Pregnancy: What to Eat?

26 Weeks, Weight - 178 Pounds, Measuring 36 Weeks

This is one of M.O.M.’s  most-pondered questions, and probably the least-answered. Most everything in the books is geared to singleton moms. And even then, the standard pregnancy book doesn’t include much detail about nutrition, even less how to manage getting all that low sodium, preservative free, fresh fruit and vegetable, lean protein baby fuel in your belly when you can hardly keep down Ramen Noodles and hardly stay awake late enough to brush your teeth before hitting the hay! But that’s why we’re all here, isn’t it!Rather than write a book on the subject (that's already been done), I’ll save you the trouble and do my best on what kinds of foods to eat, how much and how to do it without hiring a personal dietitian and chef.

Quantity
First of all, I think the most important thing is that it doesn’t matter if you are overweight, you need to eat a sensible diet of nutritious foods in amounts that roughly match your hunger. Being pregnant with two or more babies is NOT the time to ignore your hunger or worry about your waste line - manage your cravings, yes perhaps – but NOT your hunger. That is your body talking to you, and your body is very smart. Listen to it.  Learn to recognize what it is telling you. If you can learn to do this you will be well on your way to a healthy pregnancy and birth. I have not known a doctor to give any woman of any size a prescription on how much weight to gain when she is pregnant with multiples. I was overweight for a 5’ 3” person starting at almost 150 pounds, but my doctor never told me to slow down. She said the more I gain the better. If your doctor does advise you to limit weight gain, I would seek another opinion or input from another physician in the practice. Also consider requesting a consultation with a dietitian.
I gained 60-70 pounds during my first twin pregnancy, and lost all but 15 of it immediately (much of it was edema and swelling). I shed most of the rest off with the South Beach Diet, which lasted until my second pregnancy. Perhaps you don’t want to gain extra weight, but to me, it was well worth the peace of mind to know I was getting the needed nutrients to my babies. I  would do it again to have healthy babies again (and in fact I did)! An extra pant size is a much more pleasant prospect than premature or low birth-weight babies - and poor nutrition has been linked to.
Though I don’t encourage stressing over your weight, I think it is helpful to know where you are at on the continuum of average so you know what challenges you might have. According to the 'Mother of All Pregnancy Books' , twin moms should gain about 4-6 pounds during the first trimester and  1 ½ pounds per week on average after that. I have heard from several sources that gaining 24 pounds by 24 weeks is a goal for twin moms to strive for.
As you can see, I’ve attached photos to some of my posts of my pregnant belly with my first set of twins. I also noted my weight one each as well as my belly’s growth measurement! Hopefully this will help satisfy your curiosities about what your growing body might look like!

Nutrition
 My first pregnancy was really the beginning of my journey in nutrition. I grew up drinking Mountain Dew and eating Pop Tarts and sometimes worse for breakfast. Really. So I had no clue. I thought a slice of wonder bread with butter was pretty balanced. Now I see it as equal to eating a cup of sugar with butter on top. If even I can convert to somewhat-more-nutritious-eating habits without feeling like I am living a destitute life, you can too! Not that I eat great. But it’s certainly better than I did the first 20 years of my life!
Since it seems otherwise elusive, here is a chart of how many servings of various food types you should have if you are carrying 1,2 or more babies. I created this chart with information from ‘What to Eat While You are expecting’. Keep in mind that if you drink a glass of milk, that one serving would count both as a protein and a calcium serving, so adding up the number of servings of all the groups does not create a grand total of servings you are to eat daily.

Now this chart looks all scientific and such. But I really don’t think you must run out and buy a food scale or an iPhone app. Charting your intake is not a necessity to eating right during pregnancy! I think if you have an idea of what your body needs, and you occasionally count how many items you ate from a given category that day, you have done your babies a great service.
Note that white bread and empty carbohydrates do not even appear on this list! It is significant, and is consistent with the nutrition wisdom of the day that I have read elsewhere.  If you haven’t learned to find ways to enjoy eating whole grains, the time to experiment is now!  Whole grain breads needn’t scratch your throat on the way down. Whole grain crackers with a smear of cheese are a great snack. I think the best impact this chart should have on you is not what you choose out of your fridge, but what you choose at the supermarket. If your fridge is stocked with good choices, it makes it hard to mess up!
What I mean is that the more categories a food falls into, the more nutritious it is and the more of it you should aspire to eat. So plain ol’ applesauce counts only for 1 of your 2 daily ‘other fruit and vegetable’ servings. But if you shop for the vitamin C fortified version, then you’re doing better. Try whole grain pasta versus regular. To increase your likelihood of eating healthy snacks, search the grocery for some that are high in protein and low in sugar and salt. Find some all natural fruit leather
with no added sugar. Definitely get some protein bars. These were, ok ARE my favorite!
– the ones sold near the pharmacy section of the store. Keep them in your purse, desk and car glove box so that you never let your babies go hungry on account of your schedule! Keep hard boiled eggs handy in the fridge for a quick protein and Omega 3-packed snack. Try a pomegranate, star fruit or other fresh fruit or vegetable you haven’t before. Or try eating a food you didn’t like before with a new sauce or dip. One thing that changed my fresh fruit & veggie eating habit was buying Tupperware Fridgesmart storage containers that helped preserve freshness, and stack efficiently in my fridge. It was a lot easier to cut and keep melon, lettuce and veggies in a nice sleek and efficient rectangular boxes with lids instead of in the glass mixing bowls with plastic wrap on top that I once used! And it stayed fresh longer, so that it tasted better for more days. Previously, slicing a melon meant making a commitment to be sick of eating it in 2 days.

Cravings
When it comes to cravings, indulge with this caveat: Make yourself ‘pay’ for the right to indulge by first eating something from the healthy list. This will provide more needed nutrients for baby, and fill you up so you eat less of the indulgent food. Also, when you are at the store being tempted to buy that indulgent food – buy the most healthy version of it that still tastes like a treat to you! So instead of Ben and Jerry’s Ice Cream, pick one with perhaps less fat or less sugar and more calcium and protein compared to the others. If you start searching for nutritious foods at the store, you will find them in your cupboard when you are hungry!
I highly recommend The South Beach Diet book
AFTER babies are born if you want to take off some midnight ice cream! It is a diet book, but the ‘Stage III’ of the diet is no longer a weight loss diet. It is a recommendation for life-long heart-healthy eating and is quite educational about how our bodies work and process food. It is also somewhat consistent with other nutrition wisdom I’ve read…it just has the added benefit of explaining WHY it’s important. I also love the The Dr Sears Nutrition Deficit Disorder Book. It explores what a healthy diet is for children, and that is exactly the journey you are embarking on! It too, warns of nutrient poor carbs and spends lots of time on which additives and chemicals are of questionable safety. It also speaks in depth on the benefits of Omega 3 fatty acids. I began to take an Omega 3 supplement early on and make a conscious effort to eat Omega-rich foods because of the potential benefits it has for baby.

