Leading Sydney Gynaecologist and Obstetrician

Multiple Gestation (Twins, Triplets, or more) | Dr Norman Blumenthal

A twin or triplet pregnancy is many times referred to as a 'multiple gestation', this simply means more than one baby is born to a mother. Twins pregnancies occur more often than you might expect. In fact, approximately 2% of all pregnancies produce twins.

As with any pregnancy, getting the proper prenatal care is the key to promoting the health of both you and your babies. Be sure to keep all of your scheduled visits with our office. Our doctors and nurses will want to frequently check on the growth and development of your babies. Also remember to check with our doctors and nurses before taking any medicine, even an over-the-counter (OTC).

• Weight Gain

The amount of weight you will need to gain depends on your weight and height before pregnancy. In general, women who begin pregnancy underweight should gain more, and women who begin pregnancy overweight may safely gain somewhat less.
 
Here are some general weight guidelines, but check with our doctors and nurses for guidance and recommendations for your individual weight gain.

- Twins

• Overall range for weight gain is 15-20 Kgms.
• Gain about 1 Kgm each week during the last 6 months of pregnancy
• Avoid weight loss or low weight gain
• Underweight mothers may gain closer to 20 kgm.
• Overweight mothers may gain closer to 15 Kgm.

- Triplets

• There is no official weight gain guideline
• Expect to gain approximately 50 to 55 pounds
• Gain about 2 pounds each week during the last 6 months of pregnancy
• Avoid weight loss or low weight gain

Relief of Discomforts

Nausea and vomiting 

Prevention 

• Eat several small meals
• Eat protein rich foods several times a day
• Drink fluids between meals
• Avoid greasy, acid, or strong flavoured foods
• Snack on dry, starchy foods such as cereals and crackers

Remedies

• Replace fluids with chicken broth, ginger ale, or sports beverages
• Try water ice/gelato or carbonated drinks and ginger snaps
• Check with our doctors and nurses about Vitamin B6

Heartburn 

Prevention

• Eat several small meals
• Avoid stomach irritants such as coffee and cigarettes
• Avoid gas-producing foods such as garlic, peppers, onions, and cabbage
• Avoid greasy or spicy foods

Remedies

• Sip carbonated water
• Eat a spoonful of yogurt, heavy cream or milk
• Check with our doctors and nurses about which antacids would be safe for you

Constipation 

Prevention

• Drink lots of fluids
• Eat high fibre foods such as fruits, vegetables, and grains

Remedies

• Drink hot liquids in the morning and before meals
• If constipation persists, call our office

Reduction of Stresses and Strains
To reduce your physical stress and strain, our doctors and nurses may ask you to consider the following:

• Good posture helps reduce back strain
• Try to avoid sudden 'jerky' movements which will add stress to your abdomen and back
• Lower yourself by squatting instead of bending over from the waist
• Use a pillow to support your lower back while sitting
• Elevate your feet to increase circulation and help reduce minor swelling of the ankles
• Avoid lifting or pushing heavy objects. Do not lift more than 20 Kgm at a time
• Use your arms and legs to help push you back up on your feet from a sitting position
• Blood circulation to your babies is best if you rest or sleep lying on your side. When lying down, you may find it more comfortable to bend your knees slightly and place a pillow between them
• Use additional pillows to help support your abdomen, buttocks, and shoulders
• It is very important for you to take care of yourself. Whenever you feel the need to rest, do so

Preterm Labour in the Multiple Gestation Pregnancy

Multiple gestation pregnancies have a higher rate of preterm labour and delivery than non-multiple gestation pregnancies. You can help reduce your risk of preterm labour by receiving good prenatal care, eating a balanced diet, getting plenty of rest, and promptly reporting any problems.

Recognizing the early signs and symptoms of preterm labour that are many times associated with multiple gestations, can help us provide timely treatment for controlling contractions so your pregnancy can continue until the babies are more fully developed and mature.

The following are signs and symptoms that are associated with preterm labour. However, these signs can also be a part of a normal healthy pregnancy. What you need to keep in mind is what may represent a change from your normal patterns and experiences:

• Uterine contractions

The uterus (womb) is composed of muscle fibres. A uterine contraction is the tightening of the muscles within the uterus. Using your fingertips to feel your uterus, you should be able to slightly indent your uterus when it is relaxed. During a contraction you can feel your uterus tighten and become hard. Contractions occur normally throughout pregnancy. However, women with multiple gestation pregnancies may experience increased contractions. These contractions are usually painless and they can occur at any time. Contractions could be a sign or early labour and, if undetected, could lead to a preterm delivery.

