And then there were two

Multiple pregnancy is an intense time for expectant mothers

Annina’s twin daughters developed at different rates in the womb and were born as preemies. To relieve her stress, she wrote lists of the questions on her mind to ask from doctors.

“There they are”, announced the nurse and pointed at the ultrasound image. Annina, who was in her thirteenth week of pregnancy, looked at her husband in confusion and wondered if she’d heard correctly. They?

The weeks preceding the ultrasound had been confusing. At the beginning of her pregnancy, 31-year-old Annina didn’t even know she was expecting, because she’d had her period as usual. As her belly kept growing, she eventually took a pregnancy test just in case. At that point the pregnancy was already in the eleventh week. Now there were two babies coming instead of one.

That was the beginning of 2015. After the first ultrasound, Annina sat on a couch in the hospital lobby, took a deep breath and wondered how on earth there’d be enough space at home. There were already two under school-age children in the family. Once Annina got over the initial shock, concern over the risks of multiple pregnancy took precedence over practical matters.

Ultimately, the risks of multiple pregnancy are quite small and not worth losing sleep over.

The lack of symptoms was surprising, the risks weren’t

The identical twins shared the same placenta, which is why the progression of the pregnancy was closely monitored. At the beginning, Annina underwent a pregnancy ultrasound every two weeks, then weekly and eventually she stayed in unit monitoring. The babies had a weight difference from the start, which only grew as the weeks went by. After delivery it was discovered that the placenta had been shared unequally between the fetuses, and the other one only got a third of it. One of the babies was almost a kilo smaller than the other.

”It was surprising that even though the children had the same genes and starting points, one was born so much smaller than the other. She had umbilical cord blockage and after birth a structural abnormality was discovered, which required corrective surgery.”

Even though the babies didn’t develop at the same rate, the mother’s pregnancy progressed painlessly. Surprisingly, the pregnancy was almost symptomless, apart for the contractions and back pain, until the 20th week of pregnancy when Annina had to take sick leave because of early pregnancy bleeding. Although bleeding is a common symptom, it can also be a sign of abnormal pregnancy or miscarriage. Luckily, Annina had nothing to worry about.

In the midst of risks and various symptoms, the expectant mother had a great need for information during pregnancy. At each ultrasound she was nervous about what the image would show this time. That’s why Annina wrote lists of issues and questions on her mind for the clinic visits and asked the doctors for answers.

From incubators into warm arms

The identical twin girls were born in November 2015 with a minute’s age difference. The 31st week of pregnancy was nearing its end and the babies were born by C-section with only a few days’ notice.

“I knew for many weeks that the C-section could be done at any moment. But when the day came, I was in a panic and didn’t feel like I was ready yet”, Annina says.

The neonatal intensive care unit doctor came to speak with the mother preparing for a C-section to calm her down. Both babies needed respiratory support after birth. A structural abnormality was discovered in one of the baby’s food pipes within the first day and she was rushed to surgery. The twins were in aftercare in hospital for weeks, and initially Annina could only hold them for an hour at a time.

In autumn 2016 the girls are doing well. The next check-up at the hospital is only in a few years. The multiple birth family’s life continues to be hectic, but far away from the hospital’s machines and tubes.

Expert: Risks of multiple pregnancy are smaller than feared

Multiple pregnancies are often referred to as risk pregnancies. It’s likely that the children will be born prematurely. However, according to Doctor Jonna Haapkylä, family coaching officer of Helsingin seudun monikkoperheet (Helsinki Region’s Multiple Births Association), only 1.2 percent of twins are born before the 28th week of pregnancy. She says the risks of multiple pregnancy are quite small and not worth losing sleep over.

“On average, twins are born in the 36th week of pregnancy. Over half of the twins born in Finland are born during full-term weeks of pregnancy”, Haapkylä explains.

 The health risks for babies during pregnancy are related to the placenta and amniotic sacs. If the babies have separate placentas and sacs, the prognoses of pregnancy are excellent. If they have a shared placenta but separate sacs, the pregnancy is monitored more closely. In this case there is a risk that blood flow in the placenta is distributed unequally and the other twin gets less blood than the other. Pregnancies where the babies have the same placenta and amniotic sac are the most rare, but most risky. In that case it is possible for the babies to become interlocked in the womb.

A mother expecting twins has the same symptoms as a mother expecting one child has at the end of pregnancy, but at an earlier stage.

 The symptoms of multiple pregnancy don’t differ much from ordinary pregnancy symptoms. A mother expecting twins suffers the same symptoms as a mother expecting one child has at the end of pregnancy, but at an earlier stage. These are, for example, pain, swelling and contractions. The womb of a mother expecting more than one child stretches more, so premature contractions may occur more easily. That may lead to premature birth.

More information (in Finnish): Finnish Multiple Births Association (Helsingin seudun monikkoperheet ry)

The risk of premature birth can be determined at the maternity clinic with the Actim Partus test