EDWARD WOLF, M.D.,
Division of Maternal Fetal Medicine and New Jersey Perinatal
Associates
Vice Chairman, Department of Obstetrics and Gynecology.
Think of the excitement when a couple is told that the
woman is pregnant. Now imagine being told that there is
not just one fetus but two. Or three. That stunning news
is happening much more frequently in recent years, and
the announcement brings with it a flood of emotions from
shock to elation to fear.
The societal trend toward delayed childbearing has brought
a number of unintended consequences. Two generations ago
it was common for women to begin having children in their
late teens or early twenties. Today many women are electing
to wait until their late thirties or even their forties
to begin their family. But waiting until that age increases
the chance that infertility issues may arise and the use
of assisted reproductive techniques has resulted in a stunning
rise in the number of twin and triplet pregnancies.
 When
most of us hear that a woman is pregnant with twins we
imagine only the fun consequences (and the work…and
the tuition payments). Will they be identical? Girls?
Boys? One of both? Unfortunately when taken as a whole,
twin pregnancies are more likely than singletons to develop
any number of possible complications, including preterm
birth, operative delivery, bleeding, gestational diabetes
and hypertension. While most will have a successful outcome,
the couple and their obstetrical team are challenged
to provide the best possible care for these high risk
pregnancies.
When a couple presents to the Division of Maternal-Fetal
Medicine at Saint Barnabas Medical Center with a known
twin gestation, a team approach is used to help the anxious
family with their exciting and intimidating news. The patient
meets with a perinatologist for a prolonged consultation
and evaluation.
Sonographers with extensive experience in scanning multiple
gestations work with the physicians to image the developing
fetuses. Great care is taken to determine the type of placenta
and membranes and to evaluate the health of the babies.
It is not uncommon for two sacs or fetuses to be seen very
early but for one to fail to develop. This “vanishing
twin” phenomenon can lead to an emotional roller
coaster ride for a couple.
Much of the first session is spent determining if there
are other risk factors in the medical or family history
that might contribute to problems for the mother or fetuses.
In fact, much of the time is spent educating the families
on the expectations for the pregnancy. Some of the aforementioned
concerns are preventable while others are treatable or
might affect the timing of the delivery. Her care will
be much more extensive than in her prior pregnancy or that
of her friend or sister. The hope, of course, is that the
close monitoring never reveals anything more than two normally
developing fetuses in a mom with normal blood pressure
and no signs of preterm labor. If problems do indeed arise,
a talented experienced team can help guide the family to
the best possible care.
Much of the first half of the pregnancy is spent ensuring
that both twins are normally formed and in helping the
mother adjust to her new status. Many moms will experience
nausea or vomiting early in the pregnancy to a greater
degree than they did when they were pregnant with one fetus.
In twin pregnancies the recommended caloric intake is about
400 kilocalories greater than with singletons. Weight gain
is often 1-1.5 pounds per week with a desired weight gain
often in the 35-45 pound range. While exact amounts vary
and depend on factors such as the woman’s pre-pregnancy
weight, the amounts are still greater than in women with
one fetus.
Ultrasound remains the gold standard in evaluating the
developing babies. This fascinating and indispensable
tool allows complex study of the fetal organs as well
as continued calculations of fetal growth. If all goes
well, the family can be told at the halfway mark of the
pregnancy that they have two fetuses that appear to be
developing normally.
Most of the second half of the pregnancy is spent looking
for signs of preterm labor, preeclampsia or growth problems
in the fetuses. Perinatal nurses educate the mother-to-be
on the warning signs of preterm labor and preeclampsia.
In some situations bed rest or hospitalization may be needed
to allow the best care. Ultrasound is used at least monthly
to check fetal growth.
The average gestational age at delivery of twins is about
36-37 weeks. As the time for birth approaches, the mother
will meet with her obstetrician to review some of the special
issues that may develop in a twin pregnancy and delivery.
At Saint Barnabas Medical Center, the Department of Anesthesia
provides 24-hour coverage on the Labor and Delivery suite.
The presence of such highly qualified caregivers at this
critical time allows the family to know that both mom and
the babies will receive outstanding care from experts with
a wealth of experience in caring for multiple gestations.
The renowned neonatal team at Saint Barnabas ensures that
if specialized care is needed for the new arrivals, an
exemplary group of professional dedicated to helping the
tiniest babies will be caring for the entire family.
Certainly the announcement, “You’re having
twins” is a life-altering event. Hopefully the combined
efforts of the proud parents and a caring, professional
team will lead to the day where those college tuition concerns
are a reality.
Marvelous Multiples at Saint Barnabas
The number of expectant mothers carrying twins is an increasing
population. To meet the needs of these families, a course
entitled, “Marvelous Multiples” was implemented
as part of the comprehensive childbirth preparation programs
offered through the Women’s Health Education Department
at Saint Barnabas.
This prenatal education course is designed for those expecting
multiples on all aspects of their unique pregnancies. Topics
to be discussed include nutrition, labor and delivery,
anesthesia options, cesarean birth and relaxation techniques.
Also included in this course is recovery, caring for multiples,
adjustment to home life and baby care basics. Orientation
to a Birthing Room is part of the session.
Call Women’s Health Education at (973)
322–5360 for more information or to register for class.
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