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More babies, more everything

Having twins, triplets poses challenge

By Jean Weinberg
CNN

YOUR E-MAIL ALERTS
Parenting
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NEW YORK (CNN) -- Having already given birth to two girls, Soledad O'Brien was ready for another addition to her family last winter. Yet she and her husband, Brad, were in for a surprise when, several months into her most recent pregnancy, her doctor told her she had not one, but two babies, on the way.

For eight-plus months, New York University Medical Center practically became O'Brien's second home. She suffered everything from pronounced morning sickness to extreme dehydration, which made bearing the twins tougher than her first two pregnancies, but was not uncommon among the growing numbers of U.S. women expecting multiple babies.

"With [one] child, you know what you're going to get," said O'Brien, co-anchor of CNN's "American Morning." But with twins, "it was so much harder on my body."

Her experience was more the norm than the exception, as mothers of multiples typically face more challenges than those giving birth to one infant at a time.

Expectant mothers of twins, triplets or more often suffer from nausea, fatigue, water retention and difficulty sleeping at a greater rate and severity than those with one baby. In addition, carrying more than one fetus puts extra strain on the legs, back and rest of the body.

Those giving birth to multiples also face higher risks of miscarriage and premature births, which can result in low birth weights and other problems, plus a greater likelihood of developing gestational diabetes, urinary tract infections, anemia and excessive postpartum bleeding, according to the American Society for Reproductive Medicine.

Experts say such mothers should make ample preparations, know the risks and set realistic expectations. But they admit nothing can replicate the real thing.

"I don't think most of the patients realize how difficult it is to [be pregnant with twins]," said Dr. Michael Divon, Chairman of Obstetrics and Gynecology at Lenox Hill Hospital in New York City.

More tests, hormones

O'Brien gave birth to healthy twin boys -- Charlie Raymond, weighing 7.1 pounds, and Jackson Raymond, weighing 7.2 pounds -- on August 30 at NYU Medical Center. The fraternal twins join sisters Sofia, 3, and Cecilia, 2.

While O'Brien's delivery went smoothly, the weeks and months leading up to it were not always easy. She had acute morning sickness in her pregnancy's first few months, saying she "just felt crappy ... as though I had the flu everyday."

Even when things are going well medically, women carrying multiple babies often suffer from severe morning sickness. Dr. Jane Cleary-Goldman, who specializes in high-risk pregnancies at Columbia University Medical Center in New York, said this stems from a higher level of hormones. Hormone levels increase in all pregnant women, and even more so in women carrying more than one baby.

O'Brien also experienced several instances of severe dehydration, two of which required brief hospitalizations.

The entire process had O'Brien going to NYU Medical Center one or two times a week, typically for hours at time -- far more frequent doctor visits, she said, than during her first two pregnancies.

There she underwent a battery of tests including ultrasounds, biophysical profiles of each fetus and tests gauging their breathing, movement and weight, plus regular check-ups on her own condition.

Multiple babies 101

Having twins is not as rare as it once was. Since 1990, the birthrate for twins has risen 38 percent, and since 1980 it has jumped 65 percent, says the CDC National Vital Statistics Report.

According to the National Center for Health Statistics, 33 out of 1,000 births in the United States are multiples. Of that total, 31 of 1,000 are twins.

The growing popularity of fertility treatments -- such as ovulation-inducing drugs and in vitro fertilization -- has contributed to the rise, says NCHS.

Age is also a factor, with older women -- in their 30s or 40s -- more likely to have multiples. Compared with previous generations, more women nowadays are giving birth at a later age because "women want to work, they want to establish a career, so they postpone having a family," said Dr. Divon of Lenox Hill Hospital in New York.

The average duration of a single pregnancy is around 280 days; a twin pregnancy is roughly 252-259 days, with triplet pregnancies even shorter, according to various sources. More than half of all twins are born premature, according to the American Society of Reproductive Medicine.

"The biological system is designed to grow one, and you are trying to force more fetuses into the same size uterus, which results in a lower birth weight" and sometimes premature birth, said Dr. Divon.

The medical data show that a premature newborn's organs -- especially its heart and lungs -- sometimes are unable to function on their own after birth. Twins also face greater risks for genetic defects, as well as cases in which one or both twins gets too much or too little blood or does not grow at the proper rate.

"Identical twins are at increased risk compared to fraternal, because they share their placenta and it can lead to different complications," notes Dr. Cleary-Goldman.

Identical twins come from a single egg that has been fertilized by one sperm. The fertilized egg splits into two or more embryos during the first stage of development.

Fraternal twins --which do not look exactly alike -- develop when separate eggs are fertilized by separate sperm. Fraternal fetuses, thus, have separate placentas and amniotic sacs.

According to WebMD, genetics and the mother's makeup play a part in the likelihood of fraternal, but not identical twins. Fraternal twins occur more often in certain families and in certain ethnic groups. The rates are one in 70 among African Americans and one in 300 for women of Chinese descent. Whites fall in between. The incidence of fraternal twins also increases with maternal age, weight, height, and parity (the number of pregnancies a woman has had).

A lot to handle

Finding out you are having multiple babies can be both joyous and stressful. Parents must juggle preparing the house for new babies, planning their work schedules and, if they have children already, making the young ones aware how their lives and household will change.

O'Brien says she and her husband Brad had always planned on having three children but quickly warmed to the idea of having four. "We are glad to have four, and I think it will be fun. But it never even crossed my mind," said O'Brien.

O'Brien said her biggest concern when she found out she was having twins was from a work perspective. During her past two pregnancies she worked "'til the bitter end, and always was able to travel." This time, she worked through the first week of July -- just less than two months before her due date -- at which point her doctor ordered her on bed rest.

One of the best ways parents can prepare themselves for a multiple pregnancy is by getting as much rest as possible, especially considering it is unlikely they will get much sleep once the babies are born.

Experts also stress the importance of talking to the children already in the family about changes that will occur when the new babies arrive.

O'Brien said her two young daughters have had to make adjustments. To better prepare the family for the impending arrivals, she recommends "What to Expect When You're Expecting," a book by Heidi E. Murkoff.

Though having multiple babies is by no means easy, preparing yourself in advance for what's to come will make it more manageable, says Columbia's Dr. Cleary-Goldman. Despite the many concerns, she said, "the majority of my patients having a multiple pregnancy are very excited, even though it can be stressful, [and] they are very happy."

However, no matter how ready expectant parents of twins or triplets may think they are, there is only so much one can do to prepare after the babies are born -- in the form of round-the-clock feedings, diaper changes and more.

"It's pretty difficult to deal with one baby, it's pretty rough day and night with one -- and imagine if you have two," said Dr. Divon.


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