5 Things You Need To Know Right Now About Your Multiple Pregnancy

 

Order your pre-launch copy of the book DOUBLE HAPPINESS MULTIPLIED - What you need to know about having Twins, Triplets, & Quads HERE: 

https://www.doublehappinessmultiplied.com/twins-triplets-quads-book/

Welcome to Season One, Episode Two of the Double Happiness Multiplied podcast.

On this episode, we’re joined by Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell who will give us some tips on what you should be asking during your appointments with your Specialist or Obstetrician.

Sonographer Sam Ward explains what to expect at your ultrasound appointments at each stage of your pregnancy.

And, Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson offers guidance about choosing the right support team for your pregnancy.

The shock

Finding out your expecting multiples can be quite a shock and can throw you into a world of confusion and anxiety. Knowing what questions to ask your obstetrician, midwife, or sonographer and when you should ask specific questions isn’t easy to navigate, especially for a first-time parent.

A few questions you’ll want to ask your obstetrician are:

  • What type of placentation do my babies have?

  • What tests and procedures will I have to have?

  • What is your philosophy on delivering twins?

  • How many multiples have you delivered in the past few years,

  • And, how do I get in touch with you if needed?

To guide you further, Maternal-Fetal Medicine Specialist Professor Craig Pennell has this advice:

The first question you should ask your Obstetrician is what do I have to do in a twin pregnancy that is different from a singleton pregnancy?

There are many things that are different in multiple pregnancies than in a singleton pregnancy, for example:

  • You’ll be seen more frequently

  • You’ll have more ultrasound scans

  • The vitamin supplementation is a lot more important

Professor Pennell says the second question you should ask is what type of placenta do my multiples have, which means are your twins identical or non-identical?

“The risk in Dichorionic Diamniotic or non-identical twins, outside of prematurity, are very similar to singleton pregnancies,”

“Whereas, if you have identical twins, depending on the type, those risks can go up from a few per cent up to 20 or 30 per cent of pregnancies having adverse outcomes.

"So, you really want to know if you are a low-risk twin pregnancy, a moderate-risk twin pregnancy, or very high-risk twin pregnancy,” says Professor Pennell.

“You really want to know if you are a low-risk twin pregnancy, a moderate-risk twin pregnancy, or very high-risk twin pregnancy. The care that you will get and your expectations will be very different depending on what group you are in.”

Time of delivery

With modern obstetric care and based on the most recent data, most twin pregnancies are delivered by the end of their 37th week.

“With Dichorionic Diamniotic twins, if the woman hasn't gone into labour by 37-weeks, then they will be induced or they have a planned caesarean section,”

“The reason for that is the rate of stillbirth starts to increase dramatically.  That’s where that window of 37-weeks comes from,” says Associate Professor Pennell.

Recommended times to deliver twins:

  • Dichorionic-Diamniotic twins – 37-weeks’ gestation.
  • Monochorionic - twins 36-weeks’ gestation.
  • Monoamniotic twins - 30-32 weeks or as early as 28 weeks’ gestation.

Multiple pregnancy protocols

Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson says after having a singleton pregnancy and birth, and then a twin pregnancy and birth she noticed a lot more protocols in place for multiple pregnancies, and oftentimes those protocols might not be relevant to you and your babies.

“I think a lot of the time especially for multiple births, but also even just for singletons, we go into the hospital system and we’re put on a little conveyor belt and we just go through that system, travel through and all of the protocols are told to us and we just follow them along,”

“So, I’d be asking what does that protocol mean to me and my babies, and is it appropriate for me to have this intervention, or have this scan, or have this test,” explains Elyse.

Elyse says if you use this following list of questions, it can make the choice to have or not-to-have an intervention or a test much easier.

What are the Benefits of this procedure or test?

What are the Risks associated with it or what are the Risks if I don’t have it?

What are the Alternatives to this?

What’s my Intuition telling me about this?

And what happens if we just do Nothing for the moment?

Communication = Less Stress

Another key part Elyse advocates for is creating minimal stress during your multiple pregnancy and the best way to go about this is to simply communicate your wishes to everyone on your team so they all can support your wishes.

“When something crops up it’s so easy to move through it,”

“That’s how I feel my birth and pregnancy went as smoothly as it did was that everyone knew what I wanted,” says Elyse.