Eating and Morning Sickness
If there is one truth I found in both my pregnancies about morning sickness, it is that it is that nausea is much worse on an empty stomach! That may seem counter intuitive, but I’ve found it to be true both in pregnancy and other general nauseous situations (insert snide in-law remark here!).  I had nausea my first pregnancy, and it was generally worse in the morning than any other time of day. I did find a way to cope though! I did everything I could to keep myself from getting hungry because when I did get hungry, I also felt nauseous.
For me, this meant eating plain Ramen Noodles for breakfast the instant I woke up! It also meant keeping snacks and protein bars in my purse and at my desk so I could have them at any time. Though I did not have very severe morning sickness, early morning was the worst, and once I got some noodles or dry cereal in me, I felt a little better. After that, I still felt a little off most of the time through that first trimester, and even until 16 weeks, but there were only a handful of days that I was so miserable that eating even the most benign food wouldn’t help.
BTW – it is thought that keeping yourself full with high protein and fiber foods keeps nausea at bay. One idea to combat morning sickness is to munch on a high protein or high fiber snack during one of your late night/ early morning potty runs. Sure it may not be convenient to eat, but just a few handfuls of cereal or a cheese stick could help keep your blood sugar consistent and prevent that early-morning sick feeling. I kept a box of mini-wheats at my bedside for those early am hunger pangs.
And what about eating the ‘healthy foods’ when you can’t even keep crackers down? My advice is to eat whatever can make a truce with your stomach! Just make an extra effort to eat only A list foods when you aren’t feeling sick!
If you find that you are daily fighting the urge to ‘toss your cookies“ and loosing, try talking to your physician about treatments for morning sickness. There are a few drugs out there to help you, and they are vital for Mothers of multiples who need to keep nutrition going to their babies from early on. You don’t need to suffer helplessly.

Middle Pregnancy: Testing...Tesing,...1,2,3!

The positive pregnancy test is only the beginning. One thing that comes along with pregnancy - and especially twin pregnancy - are tests. Some tests you may need, and others you may want to forgo. This page is a good reference from the Mayo clinic. Here is our 'test' voyage.

Early Pregnancy Tests

Because I conceived naturally, I did not have the hCG screenings that many do in early pregnancy. What I have seen from others is that hCG levels are not always consistent with what providers expect for M.O.M.s.  So don’t get your undies in a bunch if your levels aren’t rising ‘as expected’. Every woman, and every pregnancy are different!

Ultrasound

I always laugh when I see a fictional movie or TV show where a twin mom with no showing belly says ‘The doctor found two heartbeats! I’m having twins!’. Unless you are very far along in your pregnancy, AND your doctor is actively looking for two, AND your babies have the right positioning, AND your babies’ have very different heart rates – It WON’T HAPPEN THIS WAY. Even in my late pregnancy appointments when my doctor was searching for two heartbeats with a Doppler, we had trouble being certain that we were in fact finding two distinct heartbeats. But maybe there is someone out there who discovered she was having twins because they detected two heartbeats…if that’s you, I’d LOVE to hear your story!

My twins were diagnosed by ultrasound, as are the vast majority. But what if you don’t have an ultrasound right away? Many women wonder what they will find at their 20 week ultrasound. But if you just can’t wait, here are some reasons you should request your doctor send you for a ultrasound: You were taking fertility drugs, Your middle is growing more quickly than what is normal for gestational age (your doctor will monitor for this), twins tend to run in your family, and you’ve previously given birth to twins (yes, this means you too identical twin moms!). If any of these apply to you – you should ask your doctor about getting an ultrasound!

Although it isn’t the most exciting part of an ultrasound, there are a few important ‘other’ things that will be determined at your first ultrasound (well, your second one, after you know you are having multiples). They will attempt to determine whether your babies are sharing a sac or have each their own and also determine if they are sharing a placenta. Of course, ultrasound is also good because it can detect several abnormalities like heart problems thay may need treatment soon after birth. Later in pregnancy, ultrasound is used to make sure that the babies are growing at approximately the same rate and to monitor for intrauterine growth restriction or Twin to twin transfusion syndrome. 

Blood Glucose Test

This test is often done mid-way through your pregnancy to screen for gestational diabetes. There are some women who are normally healthy, but during pregnancy contract diabetes, and after pregnancy are healthy again. The test usually means drinking an orange-soda-like drink beverage and having blood drawn an hour later. If you do ‘fail’ this test..don’t worry. You will still pass the motherhood exam! Only a small percentage (about 15%) of people who fail it actually have gestational diabetes. But you will have to go back for another, more intensive test to find out. -one that involves drinking more orange soda over a longer period of time (if only it was GOOD orange soda!)

Blood Tests

No doubt your blood will be drawn at least a few times. Early on perhaps to test your immunity to certain diseases that can be dangerous to your babies if you contracted it while you were pregnant. They may occasionally monitor your levels of all kinds of things like platelet count, Strep B and blood glucose levels. I think someone could write a book on all the possibilities, so I’ll stop here in favor of providing a few links.

Urine Screening

I always promised myself I would write a stand-up comedy routine about being pregnant with twins. It would include a reference to the weekly attempts to make a ‘clean catch’ with a beach ball strapped to your belly! I had to do a pee test every time I had an appointment.  They generally screen for protein and sugar in your urine and other signs of preeclampsia or toxemia.

Amniocentesis

With this test, a needle is used to draw amniotic fluid (while monitoring via ultrasounds to make sure nothing gets unintentionally poked! Ikes!) from one or more of the babies’ amniotic sacs. It is basically a genetic test and is often done to further investigate results of a previous screening, especially chromosomal abnormalities or a whole slew of diseases or defects.

This test has a 1/200 chances of causing miscarriage or premature labor because it pierces the amniotic sac. Apparently the risk is greater earlier in pregnancy. If your physician recommends amniocentesis, make sure you understand the reasons for it and agree it is worth the risk. I once talked to a M.O.M. who had this test and had no clue why. It is SO important to be involved in your care and always know exactly what is being done and why.

Chorionic Villus Sampling

This test is actually kind of similar to Amniocenteses. The main difference is that instead of removing fluid from inside the baby’s amniotic sac, it is removed from outside the chorionic sac of tissue. It can diagnose a multitude of fetal diseases.

Our choice in which tests to do was quite simple. If the test could reveal a problem we could actually seek treatment for, we would do it. We knew that we could never bring ourselves to terminate, no matter the problem, and didn’t see any reason to do tests that would cause anxiety over something we can do nothing about. If there was some sort of problem, I would rather go on enjoying my pregnancy and basking in the joy of it rather than stressing over what may or may not be wrong. My doctor didn’t wrestle me on the decision and said that with the many ultrasounds done on twins they would probably pick up on most problems anyway. We forwent the genetic testing and only had ultrasounds and standard maternal urine and blood glucose and screening test.

One thing to be aware of is that your insurance may not cover some of the genetic tests. Make sure you call your insurance company and get pre-approved for genetic tests so you don’t get stuck with an unexpected bill!

Middle Pregnancy: Oh My Aching Back!

24 Weeks, 175 Pounds, Measuring 32 Weeks

For me, this was quite possibly the most miserable aspect of my first pregnancy. It began already when I was only 12 weeks along. I could feel a little ‘twinge’ right on my tailbone. That soon spread to my hips. I was gaining weight and just the weight of my growing pregnant body on my hips at night was enough to roll the muscles into painful knots as they tried to hold my hips together! I prayed to never have to go on bedrest, because the pain of laying in bed for me was sheer torture! And if peeing every 3 hours in the night wasn’t enough, I couldn’t sleep for more than 2 consecutive hours waking in pain in the hip I was sleeping on! It was like sleep training preparing me for life with two newborn babies!

I would wake up with the hip of whichever side I was laying on just throbbing with tension.  I would get up, stretch it, and roll over and try to sleep again. Finally after tossing and turning for a few hours, I’d head for the couch, hoping it would help. On the couch I usually used pillows to make a reclining lounger for myself since we didn’t have a lazy boy chair! This way, at least there was no weight on my hips so they got a break for a bit. Somehow there is still only so long it is comfy to sleep reclining on pillows and I was up, again, looking for a new way to sleep.

So what helped? Different things at different times I guess. But here’s a complete list to give you some ideas of what might help you! 

