to manage your pain.

4. Listen to your body

Be sure to take extra care getting around while you heal, so avoid going up and down the stairs as much as possible. A good idea is to keep everything you need close by, such as diaper changing supplies close to you so that you don’t have to get up too often. It’s also important not to lift anything heavier than your babies and certainly do not try to hold both of them in their car seats at one time, until you feel stronger, because you do not want to risk tearing your incision. Ask for help as much as possible and whenever you have to sneeze or cough, hold your abdomen to protect the incision site. It could take up to eight weeks for you to get back into your normal routine. Ask your doctor when it’s okay to exercise, go back to work, and drive. Also, wait to have sex or use tampons until your doctor gives you the green light.

5. Wear loose-fitting clothing and underwear

You’ll want to avoid putting too much pressure on your healing scar, so it’s best to either wear underwear a size bigger or you can buy special knickers that fit over the area to make it more comfortable while you are healing.

6. Beware of a good laugh

Laughing normally feels good, but not necessarily post a C-section. You can be more comfortable when laughing, coughing, and even pooping if you hold a pillow to your abdomen. This will help your core muscles from aching. Anything that puts pressure on the abdominal area will probably be painful at first, but you’ll feel a bit better day by day. Be sure to use your hands or a pillow to support your incision when you cough, sneeze, or laugh.

7. When to call the doctor

You’ll probably feel some soreness in the incision and you may have bleeding or discharge for up to six weeks after the C-section. That’s normal. But the following symptoms warrant a call to your doctor because they could signal an infection:

• redness, swelling, or pus oozing from the incision site
• pain around the site
• fever of more than 100.4 degrees Fahrenheit
• bad-smelling discharge from the vagina
• heavy vaginal bleeding
• redness or swelling in your leg
• difficulty with breathing
• chest pain
• pain in your breasts

Also call your doctor if you feel sad and your mood never seems to lift, especially if you have thoughts of hurting your babies. Finally, if you have a friend or sibling who went through a C-section, try not to compare yourself to her. Every woman’s experience with this surgery is different. Focus on your own healing right now and give your body the time it needs to get back to normal.

The post 7 Tips on Recovering from a C-Section appeared first on TWINS Magazine.

I was almost 30 years old and resigned to the fact I would never have children. Suddenly I learned I was having identical twins. My husband, a fraternal twin himself, was less surprised, knowing the genetic lottery we were playing.

What we didn’t know …

• Identical twins aren’t hereditary—our girls were just a stroke of luck.

• How sick I would get.

• How big I would become.

• How many diapers we would need.

And on and on. What we didn’t know could fill a bassinet.

What we did know … is that we were very unprepared.

Normally, I am very organized, in my career and my personal life. I’m uncomfortable being disorganized. Even worse, I hate being caught off-guard. Once I regained my senses after “twinshock” and came to embrace the idea I was having two babies, I set out to prepare myself for the journey of a lifetime. But it was very difficult to find what I needed.

I was given books upon books on how to have a baby—one baby, that is. I received countless suggestions and ideas for having a baby—one baby, of course. But where was the advice and hands-on experience for moms preparing to have twins? I spent eight months searching fruitlessly. What I found was eye-opening.

Get Ready To Be Sick

Morning sickness—whether it occurs morning, afternoon, or at night—will be part of your life. With twins, it’s worse than when pregnant with a singleton. A few lucky souls manage to escape twin-nausea, but for most, it is a part of the pregnancy. Morning sickness doesn’t always include vomiting. For me, morning sickness meant constant nausea for three months—24/7. Foods I had once loved, like canned green beans, I couldn’t even bear the sight of.

Allergies, whether chronic or seasonal, are likely to be greatly magnified as well. I was unfortunate enough to be pregnant during the summer and fall. I carried a whole tissue box in my purse at all times. Some mornings I couldn’t even open my eyes. Yes, this is normal.

