Coping with your multiple pregnancy

The rise in multiple pregnancies is at least in part due to the rise in fertility treatments like IVF and AI. Many women are also waiting until they’re after 35 to have children... and this definitely increases your chances of conceiving multiples. Since 1980, multiple pregnancies have increased by 65-75% and the chance of having triplets has increase 5 fold.

It’s important to realise that carrying multiples comes with its’ own set of unique challenges, concerns, questions and complications.

Possible Complications during pregnancy

Unfortunately, there are greater risks associated with a multiple pregnancy. 2 of the more common risks include high blood pressure and pre-eclampsia. While a minor rise in blood pressure is nothing to fret about, pre-eclampsia can be. It is a serious blood circulation problem, which affects the placenta, as well as the mother’s vital organs.

Pre-eclampsia

According to Cape Town based ob/gyn, Dr Christo Benecke, “there is a significant increase in the chances of pre-eclampsia in a multiple pregnancy”. Warning signs include; vision problems, a constant headache, pain in the upper right abdomen and swelling of the hands and feet. Although pre-eclampsia is serious, it is important not to panic. Remember it is perfectly treatable with bed rest and medication.

Gestational diabetes

Gestational Diabetes is another, more common risk. It occurs when the pregnancy hormones interfere with the action of insulin in the mother’s body. Gestational diabetes can also be managed with regular check ups and a change in diet, like switching to low GI foods.

Intrauterine Growth Restriction (IUGR)

Another common risk is Intrauterine Growth Restriction (IUGR), or a baby that is not growing at a normal rate. Incidents of IUGR definitely increase with a multiple pregnancy, in all likelihood because the growth rate of multiples slows down in the last trimester.

This slowing occurs for various reasons, either the placenta cannot handle further growth, or there is simply just not enough leg room in there anymore.

Risk of miscarriage

There is also a greater risk of miscarriage in a multiple pregnancy. However, Dr John Fassler, an ob/gyn at the Stellenbosch Medi-Clinic, points out that this risk is only “slightly higher”. Other complications include a greater chance of foetal abnormalities and foetal demise in-utero, but these are both very rare.

Although overall, there seem to be more risks associated with a multiple pregnancy, with the correct care and medical supervision, your pregnancy is likely to go smoothly.

Pregnancy symptoms

Assumptions are always made that all expectant multiple mothers suffer from exaggerated pregnancy symptoms, like cramping and nausea. And of course this can be very true!

Dr Benecke says that,  “generally speaking, multiple moms will probably suffer more exaggerated pregnancy symptoms like, nausea, breast tenderness and just a general tired, crappy feeling”. But Dr Fassler insists that this needn’t be the case at all.

“In fact, the only thing we know for sure will happen”, he says, “is that the multiple mom will need to rush to the loo more often, as her larger uterus pushes down on the bladder”.

Nausea

Cheryl Lieberman, mother of 16- month old twins, says she “breezed” through her pregnancy. “I really enjoyed it and I didn’t suffer from any morning sickness in my first trimester, instead that seemed to come towards the end”.

However, mom of twins, Maryna Russel was not so lucky.  “I was literally green with morning sickness - sorry, not morning sickness - all day sickness” Maryna jokes. It seems that experiencing enhanced pregnancy symptoms is entirely individual and there are no set rules.

Weight gain

This is probably one of the first questions that most moms ask. How much weight should I put on? Dietician Larissa West, from the Menlyn Med Pregnancy Wellness Centre, says, “There are simply no hard and fast rules. It depends on so many different factors -  height, body type, age and pre-pregnancy weight”.

Weight gain during a multiple pregnancy is essential though, even more so than in a singleton pregnancy.

Healthy weight gain, especially between weeks 20-24, helps reduce your chances of early labour and low birth weight. Although it’s important to assess each pregnancy individually, there are some general guidelines for appropriate weight gain.

For twins, a suggested 16-20 kg’s is recommended and for triplets, about 22-27 kg’s.

Premature birth

A premature birth is almost a given with multiples, 60% of all twins are born prematurely and 90% of all triplets and more are born prematurely. “The uterus is designed to carry 1 baby,” says Dr Fassler, “it can take more than 1, but then it comes with added risks”.

The good news is that with modern medicine, most babies born prematurely survive.

The survival rate of premature babies

The survival rate for babies born at 34 weeks is 98%, 30 weeks, 95%, 27 weeks 90%, 26 weeks 80-90%, 25 weeks 50-80% and even at the very low 24 weeks, a baby still has a 40-70% chance of survival. Even so, the earlier your baby is born, the higher the risk of permanent severe disability.

 “Premature birth can be very difficult for parents, especially the mother, who will experience feelings of guilt or inferiority”, says Lavorne Prinsloo, the CEO of the SA Preemie Association. “A mother may experience symptoms of deep sadness, loss and even blame herself for not being able to keep her baby. But if you know you are carrying multiples, you can prepare yourself psychologically for the inevitability of a premature birth”.

Dr Baker, a Joburg based ob/gyn, says that a “premature birth tends to reduce the initial bonding between mom and babes, which occurs in a singleton birth.” He believes it is important a mom is well informed about premature birth, and reassured that her babies will be managed with the best expert care.

Go to page 2 to find out more about how moms cope with a multiple pregnancy