Congratulations! You’re pregnant with 1… no, not 1, but 2, 3, perhaps even 5 bundles of joy! But how will you manage?
The rise in multiple pregnancies is at least in part due to the rise in fertility treatments like IVF and AI. Many women are also waiting until they’re after 35 to have children... and this definitely increases your chances of conceiving multiples. Since 1980, multiple pregnancies have increased by 65-75% and the chance of having triplets has increase 5 fold.
It’s important to realise that carrying multiples comes with its’ own set of unique challenges, concerns, questions and complications.
Possible Complications during pregnancy
Unfortunately, there are greater risks associated with a multiple pregnancy. 2 of the more common risks include high blood pressure and pre-eclampsia. While a minor rise in blood pressure is nothing to fret about, pre-eclampsia can be. It is a serious blood circulation problem, which affects the placenta, as well as the mother’s vital organs.
According to Cape Town based ob/gyn, Dr Christo Benecke, “there is a significant increase in the chances of pre-eclampsia in a multiple pregnancy”. Warning signs include; vision problems, a constant headache, pain in the upper right abdomen and swelling of the hands and feet. Although pre-eclampsia is serious, it is important not to panic. Remember it is perfectly treatable with bed rest and medication.
Gestational Diabetes is another, more common risk. It occurs when the pregnancy hormones interfere with the action of insulin in the mother’s body. Gestational diabetes can also be managed with regular check ups and a change in diet, like switching to low GI foods.
Intrauterine Growth Restriction (IUGR)
Another common risk is Intrauterine Growth Restriction (IUGR), or a baby that is not growing at a normal rate. Incidents of IUGR definitely increase with a multiple pregnancy, in all likelihood because the growth rate of multiples slows down in the last trimester.
This slowing occurs for various reasons, either the placenta cannot handle further growth, or there is simply just not enough leg room in there anymore.
Risk of miscarriage
There is also a greater risk of miscarriage in a multiple pregnancy. However, Dr John Fassler, an ob/gyn at the Stellenbosch Medi-Clinic, points out that this risk is only “slightly higher”. Other complications include a greater chance of foetal abnormalities and foetal demise in-utero, but these are both very rare.
Although overall, there seem to be more risks associated with a multiple pregnancy, with the correct care and medical supervision, your pregnancy is likely to go smoothly.
Assumptions are always made that all expectant multiple mothers suffer from exaggerated pregnancy symptoms, like cramping and nausea. And of course this can be very true!
Dr Benecke says that, “generally speaking, multiple moms will probably suffer more exaggerated pregnancy symptoms like, nausea, breast tenderness and just a general tired, crappy feeling”. But Dr Fassler insists that this needn’t be the case at all.
“In fact, the only thing we know for sure will happen”, he says, “is that the multiple mom will need to rush to the loo more often, as her larger uterus pushes down on the bladder”.
Cheryl Lieberman, mother of 16- month old twins, says she “breezed” through her pregnancy. “I really enjoyed it and I didn’t suffer from any morning sickness in my first trimester, instead that seemed to come towards the end”.
However, mom of twins, Maryna Russel was not so lucky. “I was literally green with morning sickness - sorry, not morning sickness - all day sickness” Maryna jokes. It seems that experiencing enhanced pregnancy symptoms is entirely individual and there are no set rules.
This is probably one of the first questions that most moms ask. How much weight should I put on? Dietician Larissa West, from the Menlyn Med Pregnancy Wellness Centre, says, “There are simply no hard and fast rules. It depends on so many different factors - height, body type, age and pre-pregnancy weight”.
Weight gain during a multiple pregnancy is essential though, even more so than in a singleton pregnancy.
Healthy weight gain, especially between weeks 20-24, helps reduce your chances of early labour and low birth weight. Although it’s important to assess each pregnancy individually, there are some general guidelines for appropriate weight gain.
For twins, a suggested 16-20 kg’s is recommended and for triplets, about 22-27 kg’s.
A premature birth is almost a given with multiples, 60% of all twins are born prematurely and 90% of all triplets and more are born prematurely. “The uterus is designed to carry 1 baby,” says Dr Fassler, “it can take more than 1, but then it comes with added risks”.
The good news is that with modern medicine, most babies born prematurely survive.
The survival rate of premature babies
The survival rate for babies born at 34 weeks is 98%, 30 weeks, 95%, 27 weeks 90%, 26 weeks 80-90%, 25 weeks 50-80% and even at the very low 24 weeks, a baby still has a 40-70% chance of survival. Even so, the earlier your baby is born, the higher the risk of permanent severe disability.
“Premature birth can be very difficult for parents, especially the mother, who will experience feelings of guilt or inferiority”, says Lavorne Prinsloo, the CEO of the SA Preemie Association. “A mother may experience symptoms of deep sadness, loss and even blame herself for not being able to keep her baby. But if you know you are carrying multiples, you can prepare yourself psychologically for the inevitability of a premature birth”.
Dr Baker, a Joburg based ob/gyn, says that a “premature birth tends to reduce the initial bonding between mom and babes, which occurs in a singleton birth.” He believes it is important a mom is well informed about premature birth, and reassured that her babies will be managed with the best expert care.