It Happens So Fast

Avoid reading books about singleton pregnancies. They will only confuse you and make you worry needlessly. In a multiples-pregnancy, things progress much quicker. If you read in a book you should be feeling ligament stretching at 20 weeks, and you’re feeling it at 12 weeks, you’ll more than likely become upset and wonder if something is wrong. Books fail to mention that in a multiples-pregnancy, feeling ligament stretching at 12 weeks is completely normal.

Be Prepared Early

I felt like the worst mother ever when my hospital nurse asked me for the name of my pediatrician, and I responded with a blank stare. “You did pick out a pediatrician didn’t you?” she glared. Well, no, I shook my head. I delivered at 35 weeks and finding a pediatrician had slipped my mind. I felt awful.

A good rule of thumb: Have everything accomplished by 30 weeks. That helps ensure you will be prepared and allows for relaxation during your last weeks of pregnancy. Believe me, you’ll need it and will be thankful for the downtime.

So what is included in that elusive “everything” you should do? The basics:

• Purchase or collect enough clothing for two babies’ first few weeks.

• Have enough bottles, diapers, and formula (if not breastfeeding) for two babies’ first few weeks.

• Decide where the babies are going to sleep and if they will sleep together.

• Line up helpers to be on-call during your first few days at home.

• Select a pediatrician.

Ask for Help

As a self-proclaimed independent woman, I had the hardest time asking for help. I had no idea how much help I would need. Having my mother, mother-in-law and stepmother on hand to help with chores like laundry, dishes, and some light housecleaning was the best gift they could have given me. Chances are you won’t sleep much at night, so having someone available to fill in so you can sneak catnaps during the day is the best way to maintain your sanity.

In today’s society, many women return to work fairly soon after having children. This is especially difficult for moms of multiples, given sky-high childcare expenses and double the “getting ready” time required each day at 7 a.m. I was very clear with my husband about our ground rules from the start: Since we both work full-time, we will co-parent with equal responsibility. Gone are the days when a man wouldn’t change a diaper.

Find Friends

An invaluable resource while pregnant with twins, and one I will continue to use through my babies’ first year is online communities. Wonderful support is available from people going through the same thing you are, at the same time. TWINS Magazine has a variety of articles for families with twins and higher multiples, from pregnancy through the kids’ teen years. Another wonderfully informative site is Pregnancy.org. These sites contain invaluable advice, wonderful friends, and when you need it (which you will), shoulders to cry on.

It Really Isn’t That Bad!

My husband still complains about the reactions he receives when he tells people we have twins. Most people respond with something like a moan and a quip: “Oh, just wait!” or “Double the trouble!”

Yet, having twins not only is not as bad as you think it’ll be but is actually better than you ever imagined. Some benefits of having twins include:

• One pregnancy, instant family. If you never want to have kids again, you already have an instant family!

• Two kids, same age. I pity my friends who have one child finally entering school, only to find themselves pregnant again. Now they must again find childcare again, endure the nightmare of getting a baby to sleep through the night, and experience it all while raising another child.

• Their own best friends. When I put my girls down in their crib at night, if one is still awake, she never cries. Why? Because her sister is lying alongside her. They are never alone. This means more free time for mom since they amuse one another.

Having twins doesn’t have to be scary. Support and reference material is out there if you know where to look. You may feel overwhelmed at first at the prospect of having two babies at the same time, but take solace in the fact that twin pregnancies are more common now. And with numbers on the rise, you benefit from having more people available with more knowledge, more resources, and more support.

I never knew, beforehand, the love I would feel when I see my daughters’ two heads pressed up against one another as I dim the nursery light. I know now I’ve given my children more than life itself; I’ve also given them a best friend.

The post What I Wish I Had Known While Pregnant With Twins appeared first on TWINS Magazine.

Nothing was easy about Desiree Childress’s third pregnancy. Soon after she and her husband, Will, learned they were expecting identical twin boys, she experienced severe nausea. Having trouble holding anything down, she became dehydrated and IV lines for fluids were placed.

