So you’ve been reading all about what to expect during pregnancy, but now you’ve just heard some news that changes everything - you’re carrying double, triple, or more! Whether you’re overjoyed, overwhelmed, or both, before you can push around the double stroller or dress your little duo in matching rompers, you’ve got to get through your pregnancy. Here’s a rundown of what you should expect now that you’re having multiples.
The First Signs of Multiples
You probably discovered that you’re carrying twins (or more) during a routine ultrasound in the first trimester. Of course there’s a chance that you, a nurse, or your doctor noticed you looked slightly bigger than normal for your delivery date well before you saw what was going on inside.
With a singleton pregnancy, you’ll normally notice your belly start to bulge around 12 weeks and after about 16 weeks you’ll no longer be able to hide your pregnancy with clothing. But if you’re carrying multiples, you might see a bulge as early as 8 weeks and by week 10, you should probably give up on covering it up.
When you’re carrying two babies, your body produces twice as much of the pregnancy hormone hCG, says Barbara Dehn, RN, a member of The Cradle advisory board. As a result, don’t be surprised if you experience more severe morning sickness and are even more tired than you would be if you were carrying a single baby.
Carrying the Extra Weight
If you think you’re going to gain double the weight, don’t worry; an extra baby will usually only result in an extra 10 to 15 lbs, says Dr. Anthony Chin, an OB/GYN in Beverly Hills and a member of The Cradle Advisory Board. With a single pregnancy, women usually gain 25 to 35 lbs, so with twins you’ll probably gain around 35 to 50 lbs. Though if you’re underweight to begin with, expect to gain more.
Remember, you’re not gaining weight for no reason. To ensure your babies are getting enough nutrients, moms pregnant with twins should be eating an extra 500 calories a day, says Dehn - 300 for a single baby and 200 for each one after that. And as with any pregnancy, the most important thing is to consume a good variety of nutrients and to continue taking prenatal vitamins.
Despite the necessity, all that extra weight can make you uncomfortable. Discomfort is a normal part of the third trimester of any pregnancy, so you can imagine this feeling may be magnified when you’re carrying multiples. As your babies and uterus grow and push on your stomach, you may experience a lot more indigestion a lot sooner than if you were having a singleton pregnancy. Women carrying two or more babies are also more susceptible to aches including pelvic pain, sciatica, or other back pain.
Gratefully, there are a few things you can do to ease the strain. As long as your pregnancy is normal, many doctors suggest exercise. Non-weight bearing activities like swimming and water aerobics are especially good exercises to try when you’re carrying multiples. Simply being in the water, floating around, and feeling weightless for a while can be a big relief.
Barbara Dehn also suggests wearing a pregnancy belt to help redistribute the weight of your belly over your entire back and torso. If you’re having trouble sleeping at night, a body pillow (and lots of other pillows) can help you prop yourself up in a more comfortable position.
Stretching skin can also be more irritating during multiple pregnancies. If your skin becomes itchy as it stretches, use a cream for relief; but Dehn notes that any cream, not just stretch mark creams, will help. She also suggests wearing bike shorts or leggings to give your tummy added support. The counter-pressure will help hold your belly up so your skin doesn’t have to do all the work.
More Babies, More Doctor’s Visits and Tests
Carrying multiples doesn’t guarantee problems, but most doctors agree that multiple pregnancies are higher risk. In other words, expect to see your obstetrician more often. You’ll need more ultrasounds and other tests to make sure your babies are healthy and that everything is going well. After 20 weeks, you’ll start getting monthly ultrasound exams to monitor interval growth, which can determine if your twins are growing at the same rate or if one is lagging behind. If at any point your doctor thinks premature labor is likely, you may need to take steroids, which will help your babies’ lungs get stronger before entering into the world.
If you’re having multiples as a result of in vitro fertilization (IVF), your babies will be dizygotic or fraternal twins created from two different fertilized eggs. If you didn’t have IVF, you could be having monozygotic (identical) twins created from just one egg. In the case of monozygotic twins, your pregnancy is considered much higher risk since your babies are sharing one placenta. That doesn’t automatically mean you’ll have more problems, but you should expect to have a few more tests to check for abnormalities - such as a shared umbilical cord or twin-to-twin transfusion (a condition in which one baby is getting more of the circulating blood than the other).
One test you may receive toward the end of your pregnancy is the full-term test, which can predict whether or not you’re likely to deliver early. If the test comes back positive for possible early delivery, your doctor will do additional tests to look at cervical length and other indicators, says Dehn.
With a singleton birth, you’ll normally carry to a full term of 40 weeks; but when you’re carrying twins, 36 weeks is a typical term. With triplets you’ll most likely give birth at 32 weeks or earlier, according to Chin. Of course, your doctor will want to do everything he or she can to prevent an early delivery, but your body may have a different idea.
With three or more babies, you can pretty much expect to go on bed rest, though it’s not completely impossible to stay mobile, says Chin. Bed rest can help prolong your pregnancy, so don’t be surprised if you have to spend a few weeks or months off your feet even if you’re just having twins. While not inevitable, you may even have to spend a few nights in the hospital during the later part of your pregnancy so you and your babies can be under close observation.
But just because you’re carrying double (or more) it doesn’t mean you have to throw out your birth plan. However, you should be prepared for delivery to follow a different route. While most women deliver twins by C-section, according to Chin it is possible to have a natural birth if the babies are in an optimal position. “C-sections can happen more often since giving birth to twins is like having two people going through the same doorway at the same time,” he says. “If they get in each other’s way, they get stuck.” And even if you deliver one baby vaginally, be prepared that your second baby could go into distress and you still may have to have a C-section for delivery number two. If you’re having triplets or more, you’ll almost certainly have a C-section.
Close to your delivery date, your doctor will do an ultrasound to check the position of your babies. If you’re carrying twins, the first baby must be in a head down position to even consider a vaginal delivery, says Dehn. If your first baby isn’t in the optimal position, you’ll automatically need to deliver by C-section.
Despite all the complications and extra issues that can occur, you should be reassured by the fact that some moms make it through a multiple pregnancy with few troubles. In fact, for some women the experience can be much like a singleton pregnancy.
Julie Knapp is a lifestyles writer. Her work has been published in Parents and Weight Watchers. She’s also the founder of a blog, JivaFit.com, which covers health, fitness, personal development, and eco-friendly living.