Sharing a womb for nine months isn’t easy: space is at a premium and resources must be stretched for two. It’s no wonder most twins tend to be in a hurry to come out. When they do, their parents often discover that twins present a challenge. Raising any baby is demanding – but two at the same time? That requires more emotional and physical stamina. This week we speak with Dr. Ishani Rodrigo, consultant paediatrician on some of the things to look out for if you’re expecting twins.
Twin types
Twins aren’t as unusual as they used to be, says Dr. Rodrigo, explaining that treatment for infertile couples including fertility drugs and in vitro fertilisation (IVF) techniques can increase your chance of having twins or triplets. Women who are given drugs to simulate ovulation (take hormonal injections) are even more likely to have multiples. In cases of IVF, there are multiple fertilized eggs put back into the uterus in the hope that at least one will 'take', explains Dr. Rodrigo, adding that every now and then two or three will 'take'.
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However, twins can and do run in families, with some women more likely to conceive twins without the use of any drugs. How does it happen? When a woman is ovulating, her ovaries may release multiple eggs or she might have more than one ovulation. Fraternal or dizygotic twins (also referred to as non-identical twins) are the result of two such fertilized eggs being implanted in the uterus wall at the same time. The sperm cells that fertilized them are different as well. This is why fraternal twins are often compared to siblings – they may each belong to a different sex and look entirely dissimilar – even though they share a birthday.
Identical or monozygotic twins occur are the result of a single egg being fertilized and forming a zygote which then divides into two separate embryos. Since they share the same DNA set, many identical twins have similar physical attributes and may even have similar personality quirks.
If you’re carrying twins, the first indication will be when tests reveal that your HCG hormone level is higher than it should be in the initial stages of pregnancy. Early scans should then provide confirmation, says Dr. Rodrigo.
Inside the womb
Sharing such a tiny space can cause various abnormalities in twins. Part of the cause lies in the fact that conditions inside the womb can be very different for each twin. Sometimes it’s as temporary as an oddly shaped head at birth, at other times it has more serious repercussions. In the very first stages of pregnancy, there is still a risk of Vanishing Twin Syndrome (VTS), cautions Dr. Rodrigo, explaining that this happens when one baby dies in the womb in early pregnancy and is absorbed back into the mother’s body so that it appears at delivery as a singleton pregnancy.
There are other risks too. For instance, the blood supply from the placenta can sometime be inequitably distributed, resulting in complications like twin-to-twin transfusion syndrome (TTTS). Since the placenta is sometimes shared by identical twins, there are often blood vessels that connect both babies. Unfortunately, in some cases it happens that more blood is directed from one baby towards the other. The first baby essentially takes on the role of a ‘donor’, pumping his blood into the second baby, the ‘recipient’.
Unfortunately, neither thrive says Dr. Rodrigo: the one that is receiving too much is overwhelmed as the blood begins to place too much strain on the heart, while the one that is donating usually has its growth inhibited by too poor a supply of blood and nutrients. If TTTS takes hold early in the pregnancy, treatment must be attempted. If neglected, TTTS has been linked to high mortality in twins and severe handicaps in those who make it to birth. Modern treatment techniques for TTTS focus on equalising the blood supply to the twins. For instance, a clot might be introduced into specific blood vessels by an ultra sound technique while the twins are in the womb, blocking the flow between the twins and re-establishing normalcy.
In labour
Twin pregnancies carry more risks for obvious reasons, says Dr. Rodrigo pointing to the need to share the womb and nutritional resources. One of the best known risks is that of an early delivery, precipitated by the amount of pressure applied by the combined weight of the twins. Though it doesn’t mean you should stay in bed throughout the last months of your pregnancy, it’s a good idea to get plenty of rest if you’re expecting twins.
It’s for this reason as well that twin foetuses and their mothers must be carefully monitored, explains Dr. Rodrigo. The latter for blood pressure, gestational diabetes and the former for their growth and activity levels. As they come to term, many women opt to have a normal birth. Each twin has his or her own pushing stage, but mothers often find that to their great relief the second twin is born with much greater ease than the first. The average time between the birth of the first and the second is normally less than 20 minutes.
However, depending on the position and health of your babies, a doctor might suggest you go for a caesarean. Sometimes the decision to go into surgery is made after the birth of one baby. A complication like a prolapsed cord can cut off the oxygen supply to the second baby and prompt your doctor to go for a combined vaginal/caesarean birth. “This is a situation that is best prevented by timely intervention as it carries a high risk of brain damage to the second twin,” cautions Dr. Rodrigo.
Though many mothers have carried their babies to full term, twins tend to be in a hurry. Those born prematurely, especially around 34 -35 weeks, could use a day or two in the baby unit to stabilise.
Raising twins
For many new mothers, twin infants can prove absolutely exhausting. Breast feeding can be very stressful, says Dr. Rodrigo. Pointing out that it’s very hard to grab some rest when you have not one baby but two, she suggests that parents expecting twins should prepare a support system well in advance. To have someone there to help with the feeding might be crucial, and it’s a good idea to decide if you’d like to supplement breastfeeding with bottled formula milk.
Remember, the children may need to eat, sleep and be changed at different times when they are infants. Most mothers will tell you that as soon as one complains of flu or fever, the second will follow in matter of days – but that is something that happens even with siblings, says Dr. Rodrigo.
Once they’ve had a chance to grow up a bit, nurturing twins can become a careful balancing act. All the shared time in the womb is believed to lie at the heart of the strong emotional bond between twins. However, though they may look identical, twins are individuals and should be treated as such, especially by their parents.
Dr. Rodrigo recommends that parents resist the temptation to turn them into clones of each other – avoiding giving them the same initials and the same wardrobes is the first step. As they grow older, it helps to recognize the interests and preferences of each twin and to encourage them to pursue their own activities independent of each other. Wherever possible, parents should encourage teachers and friends to do the same. |
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