It’s not just a celeb trend, twin pregnancies are on the rise but need to be carefully monitored by medics, says Andrea Mara.
WATCHING Beyoncé perform at the Grammys earlier this month, you’d be forgiven for thinking a twin pregnancy is a run-of-the-mill experience that doesn’t preclude the wearing of gold headdresses or dancing on stage for millions of viewers worldwide.
The reality is a little different for most mothers, and indeed, although now more common than ever, twin pregnancies are still carefully monitored by medical professionals.
Caroline Cummins has nine-month- old twin daughters and remembers a very un-Beyoncé like experience.
“For the first 12 weeks, I was very tired — it felt like waking up from an anaesthetic and then dropping straight back to sleep. I had taken redundancy before my pregnancy so I was at home thankfully. I wasn’t that sick, but I think I pretty much slept through it!”
Caroline remembers that she got big quite quickly.
“I was showing at nine weeks, and towards the end, even maternity clothes didn’t fit. Just to walk from the couch to the downstairs bathroom, I had to have a chair half-way so I could take a rest.”
But Caroline says the discomfort didn’t bother her.
“Our babies were as a result of ICSI (intracytoplasmic sperm injection) fertility treatment and because I waited for them for so long, I really didn’t mind — I was just so happy to be pregnant.”
Because this was her first pregnancy, it seemed normal to Caroline, but mum of 16-month-old twins Niamh Murphy has an older child and found the twin pregnancy very different.
“It’s tougher carrying two babies — it’s very tiring. Plus doctors are telling you to rest but it’s hard to do that with a toddler. And I was massive — I was so uncomfortable.
"I finished work a lot earlier, but thankfully I had no other complications. I had morning sickness with the twins until 17 weeks, whereas I had none first time round.”
Indeed, many of the physical manifestations of pregnancy present earlier and more significantly, says consultant obstetrician Keelin O’Donoghue, founder of the Multiple Pregnancy Clinic at Cork University Maternity Hospital.
“Women with a twin pregnancy may experience more hyperemesis, more heartburn, and are more likely to have physical discomforts like back pain, fatigue, pelvic girdle pain and varicose veins.”
Twin pregnancies are also monitored more closely with extra antenatal scans.
“For many women, particularly if they’ve had babies before, a twin pregnancy should be quite straightforward. But even if the woman is very healthy, her babies might need more surveillance,” Dr O’Donoghue explains.
“You’re trying to pick up complications such as being small or not growing enough in order to do something about it; increase monitoring of the pregnancy, decide the right time for the babies to arrive, and then anticipate neonatal care.”
Caroline’s children, Chloe and Lucy, arrived when she was induced at 37 weeks: “I had a natural delivery with an epidural, and everything was so calm and so organised, I can’t say I felt any pain,” she says.
“Twin one was head down and once she was born they did a quick ultrasound to see what way twin two was — she was still head down, and arrived within six minutes.”
Niamh also had a natural delivery: “My waters broke at 35 weeks — I could have stayed at home longer but because it was twins, they said to come in.
"Twin one, Ben, was head down and born fine with no issues, but Kate was born breach — that was tough.”
In Ireland, approximately 60% to 65% of twins are born by Caesarean section according to Dr O’Donoghue.
“Around half of those are because the woman has had a past C-section. Then there are women who attempt labour and for whatever reason — position of babies, concerns about the babies’ wellbeing, or labour doesn’t go so well in other ways — they may end up with an emergency C-section.
"We try to encourage vaginal delivery but it depends on what’s happened in previous pregnancies, as well as other factors like the woman’s age or medical history.”
It seems there are more twins than ever today — Amal Clooney’s news that she is due twins was quick to follow Beyoncé’s announcement — and at any given school-gate or shopping centre, twin buggies are no longer an anomaly.
So what is the current rate of twin pregnancies in Ireland?
“Around one in 80 pregnancies is a twin pregnancy naturally,” says Dr O’Donoghue.
“But the rate increases if women are 35 and above, and 25% to 30% of twins come to us through some degree of fertility treatment. So the current rate of twin pregnancies in Ireland is around one in 65.”
And do twins often require neonatal care?
“Yes, many twins arrive early, although very few arrive extremely preterm.
“In CUMH, we have around 50% of identical twins admitted to NNU and around 40% of non-identical twins admitted,” says Dr O’Donoghue.
Happily, for Caroline Cummins, this was not the case for Chloe and Lucy.
“We were actually sent home after two days — they were a good weight, I had no section, and they were feeding well,” she says.
“They’ve always been so happy and healthy — I feel extremely lucky.”
Tips on twins
Rachael Joyce, vice-chair of IMBA, the Irish Multiple Births Association, has some tips for mothers carrying twins:
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