Pregnant with Twins or More

A twin or triplet pregnancy is many times referred to as a "multiple gestation," this simply means more than one baby is born to a mother. Twins pregnancies occur more often than you might expect. In fact, approximately 2% of all pregnancies produce twins.

As with any pregnancy, getting the proper prenatal care is the key to promoting the health of both you and your babies. Be sure to keep all of your scheduled visits. Your doctor/midwife will want to frequently check on the growth and development of your babies. Also remember to check with them before taking any medicine, even an over-the-counter (OTC) or "home remedy".

Weight Gain

The amount of weight you will need to gain depends on your weight and height before pregnancy. In general, women who begin pregnancy underweight should gain more, and women who begin pregnancy overweight may safely gain somewhat less.

Here are some general weight guidelines, but check with your doctor/midwife for guidance and recommendations for your individual weight gain.

Twins

  • Overall range for weight gain is 34 to 45 pounds
  • Gain about 1 ½ pounds each week during the last 6 months of pregnancy
  • Avoid weight loss or low weight gain
  • Underweight mothers may gain closer to 45 pounds
  • Overweight mothers may gain closer to 35 pounds

Triplets

  • There is no official weight gain guideline
  • Expect to gain approximately 50 to 55 pounds
  • Gain about 2 pounds each week during the last 6 months of pregnancy
  • Avoid weight loss or low weight gain

Relief of Discomforts

Nausea and vomiting
   Prevention:

  • Eat several small meals
  • Eat protein rich foods several times a day
  • Drink fluids between meals
  • Avoid greasy, acid, or strong flavored foods
  • Snack on dry, starchy foods such as cereals and crackers

   Remedies:

  • Replace fluids with chicken broth, ginger ale, or sports beverages
  • Try ice pops, gelatin, or carbonated drinks and ginger snaps
  • Check with your doctor/midwife about Vitamin B6

Heartburn
   Prevention:

  • Eat several small meals
  • Avoid stomach irritants such as coffee and cigarettes
  • Avoid gas-producing foods such as garlic, peppers, onions, and cabbage
  • Avoid greasy or spicy foods

   Remedies:

  • Sip carbonated water
  • Eat a spoonful of yogurt, heavy cream or milk
  • Check with your doctor/midwife about which antacids would be safe for you

Constipation
   Prevention:

  • Drink lots of fluids
  • Eat high fiber foods such as fruits, vegetables, and grains

   Remedies:

  • Drink hot liquids in the morning and before meals
  • If constipation persists, call your provider

Reduction of Stresses and Strains

To reduce your physical stress and strain, our doctors and nurses may ask you to consider the following:

  • Good posture helps reduce back strain
  • Try to avoid sudden "jerky" movements which will add stress to your abdomen and back
  • Lower yourself by squatting instead of bending over from the waist
  • Use a pillow to support your lower back while sitting
  • Elevate your feet to increase circulation and help reduce minor swelling of the ankles
  • Avoid lifting or pushing heavy objects. Do not lift more than 35 lbs at a time.
  • Use your arms and legs to help push you back up on your feet from a sitting position
  • Blood circulation to your babies is best if you rest or sleep lying on your side. When lying down, you may find it more comfortable to bend your knees slightly and place a pillow between them
  • Use additional pillows to help support your abdomen, buttocks, and shoulders
  • It is very important for you to take care of yourself. Whenever you feel the need to rest, do so

Preterm Labor in the Multiple Gestation Pregnancy

Multiple gestation pregnancies have a higher rate of preterm labor and delivery than non-multiple gestation pregnancies. You can help reduce your risk of preterm labor by receiving good prenatal care, eating a balanced diet, getting plenty of rest, and promptly reporting any problems.

Recognizing the early signs and symptoms of preterm labor that are many times associated with multiple gestations, can help us provide timely treatment for controlling contractions so your pregnancy can continue until the babies are more fully developed and mature.

