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.

Sherene Silverberg, a marketing consultant, who lives with her husband, Marc, in Norfolk, Virginia, was thrilled to learn one August that she was pregnant for the first time and carrying twins.

Then the stories started.

“It seemed every person I met insisted on telling me a horror story about twin pregnancy, about someone they knew who had a long bed rest, terrible complications, or a premature delivery,” says Silverberg. “I became very fearful that my babies would end up in the neonatal intensive care nursery.”

In fact, multiples are often born prematurely (before 37 weeks’ gestation). “For every additional baby inside the womb, you can deduct three and a half weeks off of your due date,” says Dr. John Elliott, director of maternal-fetal medicine at Good Samaritan Hospital and a partner with Phoenix Perinatal Associates, in Phoenix, Arizona. Twins typically arrive at 36-1?2 weeks, triplets at 33 weeks.

Babies born prematurely are at risk for medical and developmental problems, but “the majority of babies who are born between 34 and 37 weeks have fewer and milder problems,” Dr. Elliott says.

Besides premature birth, “any complication that can happen with a singleton is two times as likely to happen with twins,” says Dr. Elliott. Of primary concern is preterm labor. Mothers carrying multiples are also at increased risk for preeclampsia (high blood pressure that only occurs during pregnancy). Twins are at higher risk for birth defects, too.

The Power of Positive Thinking

Though these statistics are disheartening for mothers-to-be, like Silverberg, Dr. Elliott and other perinatal health experts say there is much a woman can do to increase her chances of delivering healthy babies. One of the most important of these is having a positive attitude: “If you tell a woman that she is not going to succeed, it can negatively affect the outcome,” says Dr. Elliott. “But if you give a woman confidence that she will succeed, you’ll see better results.”

A case in point is Silverberg’s experience. “Hearing those awful stories and reading books about all the bad things that could happen during my pregnancy really messed up my mind,” she says. At sixteen weeks, Silverberg began experiencing mild contractions, which she believes were caused by all the worry and stress. She began seeing a therapist, who helped her focus on the positive and less on the negative, and the contractions stopped.

Silverberg continues to keep her spirits up throughout her days in waiting by listening to relaxation tapes and meditating several times each day. You can also keep a diary of your pregnancy progress, or a journal of your feelings. To stay upbeat, some women practice saying frequent positive affirmations, such as “My babies will arrive healthy and strong.”

Deciding on a Doctor

Finding the right doctor is critical. “Women carrying multiples need to make sure their pregnancy is being treated as a multiple pregnancy, not a singleton pregnancy, and that their practitioner is aware of the special issues concerning multiples,” says Dr. Gila Leiter, assistant clinical professor at Mt. Sinai School of Medicine, in New York City, and author of Everything You Need to Know to Have a Healthy Twin Pregnancy (Dell, 2000). “It’s a warning flag if your doctor says he or she is not going to treat your twin pregnancy any differently.”

You may choose an obstetrician/gynecologist (look for one with experience in multiples) or a perinatologist, a doctor who primarily focuses on high-risk pregnancies. Midwives typically do not care for twin pregnancies. Ask your doctor or hospital if there are any prematurity prevention programs in your area. Some larger communities offer clinics that specialize in multiple births, too.

When choosing your doctor, consider these questions:

• Is it a solo or group practice? Weigh the pros and cons. You’ll get one-on-one attention in a private practice, but your doctor may cancel appointments during deliveries, or even be on vacation when you go into labor. In a group practice, you probably won’t see your primary doctor at every appointment, but all the physicians who may deliver your babies will know your medical history.

• What access does your doctor have to sonography?

• Twin pregnancies typically require frequent ultrasounds.

• How will your doctor monitor this pregnancy? Ask for specifics regarding frequency and content of appointments, and what tests and procedures may be needed.

• What hospital is your doctor affiliated with? You may need a hospital with a nursery that can handle very premature babies?