Massage

Most often what I wanted was a massage. While I could have spent my future kids’ college tuition on massages during my pregnancy, instead I found it worked great for my dear husband (bless his heart for all the massages!) to actually sit in front/behind me while I layed on my side and he would use his elbow to knead the muscles in my hips and buttocks. This way his hands didn’t get so tired, and the bluntness of his elbow was just about perfect. When he wasn't available (ie – I was awake in the middle of the night!) I would use a rubber 'bouncy' ball between me and the wall to knead the muscles. I would just lean and roll against it.

Of course, nothing beats a professional massage from someone with strong hands. I got to know the massage therapist really well at a massage center down the street! I think I went in about monthly until the last month (which for me went to 39 weeks!) I rewarded (or is 'consoled' a better word?) myself for staying pregnant so long by getting a massage just about every week!  Erika soon knew EXACTLY where my rough spots were and exactly how to make them better! Also, if you can get your physician to ‘write a prescription’ for massage, you can pay for it with Flexible spending account or Health Savings account funds.

Heat

Of course heat and massage often go together. I really liked my 'bean bag' heat pack to help loosen the tension in my muscles. I don't remember where I got it though. My chiropractor has some that are filled with some sort of bean and my massage studio had ones that were filled with corn. Either is great! It is basically a heating pad but you just put it in the microwave. It is also GREAT for postpartum cramping and keeps you from having to take so much meds.  Here is one on Amazon that appears to fit the bill - complete with aromatherapy built-in! If you are more practical and not into fragrance, this heat wrap fastens around your waist. I highly recommend bringing one with you to the hospital!

Chiropractic

Another date I could hardly wait for – the chiropractor. I can't say enough good things about my chiropractor. I didn’t go to the chiropractor in my first pregnancy until I was past my first trimester and my back was already my worst pregnancy ailment. I had been to him before for a back problem right out of college and he fixed it in just a few visits, whereas another chiropractor at that time had told me I was in for almost a few years of treatments. The point is I knew I could trust him. Find a chiropractor you can trust. Either with a referral from a trusted friend, or an online search that gives good feedback.

When I found out early on that I was having my second set of twins, I started going to him right away and my back worked 100% better for my second pregnancy compared to my first. There were times I would walk into his office, not even being able to stand up straight, and when I walked out and hour later, I was completely normal. Beyond back care, he gave me tips on vitamins that helped my energy level (B vitamins and vit D3) – something I would expect to hear from my doctor, but never did (outside of making sure I was taking a prenatal vitamin).

 Also, my doctor diagnosed me with Carpal Tunnel late in my first pregnancy – which is actually listed as a pregnancy ailment because of the extra fluid in your body that can temporarily create this complication. So when I showed up at the chiropractor to have my back adjusted and he saw the braces on my wrists, he asked about it and examined them. He told me I did NOT have carpal tunnel, and in fact I had tendonitis. He taped my arms to take the pressure off the tendons that were bothering me and it worked wonders! I was symptom free in a few days and ditched the braces!

He even fixed my jaw once when the dentist leaned on it too much during a long visit. My adventures in pregnancy have really led me into a relationship of trust and gratitude for my chiropractor! I now run to him for many ailments of my own and my kids’ because where a doctor has a treatment, a chiropractor has a solution. And it happens to be faster and easier and cheaper that a doctor visit every time. I guess there are some things a chiropractor can’t fix though!

Getting in Water

Swimming was a great relief for my hips and back. Taking a bath in a nice deep tub helps too. Anything that takes the weight off for even a short time is such ecstasy! I added 40% to my bodyweight by the end of my pregnancy! IKES! So I really needed that kind of relief to make it through with some cognitive ability left! Now in the Midwest in February, you can’t exactly just go jump in a lake. But I bought a YMCA punch card, which was relatively inexpensive compared to a monthly membership, so I could still go swim in the pool there once or twice a week. In those final days of my pregnancy, rotating days where I got a massage, visited the chiropractor and went swimming was the only way I made it day to day!

Sleep Positioning

As for sleep, I found that the couch was a comfy alternative in the middle of the night. - I think it distributed the weight better and kept it off my hips. Plus I would stack up pillows so I could sleep on my back in a reclining position, which kept the weight off either side of my hips. What I really wish I would have done in my first pregnancy is to buy a recliner so I could actually get some sleep at night. Back sleeping isn't 'allowed' but in a recliner should fine because you can control how far back you lay (check with your doctor to find out how far is ok for sleeping at night). A mess of pillows on your bed including some body pillows is also helpful to try and distribute all of your weight evenly. I found a nice squishy one to always put under my belly to help distribute that helped too!

Stretching

Being very active in dance growing up, I am addicted to stretching. It really helps flexibility and that comes in very handy when trying to find comfy positions to sleep in. Not to mention for labor and juggling two babies while trying to breastfeed and feed yourself simultaneously! Here are two of my favorites!

-Stand next to the wall with your right side near the wall and right hand on it for support. Bend your right knee and stick out your left hip (you will feel it in the left hip).
-lay on your back (just for a minute – it’s ok!) and cross your right ankle onto your left knee. Use your left knee to push your right leg close to your belly while using your hands to push your right knee away from your belly. You will feel it in your right buttock/hip.

And...

One other thing you should know is that you can request your doctor refer you for physical therapy treatment and it may be covered by your insurance. If you are on bedrest – the therapists might even come to you! It’s definitely worth a try if you are in pain and miserable.

Of course I don’t have all the answers, so please share what worked for you in the comments!!!

Middle Pregnancy: Measurements and what they Mean

At your average prenatal visit, your doctor will take a tape measure starting at your sternum, pull it over your belly to your pelvic bone (while you are laying down) and announce a resulting number as ‘you’re measuring 18 weeks). What she is actually announcing is the number of centimeters that measurement it – which just happens to roughly coincide with the number of weeks gestation a normal singleton pregnancy is. The purpose is to make sure that there is consistent growth – consider it your baby’s first growth chart for all practical purposes.
This method obviously has some limitations though! For instance, if your baby happens to have a generously filled amniotic sac, you might think you are having the Goliath of babies, only to find that instead, you have been growing more Olympic swimming pool inside you than baby mass. Let’s hope that means he’ll be a good swimmer!
With twins, the technique is only mildly useful. Obviously, you’ll be measuring larger than a singleton mom. So when you’re in for your 20 week appointment and your doctor announces ‘You’re measuring 24 weeks’, that simply means, ‘You’re belly is about as big as a singleton mom’s is at 24 weeks’.  So yes, if you stay pregnant long enough, you too will have the joy of measuring 42 weeks, 45 weeks, or maybe even 50 weeks!
The challenge with using measurements as a growth indicator for M.O.M.s is this. As long as you are growing, you know that at least one of your babies must be growing, but you don’t know if they are BOTH growing. For that reason, there are typically more ultrasounds done for mothers of multiples than for singleton mothers.
Below are some of my measurements at various times in my first pregnancy. FYI – my babies were both 7 pounds when they were born, so this is approximately what one would measure with 2 very average-sized babies inside of her!
At 17 weeks, measuring 21 cm
At 19 weeks, measuring 23 cm
At 21 weeks, measuring 28 cm
At 23 weeks measuring 32 cm
At 26 weeks measuring 36 cm
At 27 weeks, measuring 37cm
At 30 weeks, measuring 41 cm
At 32 weeks measuring 40 cm (must have been off on one of these, or babies changed position)
At 34 weeks, measuring 46 cm
At 36 weeks, measuring 47 cm
At 37 weeks, measuring 49 cm
At 38 weeks, measuring 50 cm
That was the last measurement taken! I actually measured my girth...I have to double check the exact figure - but if memory serves, I think it was 50 inches! IKES!

