What to expect when you're expecting (161 page)

So what’s up with this multiple-baby boom? The surge in older moms has a lot to do with it. Moms over the age of 35 are naturally more likely to drop more than one egg at ovulation (thanks to greater hormone fluctuations, specifically FSH, or follicle-stimulating hormone), upping the odds of having twins. Another factor is the increase in fertility treatments (also more common among older moms), which multiplies the chances of a multiple pregnancy. And yet another surprising factor, say some experts, might be the increase in obesity. Women with prepregnancy BMIs higher than 30 are significantly more likely to have fraternal twins than women with lower BMIs.

Carrying one baby comes with its share of challenges and changes; carrying more than one—well, you’ve probably already done the math. But not to worry. You’re up for it—or at least you will be once you’re armed with the information in this chapter (and the support of your partner and your practitioner). So sit back (comfortably, while you still can) and get ready for your marvelous multiple pregnancy.

“I just found out I’m pregnant and I have a feeling it’s twins. How will I find out for sure?”

Gone are the days when multiples took their parents by surprise in the delivery room. Today, most parents-to-be of multiples discover the exciting news pretty early on. Here’s how:

Ultrasound.
The proof is in the picture—the ultrasound picture, that is. If you’re looking for indisputable confirmation that you’re carrying more than one baby, an ultrasound is the best way to get it. Even an early first-trimester ultrasound done at six to eight weeks (which you’re very likely to have if your blood hCG level is high or if you’ve conceived using fertility treatments, though some practitioners also do them routinely) can sometimes detect multiples. But if you want to be absolutely sure you’re seeing double, you’ll want to look to an ultrasound done after the 12th week (because very early ultrasounds don’t always uncover both babies).

Doppler.
The beat goes on … and on. Your practitioner can usually pick up a baby’s heartbeat sometime after the ninth week. And though it’s hard to distinguish two heartbeats with just a Doppler, if your practitioner is an experienced listener and thinks he or she detects two distinct beats, there’s a good chance that you’re carrying multiples (an ultrasound will confirm the news).

Hormone levels.
The pregnancy hormone hCG is detectable in your urine about 10 days postconception, and its level rises rapidly throughout the first trimester. Sometimes (but not always), a higher-than-usual hCG level may indicate multiple fetuses. That said, the range of normal hCG levels for twins also falls within the normal range for singletons, so an elevated level of hCG does not, in and of itself, indicate a multiple pregnancy.

Fraternal or Identical?

Fraternal twins (first image), which result from two eggs being fertilized at the same time, each have their own placenta. Identical twins (second image), which come from one fertilized egg that splits and then develops into two separate embryos, may share a placenta or—depending on when the egg splits—may each have their own.

Fraternal twins are the more common type of twin, with your chances of having fraternal twins increasing with your age and the number of children you have. Your chance of having twins in general increases if you have twins in your family on your mother’s side.

Test results.
An unusually high (positive) result on the triple (or quad) screen (see
page 63
) in the second trimester can sometimes indicate a multiple pregnancy.

Your measurements.
Not surprisingly, the more babies, the bigger the uterus. At each visit, your practitioner feels for the height of the fundus (the top of your uterus) to measure that growth. Measuring larger than would be expected for gestational age may be a sign that you have more than one baby on board (but not always; see
page 162
).

Bottom line on your hunch: Lots of clues can point to a multiple pregnancy (including your mom-to-be instincts), but only an ultrasound can tell you for sure. Check with your practitioner.

“I just found out I’m having twins. Can I use my regular ob-gyn, or do I need to see a specialist?”

If you’re happy with your practitioner, there’s no reason to trade in for a specialist’s care just because you have two babies to care for. (Just make sure you are really happy with your practitioner, since you’ll be spending more time with him or her during your twin pregnancy—more babies equals more office visits). Even if your regular practitioner is a midwife, you’ll likely be able to continue seeing her as long as you also have a physician on board for regular checkups and for delivery.

Do you like your regular ob but also like the idea of extra-careful care? Many ob-gyn practices send patients who are pregnant with multiples to a specialist for periodic consultations—a good compromise if you’d like to combine the familiar comfort of your practitioner’s care with the expertise of a specialist’s. Moms-to-be of multiples who have specific special needs (such as advanced age, history of miscarriage, or a chronic health condition) may want to consider switching to a maternal-fetal medicine specialist (also known as a perinatologist). Talk that possibility over with your practitioner if your pregnancy falls into a higher risk category.

When choosing a practitioner for your multiple pregnancy, you’ll also need to factor in his or her hospital affiliation. Ideally, you’ll want a facility with the ability to care for premature babies (one with a neonatal intensive care unit) in case your bundles arrive early, as multiples often do.

Also ask about the practitioner’s policy on topics specifically related to multiple births: Will you be induced at 37 or 38 weeks as a matter of course, or will you have the option of carrying beyond that time frame if all is going well? Will a vaginal birth be possible, or does the practitioner routinely deliver multiples via cesarean delivery? Will you be able to give birth in an LDR (labor and delivery room), or is it routine to deliver multiples in an OR as a precautionary measure?

For more general information about choosing a practitioner, see
page 21
.

“I’ve heard that when you’re pregnant with twins, your pregnancy symptoms are worse than with just one baby. Is that true?”

Twice the babies sometimes spell twice the pregnancy discomforts, but not always. Every multiple pregnancy, like every singleton pregnancy, is different. An expectant mom of one may suffer enough morning sickness for two, while a mom-to-be of multiples might sail through her pregnancy without a single queasy day. The same with other symptoms, too.

But though you shouldn’t expect a double dose of morning sickness (or heartburn, or leg cramps, or varicose veins), you can’t count it out. The miseries do, on average, multiply in a multiple pregnancy, and that’s not surprising given the extra weight you’ll be carrying around and the extra hormones you’re already generating. Among the symptoms that might be—but won’t necessarily be—exponentially exacerbated when you’re expecting twins or more:

Morning sickness. Nausea and vomiting can be worse in a multiple pregnancy, thanks to—among other things—the higher levels of hormones circulating in a mom’s system. Morning sickness can also start earlier and last longer.

Other tummy troubles. Hello, heartburn, indigestion, and constipation. More gastric crowding (and more gastric overloading, since moms of multiples are eating for three or more) can lead to an increase in the kinds of digestive discomforts pregnancy’s known for.

Fatigue. This is a no-brainer: The more weight you’re dragging around, the more you’re likely to drag. Fatigue can also increase with the extra energy an expectant mom of multiples expends (your body has to work twice as hard to grow two babies). Sleep deprivation can also wear you out (it’s difficult enough to settle down with a watermelon-size belly, let alone one that’s the size of two watermelons).

All those other physical discomforts. Every pregnancy comes with its share of aches and pains; your twin pregnancy might just come with a little more than its share. Toting that extra baby can translate to extra backache, pelvic twinges, crampiness, swollen ankles, varicose veins, you name it. Breathing for three or more can also seem an extra effort, especially as your babies get big enough to push up on your lungs.