In the United States, 1 in 9 babies is born prematurely, 1 in 10 in Canada. Worldwide, over 15 million babies are born too soon each year. While not all multiples are born prematurely, a multiple birth increases the probability of an early delivery. Babies born prematurely, before 37 weeks gestation, are at a higher risk for health complications in infancy, some of which can have long-term effects.
In honor of November’s Prematurity Awareness Month, led by the March of Dimes, How Do You Do It? is focusing this week’s posts on The Moms’ experiences with premature deliveries, NICU stays, health complications, and how we’ve dealt with these complex issues.
When we found out that I was carrying twins, my husband and I were both thrilled and terrified. I imagine this is a common response among expectant parents of multiples. On one hand, I was excited to be able to complete our family in one fell swoop, but on the other hand, I was keenly aware of the potential complications of a multiple pregnancy. In my own circle of friends, I know one mom who lost her twins prior to viability and I’m good friends with Sadia, whose girls arrived at 33 weeks and had to spend some time in the NICU. Meanwhile, I wasn’t aware of many moms of twins who had managed to carry their babies to term.
Between having suffered a prior pregnancy loss and the stress I felt over the possibility of serious pregnancy complications, I dealt with a lot of anxiety throughout my pregnancy, but especially in the early months. My worry led me to do a lot of research on twin pregnancy and to seek out supplemental care in addition to my normal prenatal care.
It is important to note that while my outcome was a healthy pregnancy and two full-term babies, the supplemental care I received did not directly lead to those great results. I happen to have been one of the fortunate ones whose bodies handle a twin pregnancy relatively well. There was nothing I could do to guarantee a healthy pregnancy for myself and for my babies. My goal in seeking out more care was to try to detect and adjust for any major complications as soon as possible. As it turned out, my complications were all pretty minor, but some of the supplemental care I pursued could come in handy to other moms of multiples.
I faced a conundrum when I was choosing an OB practice to visit during my pregnancy. On one hand, I wanted the best care for multiples that I could get. On the other hand, I was committed to giving birth to my twins in a well-equipped medical setting but with as few interventions as possible. To that end, I chose a practice that prides itself on a low rate of caesarian sections, but that has plenty of experience with twin births, as well. The standard of care is for each patient to visit with all the health care providers in the practice over the course of her pregnancy, and while my twins would ultimately be delivered by a doctor, much of my care early in the pregnancy was handled by certified nurse midwives.
I was generally confident in the care I was receiving from my midwives, but it was important for my elevated anxiety levels to have medical twin experts keeping a closer eye on my pregnancy, as well. To that end, I did a great deal of research on twin pregnancies and discovered that the Texas Children’s Hospital in Houston, TX, has a dedicated Program for Multiples. For the cost of an insurance copay and a tank of gas, I was able to receive a personalized assessment including a comprehensive ultrasound, genetic counseling, and, most important to me, individualized nutritional advice.
As it turns out, my assessment indicated a clean bill of health for my fraternal twins and me at around 13 weeks of pregnancy. Had I been carrying identical twins showing signs of Twin-to-Twin Transfusion Syndrome, the ultrasound could have detected it early, and I would have been referred for further treatment and, hopefully, a successful outcome.
My pregnancy was otherwise fairly unremarkable until my blood pressure began to creep higher around 26 or 28 weeks. At that time, I was referred to a MFM doctor in town, who provided more supplemental sonogram to monitor the growth and development of my babies. Each ultrasound indicated that growth was steady and my babies were stable, but by 32 weeks, it became increasingly clear that they were locked in a breech position and didn’t have much room to rotate head-down. Knowing that my chances of getting them to turn were small, and that my doctor could not deliver them vaginally if they were breech, I had time to mentally prepare myself for the possibility that I would need a c-section after all.
At 36 weeks 6 days, an ultrasound indicated that growth had stalled, and my MFM and OB conferred and decided that my twins would be delivered the next day. My c-section was scheduled, and I was left with about 18 hours to wrap up my preparations and finish up the work I had planned to do before going on leave. The next day, my twins arrived, weighing 6 lbs 15 oz and 7 lbs 1 oz. They required no time in the NICU.
Ultimately, beyond listening to our doctors’ advice and taking care of our bodies during a twin pregnancy, we can do very little to control the outcome. According to the March of Dimes, 60% of twins are born prematurely. I was one of the fortunate 40% who managed to carry my pregnancy to term. But I feel it’s important to share my story during Prematurity Awareness Week to let those expecting twins know that a successful pregnancy is possible, and that seeking out supplemental care early on could help you identify warning signs for complications and improve your chances of a healthy pregnancy.