Saturday, July 24, 2004

‘We were in shock.” That’s how Downey Hinrichs, 36, describes her and her husband Lance’s state of mind after finding out last fall she was pregnant with twins.

The Hinrichses say they were excited and thrilled, but like many expecting parents of multiples, they also felt overwhelmed.

“Other twin moms have told me to prepare for the first year just being a blur, but that every six months it gets a little bit easier,” says Falls Church resident Mrs. Hinrichs, who delivered a boy and a girl (Michael and Lindsey) two weeks ago.



Having twins means double the joy but also double — or more — the work and complications, parents of twins say. They and doctors agree that a well-informed family will be better prepared to deal with, and prevent, some of the emotional, physical and practical strains of carrying, delivering and caring for twins.

“Don’t believe the people who say it’s twice the work,” says Kathy Stokes Murray, 38, of Arlington, whose twins Aidan and Cailyn are 3 years old. “It’s more like 10 times the work,” she says, and smiles.

The “work” starts before the twins are born. Mothers pregnant with twins are more likely to experience discomfort and complications during pregnancy.

“They are at a higher risk of any gestational complication that can occur,” says obstetrician and gynecologist Dr. Barry Rothman, president of the medical staff at Inova Alexandria Hospital.

These complications include hypertension, preeclampsia, gestational diabetes and premature labor, Dr. Rothman says.

Gayle Weiswasser, 34, of Chevy Chase started having premature labor at week 32 and had to go on strict bed rest, meaning only leaving the bed when absolutely necessary.

Premature labor, the biggest risk in twin pregnancies, means that either the cervix softens and/or contractions start. Doctors are unsure exactly what triggers premature labor, but they think the protein fibronectin is involved, Dr. Rothman says.

“I also had bleeding early on, and I started having back pain at 18 weeks,” says Ms. Weiswasser, who delivered her twin daughters, Alexa and Madeleine, by Caesarean section on May 7, at week 36.

Mrs. Murray had several complications, including bleeding, premature labor, preeclampsia and fluid retention around her abdominal organs. She was put on bed rest early in the pregnancy and later spent time in the hospital hooked up to a feeding tube, she says.

Her babies were born one day short of 34 weeks, after a Caesarean section during which Mrs. Murray lost so much blood she needed a transfusion.

She says some of her complications likely stemmed not only from being pregnant with twins, but also from the fertility treatment she had undergone.

Women who are 35 years old and older and those who undergo fertility treatments are more likely to have twins, says Dr. Alessandro Ghidini, an Alexandria perinatologist.

Because of all the risk for complications, a woman pregnant with twins is more likely to deliver her babies early, whether by vaginal delivery or Caesarean section.

In fact, having the twins at week 38 or 39 is considered optimal as opposed to the 40 weeks for a singleton, says Dr. Ghidini, who also is the medical director of the Perinatal Diagnostic Center at Inova Alexandria Hospital.

“We think there is an accelerated aging of the placenta in women expecting twins,” he says. The placenta is where the baby or babies get their nutrition in the womb.

If the twins share a placenta and/or the amniotic sac, which protects the babies from the outside environment and blocks bacteria, they might have to be delivered as early as 32 weeks, Dr. Ghidini says.

However, some women, like Mrs. Hinrichs, who delivered by Caesarean section two weeks ago, have relatively easy twin pregnancies. In fact, she describes it as only slightly tougher than with her singleton, Julia, who is 2 years old.

Delivering twins

Many women expecting twins end up having a Caesarean section, Dr. Rothman says. In his practice, about 70 percent of the mothers of twins have Caesarean sections.

In the overall population, about 26 percent of women have Caesarean sections nationwide, according to the American College of Obstetricians and Gynecologists. The statistic doesn’t differentiate between twin and singleton births.

The number of Caesarean sections is higher for women pregnant with twins for several reasons, Dr. Rothman says.

One reason is that women want to plan the birth at the optimal 38 weeks instead of going 40 or more weeks and risking complications or less-than-ideal conditions for the baby, he says. Another is that if one or both babies are breech, a Caesarean section is the safest delivery method, the obstetrician adds.

A third reason is that mothers are afraid they will be able to deliver only one of the babies vaginally and then have to have an emergency Caesarean section with the second one.