Middle Pregnancy: Quickening

22 Weeks - 171 Pounds
Measuring 30 Weeks

Feeling your babies move for the first time is a mysterious experience. I remember thinking that I had perhaps been feeling something, but that it also might have been just gas.  But I was pretty sure that I didn’t have THAT much gas! Yet, I couldn’t easily tell the difference.
I remember the first time I was CERTAIN that I felt one of my babies move. I was at home relaxing and working on some projects on my couch. I felt a flutter which seemed to be up in my ribs way further than baby should ever be! At first I thought maybe was it just some intestinal juices… A minute later, I felt it again in the same place and knew it much have been baby! That was in my 15th week of pregnancy. By my 17th week, I could feel them moving just about every day.
For a singleton pregnancy, the first movement is usually felt between 20 and 24 weeks, but it seems that twins can be felt sooner. Some think the reason behind this is mysterious or non-existent, but to me it seems quite straight forward, because around 18 weeks for a twin mom, the babies are taking up about as much space in your abdomen as a singleton would at 20-24 weeks. So their limbs are going to be as ‘crowded’ and up close to your insides as an older singleton.
One cold November morning in my 22nd week, I woke up to a serious bounce on my belly! I looked down and saw a little ‘thump…thump… thump’, knocking on my belly above my belly button. She must have had the hiccups! In meetings when I was bored, I could sit and ‘snuggle’ with my babies, feeling them bump around bringing a feeling of such joy and comfort!
I have heard it said that moms often can feel their babies move much earlier (about 4 weeks earlier) in their 2nd and subsequent pregnancies. This proved true for me that it was again mid-September when I first felt my second twins move – but I was only 13 weeks along in my pregnancy! So it took me by surprise. But it was difficult to deny or write off as gas because it felt so different this time. Surprisingly, it wasn’t the ‘flutter’ of the first time, but more of a direct poke at my bellybutton! And it happened for the first time when I leaned against the sink washing dishes. As if to say ‘hey mom, quit bumping me!’. It happened a few times that day! I thought it so strange that the first movement would be so strong – but maybe I was too busy to miss the first fluttery ones, or maybe I’d been eating too many Taco Bell bean burritos.

Twin Terms Part III: Plumbing Arrangements

White line laying on top of baby's face is the amniotic membrane

We’re done with the simple nomenclature and off to the plumbing designations, which can be a little complicated, and has lots of lingo, which you probably won’t be familiar with the first time you hear it. Don’t worry though –you soon will be!
Dizygotic (fraternal) twins will always have all of their own structures within the womb, often referred to as ‘di-di’. Each has their own water filled play area called an amniotic sac. Each amniotic sac is contained within its own outer covering, or chorionic membrane. The chorion is synonymous with the placenta. So every fraternal twin will have its own placenta.
Monozygotic (identical) twins however, have several possible ‘womb-mate’ arrangements. Usually you will see this expressed or referred to with the lingo ‘mo-mo’ or ‘mo-di’. Those words can be translated so that the first ‘mo’ or ‘di’ refers to the twins’ chorionicity, and the second ‘mo’ or ‘di’ refers to the twin’s amniosity. (Note that is not animosity, which will certainly come into play around age 2 or so! LOL)
The chorion is a membrane that surrounds the amniotic sac (or sacs) and it is synonymous with the placenta. So if there is one chorion, there will be one placenta. If there are 2 chorions, each baby will have its own placenta. Monochorionic means that there is one chorionic membrane and that the babies will share a placenta. Sharing a placenta does generally put you at a higher risk for twin to twin transfusion syndrome where one twin gets more blood from the placenta than the other, causing variations in growth which pose a hazard to both twin’s health. But stress over it because there are many monochorionic multiples that do just fine! Your doctor will do lots of ultrasounds to monitor their growth and make sure they are growing at approximately the same rate.
The exception in this case is that there are cases where babies are dichorionic and have their own placentas, but as they grow, and as the placentas grow, they fuse together. Once the placentas fuse, it can be difficult to determine if your twins actually shared a placenta or each had their own which fused together. So, if you find out you are having twins at your 20 week ultrasound, and there only appears to be one placenta, you may not know the true chorionicity of your twins unless you have the placenta examined after their birth.
Amniosity refers to whether or not your babies have their own amniotic sacs. If your twins are monoamniotic, (‘mono’ meaning 1), they have only one amniotic sac and share a swimming pool together inside you. If they are di-amniotic, (‘di’ meaning 2) that means there are two sacs and each baby has it’s own pool of water which is separated from his siblings by a curtain-like membrane.
Unfortunately, sharing one amniotic sac does have its risks with the possibility of cord entanglement, which can. For this reason, it is normal for your physician to admit you to the hospital for constant monitoring of the babies at the point which they are viable (able to live outside the womb), which is around 20 weeks. The reasoning is that they want to monitor the babies for distress, so that at the first sign of trouble (likely resulting from cord entanglement) they could deliver the babies and save their lives. Note that this is not the same as bed rest that was indicated because of a risk for preterm labor. It is mostly for monitoring purposes. If your physician does NOT advise this, I would seek a second opinion.
The number of placentas and amniotic sacs can best be determined by ultrasound at around 12 weeks. At that time, the placentas and amniotic membrane are more highly visible than they are early in pregnancy when they are very small, or later in pregnancy when placentas can potentially grow together.
Now, if you are having triplets or more, you could have any combination of shared or individual placentas. So two of the babies could share a placenta and the third have its own, or all three share one placenta, or each of the three have their own placenta. Same thing with amniotic sacs – some babies could share a sac while others have their own.
Ok, if you fell asleep during that, you are probably not alone! So here is a brief review!
Fraternal Twins = Dizygotic twins (originating from 2 separate eggs and sperms) Fraternal twins will ALWAYS be ‘di-di’, meaning dichorionic and diamniotic having each their own placenta and amniotic sac.
Identical Twins = Monozygotic Twins (originating from the same egg & sperm which divided into 2!) Identical twins can be ‘mo-mo’, ‘mo-di’ or ‘di-di’. That means that even if your twins have their own placenta and their own amniotic sacs, they could still be identical and the only way for you to learn that they are NOT identical would be to rule out monozygosity with one of the following tests:
1.    Babies are different sexes, therefore not identical (duh!)
2.    Babies have different blood types, therefore not identical.
3.    Babies have a DNA test which compares their DNA and determines zygosity.
I hope you studied well..there may be a quiz later!

Twin Terms Part II: Identical & Fraternal

This is one of the most pondered concepts of twinning and it lends to the unique insight of the answer to the 'nurture vs. nature' question. This is why there are many studies done on identical twins - they provide a control group for genetic factors into disease and personality difference so that it is possible to have insight into how much of a disease is caused by genetics versus how much of it is attributable to an environmental element.

Ingrid & Helen (Identical Twins) age 2

Twins who came from the same fertilized egg are considered ‘monozygotic’, or ‘identical’ twins. They are begotten of 1 egg and 1 sperm, which after joining and growing for a time, divided in half, creating two blastocysts. There are a few exceptions to the above traditional origins of monozygotic and dizygotic twins, but they are mostly related to genetic mutations that are not common, and I won’t go into explaining them. If you want more info though, check here (see 'Half-Twins' Heading).

Helen & Ingrid age4

Generally, identical twins look very similar, though they may not look exactly identical.  My first twins were monozygotic, but I didn’t know it. They had slightly different shapes to their faces, but they looked more and more alike the older they got which led us to get them DNA tested. As they got older, other apparent differences were in their unique voices and facial expressions. My youngest, were also monozygotic, and they always looked alike it too, but they did have a slightly different shape in their ear which helped us tell them apart!

