Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women — including those who are carrying twins, according to guidelines released this week by The American College of Obstetricians and Gynecologists (ACOG).  This is great news for women expecting twins.  Previously, VBAC was not recommended for women carrying twins although there were no conclusive studies to suggest that twins posed a higher risk. 

In fact, VBAC was often not recommended for many women, and the rate of C-sections in the United States had risen significantly over the past four decades.  In the 1970’s, the C-section rate was about 5%, but by 2007, it was up at a whopping 31%.  One reason for the increased rate of C-sections was due to insurers, doctors, and hospitals opting for a repeat C-section rather than attempting a trial of labor after cesarean (TOLAC).

TOLAC and VBAC do present some added risk.  If uterine rupture occurs (between 0.5% and 0.9% of the time), it is an emergency situation that can cause serious harm to a mother and babies.  For this reason, TOLAC and VBAC should only be undertaken in a hospital where an emergency C-section can be performed in the event of complications.

Patients and doctors will need to work together on a case by case basis to determine if TOLAC and VBAC are appropriate.  New moms having twins should do their research and come prepared for a discussion with their OB/GYN about the possibility for VBAC with twins if that is their desire.  Patients who encounter doctors that won’t even consider VBAC for a twin pregnancy should consider moving to another doctor.  While there may be very valid reasons why a VBAC is not appropriate for your particular twin pregnancy, you should expect your doctor to cover those reasons with you in detail rather than rejecting the option out of hand.

These new guidelines will provide women expecting twins with more options than were readily available previously.  And when you’re having twins — your options are often limited and out of your control.  So bringing back options is always a good thing.  And reducing the number of “automatic” C-sections is a good thing.  Hopefully these guidelines will help to reduce the overall number of C-sections being performed in the United States.

Source:  The American College of Obstetricians and Gynecologists, “Ob-Gyns Issue Less Restrictive VBAC Guidelines“, July 21, 2010.

Copyright 2010 Kathryn Whiteley — TwinParenthood.com

Having twins and multiples means more of everything — including morning sickness. The majority of all pregnancies experience nausea to some degree, and that increases with each additional baby in the mix.  The severity of the nausea is also increased with each additional baby.

Pregnancy nausea is usually attributed to the increased hormones during pregnancy. Many of these hormones are produced by the placenta. So, when there is more than one placenta (as in many twin pregnancies), more of these pregnancy hormones are produced — causing increased nausea.

“Morning Sickness” can occur at any time of day, but is often associated with the morning because it can be more strongly felt with an empty stomach. In addition, a twin pregnancy can put more pressure on the tummy — increasing nausea.

One little trick to help with this is to keep crackers or a banana at your bedside. When you get up in the middle of the night to use the bathroom (as pregnant twin mamas often must do), eat a little bit. It is healthy for you and your babies — and will help reduce the morning nausea.

Increased nausea is one of many signs that you might be having twins.

Do:

• Eat small meals often
• Take a nap and get plenty of rest
• Learn your particular triggers and avoid those foods and smells that increase your nausea
• Dress in layers so you can peel off if you get too hot (feeling too warm increases nausea)
• Drink lemonade, eat watermelon, or something with ginger — as these help reduce nausea
• Exercise (but talk to your doctor about the amount and type that would be appropriate for your twin pregnancy)
• Eat salty potato chips
• Consult with your doctor — keep your doctor informed of your level of nausea (too much naseua can indicate a problem)
• Eat healthy with lots of protein

Don’t:

• Do not drink a large amount of fluids with meals
• Do not lie down after eating
• Do not skip meals
• Do not cook or eat spicy food

While morning sickness in a twin pregnancy can be more severe and can last longer into the pregnancy, it is survivable — as is just about everything twin related.  Take it one day at a time, and your little sweethearts will be here before you know it.

Did you or do you have morning sickness with your twin pregnancy? Any tips for coping?

Copyright 2010 Kathryn Whiteley — TwinParenthood.com

Expecting Twins?

Learning that you are expecting twins is both exciting, and a little frightening. Most parents expecting twins really have no idea what to expect. From the pregnancy onward, you’re in for some big changes.

So, here is the “critical, need-to-know information” about your twin pregnancy:

FACT 1:

Because twin pregnancies are classified as “high risk”, you will receive more ultrasounds and tests than an average singleton pregnancy to ensure the babies (and mom) are staying healthy.

• higher rate of miscarriage
• higher rate of maternal anemia
• higher rate of postpartum hemorrhage (bleeding) after delivery
• higher risk of developing gestational diabetes
• higher risk of preeclampsia (high blood pressure, protein in the urine, and sometimes swelling in feet, legs, and hands)
• higher risk of preterm labor and delivery

Advice:

1. Seek out an Obstetrician that specializes in high risk pregnancies, or see a perinatologist.
2. Visit your Obstetrician early in your pregnancy, be diligent about keeping all dr visits.

