I'm Having Twins!?!

There are at least one set of twins are born in about every 41 births. While having twins can double the joy and rewards to a family there are still some additional risks to the mother and her babies. Some of these complications require special care.

Twins occur when a sperm meets an egg in the fallopian tube, fertilization—union of egg and sperm—can occur. If this happens, the fertilized egg moves down the fallopian tube to the uterus where it attaches and grows into a fetus. During this process, twins can form. Women who take fertility drugs or have in vitro fertilization also have a greater chance of having twins.

Twins can be either fraternal or identical. Fraternal twins develop from a separate egg and sperm. Fraternal twins each have their own placenta and amniotic sac. Because each twin develops from the union of a different egg and a different sperm, these twins may not look alike. The twins can be boys, girls, or one of each. Identical twins are more rare and occur when a fertilized egg splits early in pregnancy and develops into two fetuses. Identical twins may share a placenta, but each baby usually has its own amniotic sac. Identical twins are the same sex and have the same blood type, hair color, and eye color, and they look very much alike.

Most of the time twins are diagnosed before delivery due to your uterus growing faster than normal or it becomes larger than expected. The most common way to see whether you’re having twins or not is through an ultrasound, where you might also be able to tell if the twins are identical or fraternal.

Prenatal Care With Twins
Taking care of your health during your pregnancy is important during any pregnancy but you have to be extra careful when pregnant with twins. You will need to eat more than if you were carrying one baby. Eating well and gaining weight are important when pregnant with twins, you will need to eat more than if you were carrying one baby. Eating well and gaining weight are important for your health and the health of your twins. Your body must nourish the babies and meet your energy needs as well. You will need to eat about 2,700 calories every day, if you are of average weight.

The average weight gain for a woman carrying twins is 35–45 pounds. In the first half of pregnancy, you should gain about 1 pound per week and in the second half, you should aim for a little more than 1 pound each week. If you are underweight, you may need to gain more. If you are overweight, you may need to gain less.

In addition to a prenatal vitamin, your doctor may prescribe extra vitamins and minerals to help your babies grow. Anemia (iron-poor blood) is more common in women who are pregnant with twins, so it's especially important to take your prenatal vitamins and iron as prescribed. Folic acid also is important for twins. It is hard to get all the folic acid you need just from your diet, so you should take a prenatal vitamin that contains folic acid.

Any pregnancy will leave a soon to be mother very tired and having twins can make you more uncomfortable than usual during pregnancy because the uterus becomes much larger. Resting during the day will help give you energy. Talk with your doctor about your job or your work at home. Some women may be asked to restrict their activity.

Monitoring A Twin Pregnancy
There are various techniques that are used to check the well being of your babies. Your doctor may use some or all of these techniques to monitor your babies:

* Have you count your babies' movements, called kick counts, at home
* Examine your cervix by physical exam or ultrasound exam for changes that may show early signs of preterm labor
* Repeat ultrasound exams to check the babies' growth
* Measure the babies' heart rate in response to their own movements (non-stress test)
* Perform a biophysical profile, which includes checking the babies' heart rate, body movement, muscle tone, and the amount of amniotic fluid by ultrasound

Growth Problems
Twins are more likely to be smaller than average and an ultrasound is often used to check the growth and the amount of amniotic fluid of each baby. Twins are called discordant if one is much smaller than the other. Discordant twins are more likely to have problems during pregnancy and after birth. Twins may be discordant because of poor functioning of the placenta or twin-twin transfusion syndrome (TTS). TTS can develop when identical twins share a placenta. The blood passes from one twin to the other through their shared placenta. The twin that gives the blood will be very small and have too little amniotic fluid. The other twin can have too much blood and amniotic fluid. Some of the extra fluid may need to be removed. If TTS is severe, the twins may have to be delivered early or, in rare cases, they may die.

Preterm Labor
Preterm labor is labor that starts before the end of 37 weeks of pregnancy. This can result in preterm birth, the most common problem of multiple pregnancy. About half of all twins are born preterm. When babies are preterm, they often have problems breathing and eating. They will have to stay in the hospital nursery longer than usual. Extremely preterm babies can die or have severe mental or physical problems, even with the best of care. In others, problems can occur as they grow and develop.

If you have preterm labor, you may be given injections of a steroid medication. This can help the babies' lungs work better. If preterm labor is found early enough, delivery can sometimes be postponed for several days. This allows time for the steroid medication to help treat the babies' lungs. Postponing the birth for even a few more days can make a big difference.

Delivery
There are certain factors that determine whether twins will be delivered by vaginal birth or through a cesarean birth.

* Position of each baby
* Weight of each baby
* Your health
* Health of the babies

Twins usually can be born vaginally if they both are in the head-down position. A vaginal birth also may be possible when the lower twin is in the head-down position but the higher twin is not. Once the first twin is born, the other twin can sometimes be turned or delivered with feet or buttocks first. When this can't be done, the second twin is delivered by cesarean birth. When the lower twin is not in the head-down position, both twins are delivered by cesarean birth. Because you will be delivering two babies instead of just one the labor, especially the pushing stage, may take longer. Babies usually are born several minutes apart in a vaginal delivery, but it can take longer.

Caring for Your Newborn Twins
Caring for twins can be stressful at times. It’s important to get as much rest as possible. You may feel overwhelmed, or even sad sometimes. If this occurs, let you gynecologist know. They will be able to encourage you and help you take steps to make caring for your twins a little easier. If the babies are born early, they may need special medical care to breathe, eat, and keep warm. Preterm and small twins may be cared for in a special nursery called a neonatal intensive care unit at the hospital.

A common question many new mother of twins have is whether they can breastfeed more than one baby and the answer is yes. Mother's milk is the best food for any infant because it has the right amount of all the nutrients the baby needs. When you breastfeed, your milk supply will increase to meet the amount needed by your babies. You will need to eat healthy foods and drink plenty of liquids. If your babies are premature, you can pump and store your milk until they are strong enough to nurse from the breast. You may find it helpful to talk with a lactation specialist who is trained to teach women about breastfeeding.

Having twins can be an exciting time. You can give your babies the best possible start by taking good care of yourself. Learn the warning signs of problems, and talk to your gynecologist about your questions and concerns. They may also be able to put you in touch with other new mothers of twins who can offer more support and encouragement.