Dizygotic twins are no more genetically alike than any brother and sister. They originate from 2 separate eggs, which are fertilized by 2 separate sperm. That is why you should never ask a twin mom who has boy/girl twins if her twins are identical! (yes, some people do ask this!) some interesting exceptions to this include the possibility that fraternal twins could actually be the children of two different fathers! (Though I don't recommend this!)


One interesting note is that even though monozygotic twins are referred to as 'identical' twins, thier DNA is not completely identical. This is because there is a small amount of genetic material that is stored in the plasma of cells (not the nucleus where the most DNA is). So when the newly fertilized egg divides, one twin will end up with some mitochondrial DNA from the cell plasma and the other side will have the rest of it.

Ingrid & Helen age 5

A short delay...

Hi Guys,
Sorry for the lack of posts...soemthings come up this week and last, but I'll be back on track next week and try to make up for it!
Thanks for being patient!

Twins =Terms. Part I: Who's first?

As soon as you walk though the double doors of the twinning community (pun intended), you start hearing lots of befuddling words that describe the various possibilities of number, condition, and location of multiples in uetero. “Baby B, Baby 3,  dizygotic, monochorionic, transverse, Vertex, and even ‘mo/mo” what do they all mean? This is your all-expense paid trip to find out ‘what’ your babies are.



 Baby A, meet baby B, and perhaps Baby C and D too!
The first medical terminology you come across is likely to be during your first ultrasound. To differentiate your babies throughout pregnancy, they are labeled with the letters of the alphabet. Creative, eh? The baby who appears closest to your cervix is given the letter ‘A’ anticipating that he will be the first born. B is the second place winner and C the runner up.

Because the letters are used to distinguish one baby from the other, they will NOT rename them even if the babies (knowingly) switch places and one wrestles the other away from the cervix. However, if you have an early ultrasound, say 6 weeks and do not have another for a few months, it is very difficult to know that the baby that is A at the later ultrasound was actually the baby labeled A at your initial ultrasound. This is because the babies positions can change a lot and it is difficult to identify placenta location on early ultrasounds. Location of the placenta for each baby gives those ultrasound techs the best clue at who was A last time and who was B, because even though the babies can move, the placentas can not! Thank goodness that unless there is a medical concern, it is also irrelevant who was labeled who. (Except for us sentimental types who are wondering which book to scrapbook the ultrasound photo in!)

This can also make the end of pregnancy interesting as if they DO switch spots, your doctors and nurses start to get very confused at who is A and who is B – especially at the hospital. It also causes very interesting conversation with coordinating physicians who are appalled that you are going to attempt vaginal deliver when 'baby A' is not vertex.



 So this brings up an important point in medicine that applies to everyone who ever seeks medical care or treatment: Always know everything about your condition and pay attention to what is happening to you during your care. If you are supposed to have your left kidney removed, take a permanent marker and write on your back “Keep in” on the good side and “Take this one” on the other side. Folks, it happens too often. I am not joking about this – use the markers on your body. Ok, enough of a side rant.

After the babies are born, they receive new names. No, I’m not referring to the ones YOU will give them. Rather, they are warmly welcomed into the tradition of our modern society with the caring designation of (you guessed it!) a number. The first born is called ‘Baby  1’, the second, ‘Baby 2’ and you can guess from there. This is regardless of what their letter designations were. The baby who was born second will always be ‘Baby 2’ even if she was ‘baby A’ in utero. [Can’t help but bring images of Star Trek Voyageur to my mind ‘My designation is 7 of 9’. That’s what happens when you’re married to Mr. Geek.]

Surviving Pregnancy: Mood Swings... or Not

Week 20 - 167 Pounds
Measuring 28 Weeks

For as much stress as Mr. Geek (my DH) was under while we were finishing some home improvement projects, (he's about as handy as a swimsuit on a snowy day) he was still pretty much his cheerful, silly self most of the time. Though that wasn't really the case for our second pregnancy when we already had kids to care for and were too exhausted to be cheery. But one time, while he was reading a pregnancy book to the babies, (yes, we did the whole cheesy have dad talk to the babies to get used to hearing his voice thing). It instructed dad to try to be understanding of mom’s unpredictability and moodiness from pregnancy hormones. I asked him if that was really the case for me, and he said that I’m actually LESS  moody than before I was pregnant! I sometimes wonder if it had anything to do with the hormonal birth control I was on, but I think if I had mood swings, they were more noticeable in early pregnancy than later on. Or maybe I was just so full of excitement and anticipation for being a busy mom and leaving behind a stressful role in a family business that it adjusted my outlook on life.

Mr. Geek had a way of  making me smile with his silly antics while I was pregnant. Here are a few of my favorite Mr. Geek quotes:

In a frantic voice: Where’s the babies? (Then I would point to their last known ultrasound location and say 'right here & here!" He would respond :"I love all three of you!

With a blank look on his face, a distant stare and a melancholy tone: “*sigh* Twins. We’re gonna have two babies. *sigh* When asked how he feels about this, he never has a definite answer. Usually it was he didn't think he was ready for it.

Staring blankly at my belly: “Wow, your pregnant”. He claims that although he didn't find my belly sexy, he thought it was cute.

Staring at my recently-endowed chest and, uh, 'commenting' on it!  Pretty much every time he looked below my neck and above my belly, he felt the need to express his interest and pleasure with this change in my body. Yes, I noticed too dear, I didn't know we had to be so expressive about it though. (If I knew how to insert a rolling-eyes smiley I would do it here.)

Guys, if you are reading this far, note that expressing to your wife your continued love and undying affection is especially critical  and complimenting her physical appearance is generally very important during pregnancy! She needs your love and reassurance!

Surviving Pregnancy: Body Image, Hormones and Wildlife in the Bedroom

In the previous post about what to wear, I touched on pregnancy body image. Some people feel, ugly, fat, clumsy, or otherwise totally unattractive in their mom-bods. Others feel ultra-feminine, uninhibited, cute, voluptuous, totally proud of their natural beauty found in the amazing miracle their body is actively yet subconsciously nurturing.
Before pregnancy, my belly had been the part of my body I was most self-conscious about. One might expect that to be exacerbated by a growing pregnant belly…but actually the opposite is true. You see, for the first time in my life, I felt I could let it ‘hang out’ without shame. My growing belly was not just cute, it was a shining example of completely beautiful and exciting blessing.
For the first time, I felt completely at peace with my body. (Obvious note that this is in reference to body image and not the physical aches and pains of pregnancy!)  This gave me a feeling of freedom, and sexiness that I had not had before. Granted, my dear husband tells me that he thought I looked cute, but that my un-pregnant body was more attractive. But this wasn’t about his perception, it was about my own, and through my own skin, I felt like a goddess. And a woman who feels like a goddess wants to revel in it with her husband. And let’s face it ladies, the lucky guy married to a woman who is constantly pursuing her husband like a lioness seeks it’s prey is going to think she is super sexy – belly or not. Which of course gave our intimate life a touch of enthusiasm that it hadn’t had since early in our marriage.
It is interesting to note that it wasn’t just the improved body-image creating the spark. Pregnancy hormones are in fact KNOWN to fan the flames of libido for some expectant mothers. Increased sensation in some key nerve endings and increased natural lubrication are contributing factors. I found that arousal came much more easily and intensely and from things that wouldn’t even interest me previously. And the intensity and ease of climaxing was, ahem, very notable. There were even a few times that my entire pregnant belly contracted during climax, which was startling at first, but completely normal, and according to my doctor, nothing to be concerned about.
And yes, some women will feel just the opposite because of exhaustion, nausea, and the other physical discomforts and because generally having a four foot girth does not fit our cultural norms of sexy. No two people or pregnancies are alike. Guys (if Heaven forbid you are still reading this!) you should know that your wife might not appreciate the appearance of her mom-bod as much as I did. Know that your constant verbal and physical approval is necessary to help her feel good about herself. Be sure to point out whatever positive qualities you can see in her changing body - even if they are different than the things you appreciated before you installed that watermelon in her midsection. If you change the frequency or freeness with which you give her loving, touching and sexual affection, she will likely notice. Be sensitive and share any struggles you are having in a gentle way.