This all sounds very empowering; however, Elyse warns that if you’re challenging the norm, make sure you have researched the protocols first. Instead of making demands, try asking questions along the lines of,

"I know this is your protocol, but what happens if we try it this way?"

"Is that an option for me?"

"Here’s all the research I’ve done on it, what do you think about that?"

You’re more likely to find a sympathetic ear that way.

“So, going in and asking the questions and finding out if your care team is supportive of that, or if there is someone down the road who is skilled in that or who does work in that way,”

“Choosing those people you have around you is the most important thing,”

“I would absolutely be recommending women who do have more than one baby on board to go out there and do their research, or go out there and find a childbirth educator, or a doula, or a midwife, or someone who can help you navigate all the protocols and systems in place,” says Elyse

Your Sonographer

Just as important as having a team that you’re confident with to guide you through your pregnancy, a sonographer who is skilled in multiple pregnancies is also crucial to not only your diagnosis but how the management of your pregnancy is handled.

Samantha Ward is a sonographer who has worked with Multiple Births Specialists for more than a decade. She agrees that the more informed you are about what to expect during your pregnancy you’ll be more prepared for each milestone or hurdle.

She says the most important thing is to check what type of twins you’re having or what type of higher order multiple you’re having because the obstetric care differs very greatly between Dichorionic (fraternal) and Monochorionic(identical) twins.

Dichorionic twins are the least complicated set of twins and Monochorionic twins can develop various potential complications because they actually share a placenta,”

“So, knowing whether the twins are Dichorionic or Monochorionic will greatly change the obstetric care and the number of scans that the patient will have during their pregnancy,” says Samantha.

Once it’s been established that you have Monochorionic twins on board, whether that’s part of a twin, triplet, or quadruplet pregnancy the schedule of scanning would look something like this:

  • Dating scan

  • 12-weeks’ gestation – to assess for chromosomal abnormalities, stages of early development, and cord insertion.

  • 15-weeks’ gestation - to assess for chromosomal abnormalities, stages of early development, and cord insertion.

  • 19-weeks’ – anatomy scan.

  • Then, every 2-3 weeks, if there are no complications.

For Monochorionic Monoamniotic gestations:

  • Dating scan

  • 12-weeks’ gestation – to assess for chromosomal abnormalities, stages of early development, and cord insertion.

  • 15-weeks’ gestation - to assess for chromosomal abnormalities, stages of early development, and cord insertion.

  • 19-weeks’ – anatomy scan.

  • Then, bi-weekly progressing to daily with inpatient care at about 26-weeks’ gestation.

For Dichorionic gestations:

  • Dating scan

  • 12-weeks’ gestation – to assess for chromosomal abnormalities, stages of early development, and cord insertion.

  • 15-weeks’ gestation - to assess for chromosomal abnormalities, stages of early development, and cord insertion.

  • 19-weeks’ – anatomy scan

  • Then, every four-weeks if there are no complications.

With multiple pregnancies, there are things that are examined more closely than a singleton pregnancy. Equally, with a Monochorionic set of twins, there are some things that are looked at more closely than in a set of Dichorionic twins.

“So, with the Dichorionic, or non-identical twins, we compare the babies’ growth to see if the babies are growing along the same centile, and are both the babies are growing along the centile that we’d expect for their gestational age,”

“We also need to check to see if the fluid is equal in both of the sacs,"

"Even though Dichorionic twins have their own placentas and don’t share any blood flow through the placentas, however, they are still at a higher risk of structural anomalies,"

"So, even these least complicated twins are at risk of heart anomalies and various other structural anomalies,” says Samantha.

What is being assessed?

Dichorionic

  • Growth.

  • Fluid volumes.

  • Placental function.

  • Structural anomalies.

With Monochorionic twins there are quite a few different tests that are required for each scan.

  • Growth.

  • Fluid volumes.

  • Bladders – does one baby have a full bladder and the other an empty bladder?

  • Examination of the dividing membrane to ensure it is floating freely.

  • Placental cord insertions.

  • Placental appearance.

  • Fetal Doppler studies – checking the blood flow through the cord of each baby, blood flow through the middle cerebral artery, and the blood flow through the Ductus Venosus.

