Multiple Births in the Third Trimester

You may  feel exhausted as your body carries and nourishes two or more babies. You will be seeing your health care provider a lot during these last weeks so take the time to discuss any questions you have. Slow down. Limit your activities and get the rest you need. Talk to your health care provider about when you should stop working. Many women who carry twins or more need to stop working during the third trimester.

Staying Healthy

Women carrying multiples are at risk for developing high blood pressure and diabetes. These health risks plus the developing babies you are carrying make your health a top priority.

Nutrition. To support the growing babies, continue to eat up to 300 extra calories each day.  Plus, drink plenty of water every day. Drink before you feel thirsty. Your body needs liquid to make the extra blood and fluid to support your baby.

Rest. Although you don't need to stay in bed (unless your health care provider tells you to), you do need to rest often. Sit down and put your feet up.

Avoid falls. As your belly grows, your center of gravity changes, placing you at greater risk for falls. Wear supportive sneakers that will help you keep your balance. Walk slowly and hold on to something or someone for extra support.

Exercise. You may not feel like exercising, but if you do, swimming, controlled stretching or a yoga class for pregnant women are your best choices. Don't exercise to the point of being out of breath. And don't choose any activity that places you at risk for falling.

Braxton-Hicks

Most pregnant women experience Braxton-Hicks contractions, which are similar to regular contractions but not as strong. Braxton-Hicks contractions also do not occur in a rhythmic pattern like regular contractions. Women who are carrying multiples will experience Braxton-Hicks frequently. It may even feel like you have them constantly. Braxton-Hicks is a healthy sign that your uterus is getting ready for birth. It does not mean that you will deliver soon, only that your body is getting ready.

Weight Gain

A healthy weight gain reduces the risk of delivering a low birth weight baby. Weight gain during pregnancy varies from woman to woman. You can expect to gain somewhere around 1.5 pounds per week during the third trimester. You will be weighed at each prenatal visit and your health care provider will advise you if you are gaining too much or too little.

Seeing Your Provider

Your prenatal visits will increase during your third trimester to weekly visits. In some cases, you may need to see your health care provider twice in one week. Your provider will closely monitor the growth of your babies, so you can expect frequent ultrasounds.  He or she will also perform internal exams to look for signs of preterm labor. Because your pregnancy is high risk, there is also a concern that one or more of your babies will have a low birth weight, weighing less than 5-1/2 pounds. Low birth weight places your baby at risk for serious health problems, as well as long-term disabilities. At your visits, ask any questions you may have about the remainder of your pregnancy, labor and delivery.

During this trimester, you may need more tests, such as a nonstress test (checks the babies' heartbeat and how they are moving), an ultrasound (checks how the babies are moving and also how much fluid is in the amniotic sac around the babies) and amniocentesis (checks how developed the babies' lungs are).

Childbirth Classes

If you haven't already attended childbirth classes, do so right away. Because you are at high risk for preterm labor and could be placed on bed rest or deliver early it is best to complete your classes early. Some of the class information will not apply to you because you are delivering more than one baby. Ask your health care provider if there is a nurse educator in the office or at the hospital who could speak with you about delivering multiples. Even better, look for childbirth classes designed for mothers of multiples. There aren't many, but they do exist.

Breast-Feeding Decisions

If you haven't already decided how you will feed your baby, talk with your health care provider about your options. Your body can supply enough milk to feed one or more babies if you choose. Enlist the support of your pediatrician and a lactation consultant, who will advise you on positioning, feeding schedules and pumping breast milk. In addition to the many health benefits for your baby, breast-feeding can be an economical decision for you since you won't need to buy formula while you breast-feed. Remember, the decision to breast-feed or bottle-feed is yours to make, and no one should make you feel guilty for your choice. Other mothers of multiples may offer helpful advice based on their experience.

Preterm Labor

Because you are carrying multiples you are at risk for preterm labor (delivering before 37 weeks). If you develop preterm labor, your health care provider may advise bed rest and/or medication to stop the labor. If your provider believes the labor cannot be stopped, you may receive medications that help speed fetal lung development and reduce the chances of other health problems at birth.

Preeclampsia

Mothers of multiples are at high risk for preeclampsia (pregnancy-induced high blood pressure). Your health care provider will watch you closely for any signs of this serious disease, because it has no obvious symptoms. He or she will take your blood pressure and check your urine for protein. If your provider detects preeclampsia, it can be treated quickly. If left untreated, preeclampsia can cause severe problems, including kidney, liver and brain damage; it also can slow the babies' growth. Many times preeclampsia is treated by increasing your water intake, decreasing your sodium intake and/or bed rest. The condition usually ends once the babies are born, although mothers are at risk for developing the more serious condition eclampsia for up to six weeks after delivery. Symptoms your provider will look for (and you should to) include:

• Puffiness or swelling in the face, hands or feet

• Elevated blood pressure

• Protein in the urine

• Weekly weight gain of more than two pounds, or daily weight gain of more than a pound

• Agitation or confusion

• Shortness of breath

• Blurred vision

• Severe headache

• Dizziness

Bed Rest

Your health care provider may order bed rest if there is a concern you are developing preeclampsia or entering preterm labor. It is important to understand exactly what your provider means by bed rest. Sometimes bed rest means frequent rest. Often it means staying in bed all the time. When you are on bed rest, arrange to have someone else handle your daily responsibilities. You may feel overwhelmed, frustrated, anxious, and/or depressed while on bed rest. You may have to make arrangements with your employer to take time off from work. Keep in mind that this is temporary and you are doing what is best for your babies.

Interview Pediatricians

Now is the time to choose a pediatrician who will care for your multiples. Compile a list of pediatricians (either from friends' recommendations or your insurance plan) and make an appointment to speak with one of the doctors. Because some multiples are born with health complications and may require frequent doctor visits, be sure the pediatrician's office is close to your home. When you speak with prospective doctors, ask questions such as:

• How many doctors are in the practice? Who will see my babies if one or more is sick?

• Who speaks with me when I call with a question? How long should it take before someone returns my call?

• What hospitals are you affiliated with?

• Do you support breast-feeding multiples (if that is your decision)?

• Who can I call if my baby is sick in the middle of the night?

• How many other sets of multiples do you treat?

Preparing Siblings

If you have other children at home, their life is going to change in a big way and that transition may be difficult. Talk with siblings about the babies. Involve them in some decisions, like what color to paint the babies' room or where to place the high chairs. Try to prepare siblings for the amount of attention the babies will receive but be aware of possible behavior changes in siblings when the babies come home.

Hospital Policies

This is a good time to review hospital policies pertaining to after delivery.  Some questions to ask:

• Will you be in a private room?

• Will the nursing staff support you if you breast-feed your babies?

• Will your babies be allowed to room with you?

• What is the visiting policy?