Ladies, on the days and weeks that you feel well, take advantage of them and give your body a chance to speak to you and tell you what it needs and wants. And maybe consider thanking your hubby in an intimate way for all the help he’s going to be giving you with these babies in a few months. After all – there won’t be as much time and energy to 'thank' him then! Just enjoy your free time while it lasts!

Placeholder

In case I miss an early pregnancy topic :)

Surviving Pregnancy: Stretch Marks - not just for your belly anymore!

So, having twins, I pretty much KNEW I would be getting stretch marks. I just never realized WHERE I would be getting them!  In my 7th week, we spent a weekend away from home. I generally felt pretty good, the cramping was finally going away, and morning sickness hadn’t totally kicked in yet. When I woke up on lazy morning, I felt good. The day was beautiful and the air fresh and crisp...and my husband and I didn't want to get out of bed just yet [insert winking smiley here]. Suddenly, a huge grin came across his face. (Yes, even more than otherwise expected.) Ahem - let's say he simply observed an amazing over- night growth spurt of my breast tissue. It was a serious growth spurt. Overnight, I grew at least a cup size. I voluptuously (and only somewhat uncomfortably) overflowed my bra for the remainder of the weekend.
And while the size may have been thoroughly a benefit, the quick growth brought with it stretch marks. That really didn’t bother me much though, as there is really only one adult that will regularly see them, and he’s too distracted with their other attributes to care. pregnancy thing could be fun after-all. Which leads me to my next post…

Surviving Pregnancy: Choosing a care provider

18 Weeks of Pregnancy - 164 Pounds
Measuring 23 Weeks

This is the one task that brought more stress to me during my pregnancy than any other single topic. At one point, the birth educator in a hospital class questioned the fact that I had a family practitioner for a high risk pregnancy and urged me to transfer care immediately. After calling around and learning I was too far in my pregnancy for any of them to willingly take my case, I consulted with one of specialists my doctor was working who completely laughed off the concern and said my doctor was certainly more than capable!

Choosing a Clinic
Early on, I chose a clinic and doctor because they had family practice physicians that would attend your birth and deliver your child. This was at Allina Clinics. I simply went to the Allina clinic website and read doctor profiles and philosophy and picked the one I liked.
The advantage of this was that unlike a standard OB/GYN practice, you could be assured that you would see the same individual for your prenatal visits as you would in the delivery room, ensuring as few surprises as possible. In other words, if you know your physician only performs episiotomy in urgent situations where the only other choice is C-section, then you won’t have to wonder about that when you are dilated to 10 and someone you’ve never seen before walks into your room covered in light green sterile clothes and only her eyeglasses peaking out as she says ‘hi, I’m doctor Smith and I’ll be delivering your baby today!”

Choosing a hospital

Another consideration is which hospitals your physician works with. In this respect, you might start your physician hunt by hospital shopping. You can start by going online and looking up the birthing centers or maternity wards of hospitals in your area. Often, their websites include basic information on rooms and policies. Most often however, if you want any specific information you will have to call. When you call, ask if they have a free tour or information session that you can attend. This is often the best way to lean more, and will give you an idea of how hospitals are different.
The hardest part is deciding what is important to you. Any good literature on multiples will recommend that you choose a hospital with a level II Neonatal Intensive Care Unit, as many multiples end up spending some time in a NICU. One consideration, especially for those who have high risk pregnancies (besides the fact you are having multiples) or are having  triplets or more is how easily accessible the hospital is from your home in case there is an extended stay there. The choices in this respect may be limited. Also, consider that if you are leaning toward a hospital without a level II NICU, that if your babies must be transferred there, you will still be recovering at the hospital you birthed at – making visiting your new babies complicated.
Aside from those factors, other items may be important to you, such as
*What are is the practice regarding fetal monitoring during labor? (see my birth stories to understand why this may be significant)
*In what situations are IVs are mandatory for laboring moms?
*Do I labor, deliver and recover in the same room?
*Where will you be delivering? (it is common for mothers of multiples to deliver on the operating table in an Operating room.)
*Is there a bathroom with a bathtub in the labor room?
*During recovery, may the baby(ies) remain with me, or are they required to be monitored in the nursery for certain periods of time?
*In what circumstances will the babies need to stay in the NICU? (based  on birthweight? Feeding needs? *Body temperature maintenance? Breathing assistance? etc.)
*Are laboring mothers able to eat, drink and eliminate on their own? (You may need to ask your physician this question also)
Be sure to preface these questions with the fact you are expecting multiples as the answer is often different.

Multiples: an automatic 'high risk pregnancy'
Most hospital and physician protocols go into ‘hyper-over-protective’ mode because you are having twins. And yes, they have some good reason to, as multiples are often born earlier, or smaller, and have complications such as Twin to Twin transfusion that singletons are not at risk for. However, there is a tendancy for protocol to be over-restrictive or overly-intervening even when there is no true benefit to the action in YOUR particular case.
I personally believe this is due both to lack of adequate research regarding risk in multiple pregnancy as well as a subconscious tendency to practice ‘defensive’ medicine. There is often not enough research to know for sure what things really are more risky for expectant M.O.M.s because there are just not enough multiple moms out there and not enough studies being done on them to provide reliable risk information. The tendency to practice medicine defensively stems from an emotional reaction (rather than a logical one) which inappropriately favors a known risk over an uncertain risk. This happens because we all have an innate desire to avoid liability and potentially poor outcomes, but as a result we may minimize or ignore the known and unknown side effects and risks of the intervention or restriction being proposed. (More on this in a future post).
This means it is critical for you to know and understand what conditions and risks are pertinent to YOUR pregnancy, and not just multiple pregnancy in statistics. Statistics often don't account for factors like previous poor pregnancy outcomes, socioeconomic status, access to health care and education. All of these are factors in general in pregnancy outcomes, and all should be considered when making decisions about YOUR pregnancy - not JUST a raw statistic. It is also very important to understand every procedure, test and intervention your provider recommends, why it is being done, what it's risks and side effects are, whether you and your physician has reason to think those same statistics would apply to you, and what the risks are of NOT doing it.

 So for instance, a doctor may recommend that you do not do any regular exercise because it is a risk that in their mind is not worth taking, but there is not data to show how risky it is - or even that it is correlated with complications at all. My question would be, what is at risk? They probably think the extra stress on your body could cause early labor. But are the chances of that really significant? Especially if you have had previous non-complicated pregnancies in which you DID exercize? Are there studies that show complications arising due to M.O.M.s exercising? Or is it just an 'extra' precaution? Is there is an intuitive reason that exercise will cause complications? If not, what are the potential side effects and risks of just remaining sedentary during multiple pregnancy?  You can see there is nothing clear cut, it all requires reliance on your doctor's knowledge and communicating your own risk tolerance and preference to her, and finally, using your intuition when logic is not available.

Natural Birth hopefuls: Critical Question for your physicians!
In the end, I worked with the same doctor both times – but the important part, which is critical here, is that she worked in coordination with a group of perinatologists who were on call during my birth, and actually attended them. In fact, because of a slight complication with thrombocytopenia, I was transferred totally into the care of the perinatology clinic for my second birth. Because of my experience, I highly recommend that all M.O.M.s (mothers of multiples) seek a highly trained perinatologist either for primary care, or that will coordinate with  your physician to attend the birth. The reason for this is that many physicians (even OB/GYNs) and midwives are not trained or experienced in breech birthing, especially the younger ones who were not practicing decades ago when it was more common.