The following are signs and symptoms that are associated with preterm labor. However, these signs can also be a part of a normal healthy pregnancy. What you need to keep in mind is what may represent a change from your normal patterns and experiences:

  • Uterine contractions: The uterus (womb) is composed of muscle fibers. A uterine contraction is the tightening of the muscles within the uterus. Using your fingertips to feel your uterus, you should be able to slightly indent your uterus when it is relaxed. During a contraction you can feel your uterus tighten and become hard. Contractions occur normally throughout pregnancy. However, women with multiple gestation pregnancies may experience increased contractions. These contractions are usually painless and they can occur at any time. Contractions could be a sign or early labor and, if undetected, could lead to a preterm delivery.
  • Menstrual-like cramps: These are felt low in the abdomen, just above the pubic bone. The cramping may be rhythmic, feeling like waves or fluttering. You may also feel a constant cramp.
  • Lower, dull backache: This backache is located mainly in the lower back and may radiate to the sides or front. It may be rhythmic or constant. And often is not relieved by changing position.
  • Pelvic pressure: You may feel pressure or fullness in the pelvic area, in your back or thighs. It may feel as though the baby is going to "fall out."
  • Intestinal cramps: These may occur in the presence or absence of diarrhea. You may have the feeling of "gas pains."
  • Increase or change in vaginal discharge: The amount may be more than is normal for you. The consistency may change to mucous or watery. The color may become pink or brown-tinged.
  • A general feeling that something is not right: Even without a specific cause.

If you experience any of the above, or if you feel something is different, contact your doctor/midwife.

If your provider believes that you are experiencing any of the early warning signs and symptoms of preterm labor, or are at-risk of experiencing preterm labor, you may be ask to do the following:

  • Increase your rest - Resting on your side is a helpful way to keep your uterus relaxed. Also elevating your bed so that your hips are slightly higher than your head will keep the pressure of the baby off your cervix.
  • Fluid intake - During your pregnancy, it is important to drink 6 to 8 glasses of fluid per day or as other wise directed.
  • Bedrest - Your doctor/midwife may ask you to take rest periods during the day, or stay in bed all day except for getting up to go to the bathroom and sitting up for meals.
  • Decrease strenuous activity - You may be asked to not do any heavy physical activity such as jogging, running, tennis or frequent trips up and down stairs. Also, you may be told to limit heavy lifting, cleaning, and long trips.
  • Consider a temporary change in work activities - Work activities may need to be changed or stopped. Your doctor/midwife will tell you about decreasing your activity and what they feel would be best for you. They can provide you with a doctor ordered limitation list for work.
  • Sexual activity - Your midwife/doctor may ask that you stop or limit your sexual activities.
  • Be alert for the signs and symptoms of preterm labor.
  • Be aware of your uterine activity using one or more available methods:
    • Use of Self-palpation - You can check for contractions after the 20th week of pregnancy by emptying your bladder and drinking a glass of water. Lie down on your left side. Use pillows to help support yourself so you can find a comfortable position. Do not lie flat on your back. Place your fingers on your stomach on either side of your belly button. Wait for your uterus to contract or tighten. During a contraction, your uterus will feel hard like your forehead. Use a watch to see how long the contraction lasts. After the contraction, your uterus will relax and you can press into it with your fingertips. If you have 4 or more contractions in an hour, call your provider right away. Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. If you are having difficulty feeling contractions, you may not be having contractions or you may not be aware they are occurring.
    • Use of a small recording device similar to the one used in the hospital labor and delivery unit - An electronic monitor may be used in certain situations to detect the contractions that may be associated with preterm labor. You will wear a belt around your stomach for an hour, most likely twice a day. The belt has a sensing device, which is attached to a small recorder. If you have a contraction while you are wearing the belt, the sensing device records the information about your contraction. Once each day you will be asked to send any information that has been recorded across your telephone line to a monitoring center.

Always remember to follow your doctor/midwife's instructions about your prenatal care and activities.

What to do if you think you are experiencing preterm labor:

  • Call our office
  • Go to the bathroom and empty your bladder
  • Check to make sure you have not missed a dose of any medication you might be taking
  • Maintain adequate fluid intake as instructed by our doctors and nurses
  • Rest, lying down on your left side
  • Monitor your uterine activity

EMERGENCY SITUATIONS

Sometimes a problem can occur that needs attention right away. If you experience any of the following signs and symptoms, CALL YOUR PROVIDER IMMEDIATELY.

  • Bleeding: If you experience vaginal bleeding, a large gush or steady stream of bright red blood, IT IS AN EMERGENCY. Get help immediately, lie on your side and put your feet higher than your head. Save pads or cloths used to catch the blood.
  • Rupture of the bag of water (amniotic sac): Sometimes the bag of water around the baby will rupture prematurely. If you notice a gush of fluid or a steady trickle of fluid you should call. Be sure to note any color or odor that might be present in the fluid. Save pads or cloths and bring with you to the office or hospital.
  • Severe stomach pain: If you have constant severe pain that does not go away when you change position, with or without contractions notify our office. Any of the above situations may indicate an emergency, contact your doctor/midwife immediately.

Reprinted by Pregnancy.org, LLC from Her HealthCare.