Twins born premature

Preparing for Multiple Births (for Parents)

What Are Multiple Births?

A multiple birth is when a mother is pregnant with more than one baby. This may mean a twin pregnancy, triplet pregnancy, or more.

What Are the Types of Multiple Births?

There are two types of twins: monozygotic (identical) and dizygotic (fraternal).

Identical twins result from a single fertilized egg dividing into separate halves and continuing to develop into two separate but identical babies. These twins are genetically identical, with the same chromosomes and similar physical characteristics. They're the same sex and have the same blood type, hair, and eye color.

Fraternal twins come from two eggs that are fertilized by two separate sperm and are no more alike than other siblings born to the same parents. They may or may not be the same sex. This type of twins is much more common.

"Supertwins" is a common term for triplets and other higher-order multiple births, such as quadruplets or quintuplets. These babies can be identical, fraternal, or a combination of both.

What Are the Risks of Multiple Births?

Risks that can come with carrying multiple babies include:

Pre-term (or early) labor resulting in premature births. A typical, single pregnancy lasts about 40 weeks, but a twin pregnancy often lasts between 35 to 37 weeks. More than half of all twins are born prematurely (before 37 weeks), and the risk of premature delivery increases with higher-order multiples.
Premature babies (preemies) can have health challenges. Their risk increases the earlier they're born. Because the care of premature babies is so different from that of full-term infants, preemies are usually placed in a neonatal intensive care unit (NICU) after delivery.
Other conditions during pregnancy. Preeclampsia, gestational diabetes, placental problems, and fetal growth problems are more likely with multiple pregnancies. Because of this, moms who are pregnant with multiples are followed very closely by their doctor.
Long-term problems. Developmental delays and cerebral palsy are more likely as the number of multiples increases.

How Can I Stay Healthy During a Multiple Pregnancy?

Eating properly, getting enough rest, and regular prenatal care are ways for any expectant mother to stay healthy.

It's important to find health care professionals who have experience with multiple births, and to see your health care provider as he or she recommends. This is so that the doctor can be on the lookout for problems and treat them as needed.

Ask your doctor to recommend a facility that specializes in multiple births. You should be part of a pre-term birth prevention program at your hospital and have immediate access to a specialized NICU should you go into early labor or if one of your babies is born with a health problem.

What Should I Eat if I'm Pregnant With Multiples?

If you're pregnant with multiples, you should follow general pregnancy nutrition guidelines, including increasing your calcium and folic acid intake.

Another dietary requirement that must be increased if you're expecting more than one baby is protein. Getting enough protein can help your babies grow properly.

During pregnancy, an increased supply of iron is needed to make enough healthy red blood cells. Low numbers of red blood cells are common in multiple pregnancies. Your doctor will probably prescribe an iron supplement, as your requirement for this mineral usually can't be met by diet alone. Iron is absorbed more easily when combined with foods that have high amounts of vitamin C, like orange juice.

The doctor will also tell you what vitamins to take to get the nutrients your growing babies need.

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How Much Weight Should I Gain if I'm Pregnant With Multiples?

Mothers carrying multiples are expected to gain more weight during pregnancy than mothers carrying a single fetus. But exactly how much weight you should gain depends on your pre-pregnancy weight and the number of fetuses, so make sure to talk to your doctor.

In general, though, you should consume about 300 additional calories a day for each fetus. It might be tough to eat a lot when your abdomen is full of babies, so try to eat smaller, more frequent meals.

How Should I Prepare for Delivery?

Getting ready for a multiple birth may seem overwhelming, especially with concerns about pre-term labor. But know that you have a network of support around you: capable doctors, a caring hospital staff, and a partner, family members, and/or friends.

Discuss the options of vaginal delivery versus cesarean section (C-section) with your doctor well before your due date. Even if you and your doctor agree to attempt a vaginal delivery, things may happen during labor or delivery that make a C-section necessary.

You may choose to have additional birthing attendants in the room during labor and birth. For example, midwives are becoming more common. For multiples, it's usually recommended that a midwife work with a doctor, rather than alone.

Hiring a doula is another option. Doulas offer support services to women during the birth, as well as after delivery, by assisting with infant care and household chores.

What Will Delivery Be Like?

As labor begins, you'll be connected to a fetal monitor so your doctor can check each baby's progress.

If you're hoping for a vaginal delivery, remember that with multiples this isn't always possible. Sometimes, a C-section is needed to help keep the babies safe. Most triplets and other higher-order multiples are born by C-section.

If your doctor needs to do a C-section, a catheter will be placed in your bladder, you'll be given medicine so that you don't feel pain, and an incision will be made in your abdomen and uterus. The doctor will then deliver your babies through the incision. The babies will be delivered within just a few minutes of each other with this approach. The incision will then be closed.

Many babies born prematurely will need to go immediately to the NICU for the special care they need.

What Else Should I Know?

The first days, weeks, and months are often the most difficult for parents of multiples, as everyone gets used to the frequent feedings, lack of sleep, and lack of personal time.

It can help to join a support group for parents of multiples. Hearing what has worked well for others can help you find solutions to problems you come across.

Enlist whatever help you can — from neighbors, family members, and friends — for household chores and daily tasks. Having extra hands around not only will make feedings easier and help you rest and recover from delivery; it also will give you the precious time you need to get to know your babies.

Reviewed by: Larissa Hirsch, MD

Date reviewed: February 2018

Giving birth to twins | Pregnancy Birth and Baby

Twins are more likely to be born early, often before 38 weeks, so it's important to understand your birth options. Less than half of all twin pregnancies last beyond 37 weeks.