Most OBs and physicians will advise you that as long as baby A (the first baby to be born) is head-down, you will be able to attempt vaginal birth. If vaginal birth is important to you to avoid C-section, you should pay careful attention to this subject. Some physicians will have a low personal risk tolerance, and may advise you that unless both babies are both vertex (head down) you should really consider having C-section. This is code speak for “I certainly wouldn’t try vaginal birth, but I guess I would put up with it if you did”. Do you really want to work with a doctor with that attitude? If you are like me, this won’t be the only issue you struggle about with him or her. And in reality, the advice is extremely short-sighted, as even if baby B is in a vertex  position, she is likely to present differently after baby A is born and will either need to be turned or birthed breech. (in both my pregnancies, after A was birthed, B had changed positions from where she was even during pushing of A) It is important to know if your doctor (and the other doctors in the practice) are able and willing to do a breech extraction on Baby B if the conditions are right (they may not do it if baby B is significantly larger) or to do an internal inversion of baby B after the birth of A. If they are not able or willing to perform either of those procedures, you will very likely be one of those mothers who had the ill fortune of delivering one child vaginally and the other via C-section.
In my personal experience, and from listening and knowing the experiences of those in the mothers-of-multiples group I am in, it seems that perinatologists are much more well-trained and experienced in these procedures than your average OB or midwife. Not to say that an OB practice would not be appropriate for you, but be sure to ask the important questions, and that you are comfortable with the answers.

Questions to ask when choosing your physician:

*Are you (and those in your practice) able and willing to do a breech extraction on Baby B if the conditions are right (they may not do it if baby B is significantly larger) or to do an internal inversion of baby B after the birth of A?
*In what situations would I be required to have a C section?
*For what reasons do you recommend bed rest?
*If all is healthy, is there a reason I would need to be induced?
*Can I have a doula present at my birth?

These are not all-inclusive by any means, but they are the most likely to bring up topics that can vary widely between providers and their experiences.
In reality, and in today’s medical care economy, it is extremely rare that you would actually be able to meet with doctors from various clinics, though sometimes they will make such appointments or have office hours. More often than not, they expect you to just schedule a regular exam or checkup and become a patient first, and ask questions later. For that reason, I would choose to start by taking hospital tours very early in pregnancy to choose a hospital first. Then I would find clinics and physicians that can practice at that hospital and call their offices to find out what resources are available to answer your questions. Don’t rule out a doctor or clinic because they are too busy to take your questions – it is probably a good sign. Join a local Mothers of Twins club or Mothers club and ask what hospitals/clinics/physicians other M.O.M.s had for their pregnancies. Pick a clinic or physician and ask lots of questions your first few visits. If you are not happy with the answers, make your next appointment with someone else. Choosing the right care provider is definitely an art and not a science!

Surviving Pregnancy: Staying Active

16 Weeks Pregnant - 159 Pounds
Measuring 21 Weeks

Pregnancy may be littered with ailments. Fatigue, nausea, aches and pains, bed rest. Try not to let these ailments wear on your general mood. Take advantage of the days and weeks when you feel good and do something good for yourself and your baby, or babies!
I began doing Yoga in my first trimester. I didn’t do it every week, but I did go to a class with a friend, which helped motivate me and keep me honest about showing up! I highly recommend finding a workout buddy. We both traveled over 20 minutes to meet to work out, but since we didn’t have kids, it worked out.  In fact, it was a nice way to spend time together even though we were at different stages in our lives. I was pregnant; she was unexpectedly single only a few years ago.
After the yoga series was over, we continued to meet up and do elliptical machine and stretching together. I really treasured the connection that working out gave us, and blessing of all blessings, she found her future husband during that time! But if you don’t have a workout buddy, or can’t get out of the house, you can surely at least find a prenatal workout video and even prenatal yoga on DVD.
Note though, that I did NOT overdo it. While I didn’t check my heart rate, I was easily able to keep conversation with my friend the entire time, which is an important indication that I was not over-exerting myself. Note that I did this with the blessing of my doctor who advised me only to take pre-natal yoga, and do non-jarring machines like bikes or ellipticals. I will admit however, that I never asked when I should stop though! And I kept it up well into my 7th month!
Finally my belly was too big to be comfortable lugging it around a gym and I had such a blood volume within me that I was too easily fatigued. When this happened, I’ll admit I spent a lot of time lounging on my couch like a beached whale, or soaking in the tub. But rather than become completely sedentary, I began swimming.  This really was beneficial not only for the exercise and circulation, but it was a heavenly way to get the weight of my babies off of my belly! I remember swimming in the water just dreaming that I could take a nap there!  I actually went swimming every few days, and even the day before I delivered at 39 weeks!

Of course, you should check with your care provider about exercising during a multiple pregnancy, but if he or she completely discourages you from any activity ‘just to be cautious’, I would question that recommendation or seek a second opinion. I don't believe a healthy mom should not be discouraged from physical activity simply because she is pregnant with more than one baby. There it no research to show it is detrimental, and unless you have other risks, and especially if you were active before pregnancy, there is nothing to be cautious about until much later in pregnancy.

Surviving Pregnancy: The Ever-Shrinking Wardrobe

14 Weeks of Pregnancy - 157 Pounds
Measuring 18 weeks

As I have already alluded to, there is this terrible in-between time for all pregnancies when regular clothing becomes too small, and maternity clothing is still fits too much like a tent. This mis-fit period is shorter for M.O.M.’s thank goodness, but it also hits sooner for them, before most people know you are expecting, which presents it’s own challenge: What on earth do I wear? My jeans were already getting noticeably snugger before I was 5 weeks along! By the time I was 7 weeks jeans were out of the question and I was in elastic waistbands only. I literally wore through the seat of the 2 pairs of ‘normal’ pants that I could still fit into. I didn’t feel confident going to buy lots of maternity clothes yet because, well, nobody really knew I was pregnant, and most maternity clothes are pretty obvious, or at least have a big stretchy waistband that is a dead giveaway.

I did go shopping and found a few nifty new pairs of ‘regular’ pants with elastic waistlines that got me through, and actually they worked well for postpartum as well. Dresses would be a good option, except I didn’t have many. My favorite maternity clothing item was a pair of bib overalls. Buy large – you’ll need the room! They were the only item that actually covered my girth and stayed up in my final week!
Another great  item that I wish I would have discovered sooner was  belly bands. They are simply stretchy rings of fabric that go around your midsection. So as your cute ‘lil baby bump (or for us M.O.M.s perhaps ‘voluptuous belly bulge’ is more appropriate) starts to pop out under your regular shirt, you’re not baring your skin. The belly band shows beneath your shirt, which I think is so cute, and it saves you from having to buy a bunch of in-between-size maternity shirts…and save up for the tent-size ones you’ll need later on.
I recommend getting several belly bands that coordinate with your current (non-maternity) wardrobe because not only are they good during mid-pregnancy, but they are also EXCELLENT for nursing moms, because they allow you to nurse in public without baring your belly or buying expensive nursing shirts or futzing with a nursing cover or blanket. I used them under my clothing everyday after the babies arrived so I could nurse easily when needed. Also, be sure to buy the extra tall or wide belly bands, because some are rather ‘skimpy’ in that the fabric is only about 8” wide, and let’s face it twin mamas, 8 inches isn’t going to cover your ‘buns in the oven’ very far into this pregnancy!
It was such a relief when the cat was out of the bag, and I could proudly display my midsection because, let’s face it, at 10 weeks it was getting tuff to hide! At 15 weeks, there was not a single pair of pre-pregnancy pants I could squeeze into. I’ve always been so self conscience about my belly, and have always been very conscious of my posture, so being able to let it all ‘hang out’ was a very freeing experience. Never before did I have a reason to be proud of my figure, and now I did. Actually, it was during middle pregnancy that I felt more proud and confident in my body than I had since, well, ever in my life. And it was only about to get better…

Surviving Pregnancy: SLEEP PLEASE

12 Weeks of Pregnancy - 155 Pounds

Of course, another plague of early pregnancy is exhaustion. Your body is working hard, to build and nourish not one, but two (or more) other little bodies. You have nutrients to process, cells to divide, and blood volume to build. If you think you would be this tired if you ran a marathon, you are right. Your metabolic rate is increased. And to add to it, your body is producing more progesterone, which has a sedative effect.

