Category: Multiples

Risk Factors for Preterm Labor

  • Poor nutrition
  • Inadequate hydration
  • Insuffucuent omega-3 fatty acids in the diet
  • Physical trauma, abuse
  • Hard physical labor, standing all day, tiring travel
  • African American ethnicity
  • Substance abuse: tobacco, alcohol, street drugs
  • Emotional stress and fear
  • Finanical stress
  • Fear of increased body size by term
  • Fear of birthing 2 or more babies (in the case of multiples)
  • History of preterm labor in the maternal line (preterm labor may ne a pattern for several generations)
  • Low pre-pregnancy weight
  • Chronic cough (risk of preterm rupture of membranes)
  • Obesity or underweight
  • Placental problems (placental abruption, placenta previa, mid-pregnancy vaginal bleeding)
  • Preclampsia
  • Infection in the genital tract
  • Congenital anomalies
  • Fibroids
  • Chromosomal anomalies
  • Uterine anomalies
  • DES exposure
  • Diabetes
  • Insufficient or excessive amniotic fluid
  • Car accident
  • Severe gum disease
  • 2 or more second trimester abortions

Information from Having Twins, by Elizabeth Noble

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There are 2 types of twins
Monozygotic twins result from the union of 1 egg and 1 sperm. These identical twins are the same sex, though there have been very rare cases of male and female identical twins.

MZ twins can have the following configurations in the uterus (the chorion and amnion refer to the layers of membrane that enclose the baby and the bag of waters. Chorion is the outside membrane and amnion is the inner).

~ 1 chorion, 2 amnions and 1 placenta (most common). This means babies are divided by 2 thin membranes.
~ 2 chorions, 2 amnions and a fused placenta
~ 2 chorions, 2 amnions and 2 placentas
~ 1 chorion, 1 amnion and 1 placenta (rare). This means the babies can have skin to skin contact with each other.

The other type of twin is known as Dizygotic and results from the fertilization of 2 eggs by 2 sperm. This type of twinning is simply a double birth resulting in siblings who share the same uterine environment, birthday and have between 25-75% of their genes in common.

DZ twins can have the following configuration in the womb:

~ 2 chorions, 2 amnions and a fused placenta
~ 2 chorions, 2 amnions and 2 placentas

Prenatal Care
Eat, eat, eat!! Daily intake of 3,100 calories and 140-150 grams of protein are REQUIRED for a twin pregnancy. That’s a lot of calories and protein, but it’s the only way to grow healthy babies and carry them to full term. Tips for getting that much into a body when the stomach has little room to expand: protein smoothies, snacks by the bed for every bathroom break, eat every hour or two. As Elizabeth Noble says, “Your babies’ health depends on your weight gain!”

Unlike with singletons, mothers of multiples show the greatest weight gain in early and late pregnancy. Start eating early in pregnancy to build reserves for when babies grow rapidly later.

Women expecting multiples, if possible, should stop working by 24 weeks. Laying down for an hour, twice a day, every day is also needed so the body can rest.

Omega-3 fatty acids are essential for all childbearing women and especially those carrying twins. EFAs are depleted from women’s bodies by baby brain-building during pregnancy. Each subsequent fetus gets fewer EFAs and further depletes the mother unless she augments her diet and supplements.

What about birth
Twins present headfirst (vertex) less than 50% of the time. The first twin (Twin A) is in a nonvertex position about 20% of the time. One is vertex and one is breech in about 40% of twin births. More commonly, Twin B is breech. Both present breech about 8% of the time.

Nursing two together
It may be easier to nurse one a time in the beginning but when you can nurse two at once you’ll be saving yourself tons of time. It’s a good idea to meet with a lactation consultant immediately after the birth so she can help you with positions and holds. And yes, most women can make enough milk: Milk is made based on how frequently babies nurse. If you’re nursing two at once, you’ll have double the milk of a mom with only one baby. Two boobs, two babies.

The Postpartum
Caring for two babies is too much for parents in the early days. Enlist help before the birth. Ask family or friends to spend the night or day with you. Hire help. Look for a postpartum doula – do whatever you can to have someone at your home helping everyday for the first month. After that you can begin to think about reducing the hours of help needed, but experience has shown that you’ll need dedicated help with twins for the first 6 months. This is not a job for two people only. Newborn twins really do require a lot of help.

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