Risk in Multiple Pregnancies

You are not allowed to read this without understanding the following: risk is relative. You are at risk by driving your car, flying in a plane or crossing the street. Why do I say this? From the moment you find out that you are pregnant with twins, you will be thrust into the world of a highly managed pregnancy. That might be fine with you. It wasn’t with me, until I understood multiple pregnancies a little better.

Change of Plans

I have never had a home birth but if our insurance covered it, I would’ve. As an alternative, I found a doctor who was fine with a ‘not so hands on approach’ to pregnancy and birth. I had one sonogram, took a minimal amount of blood tests (only those that were medically necessary like glucose monitoring), and my doctor understood his proper place in the delivery room: just catch the baby and cut the cord. (My husband is a wonderful dad but the blood and guts of birth is a little too much for him. He’ll take the babies nice and cleaned, thank you.) I was very comfortable with the arrangement and planned nothing differently. Then we found out we were having twins.

Twins Are Different

As I mentioned in my last blog on twin pregnancies, twins are simply different. Women’s bodies respond differently to a twin pregnancy than they do a singleton pregnancy. Twins in utero do all sorts of things that singletons don’t–regardless of parity of the mother and regardless of her previous birthing experience. With that said, the pregnancy must be managed differently.

Some Risks of Twin Pregnancies

I will blog more extensively on risks in twin pregnancies and how some of these risks may be managed (if they can be managed at all). Again, please understand that a risk is just that. Just because I say that you are at risk. . .doesn’t mean it will happen. However, in the case of twin pregnancies, knowing your risks can help you prevent them.

Early miscarriage–If you find that you are expecting twins early in your pregnancy (before 12 weeks), it is common to lose one of the twins. Doctors are finding this to be a more common occurrence as sonograms are being done earlier. Some estimate that as many as 70% of pregnancies that start as twins–end in the birth of one baby. The body either reabsorbs the second twin, or the mother miscarries one of the twins.

Pre-term labor–It is important for the expectant MOM (mother of multiples) to understand that she is at risk for pre-term labor with twins REGARDLESS of her previous experience. Only 15% of MOMs carry past 36 weeks. The average gestational age for twins is 36 weeks, and it decreases 3 weeks for each additional baby. So with triplets the average gestational age is 33 weeks, for quads its 30 weeks, etc.

TTTS–Twin to twin transfusion syndrome will only occur in the case of identical twins. This is where the twins share blood vessels and most often occurs where the twins share the same amniotic sac. The result can be that one twin gets the bulk of the nutrients, blood and oxygen it needs to grow while the other twin “starves’. TTTS can be treated via surgery if the case is severe enough.

Delivery via C-Section

Many women who have their hearts set on more natural birthing circumstances are a little dismayed to find that all of their plans have fallen by the way side in favor of a labor that is highly monitored. But as I’ve said before twins are different. Fifty percent of twin deliveries end in c-section. Almost all triplets are born via c-section. Again, this is regardless of previous birthing experience, medical intervention or lack thereof. In most cases, the issue is how the fetuses are presenting. You would think that there is simply no room for them to move and once they’re “in position” they stay that way, however just the opposite is true.

It is normal to expect a certain amount of medical intervention during a twin pregnancy. The important thing is to make sure that you are prepared and well educated so that you can use the intervention to your advantage to have a great birth.

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