At about 18 weeks, preterm labor began and strict at-home bed rest prescribed. With two young daughters at home, Tiffany, 9, and Victoria, 5, Desiree found staying off her feet and reducing stress nearly impossible. Five weeks later, she was hospitalized.

Both nurses, Desiree and Will knew that these early complications and a twin pregnancy increased the likelihood of a premature delivery. Over 50% of multiples are born prematurely (before 37 weeks gestation), or weigh less than five and one-half pounds. Many preemie multiples require weeks of hospitalization and special medical attention.

By getting expert care in the hospital, Desiree hoped her babies would arrive close to term, but she also wanted to be prepared for the unexpected. David and Isaiah were born eight weeks early, each weighing a little over three pounds. “You really can’t prepare for the reality of delivering preemies, but knowing what to expect made it a little less overwhelming,” she says.

Julie Medas, a clinical neonatal nurse specialist at MetroHealth Medical Center in Cleveland, Ohio, agrees. She says that learning about the neonatal intensive care nursery (the NICU) and what a preemie looks like “won’t provide comfort, but it will give parents a sense of familiarity should their babies arrive early and need special care.”

Taking a Tour

Medas recommends that parents experiencing pregnancy complications ask for a tour of the NICU and visit a baby of comparable gestational age. “The perception is that seeing a preemie will overwhelm parents, but sometimes the imagination is far worse,” she says.

A neonatologist or a neonatal nurse can explain some of the medical equipment and common problems of preemies. Your hospital may also offer a video or booklet about the NICU. If information becomes stressful, cut your visit short and come back another day.

“The NICU can seem like a foreign land with an unfamiliar language,” says Medas. Take your time to absorb this new world, and don’t be afraid to ask questions. Some suggestions:

* What are visiting hours, and who can visit?
* Will my babies be placed near each other?
* How can I participate in my babies’ care?
* Does the NICU encourage skin-to-skin contact, music therapy, or infant massage?
* Are multiples co-bedded (placed in the same bed)?
* What resources are available to parents of premature babies and multiples?
* Is there a developmental program (occupational and physical therapy) for preemies?
* Is there a place for parents to spend the night?
* Is CPR training offered?

Researching Resources
On bed rest and with time on her hands, Desiree created a notebook of resources she’d need after the twins’ birth: “I made a list of dependable support systems, those who I could really count on like my church to provide meals and sitters my girls really liked.” She also included important names and phone numbers, such as her insurance provider and pediatrician, and she rented a pager so the NICU could reach her.

To find out what services and help you may need following your babies’ birth, talk with your hospital social worker or a nurse. Also, ask if there are any local preemie parent or mothers of multiples support groups: A parent of preemie multiples can offer first-hand advice. Mothers of Supertwins (631-859-1110) and The Triplet Connection (209-474-0885) offer programs and literature to support expectant mothers of multiples.

Desiree joined a mothers of multiples club in her third trimester. “At first, it was scary because all of the mothers of twins in the group had delivered prematurely,” she says, “but it also gave me hope to see that their children were okay, and they offered great support.”

Breastmilk Basics
When you’re coping with pregnancy complications and the risk of premature babies, thinking about breastfeeding can be daunting, to say the least. But learning about breast milk and how it can help your babies is something important you can do for your babies.

“Some doctors consider breast milk a medicine for preemies,” says Medas. Research shows breastmilk is less stressful on a preemie’s digestive system and kidneys, provides important antibodies that fight infection, and protects against allergies.

Babies who are born very small and very sick will not have the ability to breastfeed during their first days or weeks of life, but they can receive breast milk through a feeding tube placed in their nose or mouth. This means mothers have to pump and store their milk. A lactation consultant with knowledge of a preemie’s special needs can provide instruction. Ask your pediatrician, the hospital staff, or the La Leche League (800-525-3243) for a referral. Many NICUs have lending libraries that include breast-feeding books and videos, too.

“Even if you can’t or choose not to breastfeed, you can still provide your babies with the best nutrition possible,” says Medas. And it’s something only you, a mother, can do.

