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Division of Maternal Fetal Medicine and New Jersey Perinatal Associates
Vice Chairman, Department of Obstetrics and Gynecology.
Think of the excitement when a couple is told that the woman is
pregnant. Now imagine being told that there is not just one fetus
but two. Or three. That stunning news is happening much more frequently
in recent years, and the announcement brings with it a flood of emotions
from shock to elation to fear.
The societal trend toward delayed childbearing has brought a number
of unintended consequences. Two generations ago it was common for
women to begin having children in their late teens or early twenties.
Today many women are electing to wait until their late thirties or
even their forties to begin their family. But waiting until that
age increases the chance that infertility issues may arise and the
use of assisted reproductive techniques has resulted in a stunning
rise in the number of twin and triplet pregnancies.
When most of us hear that a woman is pregnant with twins we imagine
only the fun consequences (and the work…and the tuition payments).
Will they be identical? Girls? Boys? One of both? Unfortunately
when taken as a whole, twin pregnancies are more likely than singletons
to develop any number of possible complications, including preterm
birth, operative delivery, bleeding, gestational diabetes and hypertension.
While most will have a successful outcome, the couple and their
obstetrical team are challenged to provide the best possible care
for these high risk pregnancies.
When a couple presents to the Division of Maternal-Fetal Medicine
at Saint Barnabas Medical Center with a known twin gestation, a team
approach is used to help the anxious family with their exciting and
intimidating news. The patient meets with a perinatologist for a
prolonged consultation and evaluation.
Sonographers with extensive experience in scanning multiple gestations
work with the physicians to image the developing fetuses. Great care
is taken to determine the type of placenta and membranes and to evaluate
the health of the babies. It is not uncommon for two sacs or fetuses
to be seen very early but for one to fail to develop. This “vanishing
twin” phenomenon can lead to an emotional roller coaster ride
for a couple.
Much of the first session is spent determining if there are other
risk factors in the medical or family history that might contribute
to problems for the mother or fetuses. In fact, much of the time
is spent educating the families on the expectations for the pregnancy.
Some of the aforementioned concerns are preventable while others
are treatable or might affect the timing of the delivery. Her care
will be much more extensive than in her prior pregnancy or that of
her friend or sister. The hope, of course, is that the close monitoring
never reveals anything more than two normally developing fetuses
in a mom with normal blood pressure and no signs of preterm labor.
If problems do indeed arise, a talented experienced team can help
guide the family to the best possible care.
Much of the first half of the pregnancy is spent ensuring that
both twins are normally formed and in helping the mother adjust to
her new status. Many moms will experience nausea or vomiting early
in the pregnancy to a greater degree than they did when they were
pregnant with one fetus. In twin pregnancies the recommended caloric
intake is about 400 kilocalories greater than with singletons. Weight
gain is often 1-1.5 pounds per week with a desired weight gain often
in the 35-45 pound range. While exact amounts vary and depend on
factors such as the woman’s pre-pregnancy weight, the amounts
are still greater than in women with one fetus.
Ultrasound remains the gold standard in evaluating the developing
babies. This fascinating and indispensable tool allows complex study
of the fetal organs as well as continued calculations of fetal growth.
If all goes well, the family can be told at the halfway mark of
the pregnancy that they have two fetuses that appear to be developing
normally.
Most of the second half of the pregnancy is spent looking for signs
of preterm labor, preeclampsia or growth problems in the fetuses.
Perinatal nurses educate the mother-to-be on the warning signs of
preterm labor and preeclampsia. In some situations bed rest or hospitalization
may be needed to allow the best care. Ultrasound is used at least
monthly to check fetal growth.
The average gestational age at delivery of twins is about 36-37
weeks. As the time for birth approaches, the mother will meet with
her obstetrician to review some of the special issues that may develop
in a twin pregnancy and delivery.
At Saint Barnabas Medical Center, the Department of Anesthesia
provides 24-hour coverage on the Labor and Delivery suite. The presence
of such highly qualified caregivers at this critical time allows
the family to know that both mom and the babies will receive outstanding
care from experts with a wealth of experience in caring for multiple
gestations. The renowned neonatal team at Saint Barnabas ensures
that if specialized care is needed for the new arrivals, an exemplary
group of professional dedicated to helping the tiniest babies will
be caring for the entire family.
Certainly the announcement, “You’re having twins” is
a life-altering event. Hopefully the combined efforts of the proud
parents and a caring, professional team will lead to the day where
those college tuition concerns are a reality.
The number of expectant mothers carrying twins is an increasing
population. To meet the needs of these families, a course entitled, “Marvelous
Multiples” was implemented as part of the comprehensive childbirth
preparation programs offered through the Women’s Health Education
Department at Saint Barnabas.
This prenatal education course is designed for those expecting
multiples on all aspects of their unique pregnancies. Topics to be
discussed include nutrition, labor and delivery, anesthesia options,
cesarean birth and relaxation techniques. Also included in this course
is recovery, caring for multiples, adjustment to home life and baby
care basics. Orientation to a Birthing Room is part of the session.
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Multiple Pregnancies Pose Greater Risks