Go to page 2 to find out more about how moms cope with a multiple pregnancy
What can be done to ensure your baby is not born prematurely?
Unfortunately, there is no single course of action that ensures your baby will not be born prematurely. “If you know you are carrying multiples”, says Amanda “it is vital that you adopt a healthy lifestyle. Regular check ups are imperative and the correct diet. Take it easy! The less you stress the more chance the babies have of staying in there!”
Over the years of working in the field, Lavonne has observed that prems usually arrive over December and January, the hot months. “We call it our prem-peak. In a perfect world, if possible one should try and time your pregnancy so that your last trimester does not fall over the hottest months of the year”.
Does staying off your feet help stop pre-term birth?
Dr. Fassler says that the best way to prevent a pre-term birth is to get off your feet and literally recline. He advices slowing your activity level down at about 28 weeks, “try and rest and sit or lie as often as possible”.
But Dr Benecke disagrees, “It has been proven that bed rest does not help with preterm birth. Of course, logically it makes perfect sense, if you are off your feet you place less pressure on the cervix. But if your babies are going to come early, they are going to come early. Just be prepared for it”.
Dr Baker says of pre-term birth, “It is important that these mothers are managed as a high risk pregnancy. They require close monitoring and frequent visits to detect any early signs of impending premature delivery.”
Caesarean section or natural birth?
Although you can have a natural birth with some multiples, most doctors do not advise it. Dr Fassler, says “It’s important to educate the patient about the possible complications and the benefits of a caesarean section. It is usually always better for the baby to have a c-section, even if this is not her first wish”.
With twins, the first baby is usually not a problem, however the second baby can often present as breech or transverse and this is where the danger comes in. Twins and multiples are so unpredictable.
Another advocate of the caesarean section is Dr Benecke: “If the first baby’s head is down and the mother is hell bent on a vaginal birth, then I would support her, but it would be done in a theatre, because the risk of the second baby needing to be born via c-section, is high”.
Dr Baker agrees that in twin pregnancies, caesareans are best. “It has been well documented that these babies do far better postnatally if delivered by caesarean section. There may also be an element of prematurity in a multiple pregnancy, which favours a caesarean section. This situation is particularly common in a triplet or quadruplet pregnancy.”
Psychological factors associated with a multiple pregnancy
There are also many psychological challenges associated with a multiple pregnancy. Lana Levin, a psychologist who specialises in pregnancy related matters, says, “with multiples a woman may be plagued with feelings of fear. Fear of losing a baby, fear of a preterm delivery, fear she won’t be able to cope with the babies, fear of feeding, fear of not being able to cope financially. These can all cause a mom to feel overwhelmed and even develop panic and depression during her pregnancy.”
However, if this is dealt with in the correct manner, it does not need to become a serious problem.
Lana Levin works with various psychiatrists whom she regularly refers expectant moms to. “These mothers have been medicated with great success”, she says. “There are safe anti-depressants one can use during pregnancy”.
Psychologist, Johan Nepgen, who also deals in pregnancy related matters, agrees, “Starting interventions during early pregnancy are the best. There are also many new-age, alternative options”. He points out that hypnotherapy for example, has been proven to work wonders for nausea.
“Another factor that can impact on a multiple pregnancy is the probability that the parents have been through numerous fertility treatments prior to falling pregnant. “I have had people referring to it as a traumatic multi-stage process with both mom and dad getting increasingly desperate before success is achieved”, says Johan.
There are definitely added stakes and pressures when this is the case and counseling can be very beneficial.
Multiple Moms speak up:
- “It’s all about a positive attitude. If your mind is right going into your pregnancy, you’ll manage”. - Michelle Cuerden, mother of twins
- “I loved my multiple pregnancy, more so than my singleton one. I felt so special and people treat you differently when you’re carrying twins. I was really spoilt by my family and friends.” - Maryna Russell, Johannesburg Chairperson of SAMBA (South African Multiple Birth Association).
- “Yes, a positive attitude goes a long way, but what’s also crucial is to REST from about week 27. Prematurity is exhausting for your whole extended family, as you end up living at the neonatal icu ward for weeks, and your other kids have to be farmed out to relatives. I believe that by putting yourself on bed rest for the last 3 months of the pregnancy you can save yourself a lot of long term stress. I stupidly moved house the week before I went into prem labour at 31 weeks. Don’t do it. It’s no joke when they arrive early. Rest, rest, rest. “. - Alex Carmichael, mother of twins.
So whether you’re faced with a pregnancy of 2 or 5, just be sensible about it and don’t over exert yourself physically. Also remember that your capacity to deal with things is always greater than you think.
Yes, there are complications, but if you have a good support structure and great medical team in place, you should be fine. Women are naturally courageous. As Sarah Pezdek-Smith, writer, artist and poet said, “The strength of a woman, can carry the weight of the world”... literally!
SAMBA (South African Multiple birth Association) www.samultiplebirth.co.za - 0861 432 432
SA Preemie www.sapreemies.za.org - (021) 333 1876
Psychologists: Mrs Lana Levin 011 786 5365, Mr Johann Nepgen 021-794 6609