Preemie Parenthood
“I was prepared for the monitors and technology in the NICU, but it was still overwhelming to see those two tiny little babies,” says Desiree. “I couldn’t see their faces because of the wires and tape. I couldn’t hold them or feed them. I felt like I had really lost out.”

If your babies’ birth can’t be delayed and you become a parent of preemie multiples, like Desiree and Will, you’ll face many emotions: guilt, anger, sadness, and fear, to name a few. Having more than one baby adds to the stress: You may have two sets of medical complications to cope with, maybe even two sets of healthcare providers.

Making arrangements for help before your babies’ birth is a good idea (whether or not you delivery prematurely). You’ll need time to take care of yourself so that you’ll have the energy to take care of your babies and family.

After a difficult pregnancy, you’ll also need time to reflect on your losses. To help you cope with your feelings before and after delivery, consider starting a journal, or find someone who listens well (another parent, a social worker, a mental health expert, an Internet chat room (such as the TWINS Magazine Message Board), or a clergy member).

“Remember, feeling is healthy,” says Mara Stein, a Chicago clinical psychologist who delivered twin girls ten weeks early. “But if your feelings start getting in the way of your life, affecting your marriage or other relationships, or you find yourself constantly feeling sad, you may need professional help,” she says. Consult a trained therapist, such as a psychologist, psychiatrist, social worker, or family counselor.

“Becoming a parent of preemies is the hardest thing you’ll ever have to do,” says Desiree, whose twins are now eight months old. “But when I look at David and Isaiah and see them smile, I know it’s all been worth it.”

Amy E. Tracy is the author of The Pregnancy Bed Rest Book (Berkley Trade, 2001), and the co-author of Your Premature Baby and Child (Berkley Trade, 1999). Visit her Web site at www.pregnancybedrest.com.

Who’s Who in the NICU

Neonatologist: a doctor who is specially trained in the care of premature and sick babies
Registered Nurse: has graduated from an accredited school of nursing; these nurses provide much of the daily care of preemies.

Neonatal Nurse Practitioner: a registered nurse who has advanced training in neonatal care.

Clinical Neonatal Nurse Specialist: a registered nurse who has additional neonatal training in patient and nurse education.

Social Worker: can provide information on nonmedical care, such as insurance coverage, emotional support, and transportation.

Respiratory Therapist: a specialist who provides the respiratory needs of ill babies.

Developmental Therapists: help enhance a baby’s physical development.

Medical Specialists: doctors with further specialized training in such areas as the eyes, heart, lungs, and brain.

NICU Baby Books
NICU Notebook: A Parent’s Journal
Available from:
Mothers of Supertwins
PO Box 951
Brentwood, NY 11717
www.mostonline.org
877-434-MOST (6678)

The post Expecting the Unexpected: Preparing for an Early Delivery appeared first on TWINS Magazine.

Experts think this may be because many of preterm labor’s signs, such as a backache and pelvic pressure, are what women carrying multiples expect to experience. “There’s also so much activity inside their womb, mothers might not recognize contractions,” says Dr. Elliott.

Knowing you’re at risk and not a good monitor of contractions means you should immediately discuss any concerns with your doctor. You may need to wear a belt with electronic sensors that detect contractions around your abdomen. Several times a day, the monitor is hooked to a telephone and relay graphs of uterine activity to a nurse.

Also, ask your doctor about tests to predict preterm labor, including frequent pelvic exams, checking cervical length by ultrasound, and measuring hormones in the saliva, and ways to postpone delivery, including medication. Listen to your body carefully and look for these early labor signs:

• increased uterine contractions that are painful or painless (do not write them off as “Braxton Hicks” (false labor); let your doctor evaluate you)
• menstrual-like cramps (these can come and go or be constant)
• a low, dull backache
• diarrhea
• pelvic pressure (it feels like the babies are pushing down)
• increased frequency of urination a change in color, amount, or consistency of vaginal discharge.

The post Is it Preterm Labor? appeared first on TWINS Magazine.