A guide to expecting twins

It wasn’t a routine ultrasound after all. At seven weeks, Carol Pozsgai and her partner, Jon, of Deep River, Ont., found out they were expecting twins — two little siblings for Maria, 17 months. “You just can’t describe the feeling! We both were just so happy and amazed.”

Twins and multiples are on the rise. Currently, according to Multiple Births Canada, more than 4,000 sets of twins and 75 sets of triplets are born in Canada a year. Between 1974 and 1990, the twins birth rate increased 35 percent while the rate of triplets increased almost 300 percent. Some of the increase — but not all — results from infertility treatments.

“Parents may be thrilled, shocked, anxious, totally overwhelmed — even unhappy. Their reactions depend on their lives and circumstances. If a couple has been undergoing treatment for infertility, they may be very happy; if they wanted to have only one child, they may be upset,” says Linda G. Leonard, associate professor emerita with the Multiple Births Support Program at the University of British Columbia School of Nursing in Vancouver.

If you find out you’re expecting more than one baby and are feeling overwhelmed, you’ll want to give yourself time to get used to this big news. And be prepared for a range of feelings throughout your pregnancy: One day you may be tingling with excitement, the next wondering how you’ll manage. “There are emotions and worries that are unique to a twin pregnancy,” explains Leonard.

You probably have lots of questions about multiple pregnancies and parenting. Here are some of the answers you’ll need:

Prenatal care

Multiple pregnancies are followed with extra care. Jon Barrett, chief of Maternal-Fetal Medicine at Sunnybrook Health Sciences Centre in Toronto, explains: “It is a higher-risk pregnancy. Even with ordinary fraternal twins, there are higher rates of low birth weight and preterm birth, and there are other complications that can happen with identical twins. For the mother, there are increased risks for gestational diabetes, high blood pressure, bleeding in pregnancy and Caesarean section. All the circumstances in twin pregnancy mean that women should be getting special care — at our hospital, for example, we’ve started a specialized twins clinic.”

Rebecca Hoffe-Goodwin from Edson, Alta., gave birth to Lila and Nicholas last May. “The care was much more intense. We found out we were having twins at our 20-week ultrasound — that was a shock! — and after that I had to go to an obstetrician instead of our family doctor. I went every three weeks, then every two and, finally, every week in the last month.” 

Prenatal tests

You will likely have more tests than you would for a singleton pregnancy. “Most expectant mothers of twins and their babies come through the pregnancy without health problems,” says Leonard. “Because of the extra testing and monitoring, it’s easy to focus on all the things that could go wrong, but try to keep a positive attitude.” Leonard encourages women to ask lots of questions and participate in planning their care.

Some tests in a multiple pregnancy track your health because of the increased chance of high blood pressure and gestational diabetes. Other tests monitor the babies. Ultrasound scanning is used to assess how well each baby is growing and developing and to measure the amount of amniotic fluid surrounding the babies. Ultrasound can also check the length of the cervix (a cervix that shortens significantly during a twin pregnancy may be a warning sign that labour is imminent) and, in the last few weeks, to assess the positions of the babies.

Pregnancy symptoms

For women expecting twins or more, says Barrett, “all the minor symptoms of pregnancy — the nausea, vomiting, hemorrhoids, tiredness and so on — are not so minor.”

Hoffe-Goodwin recalls, “I was more tired for sure. I had more physical limitations with the twins — sore back, heartburn, less lung capacity, difficulty sleeping — and of course you get a lot bigger, quicker!” Her husband pitched in. “Daniel did most of the hard things like lifting car seats, bringing laundry upstairs, and anything that required standing for long periods.” She offers a word of advice: “I think women need to know that taking it easy isn’t being lazy. You’re growing two babies at once. That is special!”

Because of the physical demands on your body, you probably won’t work right to the end of your pregnancy. “A mother expecting twins may be counselled to take leave at about 24 to 26 weeks — sooner if her work is strenuous,” says Leonard. And while gentle, low-impact activity, such as walking or swimming, is a great way to relax and stay fit, take extra care with exercise. Get your health care provider’s OK, and respect your body’s signals that you’re tired, uncomfortable or hungry.

Preterm birth

It’s true that preterm birth and low birth weight are more common with twins, says Leonard. “About 55 percent of twins are born before term (37 weeks), with a small minority born before 32 weeks.” Half of twins are also considered low birth weight — that means they weigh less than 2500 grams (5.5 pounds).

There are no guarantees, but a healthy lifestyle during your pregnancy is important. Barrett says, “All the routine things may help: eating properly, taking vitamin supplements, not smoking, getting as much rest as possible.” If you can, find a doctor who specializes in twin pregnancy and plan to deliver your babies in a hospital that can care for premature babies, says Barrett.