“That’s the nightmare because then you have to heal in two places,” says Mrs. Hinrichs, who had a planned Caesarean section July 9.

Once the twins are born, they are more likely to have complications than singletons, in large part because of being born early, Dr. Ghidini says.

“Most twins don’t end up in the NICU,” says Dr. Ghidini, referring to the Neonatal Intensive Care Unit. “But those who do are usually there because they have breathing problems, trouble keeping their temperature and growth problems.”

Alexa, one of Ms. Weis-wasser’s daughters, who weighed less than 5 pounds at birth, spent a week in the NICU for apnea problems. Ms. Weiswasser says she visited the baby every day.

“In some ways, it made the transition easier to only have one of the girls at home that first week, but it was tough emotionally, too,” she says.

Apnea means there are pauses in the breathing. This is fairly common in preemies because the areas in the brain that control breathing are not fully developed, Dr. Ghidini says.

At two months of age, Alexa still has an apnea monitor, which goes off if her breathing is irregular.

Mrs. Murray’s twins, Cailyn and Aidan, who weighed less than 4 pounds at birth, stayed in the NICU for 2 weeks. They, too, had breathing problems.

At home with twins

The sigh of relief of being out of the hospital and having the twins at home is often short-lived, several parents of twins say.

“You’re just shellshocked,” Ms. Weiswasser says. “You’re thinking, ‘This is a lot.’”

Bill Murray, Cailyn and Aidan’s father, agrees.

“You’re thinking, ‘How do we survive, and what do we need to do to make everything livable for the whole family?’” Mr. Murray says.

He says he was so exhausted that looking back, those early days are just a blur.

“Being a parent of twins is almost like being a single parent; you’re doing everything for one baby — changing diapers, feeding, giving baths. You don’t get a break,” Mr. Murray says. “I have never been so tired in my life.”

Lance Hinrichs, whose twins were born two weeks ago, says he estimates he gets about five hours of sleep per night, at most.

“I’m just chronically tired,” Mr. Hinrichs says, adding that there is no way of adequately preparing oneself.

“You just have to assume that it’s going to be chaos in the beginning,” he says.

Mr. Hinrichs cooks, shops, cleans and helps feed around the clock, “keeping the house running,” as he refers to it.

However, there is one thing fathers can’t help with, and that’s directly breast-feeding. A mother needs to figure out pretty quickly how much she wants to try to breast-feed the twins.

“The health benefits are the highest if you breast-feed exclusively,” says Deborah Tobin, an Alexandria lactation consultant, “but we also say that any amount [of breast milk] that they get is beneficial.”

Breast-feeding may seem difficult in the very beginning, but eventually it can become very practical and efficient, Mrs. Tobin says.

Once on a similar schedule, the twins might be able to nurse simultaneously — tandem nurse. Some women find that not only do their babies like nursing together, but it’s a timesaver, too.

“You have to change one diaper at a time and give one bath at a time, but with nursing, you can actually feed both twins at once,” Mrs. Tobin says.

Another matter to consider is how much help to hire or ask for in the very beginning.

Mrs. Murray recommends that new parents of twins hire as much help as they can afford. Ms. Weiswasser has full-time help in the daytime and a night nurse a couple of times a week.

Dr. Rothman says the women who try to do everything on their own are more likely to wear themselves out and experience postpartum depression, which he says can afflict mothers of twins more often than parents of singletons.

Another big help is staying in touch with other parents of multiples.

“Just being able to pick up the phone and talk to someone who’s been there really helps — knowing you’re not alone,” Mrs. Hinrichs says.

Despite all the complications and problems, the joy and love overshadow any and all of that, the parents say.

“I hope I haven’t been too negative because it’s really wonderful, too,” Ms. Weiswasser says while holding baby Madeleine, who has large blue eyes and wild red hair.

Mrs. Murray, whose twins were born prematurely, continues to see complications in her toddlers, such as speech and other delays.

“It’s been hard, but I feel empowered by how well they’re doing now,” she says. “They are two of the sweetest three-year-olds in the world. They will grow up and do wonderful things in their communities one day.”

