Expecting Twins? Preparing for Childbirth

Although regular childbirth classes may have some useful information if you’re pregnant with twins, most of them don’t adequately prepare future parents of multiples. Many of these classes assume there will be a natural, uncomplicated vaginal delivery, which frequently does not happen with a multiple birth. In fact, close to 50 percent of twins are delivered by cesarean section, which may not be addressed in a regular childbirth class. Talk with your doctor about his expectations for your delivery. If you agree to try for a vaginal birth, a regular childbirth class may have some helpful tips for you, but you’ll still need to get information on the uniqueness of a twins delivery.

Fortunately, more and more classes for parents of multiples are becoming available. For example, the Marvelous Multiples program (www.marvelousmultiples.com ), started by a nurse and mother of multiples, teaches parents about the special concerns and complications with a twins pregnancy, signs of preterm labor, labor and delivery (both vaginal and cesarean), breastfeeding multiples, and managing twin newborns. Check their web site to see if a program is available in your area. If not, your local hospital or local Mothers of Multiples support group should have information on classes for parents expecting multiples. If you know other parents who are expecting twins, you could even hire a childbirth educator who specializes in multiples to meet with all of you together.

Also, keep in mind that there’s a good chance your twins will NOT be born near their due date. A “normal” pregnancy spans 40 weeks or so, but more than 50 percent of all twins and almost all triplets (and other higher order multiples) will arrive before 37 weeks gestation. Many expectant mothers of multiples are also ordered on bed rest, and are no longer able to get out and about to attend classes or prepare for their babies’ birth. For that reason, you should take your childbirth preparation classes in the second trimester.

Talk to other mothers who have given birth to multiples, but also keep in mind that there are plenty of “scare stories” out there. Every experience is different. My twins were born at 39 weeks through vaginal delivery and never went to the NICU, but other parents have had different experiences. By educating yourself as much as possible and being open to the unexpected, you’ll be well-prepared for your own unique pregnancy and delivery!

What Is Twin-to-Twin Transfusion Syndrome (TTTS)?

How often are we intrigued and amazed by the sight of identical twins? Little do we know how often identical twins don’t survive pregnancy or birth due to a deadly complication called Twin-to-Twin Transfusion Syndrome. TTTS kills more babies every day than SIDS, yet hardly anyone outside the twins community has heard about this potentially fatal condition. Here is a description of TTTS by the Fetal Hope Foundation:

TTTS or Twin-to-Twin Transfusion Syndrome is a disease of the placenta. It affects pregnancies with monochorionic (shared placenta) multiples when blood passes disproportionately from one baby to the other through connecting blood vessels within their shared placenta. One baby, the recipient twin, gets too much blood overloading his or her cardiovascular system, and may die from heart failure. The other baby, the donor twin or stuck twin, does not get enough blood and may die from severe anemia. Left untreated, mortality rates near 100%.

The cause of TTTS is attributed to unbalanced flow of blood through vascular channels that connect the circulatory systems of each twin via the common placenta. The shunting of blood through the vascular communications leads to a net flow of blood from one twin (the donor) to the other twin (the recipient). The donor twin develops oligohydramnios (low amniotic fluid) and poor fetal growth, while the recipient twin develops polyhydramnios (excess amniotic fluid), heart failure, and hydrops. If left untreated, the pregnancy may be lost due to lack of blood getting to the smaller twin, fluid overload and heart failure in the larger twin, and/or preterm (early) labor leading to miscarriage of the entire pregnancy.

One in 7 pregnancies with identical twins is afflicted with TTTS. Before the condition could be diagnosed by ultrasound, less than 10 percent of TTTS twins survived. Those who did survive were often greatly impaired. Now the odds of survival have significantly improved through medical intervention during pregnancy and after birth. Many parents of TTTS twins (as well as those parents who have lost twins from this condition) have benefited greatly from support groups. Two such organizations are the Twin to Twin Transfusion Syndrome Foundation at www.tttsfoundation.org and the Fetal Hope Foundation at www.fetalhope.org.

Please take a moment to watch this moving slide slow about a couple’s journey through TTTS: http://www.ssmpfiles.com/ourtttsjourney/index.html.