St. Mary's Medical Center

Spring 2015

Spirit of Women magazine is a national publication presented to women by hospitals and their physicians. The magazine provides up-to-date, evidence-based healthcare information and promotes our hospitals as leaders in women's health excellence.

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2 3 w w w. s p i r i t o f w o m e n . c o m S P R I N G 2 015 S P I R I T O F W O M E N SHUTTERSTOCK T he news that you're pregnant with twins or triplets can come as quite a shock, pleasant though it may be. But there's no reason to panic as long as you know what's ahead both mentally and physically throughout a multiple-birth pregnancy. "Get counseled early and well about what to expect and consider when pregnant with multiples," says Dr. Christina Pisani-Conway, an obstetrician affiliated with Penn Highlands Healthcare in DuBois, Pa. "The good news for women who discover that they are carrying twins, triplets or higher-order multiples is that the incidence of multi-fetal gestations in the U.S. has increased dramatically over the past several decades. Prenatal providers understand better than ever how to take care of mothers with these pregnancies." GET AN EARLY START Because medical complications are more common in a multiple pregnancy, including nausea and vomiting, gestational diabetes, hypertension, preterm labor, anemia, hemorrhage, cesarean delivery and postpartum depression, it's key to find a physician you trust and work well with right away, says Dr. Pisani-Conway. "Women should feel empowered to ask questions if they have concerns and to find a provider who answers their questions to their satisfaction," she says. A consultation with a high-risk pregnancy specialist early in pregnancy is also vital so you can make a comprehensive care plan. "It is important to know whether each fetus has its own placenta and amniotic sac or whether they share, because this really impacts risks for congenital defects and can sometimes only be definitively established early," says Dr. Pisani-Conway. "If we can counsel people early about the unique traits of their pregnancy, then the information doesn't sideswipe them later when it's more cumbersome to treat." She also recommends early genetic counseling because the routine tests for detecting Down syndrome can be less reliable when there is more than one fetus. PRENATAL PREPARATION Dr. Michele Johnson, an OB/GYN affiliated with North Colorado Medical Center, Greeley, Colo., says much of the advice for a multiple pregnancy is the same as that for single pregnancies: limiting vigorous activities, eating plenty of fruits and vegetables and lean proteins, getting enough rest, drinking enough fluid and taking a prenatal vitamin. The main difference for those with multiple pregnancies, she says, is making more frequent visits to the doctor and getting more ultrasounds because both twins and triplets are at higher risk for conditions like preterm labor, so they will require more monitoring. Some physicians, including Dr. Eric Fish, an OB/GYN affiliated with Schneck Medical Center in Seymour, Ind., advise moms who are pregnant with twins to up their calorie intake by 500 calories rather than the usual 300 calories for single pregnancies, and to add one milligram of folic acid daily. Dr. Fish also recommends that mothers of multiples have ultrasounds every three weeks to monitor growth. SPECIAL DELIVERIES Even though twins and triplets tend to be on the smaller side—generally 5.5 pounds up to 7 pounds each—the weight of multiples can cause more discomfort as the pregnancy nears its end. "The uterus is a muscle and it just knows when it gets full, and with multiples it gets full earlier," says Dr. Rachel Niemet, an OB/GYN at Parkview Medical Center in Pueblo, Colo. "Sometimes swimming can be very beneficial because the water takes the pressure off and can reduce the swelling of the legs," she adds. Walking can be helpful too, and some maternity support belts can help ease the pressure of the belly on the pelvis. In the last trimester of a multiple pregnancy, it's especially important to pay close attention to signs of contractions or preterm delivery symptoms such as vaginal bleeding, water breaking or other changes. Most twins will arrive between 37 and 39 weeks and may be able to be delivered vaginally, says Dr. Johnson, while most triplets will deliver by 36 weeks and almost exclusively by cesarean section. With early and frequent medical care throughout pregnancy, mothers of multiples can give their new little bundles of joy the best chance for a healthy, uncompli- cated birth before the real fun begins back at home. • Breastfeeding twins or triplets can be more challenging than feeding a single baby, but many women can produce enough milk through nursing and/or pumping to satisfy two or more babies. For help with the basics and the special strategies that make it easier to breastfeed multiples, plan on taking breastfeeding classes designed for mothers of multiples before you give birth, if possible. You can fnd classes through your pediatrician's offce, your hospital or La Leche League ( Your hospital may also offer the services of a lactation consultant and local support groups who can provide ongoing help with breastfeeding. Breastfeeding multiples

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