MORE INFO:

BOOKS —

• “EVERYTHING YOU NEED TO KNOW TO HAVE A HEALTHY TWIN PREGNANCY,” BY GILA LEITER WITH RACHEL KRANZ, DELL PUBLISHING CO., 2000. THIS BOOK PROVIDES A STEP-BY-STEP GUIDE THROUGH THE PROCESSES OF PREGNANCY AND BIRTH OF MULTIPLES. IT ALSO PROVIDES INFORMATION ABOUT THE LATEST FERTILITY TREATMENTS, WHAT TO EXPECT TRIMESTER BY TRIMESTER, HOW TO AVOID PRETERM LABOR AND PREMATURE DELIVERY, FACTS ABOUT HAVING A CAESAREAN SECTION AND WHAT IT’S LIKE TO BRING BABIES HOME. IT OFFERS CONCRETE SUGGESTIONS FOR WORKING THROUGH HOPES, FEARS AND FANTASIES.

• “READY OR NOT … HERE WE COME! THE REAL EXPERTS’ CANNOT-LIVE-WITHOUT GUIDE TO THE FIRST YEAR WITH TWINS,” BY ELIZABETH LYONS, FINN-PHYLLIS PRESS, 2003. THIS IS A HUMOROUS GUIDE TO RAISING TWINS.

• “TWINS! EXPERT ADVICE FROM TWO PRACTICING PHYSICIANS ON PREGNANCY, BIRTH AND THE FIRST YEAR OF LIFE WITH TWINS,” BY CONNIE L. AGNEW, ALAN H. KLEIN AND JILL A. GANON, HARPERCOLLINS PUBLISHERS, 1997. THIS BOOK COVERS THE PHYSICAL, MEDICAL, EMOTIONAL AND PSYCHOLOGICAL ISSUES INVOLVED IN HAVING TWINS.

• “MOTHERING MULTIPLES: BREASTFEEDING & CARING FOR TWINS OR MORE,” BY KAREN KERKHOFF GROMADA, LA LECHE LEAGUE INTERNATIONAL, 1999. THIS BOOK REASSURES MOTHERS THAT BREAST-FEEDING AND CARING FOR MULTIPLES JUST TAKES A LITTLE MORE TIME THAN CARING FOR A SINGLETON. IT ALSO PROVIDES GUIDANCE ON HOW TO TAP THE RESOURCES IN THE NEIGHBORHOOD AND AMONG FAMILY AND FRIENDS.

ASSOCIATIONS —

• THE NATIONAL ORGANIZATION OF MOTHERS OF TWINS CLUBS, PO BOX 438, THOMPSON STATION, TN 37179. PHONE: 615/595-0936. WEB SITE: WWW.NOMOTC.ORG. THIS NATIONAL NONPROFIT GROUP PROVIDES SUPPORT FOR PARENTS OF TWINS AND OTHER MULTIPLES AND HAS SEVERAL CHAPTERS IN THE WASHINGTON AREA. THE CHAPTERS CAN SET UP AN EXPECTANT MOTHER WITH A “BIG SISTER,” AN EXPERIENCED MOTHER OF TWINS.

ONLINE —

• BABYCENTER (WWW.BABYCENTER.COM), WHICH IS BASED IN SAN FRANCISCO AND IS A MEMBER OF THE JOHNSON & JOHNSON FAMILY OF COMPANIES, PROVIDES INFORMATION ABOUT BEING PREGNANT WITH TWINS, DELIVERING AND CARING FOR TWINS. IT ALSO HAS ARTICLES ON HOW TO GET TWINS ON THE SAME SLEEPING AND FEEDING SCHEDULE AND TIPS ON HOW TO TRAVEL WITH TWINS.

• THE WEB SITE WWW.TWINSLIST.ORG, WHICH IS HOSTED AT THE UNIVERSITY OF SOUTHERN CALIFORNIA, OFFERS A NEWS GROUP FOR PARENTS OF TWINS AND HIGHER-ORDER MULTIPLES, SUCH AS TRIPLETS. ASIDE FROM ONLINE DISCUSSIONS, IT PROVIDES INFORMATION ON TOPICS INCLUDING BED REST, SIBLINGS OF TWINS, COPING WITH MULTIPLE INFANTS AND CHILD-PROOFING FOR MULTIPLES. IT ALSO PROVIDES A RESOURCE LIST.

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