  • Structural anomalies.

“All of those components that we’re looking at add together to tell us the health of the baby,

"It also tells us, are the babies sharing the placenta equally because Monochorionic twins are at risk of various complications due to the shared placenta, the most common one being twin-to-twin transfusion syndrome,” explains Samantha.

What Does That Mean?

Women are very informed about their pregnancies and come to ultrasound appointments prepared and often armed with a raft of questions. Some of the most common and useful questions you can ask your sonographer are:

  • Are my babies growing nicely?

  • Are they of equal size?

  • Is there a normal amount of fluid in the babies’ sacs?

  • Are the blood flows in the cord and the brain looking okay?

  • Is the placenta looking healthy?

  • Where is the cord inserting into the placenta?

“I find it, as a Sonographer, very useful if patients ask me these question at the time because I like to show them as I’m scanning in real time the fluid around their babies, I like to show them the blood flows through the cord and to the brain,”

“If there is a complication developing, I find that the patient has a better understanding if we can actually show them, for example, the difference in the fluid in both of the sacs,” says Samantha.

It isn’t, however, the role of the Sonographer to diagnose or advise patients on available treatment options.

Remember, whether you’re navigating the public or the private system, you have the right to have your questions answered. And, if you find yourself negotiating protocols, remember to approach the situation armed with plenty of research.

KEY POINTS:

  • You will visit your obstetrician more regularly with a multiple pregnancy than with a singleton.

  • Knowing whether you have Dichorionic or Monochorionic gestations will greatly change the obstetric care and the number of scans you will have during your pregnancy.

  • Whether you’re navigating the public or the private system, you have the right to have your questions answered.

  • If you’re challenging the norm, make sure you have researched the protocols first.

  • Choosing people with experience in multiple births to be on your support team is crucial.

NEXT EPISODE

On episode THREE, we talk about the impact nutrition has at every stage of your multiple pregnancy.

Maternal-Fetal Medicine Specialist Professor Craig Pennell joins us again, explaining the currently suggested supplementation required to provide adequate vitamins and minerals for multiple foetuses.

Nutritionist and Dietician Jessica Ruescher from Essence of Eating tells us how to make the correct decisions about food to capitalise on your nutritional intake for the health of you and your babies.

And, I’ll share my story of losing a significant amount of weight in my first trimester before realising I was pregnant and the battle to gain weight while suffering hyperemesis.

Until next time…

I wish you Double Happiness ... Multiplied.

LINKS:

Double Happiness Multiplied Book

https://www.doublehappinessmultiplied.com/twins-triplets-quads-book/

Double Happiness Multiplied 

www.doublehappinessmultiplied.com

Podcast music by:

Catherine Ashley Harpist

www.facebook.com/catherineashleyharpist

www.catherineashleyharpist.com

www.facebook.com/waharpcentre

www.waharpcentre.com.au

Produced by:

Stuart James

Soundfield Studio

http://www.soundfieldstudio.com/

Voiceover:

Louise Rowe

https://www.linkedin.com/in/louise-rowe-88aa5a95/

RESOURCES:

Helping Little Hands

https://www.facebook.com/helpinglittlehandsAustralia/

http://www.helpinglittlehands.org

hello@helpinglittlehands.org

Elyse Jamieson
Hypnobirthing Australia™ Practitioner & Doula, Soma Birth

http://www.somabirth.com.au

elyse@somabirth.com.au

Australian Multiple Birth Association

https://www.amba.org.au/

Perth & Districts Multiple Birth Association

http://www.pdmba.org.au/

Multiples of America

http://www.multiplesofamerica.org/

Twins & Multiple Births Association

https://www.tamba.org.uk

The Multiple Births Foundation

http://www.multiplebirths.org.uk/

Irish Multiple Births Association

http://www.imba.ie/

Multiple Births Canada

http://multiplebirthscanada.org/

International Council of Multiple Birth Organisations (ICOMBO)

http://icombo.org/

 

About the author, Sally

Sally Barker is a Hypnotherapist, Meditation Mentor, Pregnancy & Birth Trauma Coach, Podcaster, Author, and Educator on the topic of Multiple Births.

First and foremost, though, she is the proud Mamma of identical twin girls.

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