• Menstrual-like cramps

These are felt low in the abdomen, just above the pubic bone. The cramping may be rhythmic, feeling like waves or fluttering. You may also feel a constant cramp.

• Lower, dull backache

This backache is located mainly in the lower back and may radiate to the sides or front. It may be rhythmic or constant. And often is not relieved by changing position.

• Pelvic pressure

You may feel pressure or fullness in the pelvic area, in your back or thighs. It may feel as though the baby is going to 'fall out'

• Intestinal cramps

 These may occur in the presence or absence of diarrhoea. You may have the feeling of 'gas pains'.

• Increase or change in vaginal discharge

 The amount may be more than is normal for you. The consistency may change to mucous or watery. The colour may become pink or brown-tinged.

• A general feeling that something is not right

             Even without a specific cause.

If you experience any of the above, or if you feel something is different, contact our office.

If our doctors and nurses believe that you are experiencing any of the early warning signs and symptoms of preterm labour, or are at-risk of experiencing preterm labour, you may be ask to do the following: 

• Increase your rest

Resting on your side is a helpful way to keep your uterus relaxed. Also elevating your bed so that your hips are slightly higher than your head will keep the pressure of the baby off your cervix.

• Fluid intake

During your pregnancy, it is important to drink 6 to 8 glasses of fluid per day or as otherwise directed by our doctors and nurses.

• Bed rest

Our doctors and nurses may ask you to take rest periods during the day, or stay in bed all day except for getting up to go to the bathroom and sitting up for meals.

• Decrease strenuous activity

Our doctors and nurses may ask that you do not do any heavy physical activity such as jogging, running, tennis or frequent trips up and down stairs. Our doctors and nurses may also limit heavy lifting, cleaning, and long trips.

• Consider a temporary change in work activities

Work activities may need to be changed or stopped. Our doctors and nurses will tell you about decreasing your activity and what they feel would be best for you.

• Sexual activity

 Our doctors and nurses may ask that you stop or limit your sexual activities.

• Be alert for the signs and symptoms of preterm labour.

Be aware of your uterine activity using one or more available methods (ask our doctors and nurses which method is most appropriate for your situation):

• Use of Self-palpation

You can check for contractions after the 20th week of pregnancy by emptying your bladder and drinking a glass of water. Lie down on your left side. Use pillows to help support yourself so you can find a comfortable position. Do not lie flat on your back. Place your fingers on your stomach on either side of your belly button. Wait for your uterus to contract or tighten. During a contraction, your uterus will feel hard like your forehead. Use a watch to see how long the contraction lasts. After the contraction, your uterus will relax and you can press into it with your fingertips. If you have 4 or more contractions in an hour, call our office right away. Contractions occur normally throughout pregnancy. They are usually painless and they can occur at any time. If you are having difficulty feeling contractions, you may not be having contractions or you may not be aware they are occurring.

• Use of a small recording device similar to the one used in the hospital labour and delivery unit

An electronic monitor may be used in certain situations to help you and our doctors detect the contractions that may be associated with preterm labour. You will wear a belt around your stomach for an hour, most likely twice a day. The belt has a sensing device, which is attached to a small recorder. If you have a contraction while you are wearing the belt, the sensing device records the information about your contraction. Once each day you will be asked to send any information that has been recorded across your telephone line to a monitoring centre so the information can be provided to our doctors and nurses. Always remember to follow our doctors and nurses instructions about your prenatal care and activities.

What to do if you think you are experiencing preterm labour:

• Call our office
• Go to the bathroom and empty your bladder
• Check to make sure you have not missed a dose of any medication you might be taking
• Maintain adequate fluid intake as instructed by our doctors and nurses
• Rest, lying down on your left side
• Monitor your uterine activity

Content kindly provided by Matria HealthCare.

Sydney Obstetrician and Gynaecologist Dr Norman Blumenthal has an acknowledged reputation as a specialist gynaecologist and obstetrician with many years of experience on which to draw. In addition, he has specific experience in laparoscopic surgery for hysterectomy as well as surgery for uterine and vaginal prolapse and endometriosis. He also specializes in colposcopy and hormone replacement therapy.

Contact us today to arrange a preliminary obstetric or gynaecological consultation in our Blacktown or Baulkham Hills locations or at the SAN Clinic at the Sydney Adventist Hospital in Wahroonga.