Labour day

Birth is different when there are two babies. Leonard says, “There is one labour — going from a closed cervix to a cervix that’s fully open — and two pushing stages. The mother pushes the baby closest to the cervix down the birth canal first, rests for a few minutes, and then pushes the second baby down the birth canal.” Although you’re delivering two babies, labour isn’t usually more painful than a singleton labour. It may even be less so! Leonard explains why: “The extra circulating hormones tend to prepare the cervix for labour. Some women carrying twins even have a ‘silent’ labour — they hardly feel the contractions.”

Caesarean delivery of twins is on the rise — estimates run from 30 to 60 percent, depending on the hospital. And although it doesn’t happen very frequently, a few women deliver one baby vaginally and need a Caesarean delivery for the second baby.

Hoffe-Goodwin recalls the day her babies arrived: “I was having non-stress tests to check on the babies’ heart rates every week for the last month. During one test they found out that twin B — Nicholas — had a dip in his heart rate and they decided that I should have an emergency C-section that same day.”

Because Lila and Nicholas arrived early, they stayed in the neonatal intensive care unit for almost four weeks. “The driving back and forth (a four-hour round trip) was especially difficult,” says Hoffe-Goodwin. “Seeing your little ones hooked up to monitors and tubes is stressful. You have to keep in mind that this is just a phase and that they’re in capable hands. It’s hard to leave the hospital with no baby, but many parents of multiples have to do that.”

Planning ahead

A family with two (or more) new babies needs emotional support, household help — and lots of baby gear. Pozsgai says, “Even though I had baby things from my first, I needed double of everything — another infant car seat, more clothes, diapers, another swing.” Pozsgai’s sister-in-law organized a diaper baby shower — guests all brought diapers. Four months after the babies arrived, she’s still using diapers from the shower.

You’ll also need help. “It’s essential!” says Pozsgai. Her husband, Jon, stayed home for a month after Victoria and Alexandra were born (“He’s the greatest support I have!”). And they hired a neighbour to look after Maria every morning. “Even if you don’t have other kids to look after, you’ll need more help — in addition to your spouse — at least for the first two months to clean the house, prepare meals and run errands until you get back on your feet,” advises Pozsgai.

If friends or family offer to do laundry, pick up groceries or make a meal, accept, urges Hoffe-Goodwin. “Make a list of things that need to be done and let friends choose what they can do.”

Especially valuable is the gift of time — for you. Leonard explains, “Mothers of twins can become isolated because getting two babies fed and ready to go out is like going on a week’s camping expedition!” If your partner isn’t available, invite a friend over to help you get out — the four of you can go to a parent-child drop-in, do a little shopping or have a treat at a coffee shop. Emotional support is vital. Says Leonard, “Because of the demands of parenting two infants, postpartum depression and anxiety are more common among mothers (and fathers) of twins, triplets and more.” Any networks you can manage to arrange during your pregnancy will provide rest, respite and emotional support once the babies arrive.

Life with twins (or more)

Even a few months from now, when you’ve gotten to know your babies and the days are beginning to fall into a predictable pattern, your life will feel more under control again. Hoffe-Goodwin says, “Nicholas and Lila just turned four months and now they’re smiling and giggling, they’re chatty and able to entertain themselves a little bit — they’re even sleeping through the night! We’re in much more of a routine so it’s really OK now.”

Pozsgai also is thrilled with her new and suddenly larger family: “When I look back I wouldn’t change it. Having Victoria and Alexandra is a lot of work, sure, but when they’re looking at me, smiling at me, my eyes just fill with tears. I’m amazed that they’re here with me and I feel very lucky and proud of having been able to experience this wonderful miracle.”

Seeking support

There is nothing like sharing experiences (and maybe some laughs) with other parents who’ve been there. To make connections you may want to:

• Visit Multiple Births Canada (MBC) for information on support networks, forum discussions, recommended readings, chapter locations and clothing sales: multiplebirthscanada.org or call 1-866-228-8824
• Look for a multiple birth support group in your community
• Research prenatal classes for multiple birth parents
• Ask around to find other parents of twins living nearby (your public or community health nurse may know)
• Participate in online forums

Resources

Twins, Triplets & More: Resource Guide for Multiple Pregnancy & Parenthood by Linda G. Leonard is an excellent online resource: nursing.ubc.ca.

Multiple Births: Prenatal Education & Bereavement by Lynda P. Haddon provides pregnancy information and support.
Visit multiplebirthsfamilies.com.

The Multiple Pregnancy Sourcebook:  Pregnancy and the First Year with Twins, Triplets, and More by Nancy Bowers, Contemporary Books 2001.