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Tips for Pregnancy with Multiples

bird nest

Alexandra Grablewski

There were still some items remaining on Andrea Katz's "twins to-do list" on the last day of week 32 of her pregnancy. She knew the babies might arrive on the early side, since multiples usually do, but she figured she had plenty of time left to wash their clothes and help her husband, Aaron, put the finishing touches on the nursery. Her daughter and son had other plans, though.

Born via C-section at 33 weeks and one day at Beth Israel Deaconess Medical Center, in Boston, they were considered premature and needed to stay in the neonatal intensive care unit (NICU) -- Elsie for three weeks, Owen for five. Although it pained the parents to leave their babies in the hospital for so long, it did give them extra time to get those chores done. Today, the babies are doing well. "Everything worked out, just not the way we thought it would," says Andrea.

The Katzes' experience is pretty typical for parents of twins. While you may not be able to count on things going according to schedule when you're carrying multiples, knowing what to expect during pregnancy, labor, and beyond can help make the journey feel like a double (or triple) blessing. "It's comforting to know that most multiple pregnancies do proceed smoothly and the babies have a good outcome," says pediatrician Shelly Vaziri Flais, M.D. (She should know: She is the mother of 6-year-old twins and the author of Raising Twins: From Pregnancy to Preschool.) Turn the page for more facts and advice from the experts.

Birth Stories: When You're Expecting Twins
Birth Stories: When You're Expecting Twins

Chances are, the first words you'll hear after finding out you're carrying more than one are "high-risk pregnancy." But don't panic: It just means you'll need to be monitored closely by your doctor, as multiple pregnancies carry a higher rate of health problems, including preterm labor and preeclampsia (a condition characterized by high blood pressure and protein in the urine). "Being pregnant with just one baby puts a lot of stress on your body, so it's even harder physiologically if you're carrying two or more," says Samuel Bender, M.D., clinical assistant professor of obstetrics, gynecology, and reproductive science at Mount Sinai School of Medicine, in New York City.

Many doctors will recommend that moms of multiples come into the office for a checkup every other week during the second half of their pregnancy. From 20 to 32 weeks, your doctor will probably perform an ultrasound at each of those visits in order to measure the length of your cervix (a good indicator of whether you're likely to deliver early), as well as to track the growth of each of your babies.

It's also particularly important for moms of multiples to have a carefully considered birth plan. Although you may have talked about delivery options when you first got the exciting news, by the last month of pregnancy (around 33 weeks), it's unlikely that the position of your babies will change, so it's a good time to have another conversation with your obstetrician. If you're having twins and both babies are head down, you could be a candidate for a vaginal delivery. Your doctor might even consider a natural birth if the first baby is head down and the second baby is breech -- as long as baby number two is about the same size as baby number one and your doctor is experienced in delivering a second twin as a breech. But in cases where the first baby is breech, regardless of the position of number two, a C-section delivery is the most likely scenario.

Don't count on an intimate scene during your labor and delivery. Most hospitals automatically take mothers of multiples to the operating room, whether they're having a planned C-section or not, in case the unexpected occurs, says Dr. Bender. This means more staff members are apt to be present (including anesthesiologists, pediatricians, and extra nurses), while the number of family members allowed in may be limited. You might be disappointed with this clinical feel, but take comfort in the fact that these measures are meant to ensure a safe delivery for you and your little ones.

Immediately after the babies are born, your doctor will assess whether they need to go straight to the NICU. Although some hospitals require that all babies born prematurely (earlier than 37 weeks) be admitted, others require this only of babies weighing four pounds or less. In general, though, multiples are more likely to end up in the NICU than singletons, as they're often born earlier and weigh less. Still, if your little ones turn out to be full-termers with no health issues, they'll be taken to the nursery and should only have to stay there for a day or two.

On average, the recovery time for a woman who gives birth to multiples, either vaginally or via C-section, is no longer than that of a woman who delivers one baby. Moreover, in the case of a vaginal delivery, your recovery may even be a little easier. "Multiples are smaller than singletons, so you're less likely to tear as they're coming through," Dr. Bender explains. But as with other births, your doctor will tell you to wait six weeks before you start exercising and having sex again.

While your body may bounce back quickly, the emotional adjustment could take longer. A new study from the Johns Hopkins Bloomberg School of Public Health, in Baltimore, found that women who deliver multiples are more apt to develop moderate to severe depression within nine months of giving birth than mothers who have just one baby. To avoid feeling overwhelmed, streamline your routine as much as possible, suggests Dr. Flais. For example, aim to get both babies on the same eating and sleeping schedule right off the bat. That means when one baby wakes up to eat, you should wake up the other one too. "If you're consistent, the babies will naturally adapt, so you shouldn't feel like you're doing them a disservice," she says.

Getting support from those around you is also essential, so make connections with other moms of multiples (check out the Website of The National Organization of Mothers of Twins Clubs, nomotc.org, to find a group in your area). And when friends ask how they can help, don't brush them off; suggest that they bring over dinner or babysit so you can get a little break. That way, you'll have more energy to enjoy the double dose of adorable that's been added to your life.

Some bassinets have only a 15-pound weight limit. The Arm's Reach Co-Sleeper, $200; armsreach.com, holds up to 30 pounds -- perfect for when you're trying to get two newborns to sleep.

Dual feedings are more manageable with the EZ-2-Nurse Twins pillow, $50; doubleblessings.com. It has a wide, angled top surface to better position both babies and also includes a supportive back pillow for Mom.

So much more convenient than a conventional stroller: The Baby Trend Snap-N-Go Stroller, $77; amazon.com, allows parents to place two infant car seats on its carriage frame without removing the babies first, and it can be folded down with one hand.

"I don't want my husband in the delivery room, and he's happy to stay outside. Everyone says we'll regret the decision. What should I do?"

Ignore the pressure to conform, and tell the peanut gallery your decision is what works best for your family -- no need to go into details. "What matters is that you have the support you need," says Brenda Jones, R.N., manager of the Center for Labor and Birth at Brigham and Women's Hospital, in Boston. Even if your husband isn't going to be the official coach, you might still ask him to come to birthing classes. It'll give him an idea of what you'll be going through, and if you change your mind at game time, he'll be ready to go. "There are many ways expectant fathers can be involved; being in the delivery room is just one," says Jones. Plus, the road ahead is filled with dad-friendly activities (think 4 a.m. feedings and poopy diapers).

Originally published in the January 2010 issue of Parents magazine.