Articles

By Alexandra Khoo
 

Expecting twins? Congratulations! Although expecting multiples do come with higher risks than a singleton pregnancy, with good medical and self-care, you can learn to familiarise yourself with your pregnancy and move gradually towards the safe delivery of your double blessing.

 

Hear mummy Marcia Too’s story on how she coped with her twin pregnancy.

 

How did you feel when you learnt that you were expecting twins?

“My husband and I were very happy when we learnt that I was pregnant as I had difficulty conceiving because of polycystic ovary syndrome (PCOS). We were overjoyed when we found out that we were expecting twins during our scan in the third month.”

 

How was your pregnancy in terms of the following aspects?

Physical
“I gained about 12kg and had a very big belly. I also had water retention which got worse in the last trimester, so I wore foot massage socks to control it.”

 

Emotional
“The first three months were filled with mood swings. After that, I was pretty much my typical self.”

 

Pregnancy Symptoms
“I had the usual morning sickness during the first two months. I vomited at least once to twice a day after meals.”

 

Dietary Requirements
“I’m not too fussy about food and ate almost everything except raw food.”

 

Exercise
“I went for brisk walks in the park at least two to three times a week.”

 

Did you experience any complications during pregnancy and at childbirth?

“I had a C-section at 34 weeks as my babies were not growing much and each of their weight gain was vastly different. Arriving about one month early, twin one had a good birth weight of about 2.2kg, while twin two was only 1.6kg. Twin two had to be in intensive care for two weeks as she had other issues like feeding and reflux problem.”

 

Marcia’s adorable girls, fraternal twins Odelia and Octavia Wang, aged four, give her double the trouble, fun and joy!

 

How did you cope with recovery, breastfeeding and infant care?

“I had a bad experience with a live-in helper so the first few weeks of recovery were difficult. But I got help from family members to look after my babies. I also had difficulty with milk supply as I was emotionally unstable as twin two was still in hospital. So I made the decision to switch to formula. During that time, my husband also shuttled between home and office quite a bit to look after both of us.”

 

“With twins, you would have to feed two at a go. Somebody would feed one while I fed the other one. Though there was no proper rest for me, the experience was worth it!”

 

Do you really need two of everything?

“Yes, I guess with twins, you literally need two sets of items except for the bathtub!”

 

Dr Ann Tan, O&G Specialist, Women & Fetal Cental, shares the various medical aspects of twin pregnancies.

 

Medical Needs

Supplements – Increase intake of folic acid to reduce neural birth defects like spina bifida. She would definitely need to eat more and add more supplements in particular: iron and calcium needs.

 

Antenatal Care – “Twin pregnancies definitely need more antenatal care as they are more prone to preterm labour and medical issues like gestational diabetes and pre-eclampsia. Abdominal palpation is a poor method of assessing foetal growth particularly for twins and hence serial ultrasound is the only way to assess how each twin is doing,” says Dr Tan.

 

Tests & Scans – The hospital will check your urine to ensure that you do not have gestational diabetes, urinary tract infections and pre-eclampsia. Blood pressure will also be checked. As anaemia is more common in twin pregnancies, you would have this extra screening to go through between 20 to 24 weeks as well as at 28 weeks. The usual blood screening test (to detect Down’s syndrome and other abnormalities) does not work for twin pregnancies; so you will be offered – between 11 to 13 weeks – a Nuchal Translucency Scan and a combined blood test. There will be more frequent ultrasound scans, especially in the last trimester to check the position and growth of your babies and the blood flow between them.

 

Delivery – Dr Tan shares: “A twin pregnancy is likely to end with a Caesarean delivery, ideally at 36 to 37 weeks. If the twins are both in head down positions, mummy can try for a vaginal birth. In any other presentation, a Caesarean section needs to be performed”.

 

Expect Changes

Physical – “Physical symptoms of pregnancy become obvious more quickly. Expect rapid weight gain but total weight gain should not be double that of a singleton baby!” says Dr Tan.

 

Some mums will also experience extreme breast tenderness. They will also experience indigestion, stretching of the tummy skin, and back pain earlier than in a singleton pregnancy. Apply cream or stretch mark cream if skin gets itchy. Wear bike shorts, leggings, or a maternity support belt to support your tummy and reduce back pain.

 

Emotional – Dr Tan: “As hormones rise very quickly, expect mood swings in the first trimester.”

 

Pregnancy Symptoms – Dr Tan: “Severe nausea and vomiting may occur as there is a double dose of ‘morning sickness’ hormones. You may feel extreme fatigue as the body’s working double-time to support the growth of the twins.

 

Possible Complications & Precautions

“The most common complication is that of preterm labour as the uterus is unable to carry twins to term. Other complications where identical twins are concerned are when the twins share a placenta and when their circulation is uneven leading to discordant twins. Should the sharing be very uneven, then the pregnancy may be jeopardised. There could be premature rupture of membranes as well as a prelude of preterm labour. The incidence of low-birth weight babies, gestational diabetes and preeclampsia are also higher with twin pregnancies.” shares Dr Tan.

 

Dietary Requirements

As you are feeding three – your twin babies and yourself – eat at least five meals a day. This means three main meals plus two substantial snacks in between main meals. Mums carrying twins should eat an extra 500 calories a day.

 

Do watch what you eat though. Try not to consume too much sugar and avoid alcohol and caffeine. Include the following in your diet:

 

Rice and Alternatives 
 
These include whole grains such as whole wheat bread and brown rice.
 
Alternatively you could have noodles, millet, barley, biscuits, potatoes, thosai, chapattis, pasta, oats, and cereals.
 
Fruit & Vegetables 
 
Eat a colourful variety of fresh fruit, e.g. apples, pears, strawberries, guava, kiwi, papayas, oranges, grapes, bananas, longangs, and 100% freshly-squeezed (not bottled) fruit juice.
 

Include dark green, deep yellow, purple, red and orange coloured vegetables in your diet. Dark leafy vegetables, or root vegetables like carrots or sweet potatoes, are good sources of vitamin C, beta carotene, fibre, potassium, and folic acid.

 

Meat & Alternatives 
 
Well-cooked lean meat, skinless poultry, fish, prawns, eggs, bean curd, legumes, and dairy products fall under this category.
 

Legumes are beans, peas, soybeans, peanuts, walnuts, and lentils. High levels of mercury are found in some fish and harmful to baby’s brain and nervous system. The general guideline is to avoid high mercury fish such as shark, tilefish, swordfish and king mackerel, and to eat fish in moderation.

 

Fats, Oils, Sugar & Salt (use in small amounts)
 
It is advised that you take less of this category, although some oils – mainly mono-unsaturated and poly-unsaturated fats – are an essential part of a balanced and healthy diet. Good oils include flax seed oil, sunflower oil, fatty fish, avocados, olive oil, safflower oil, nuts, and seeds.
 

Avoid saturated fats, hydrogenated/partially hydrogenated fats (also known as trans fats) – found in butter, lard, high-fat meats, whole milk, palm kernel oil, coconut oil, cookies, and chips.

 

 

Maybe Baby would like to thank Dr Ann Tan, Specialist Obstetrician & Gynaecologist from the Women & Fetal Centre for her input, and Ms Marcia Too, mummy to twins Odelia and Octavia Wang, for sharing her story.

 

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