• Will you be able to call your doctor with concerns and questions (not just emergency calls)? Make sure your doctor welcomes you as part of your medical team.

A Change of Pace

Experts say reducing the stress in your life can also help you carry your twins longer. “I tell women that if they are going to have successful pregnancies, their first job is to be an incubator; anything else they can fit into their lives is a bonus,” says Dr. Elliott.

One of the first things Jennifer Shearin, an automotive engineer, in Rochester Hills, Michigan, did when she found out she was expecting twins at 19 weeks was reduce her workload and notify her employer that she’d probably be going on temporary disability (which she did at 24 weeks).
“I was concerned about how we’d handle finances when the disability payments ran out, but I also knew I needed to eliminate some stress in my life for my babies,” says Shearin. She and her husband, Will, managed money concerns by eliminating “recreational shopping,” delaying the purchase of a new car, and cutting back on dining out.

When her blood pressure went up late in her pregnancy, Shearin rested more, napped frequently, and avoided anything strenuous, such as grocery shopping. Her babies, Emma and Olivia, were born four and a half weeks before their due date, but without any long-term health problems.

Most doctors do not prescribe bed rest as preventative treatment; however, bed rest at home or in the hospital may be prescribed if you experience complications, such as preterm labor. “A lot of studies say bed rest doesn’t work to prevent preterm birth, but bed rest is useful in high-risk situations in helping to decrease uterine activity and to get pressure off the lower uterine area,” says Dr. Leiter. (For more on bed rest, see What To Do If You’re Sent to Bed.)

Nutritional Needs

Since twins often arrive preterm, it’s important for you to gain weight early in your pregnancy. “It’s been well studied that a mother’s good nutrition and proper weight gain increases the birth weight of a baby, and the higher the weight at birth, the better a baby does,” says Dr. Leiter, who gave birth to twin girls more than a decade ago.

But gaining weight can be a challenge for multiple moms who often experience excessive nausea and vomiting. To reduce nausea, Dr. Leiter suggests consuming products with ginger (ginger ale, ginger tea, and ginger preserves) in small amounts (too much ginger may be harmful). Also, try eating dry crackers and cereal and drinking flat noncaffeinated soda. Consult your doctor about other methods to reduce nausea, including hypnosis, “relief bands” that stimulate acupressure points on the wrists, and medication. To maintain calories, eat frequent small meals throughout the day and stay hydrated by drinking water and juice.

You’ll also need to make sure you get the most nutrition from the food you do consume. Two essentials in your diet should be protein (red meat, rice and beans, nuts, and dairy products) and calcium (four glasses of milk per day or the equivalent). Ask your doctor or a dietitian for nutritional guidelines and if supplements might be needed. “Nutrition is not a minor issue during a multiple pregnancy,” says Dr. Leiter. “Women need to seek the advise of an expert.”

Silverberg knows the importance of eating well for her babies. She avoids soda and artificial sweeteners, and prepares all meals from scratch. “I believe that everything I eat and do impacts these two little souls,” says Silverberg. “It’s such an awesome responsibility, and I plan on doing as good a job as I possibly can.”

Amy E. Tracy is the author of The Pregnancy Bed Rest Book(Berkley Trade, 2001). Visit her Web site at www.pregnancybedrest.com

The post Carrying Twins to Term appeared first on TWINS Magazine.

Her husband, Scott, managed through sheer force of will to get her to Bethesda Oak Hospital in Cincinnati, on time. Unfortunately, her obstetrician was snowed in. Hours drifted by. Leah was no longer on Terbutaline, the drug preventing her from going into labor. She hadn’t expected to need it. So while Leah waited for her obstetrician, labor contractions started.

At first, she ignored them. She had experienced contractions on and off for months. But the contractions grew stronger until it was apparent she was in full-blown labor. Anxiously, she talked the situation over with her nurse, since there were still no obstetricians in the hospital. She made the decision to go through a “trial of labor” to see if she could deliver her twins vaginally.