FACT 2:

Your twin pregnancy may leave you with more of the discomforts associated with pregnancy.

• – morning sickness may be stronger in the 1st trimester
• – back aches, heartburn, and sleepless nights might be worse and begin earlier than in singleton pregnancies
• – more spotting can occur
• – Moms pregnant with twins should expect to gain between 35 – 50 pounds

Advice:

1. Get regular exercise, but don’t overdo it — especially later in the pregnancy.
2. Do not underestimate the need for extra rest and sleep.
3. Get a body pillow to use between your knees for more support.
4. Be sure to eat enough to nourish the babies — there will be time to take off the weight later.
5. A small amount of spotting early in the pregnancy without cramping can be normal, but you should still inform your doctor. If spotting with cramping or heavier bleeding or clots happens — seek immediate medical advice.

FACT 3:

Your pregnancy will require “more” of your body’s resources.

• And, you’ll need to eat more, too. You’ll need to eat an additional 500 – 1000 calories per day.  And protein is critical, you’ll need an additional 35-50 grams beginning around week 20. In total, you’ll need about 150 – 170 grams.
• You definitely will need a good prenatal vitamin with iron. Some vitamins/minerals/supplements will require a higher dosage — including folic acid. Talk to your doctor about the proper vitamins and dosage for you.
• The babies will draw calcium out of your bones & teeth if you are not taking enough in to support the twin pregnancy.

Advice:

1. Be sure to ask your doctor about the need for vitamins and supplements.
2. Make a note on your daily calendar when you have taken your vitamins, so that you will not forget.
3. Drink more milk, and eat yogurt, peanut butter, and fish. These provide more protein, and the milk & yogurt add much needed calcium.  Do be careful, though, about the types of seafood you eat, as you’ll want to avoid those species that have been found to be high in mercury. Learn more about the FDA and EPA’s recommendations for pregnant women: http://www.epa.gov/fishadvisories/advice/
4. Eat small meals, but much more often. You might find that you are not hungry — either due to morning sickness, heartburn, or just feeling full because of the babies pressing on your stomach. But, getting enough calories to support the babies is crucial. Eating protein rich foods is helpful.

FACT 4:

Chances are greater than not that you will be put on bed rest at some time during your pregnancy. And, labor/delivery are more likely to come early.

• Most moms of twins go into labor at 36 to 37 weeks (40 is the norm for singletons).
• Bed rest comes in various degrees. It can range from a modified bed rest (where the doctor simply instructs you to get off your feet whenever possible), to strict at home bed rest where you can only get up to use the toilet, to hospital bed rest.

Advice:

1. Have all your baby preparations completed no later than the 30th week of pregnancy (nursery set up, etc.). Even if you are not placed on bed rest, you will likely be too tired to complete preparations much later than 30 weeks.
2. Discuss with your doctor his/her thoughts about working during your pregnancy and if or when you should stop.
3. Drink a lot of water. Then drink some more.  More water is needed to support the increase in volume of blood. Dehydration is one cause of preterm labor.
4. For tips on how to survive bed rest, read TwinParenthood.com’s article, “Surviving Bed Rest in your Twin Pregnancy.”

FACT 5:

You are more likely to have a C-section.

• There is a higher rate of babies in the breech position.
• There is more incidence of “failure to progress” during labor, as the uterus muscles are often too stretched out to muster a coordinated effort.

Advice:

Think about your wishes for your birth plan before you are admitted to the hospital, but plan to be flexible. Don’t go into it saying, “I’ll be so upset if I have to have a C-section.”

FACT 6:

People (even strangers) are more likely to ask you personal, probing questions about your pregnancy. People are just very interested in multiples.

Advice:

Join a Twins or Multiples Support Group or “Club”. No one can relate to a mom pregnant with twins better than a mom who has “been there, done that”.   Also, you’ll be needing to get a lot of “stuff”, but most of it doesn’t need to be new. These groups often have huge sales where you can stock up.  Still unsure? Check out TwinParenthood.com’s article, “Top Ten Reasons to Join a Twins / Multiples Support Group or Club

Try to keep in mind that people are just interested in multiples, decide how much you want to reveal, and always answer with a smile. To see the humorous side of this, read our article, “Out and About with Twins — when does the carnival end?“.

A twins or higher order multiples pregnancy can be a challenge.  But, by seeking advice early, and following the doctor’s instructions, you can ensure the healthiest outcome possible. There is much you can do to prepare for the coming changes in your life. Research at TwinParenthood.com is a great start.

Copyright 2010 Kathryn Whiteley — TwinParenthood.com

What have I missed? I’d love to hear more facts and advice about twin pregnancies from all you twin moms & dads. Please leave a comment.