Friday, September 28, 2012

"Don't be so dramatic. It's just like carrying one baby."

I have noticed something quite striking during this pregnancy: women who have never been pregnant with multiples can sometimes make such rude statements that I'm left speechless.  I decided to write this to shed a little light on the misconceptions and physical differences experienced when carrying more than one baby. And yes, all of these green statements have actually been said to me.

Misconception #1 "Being pregnant with multiples is the same as being pregnant with one baby. You just get to give birth sooner! Consider yourself lucky."
Reality: A multiple pregnancy differs from a singleton pregnancy in many ways, but to focus on a shorter gestation is a fallacy. Your due date with a multiple pregnancy doesn't magically get pushed forward, and your babies won't magically grow more quickly to be ready for the world if they are born early. The fact is that humans are not built to grow more than one baby at a time. Because of this, multiple pregnancies often end in preterm labor (before 37 weeks), mainly because the placenta becomes inefficient once the babies get to a certain size and begin to require more than the mother can provide. On average a singleton pregnancy last 39 weeks, a twin pregnancy 36 weeks, and a triplet pregnancy 32 weeks. Babies born prior to 37 weeks usually need at least some NICU care. I have a feeling no mother would feel "lucky" to have any child in the NICU.
Great example of a belly difference

Misconception #2 "Don't be so dramatic. There are risks of complications in any pregnancy. Having more than one baby doesn't change that."
Reality: Aside from preterm birth discussed above, women pregnant with multiples are also more likely to experience the following (www.americanpregnancy.org):
  • Low Birthweight: Low birth weight is almost always related to preterm delivery.
  • Intrauterine Growth Restriction (IUGR): The growth rate of twin pregnancies begins to slow at 30 to 32 weeks. Triplet pregnancies begin slowing at 27 to 28 weeks, while quadruplet pregnancies begin slowing at 25 to 26 weeks. IUGR seems to occur because the placenta cannot handle any more growth and because the babies are competing for nutrients
  • Preeclampsia: Twin pregnancies are twice as likely to be complicated by preeclampsia as single pregnancies. Half of triplet pregnancies develop preeclampsia.
  • Gestational Diabetes: The increased risk for gestational diabetes in a multiple pregnancy appears to be a result of the two placentas increasing the resistance to insulin, increased placental size, and an elevation in placental hormones.
  • Placental Abruption: Placental abruption is three times more likely to occur in a multiple pregnancy.
  • Fetal Demise/Loss: Very rare, generally occurs during the first trimester.
  • Cesarean: The vaginal delivery of twins depends on the presentation of the babies. All higher multiples are born by C-section.
Misconception #3 "What do you mean you're not going back to work? You're only 26 weeks pregnant."
Reality: The beginning of a multiple pregnancy is very similar to a singleton pregnancy until around 9 weeks. At that point mothers of multiples often begin to show, and will usually need maternity or larger clothes shortly thereafter. During a singleton pregnancy mothers often experience a "honeymoon" phase during the second trimester. They are no longer feeling ill from morning sickness, and they are still very small and able to move around easily. During a multiple pregnancy however, women often experience morning sickness symptoms much longer, even into the 5th month. At this time the growth of the babies is increasing and the mother can find herself measuring 10 weeks (or more!) larger than how far along she actually is. At 20 weeks with my pregnancy I measured 29 weeks! It quickly becomes very difficult to move around. By 26 weeks, the week I would have gone back to teach school, I measured 36+ weeks. Most mothers of multiples will tell you that it is best to have as much prepared and organized by the 28th week (third trimester). The possibility of complications, preterm labor, sporadic bed rest, hospital visits, and general discomfort that you will experience increases dramatically at this time.



34 weeks 1 baby vs. 24 weeks 2 babies

Misconception #4 "Sleeping is always uncomfortable when you're pregnant. Stop complaining."
Yes, sleeping during pregnancy is uncomfortable whether you've got one baby or 5, but I would like you to consider something for a moment: When you get really big with one baby you have a significant advantage of being able to at least lay on one side! First of all, multiple mommies get "that big" much sooner, and the biggest problem is...you can't lay on either side. No stomach sleeping (obviously), no back sleeping (the increased weight of your uterus presses on the major vein that returns blood from your legs to your heart...you'll pass out), and no side sleeping because on either side you'll be pressing on a baby. They will kick, push, poke, and do lots of other stuff to make you so uncomfortable you have to adjust your position...but to what??? I spend a lot of time awake.

Misconception #5 "Why are you always at the doctor? Hypochondriac much?"
Reality: Even if there's nothing wrong with a baby's chromosomes, twins or triplets are more likely than singleton babies to be born with defects of the brain, heart, bladder, or liver. Multiples are also more likely to be born with cerebral palsy. Cerebral palsy was recently found to be four times more common in twins than in singletons. Because of these risks and the ones mentioned above, a multiple mommy should expect to be considered "high risk", even if all other aspects of the pregnancy are normal and healthy. With that label comes many extra visits to the OB for general checkups, blood tests, urine samples, ultrasounds, and the rare physical exam if necessary. Around 32 weeks, or earlier for higher multiples, it is common for mothers of multiples to begin fetal heart rate monitoring and weekly prenatal checkups. This usually means that from this point until the birth you will spend 3 days or more each week visiting with your OB and the hospital. At any fetal heart rate monitoring session it is possible that the mother will be admitted into the hospital for delivery, so multiple mommies need to be sure their hospital bag is in the car before the 32nd week begins.

If you  know a multiple mommy-to-be, think before you speak. Chances are she's tired, stressed about the health of her babies, uncomfortable, sleep deprived, and hungry :)


8 comments:

  1. Boy do I understand THIS! I wrote a blog post called "No Platitude Zone" for all of the idiotic comments I got with a breast cancer diagnosis.

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  2. For some reason hearing certain medical things cause certain people to feel they can say whatever they like. It really puts the person they're saying them to in the awkward position of not being able to say how they're really feeling. Unfortunate.

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  3. I actually didn't know a lot this stuff.!!! Looks like your little boys came out perfect: )

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  4. Very well said! I've heard them all. In the moment it's hard to explain to them. Thanks for the read :)

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  5. This is great! I actually had a mom who had just given birth to her second singleton tell me, very early in my pregnancy, "Well, at least if you lose one, you still have the other." I looked at her and said, "Ok, so if you lose one of yours, you'll still have the other, right?" It is amazing how many people don't think before they speak.

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  6. Great post! I ran into a lot of this with my twin pregnancy this past year. People couldn't understand why it was harder for me to continue my workouts, why I looked "SO HUGE" regardless of my overly healthy eating habits. As fascinated as people were, there was also a sense of alienation. Idk if anyone else experienced that, but I did. I wasn't able to go to some classes that some mothers-to-be got to go to because I was instantly high risk since I was having twins. Thankfully, I had very few complications other than bed rest my last month. At 38 weeks they induced me because they wouldn't allow twins to go past that. I was pretty lucky.

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  7. I had twins in December 2012. At the time, I also had a one year old. Being pregnant with twins was totally different. The pain was worse. Both pregnancies I vomited through the whole time, so that wasn't too different. I had doctor appointments every week, and also always got ultrasounds. I had the twins while 33 weeks, spent two weeks in the NICU. They weren't ready to come home though, so we spent a lot of time in the hospital. It is a very scary thing. It takes strong people to be parents of multiples. I've met a lot of parents with multiples though, and find it a lot easier having the right friends, even if its through the internet.

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  8. Absolutely! I have a singleton and then I had my twins. That twin pregnancy was brutal, even as smoothly as everything went for us, I would never wish that on anyone.

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