Now, in labor, Leah had to make a choice she had not been prepared for: What form of pain relief should she use during delivery? Should she ask for an epidural? If she had had the C-section as scheduled, she would have an epidural or spinal without question. But she really hadn’t explored other helpful techniques like meditation or breathing methods. What about other drugs? Leah regretted not thinking about this earlier.

Pregnant mothers of twins usually decide in advance whether they will be having a C-section or vaginal delivery. Those planning a vaginal delivery have a big decision to make about pain relief during labor. Those planning a C-section may have enough information about epidurals before the big day. Getting an epidural (or a spinal) can be a scary event, and unnecessary fears may be avoided if women are informed.

What is an epidural?

Dr. Phillip Bridenbaugh, president of the American Society of Anesthesiologists in 2015 and editor of the book “Neural Blockade” the definitive book about pain management, described an epidural as a tiny tube placed into the spinal fluid. A small amount of medicine is injected and runs through the tube in a continuous, slow drip.

The medicine is usually similar to Novocain but sometimes is an opiate, like morphine. It temporarily numbs the roots coming from the spinal cord, stopping pain and other sensations. Higher doses can numb the nerve roots more, preventing leg movements.

How is a spinal different?

A spinal is a similar method of pain control. It involves a single injection of the same medicine into (instead of outside) the sac containing the spinal fluid. It causes complete numbness and is safe. It works well for scheduled C-sections or pain during delivery, but not as well for labor pain with vaginal deliveries. This is because it is given as a single dose that only lasts for a set amount of time, typically two to three hours. Labor often lasts much longer.

An informed decision

So, what does one really need to know to make an informed decision about epidurals? Mothers expecting twins have special reasons to consider epidurals for vaginal deliveries. For one, they are more likely to end up having a C-section as there is a greater likelihood of complications delivering multiples. Dr. Bridenbaugh says that once an epidural is in place, no further steps need to be taken if a C-section is required. If a pregnant mother of twins tries natural labor with no epidural, and she ends up needing a C-section, an epidural or spinal has to be put in fast, or she may end up “knocked out” with a general anesthetic.

Women delivering twins may likely end up needing a forceps delivery. Epidurals are especially good for forceps deliveries because they cause the muscles around the vagina to relax more completely, as well as eliminate the pain caused by the forceps.

Mothers of twins also may need “manual” help delivering the placenta. This is when an obstetrician removes the placenta by hand. Difficulties can occur because the placenta is usually bigger with twins, and sometimes there are two placentas. Epidurals protect against pain in this often unexpected procedure. Prolonged labor is another issue. Many women delivering twins choose epidurals when in prolonged labor rather than relying on natural techniques, such as breathing methods, which are hard to sustain for long periods of time.

Should you worry about injury from an epidural? Dr. Bridenbaugh stated that serious or permanent injury to the nerve roots is extremely rare: one in around 40,000 to 60,000 patients. An infrequent complication is a dural puncture, which is a temporary tiny hole in the dura mater surrounding the spinal cord. This may cause a headache after the procedure. However, headaches are much less common after epidurals than they are after spinals.

Epidurals are the best method of pain relief available for labor. While her obstetrician was stuck in the snow, Leah decided to use an epidural while she tried delivering vaginally. She had felt moderately painful contractions for months while she was on bed rest.

When she received the epidural, the pain relief was so complete and immediate she described her feeling as euphoric. She said she finally realized how much pain she had been in all along, and, at that moment, she felt total relief.

Pregnant mothers of twins often get epidurals, as do mothers who already have had twins and are pregnant with another child. Learning the basic facts about epidurals may ease some fears and help with decision making. Those who use epidurals should do so without guilt, disappointment or fear that they are harming their babies.

About the Author:
Karen Jobalia, M.D., of Cincinnati, Ohio, works with many parents expecting multiples.

The post Pain Management – Should you worry about epidurals? appeared first on TWINS Magazine.