I think for me, week 8 was the worst for feeling exhausted. I pretty much fell asleep right after dinner, if I made it that far! And I often wanted a nap in the afternoon when I could sneak one in. Any mom will tell you that the only thing worse than having a full time job and being that exhausted is having young kids and being that exhausted - even worse all of the above! Just do whatever you can to get some rest. Go to bed early, sneak a nap, make your hubby drive and catnap in the car, call a friend in for help. Don't feel bad about it, your body does need sleep for you to function well and give your best to your family and your job.

It was at this time during my second pregnancy that I started the habit of putting in a longer movie in the afternoon to let my older kids watch while I snoozed for 45 minutes. If your kids are younger and you can’t let them roam around the house while you snooze, try putting him/her/them in a crib with their favorite baby-safe toys. Or even buckling ‘em in a car seat in the living room in front of a Baby Einstein movie. Of course, I don’t condone this as a regular habit, but when your body id desperate for rest, it is important listen.

I still felt pretty fatigued at 10 weeks, but after that, the worst of it was over. In general I needed more sleep, but it wasn’t overwhelming. Also, remember to take your B vitamins! I was taking a B supplement of some sort but can’t recall which…so ask your doctor if it would benefit you. If your doctor gives you a blank stare in return, ask to see a nutritionist or dietitian.

Surviving Twin Pregnancy: Morning (and afternoon, and evening and nighttime) sickness

10 Weeks of Pregnancy - 153 Pounds

So one thing that *almost* every expectant mom gets to participate in is the dreaded morning sickness. I believe mine started around 8 weeks. It seemed worse if I got hungry, so the best thing I could do to help it, ironically, was eat. Mostly I craved comfort food: Macaroni and cheese, Ramen Noodles (beware the MSG in the seasoning!), soda, or anything with lots of carbs. When I felt sick, I ate anything of the above to keep myself sane. And when I felt well, I tried to eat extra healthily to make up for it. The worst time for me definitely was in the morning. I got into the habit of waking up and immediately boiling water to make ramen noodles. It was the only thing I could stomach, but after I ate them I felt much better. Most of the day I still felt slightly off. I think this is really the worst time of pregnancy because you are so miserable and just want to keel over on the couch and watch old episodes of Friends from the season Phoebe is pregnant with triplets while sucking on preggie pops, but you can’t because most people probably don’t even know you are pregnant yet! (Or maybe because you have several little ones running around already trying to play in the toilet water and your long-abandoned maxi pad drawer). But nevertheless, you are stuck trying to live your day to day life in an honorable fashion.
Usually, for me, it got better as the day went on, though there were a handful of days that I was quite miserable and just threw up the white flag claiming illness and sympathy from my hubby. I never actually ‘tossed my cookies’, because I HATE throwing up, and resist it with my whole being. But I probably would have felt better if I did! My heart goes out to those women who can’t quit the vomiting. But especially for you twin and multiple moms, it is VERY IMPORTANT to keep food down and get lots of nutrition and weight gain a little earlier in pregnancy because twin, triplet + buns generally don’t get as much time in the oven. Talk to your doctor if you have a hard time keeping food down on a regular basis because they can prescribe drugs to help.
Also, one thing I did find helpful was this device that I already owned because I frequently get motion sick. It’s called a ‘Reliefband’ and works on the principle of emitting a small electric pulse through a pressure point in your wrist. It worked miracles for my motion sickness when flying. Unfortunately, it was removed from over the counter sale around 2005 or so and was subject to FDA approval. There is now a new version on the market called 'ReliefBand Voyeger' that seems the same, except it is considered disposable because you cannot replace the batteries. I only once replaced the batteries in my original Reliefband in years of use, so if the new ReliefBand Voyager is as high quality, you should get many good months/years of use before it is kaput.
The Seaband works on the same premise, so you could try that too, but knowing how much pressure I had to apply to my wrist when I forgot my relief band, I’m guessing the Seaband isn’t as effective, but it's cheaper and may be worth a try for the desperate. As for my second pregnancy, I did have morning sickness, but not nearly as often, nor as intense. On the other hand, I just had a constant sense of being slightly ‘off’ that could usually be controlled with eating consistently. So I got in the habit of keeping a granola bar or healthy snack in my purse every day, which seemed to help.
Do take heart that nausea is a continued sign that you are still healthy and still pregnant! In fact, if you had a very sudden drop the severity or frequency of nausea, I would give the doc a call, just to make sure everything is ok. The dreaded morning sickness did finally dissipate and get milder for me around 15 weeks, and milder and less frequent yet around 16 and 17 weeks until it was a mere memory! Good luck getting there! Be sure to post a comment if you have any tips or tricks that worked for you!

Just an ultrasound...

Baby A 11 Weeks

Baby B 11 Weeks

We had out ultrasound on August 12 when I was 11 weeks along. I’m not a superstitious person. But 11 has been a lucky number for me. I was born in the 11th month. I wore 11 on my softball jersey. I met my future husband on the 11th. And of course, if you add 1 + 1, you get 2, which is also a pretty important number in my life! I remember being in the waiting room for the ultrasound. I had to pee to the point my bladder hurt, but that was not what was making me nervous. I was going to meet my baby. See her little heart fluttering, See her springing around in nice warm gooshy balloon of goo. At least I said a prayer that we would see those sorts of  pictures of a very healthy, normal baby. But there were a few surprises. The first surprise was the goo she squirted on my belly…it was warm! Then she put the sensor on my belly and started swooping all over, way up high, down low, side to side. She would pause for a moment with a puzzled look on her face, and then move to a different area. I couldn't make out anything on the screen except black splotches of static. After about 2-3 minutes of this, I was getting very nervous. The room was dark and she hadn't said one word, there was absolute silence. I swear I could hear the beating of my own heart. Visions of 2-headed babies danced in my head. Or perhaps no baby at all. I prayed and told myself that no matter what it was, God would not give me that which I could not bear. Just then, she took the sensor off my belly and said “Well, (note that the comma you just saw represents about a decade of purgatory in my memory) “how do you guys feel about twins?” WHEW! What a relief! I was totally flabbergasted! And thrilled! Now Mike: he looked a little stunned, but he assured me that he felt, happy, excited, and blessed, just not in the same flamboyant manner in which I was. What a realization that you need 2 cribs, 2 car seats, a double graduation party and two 529 college savings accounts. At least I already have 2 boobs, eh?

We couldn’t keep this a secret long. It was a morning appointment, and my mom knew by the time we were at lunch to look at ultrasound photos. I got out one photo and said “alright, well here’s one.” Then took out the picture of Baby B and said “And here’s the other”.  That is how we told pretty much everyone, and some of them it took a while to catch on and would accuse us of playing a prank. But we had ultrasound photos labeled “Baby A” and “Baby B” by the technician to prove it!