HELP ME PLEASE! I’m Having Twins & I’m Freaking Out.

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.

So, how will you know what questions to ask and when to ask them?

To get you started, here are a few questions you’ll want to ask your obstetrician:

  • 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?

Now, that’s just the beginning.

Chair in Obstetrics and Gynaecology and Professor Maternal Fetal Medicine, Head of Discipline Obstetrics and Gynaecology at the University of Newcastle and John Hunter Hospital Professor Craig Pennell says the first question you should ask your Obstetrician is what do you have to do in a twin pregnancy that is different from a singleton pregnancy?

He goes to explain that there are many things that are different in multiple pregnancies, for example:

  • You’ll be seen more frequently.
  • You’ll have more ultrasound scans.
  • And, 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?

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

“Whereas, if you have Monochorionic or identical twins, depending on the type, those risks can go up from a few per cent 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.

This is important to understand because the type of multiple you’re carrying determines the level of care you’ll require throughout your pregnancy.

You can read more about types of multiples in this earlier post:

https://www.doublehappinessmultiplied.com/blog/having-multiples-part-one-twins/

“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 what group you are in.”

~Professor Craig Pennell~

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 women haven’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 after that, that’s where that window of 37-weeks comes from,” says Professor Pennell.

Recommended times to deliver twins:

  • Dichorionic-Diamniotic twins – 37-weeks’ gestation.
  • Monochorionic - 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 that 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 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,”

“Sometimes the protocols, they’re there for a reason and I absolutely respect them, but sometimes they’re not based on your needs as an individual,”

“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.

The BRAIN Questioning

Elyse suggests using the BRAIN acronym to determine whether certain protocols are relevant to your situation:

B – Benefits

R – Risks

A – Alternatives

I – Intuition

N – Nothing

Using this list of questions can make the choice to have or not-to-have an intervention or a test a little bit easier. So, you’ll ask questions such as;

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?

What happens if we just do Nothing for the moment?

Another key part Elyse advocates, to create minimal stress during your multiple pregnancy, is to communicate your wishes to everyone on your team so your wishes can be supported.

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

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?

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

Is this alternative an option for me?

You’re more likely to find a sympathetic ear if you approach your team this way.

“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,”

“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 does work in that way,” says Elyse

“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.”

~Hypnobirthing Practitioner & Doula Elyse Jamieson~

 

Just as important as having a team you have confidence in 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.

Ultrasound Monitoring

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 the more prepared you’ll be 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-rarely they can also be identical) 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.

“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.”

~Sonographer - Samantha Ward~

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, certain things are examined more closely than with 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.

What is being assessed?

  • Growth.
  • Fluid volumes.
  • Placental function.
  • Structural anomalies.

Dichorionic:

Even though Dichorionic twins have their own placentas and don’t share any blood flow through the placentas, they are still at a higher risk of structural anomalies. So, growth is compared to determine if the babies are growing along the same centile and if they’re growing along the centile that’s expected for their gestational age. Also, the fluid volumes will be monitored to ensure each sac is equal.

“Even these least complicated twins are at risk of heart anomalies and various other structural anomalies,” says Samantha.

Monochorionic:

There are quite a few different tests that are required at each scan for Monochorionic twins.

  • Growth - to ensure they are following the expected centile for gestational age.
  • Fluid volumes – making sure they are equal.
  • 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 and 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.

Being Prepared

 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’s important to note; however, it isn’t 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 it's advisable 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.
  • 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.
  • Whether you’re navigating the public or the private system, you have the right to have your questions answered.

 

Until next time…

I wish you Double Happiness ... Multiplied.

SallyB

LINKS:

Double Happiness Multiplied - What you need to know about having Twins, Triplets, & Quads book.

https://www.amazon.com.au/Double-Happiness-Multiplied-having-Triplets-ebook/dp/B07L6SN2RM

The Pregnancy & Birth Trauma Healing Lounge

https://www.facebook.com/groups/209171206299695/?source_id=1565097403556308

Podcast S1 E2 – What Does That Mean?

https://itunes.apple.com/au/podcast/s1-e2-what-does-that-mean/id1342450381?i=1000401095884&mt=2

Double Happiness Multiplied

www.doublehappinessmultiplied.com

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/

South African Multiple Birth Association

http://www.samultiplebirth.co.za/

 

 

 

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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