Because of the likelihood that your babies will be born early, there is a good chance one or both of them will spend some time in special care.

As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or doctor early in your pregnancy.

You should also discuss where you would like to give birth. You will most likely be advised to give birth in a hospital because there's a higher chance of complications with a twin birth.

It's common for more medical staff to be involved in the birth of twins, such as a midwife, an obstetrician and two paediatricians - one for each baby.

While the process of labour is the same as when single babies are born, twin babies are more closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once your waters have broken. You will be given a drip in case it is needed later.

Vaginal birth

About one third of all twins are born vaginally and the process is similar to that of giving birth to a single baby. If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when the mother already has good pain relief.

If the first twin is in a head down position (cephalic), it's usual to consider having a vaginal birth. However, there may be other medical reasons why this would not be possible. If you have had a previous caesarean section, it's usually not recommended you have a vaginal birth with twins.

If you have a vaginal birth, you may need an assisted birth, which is when a suction cup (ventouse) or forceps are used to help deliver the babies.

Once the first baby is born, the midwife or doctor will check the position of the second baby by feeling your abdomen and doing a vaginal examination. If the second baby is in a good position, the waters will be broken and this baby should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.

Caesarean section

You may choose to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a caesarean section later in the pregnancy as a result of potential complications. You’re nearly twice as likely to have a caesarean if you’re giving birth to twins than if you’re giving birth to a single baby.

The babies' position may determine whether they need to be delivered by caesarean section or not. If the presenting baby - the one that will be born first - is in a breech position (feet, knees or buttocks first), or if one twin is lying in a transverse position (with its body lying sideways), you will need to have a caesarean section.

Some conditions also mean you will need a caesarean section; for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.

If you have previously had a very difficult delivery with a single baby, you may be advised to have a caesarean section with twins. Even if you plan a vaginal birth, you may end up having an emergency caesarean section.

This could be because:

one or both babies become distressed
the umbilical cord prolapses (falls into the birth canal ahead of the baby)
your blood pressure is going up
the labour is progressing too slowly
assisted delivery doesn't work

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if it becomes distressed.

After the birth

After the birth, your midwife will examine the placenta to determine what type of twins you have. Twins can either be fraternal or identical.

If your babies need special care

Depending on where you plan to give birth, you may need to go to another hospital with appropriate facilities if complications in your pregnancy indicate you're likely to have an early delivery. This may not be near to home, so make sure to check there are enough beds for both your babies in the neonatal unit.

Ask if your chosen hospital has a transitional care unit or a special care nursery. These are places that allow mothers to care for their babies if they need special care but not intensive care. These hospitals are more likely to be able to keep you and your babies in the same place.

You might also want to ask if your hospital has cots that allow co-bedding (where your babies sleep in a single cot), if this is appropriate and if you want your babies to sleep together.

If you have one baby in the hospital and one at home, you will need to think about splitting your time between the two. When you visit your baby in hospital, ask if you can bring their twin and if co-bedding is allowed during visits.

If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is having trouble feeding. You may then need to put the twin who can feed on the breast to encourage milk production in order to get enough milk to feed both babies.

Check if your hospital offers support from a community neonatal nurse, which would allow for you and your babies to leave hospital earlier, for example if your baby is still tube-fed.

When you go to clinics for follow-up appointments, it's a good idea to ask not to be booked into early morning appointments. Getting out of the house with two babies, particularly if one is unwell, can be difficult.

For more information and support, visit Twins Research Australia.

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premature twins | Mothers today

It is a fact that more than 60% of twins are born before 37 weeks of pregnancy, i.e. they are premature twins . This figure, provided by the National Institute of Statistics, increases to almost one in 2018 when it comes to multiple births of more than two fetuses.

On various occasions in this blog we have talked about complications that both mother and child have premature births. This time we will focus more when we talk about two babies, whether twins or twins.

Index

1 Twins, premature, premature
2 Same incubator for two babies?
3 Other problems associated with premature twins

Premature twins, preterm

Multiple pregnancies are more difficult than single pregnancy. Among the most common are preterm labor and delivery. The higher the number of fetuses during pregnancy, the higher the risk of preterm birth. If a baby or two was born prematurely, there are organs in your body that are not yet mature. In many cases, they need help with breathing, eating, fighting infections, and maintaining body temperature.

Premature babies These are divided into sub-categories according to gestational age, extreme preterm babies under 28 weeks, they are especially vulnerable; the most preterm, between 20 and 32 weeks of age, and the moderately late preterm, born before 37 years of age. Premature twins are usually small and have a low birth weight of less than two and a half kilograms. Some of your organs are not ready for life outside of the uterus and may present problems that affect your health in the short, medium and long term.

Although it is true that the problems associated with premature babies are not too serious, some cognitive impairments that are usually identified before the age of five, or possible breathing problems, When it comes to twins, things get more complicated, so they will need to spend some time in the neonatal intensive care unit.

Same incubator for two babies?

Most twins They need an incubator at birth. Various studies, including one conducted by HM Belén Maternity, a neonatal intensive care unit nurse in A Coruña, confirm that keeping them in the same incubator has important benefits for them.

Co-bedding is a practice that consists of keeping premature twins in the same incubator or warm bed during their stay in the neonatal unit . It is logical to assume that if brothers spent several months together in the womb, touching and sharing the same space, they should not occupy different places at birth.

This bonding practice allows babies to maintain a special bond. It also promotes sleep-wake synchronization, skin-to-skin kangaroo method and breastfeeding. On the other hand, it is emotional support for moms and dads.