The Monkey Tree

You have just overcome the shock that you are pregnant, if indeed it is a shock and you are lying on your back with the ultrasonographer applying a large amount cold gel to your tummy. Your major concern at this point is to know that there is a heart beat; and there it is, you breathe sigh of relief, but wait there’s two, you quizzically look at the hospital staff member, “what do you mean two?” you ask, “how did that happen?” This may indeed be the first time that you realize that you are now in for double trouble, double fun, double everything.

Twins are not that uncommon, in fact twins occur in about 1 in 80 pregnancies and the incident of twins has increased over the last 30 years as more women have in vitro fertilization (IVF). Fertility treatments make twins more likely, up to 25 per cent of IVF conceptions result in twin births. There is also a natural propensity within the family (family history) to having twins, but this is more predominant on the mother’s side, there seems to be less influence from the father’s side even if there are twins within his family. The older the mother is the more likely she is to have twins, whilst there may be problems associated with becoming pregnant later in life, women in their late thirties are more likely to conceive twins; also the more children you have the greater chance you have of having twins.

The basic biology of twins is not too difficult to understand; during ovulation instead of one egg being released at a time two are released and these two eggs are fertilized by separate sperm. The resulting twins are non-identical and can often be referred to as fraternal or dizygotic twins. These twins can be the same or opposite sexes and will look no more alike than siblings born years apart. If one egg is produced which then divides into two (within two weeks of fertilization) and these two halves go on to form into separate embryos the twins that will develop will be of the same sex and are commonly referred to as identical or monozygotic twins.

There are conflicting reports about whether or not carrying twins is more difficult than a single pregnancy. In the early part of the pregnancy morning sickness, which also happens to some women during a single pregnancy, is likely to be worst, this is because of the higher level of circulating hormones. As well as increased sickness some women have reported an inability to sleep, fatigue, general discomfort and pain, heartburn and indigestion. Swollen hands and feet make moving around problematic and back pain is common because of the extra load combined with the ligament-relaxing effects of pregnancy hormones. Not all women will experience these types of challenges and the facts are that many of the symptoms mentioned can and do happen with single pregnancies also.

During the pregnancy all of the advice that would be given to any pregnant woman applies to the woman carrying twins; however, there will be the need to increase your nutritional intake. Some nutritionist suggest that you should plan to eat at least five times a day (three meals and two substantial snacks), even if you don't feel especially hungry. This is a time when mothers need to eat sensibly, a good mixture of protein, carbohydrates, and fat. Cheese, milk, meat, eggs, nuts, and oils will all help fuel your babies' growth; your diet should also consist of plenty of fruits, vegetables and grains this will give you and the babies the essential nutrients and vitamins required to maintain good health; the introduction of folic acid and iron supplements will help prevent neural tube defects and anaemia. Pregnancy is not the time for considering a lean diet; your twins will need all the nutrition that you put into your body; however, do stay away from empty calories such as foods with a high sugar content.

Weight gain is inevitable especially with twins, if you where overweight/underweight before the pregnancy then it is essential that you monitor your weight gain/loss. It is generally suggested that with twins you should gain about 2-3 stones (35-45 pounds or 15-20kg) over nine months, with the bulk of this weight gain occurring in the second and third trimesters

Twins are delivered earlier than single pregnancies where often women deliver between 38 and 42 weeks; most women however with twins will deliver before 37 weeks. If you have had a Caesarean Section with a previous pregnancy you will more than likely be asked to have a caesarean with your twins; 50 percent of women carrying twins will deliver their babies by C-section especially if the babies are not in a head-down position, one or both of the twins are breech or lying awkwardly. Vaginal deliveries; however, are always encouraged it does not take that much more effort than delivering a single baby; the cervix is already dilated following the first birth and the second child normally follows quite quickly. The recovery period following a vaginal birth is quicker than if twins are delivered by C-section; for a period of time the surgery site will be quite sore however if you are able to get a lot of support allowing you to rest your recovery period will be a lot quicker.

Giving birth is usually tiring and having twins is no different so accept as much help as is offered. The early days of twins will revolve around feeding and changing, and like all babies the twins will want to feed every few hours. The fact is that the twins will behave in a similar fashion as any other baby it is just that there are two babies to cope with instead of one; however, one of the main challenges is feeding time. If the decision has been made to bottle feed the twins then meticulous organisation is required to ensure that you do not have two screaming children on the go at the same time whilst trying to make up the bottle feed. The Department of Health have recently changed their guidelines on making up bottles in advance, the recommendations now are that bottles are made up fresh when they are required. If your baby doesn’t finish their feed, any milk that has not been used within two hours should be discarded. A workable alternative could be to use ready-to-feed infant milk, or you can put boiled water into a sealed vacuum flask and use this to make up fresh feeds when needed (but care is needed to avoid scalding).

If you can breastfeeding is always the best method of feeding the twins although it seems almost an impossible task. In theory, women can produce more than enough milk for multiple births regardless of their breast size, and the more they breastfeed the more they will produce. In reality breastfeeding twins can take a lot of time and effort and most mothers opt for mixed feeding (both breast and bottle feeding). Your Health Visitor (*) will be able to put you in contact with a support network to help you with the issues of breast feeding. A good investment is a V-shaped cushion in which you will be able to support both babies whilst feeding. The other option since most twins are slightly premature is to express milk and feed the twins using bottles.

The weaning process is similar to that of any child; recommendations from the World Health Organisation now suggest that children are kept away from solids until around the six month period. Here are a few points that you need to know about weaning:

• Never use salt 
• Use as little sugar as possible 
• Always stay close by whilst they are eating
• Sterilize dishes, etc until at least 6 months (some health visitors recommend 1 year so it’s as well to check!)
• Water must be boiled for the first 6 months
• Give Cow’s milk (whole milk not semi or skimmed your baby needs the fat content for healthy development) from 12 months
• If you have any concerns with how your babies are feeding or their weight gain consult your health visitor.

Many parents of twins are concerned as to whether or not they will be able to bond with their children equally, the short answer is yes. Following the early stages where the day is taken up with the routine of looking after the twins i.e. feeding, burping, changing, etc and then repeated day after day, things will begin to settle and once they do you will begin to pick up on the individualities of each child and you will begin to love each twin for their individual characteristics. You will notice that one child might take a little longer to feed the other might take a little longer to wind and you will respond to their individual needs, you and the babies will learn more about each other and your connections will deepen.

There is a lot more that can be said about twins and how to bring them up, but for now enjoy them.

Joe Lindo