Preparing for a multiple delivery
If you are pregnant with twins, triplets or more, it is likely that by week 32 you’ll be experiencing some significant physical challenges associated with carrying multiple babies.
Most babies of multiple pregnancies are born early, so you should now be thinking about and getting ready for labour. You may also feel excited, if a little daunted, at the prospect of bringing your babies home soon.
Your babies’ growth
Up to this point your babies’ growth and development will have been similar to that of a single baby in the womb. However, now that you are in the weeks of increased growth activity, your babies will start to adjust to the room they have available. So, this is likely to mean that your babies will grow at a slower rate and be smaller, compared to a single-pregnancy baby, when they are eventually born.
Your babies will be fully formed at week 32 and their chances of survival are generally good in the UK. However, the longer your babies remain in your womb the more robust they will be after birth and the chances of intensive neo-natal care being needed will be reduced.
At 37 weeks, most twin pregnancies are considered to be at term and around 34 weeks for triplets or more. Whatever your situation, your midwife will be sure to discuss your choices for labour and plans will be made to help you be prepared for birth and any care requirements in the weeks afterwards.
Your wellbeing in the last few weeks of the pregnancy
You may be finding that the additional weight gain you are experiencing has made it harder for you to be mobile, that your ability to drive is restricted as you find it difficult to get in and out your car or perhaps just getting up or down from a chair or sofa is proving to be a challenge.
Lots of mums-to-be of multiples also have problems with indigestion and find that their appetites are affected. It is important that you continue to eat a healthy, balanced diet and keep hydrated for your own wellbeing. Doing so will provide you with energy and your babies with the nutrients they need.
Be aware of changes
Try to take rest when you can, particularly at the end of the day if you spend lots of time on your feet. Carrying your babies around for long periods can cause some pregnant mums to feel some discomfort to their backs and legs.
When you do take time to rest, it is also a good time to monitor fetal movements. If you notice a change in the pattern of your babies’ movements, make sure you get in touch with your midwife straightaway. It could be a sign that there is a problem with your babies.
You should also be aware of any changes to your own condition. Mums-to-be of multiples are unfortunately at higher risk of pre-eclampsia. So, if you notice that you are getting severe swelling to your face, hands or feet, feel dizzy, short of breath or generally unwell, be sure to get in touch with your hospital or midwife, as you may need immediate treatment.
Some mums-to-be may find that these last weeks of the pregnancy are causing them to suffer fatigue and that their physical condition is affected. If you experience this, it’s possible that you may be prescribed bed-rest. If so, you will need to make arrangements to take time off work (if you haven’t already stopped working) and for your partner, or those who can offer support, to help you with any practicalities.
Be informed and meet others
Around weeks 28 to 30 (earlier for triplets or more), it’s a good idea to book onto an antenatal class. Many organisations run classes exclusively for those expecting twins or more. These will be both informative about what to expect and a great way to meet others in the same circumstances. Many people go on to become close friends in the years ahead.
Antenatal scans in the third trimester
Around week 32, you will also be offered an additional antenatal scan not offered routinely to women having a single pregnancy. This is done as a specific check on the position of leading baby (the first baby to present at birth). The position of this baby will inform the medical team in respect decisions that will needed to be taken about the best method of delivery for your babies.
The more babies you are carrying the more likely you are to be offered additional scans to monitor your babies’ wellbeing in the weeks leading up to birth. Your midwife will advise you of any appointments you may need.
Giving birth to multiples
Your midwife will also start to discuss your options for the birth around week 32. It is most likely that you will be advised to have a hospital birth because of the potential complications that could arise. In the case of twins you may be offered a vaginal birth but if you are carrying more than two babies, you will almost certainly be advised to have an elective caesarean.
Vaginal birth and labour
If you are giving birth to twins you will be able to deliver your baby naturally. Labour will follow the same progression as if you were having one baby, but your twins will be more closely monitored and you will be fitted with a drip in case it’s needed later. If you choose to have a vaginal birth, the hospital staff will be likely to advise you to have an epidural to cope with the pain and length of the labour.
The midwife will need to check that the lead baby is positioned head down and after the safe delivery will need to make a further vaginal examination to find out if your second baby is positioned in the same way. Sometimes, if the contractions stop after the first birth you will be given hormones via the intravenous drip to restart them and deliver your second baby. This will usually take place quite quickly as your cervix will be fully dilated.
Additional professionals will also support you at the birth. These include a midwife, an obstetrician and two paediatricians, one per baby.
Birth by caesarean section
If you have triplets of more, your babies will be delivered by caesarean section. Your midwife will discuss this with you. A caesarean can have implications for you after the birth, as your recovery time will be longer. Ask for help from your partner, family and friends when you first go home with your babies as you will need lots of support while you recover.
In many multiple pregnancies, including twins, a planned caesarean will be recommended for medical reasons. Usually, this will be because:
- a breech or transverse position is detected
- you have a low lying placenta
- your twins share a placenta