"You're having twins"
Whether you find out months ahead of time or at the delivery, the news that "you're having twins" has to rate as one of life's more stressful events. The reactions we had when were presented with this news varies as much within each one of us as they did among us. A lot of plans go down the drain, leaving you with many questions and mixed emotions.
Learning about twins and the feelings that newly expectant mothers of twins can experience may help you to sort out your own feelings.
There are two types of twins: fraternal or dyzygotic (literally meaning two cells) and identical or monozygotic (one cell). Each is the result of a unique set of biological circumstances.
Fraternal Twins: Fraternal twins outnumber identical twins by more than 2 to 1. They occur when two separate eggs are fertilized by two different sperm. As a result, they are genetically no more alike than any set of siblings and can be two boys, two girls, or a boy and a girl.
During pregnancy, each fraternal twin grows within its own double-membraned bag of waters, the amniotic sac, and has his or her own placenta, although as pregnancy progresses, the placentas often grow together and appear to be one.
Identical Twins: Identical twins make up only about 30 percent of all twins. They are formed when one fertilized egg divides into two, resulting in two babies with identical genetic material; they are always the same sex and look alike. Developing in the uterus, each twin may have his or her own placenta and amniotic sac, just as fraternal twins do; but more often, they will share the placenta and the outer (chorion) membrane of the amniotic sac while still having their own inner (amnion) membrane. Very rarely, identical twins will share a placenta, chorion, and amnion. In this very unique situation, the developing twins lie skin-to-skin in the same oversized amniotic sac.
Predisposition to Having Twins: The occurrence of identical twinning is not well understood; it is considered to be a fluke of nature rather than the result of genetic predisposition or environmental factors. However, several factors are known to predispose women to having fraternal twins. The most common ones are: conceiving children after the age of thirty; conceiving with the help of fertility enhancing hormones or treatments such as in vitro fertilization (IVF); having a history of fraternal twins in the extended family; and having previously given birth to several other children, especially other sets of fraternal twins.
Those of us who gave birth to fraternal twins did fit at least one of the patterns of predisposition. Linda conceived both sets of her twins when she was over thirty. After having her first set of fraternals, she had an increased chance of having twins again, which she did three years later. Debra had three predisposing factors when she gave birth to her fraternal twins: She was over thirty years old, she had a history of twins in her family, and she had given birth to two other children before she got pregnant with her twins. For Debbie, who had another child and was also over thirty when she gave birth to her twins, the deciding factor was that she had conceived through IVF: Four fertilized eggs were implanted in her uterus.
Other Interesting Facts About Twins: Other factors may affect twinning. A woman's diet, quality of health, level of sexual activity, and timing of pregnancy following the cessation of birth control pill usage may influence the likelihood of her having fraternal twins.
Black women have the highest fraternal twin birth rate, followed next by Caucasian women, with Asian women having the lowest rate. On the other hand, identical twins are represented in equal percentages among all races and cultures.
Regardless of how twins are created, the discovery of a multiple pregnancy can come about in many different ways. Some signs and symptoms suggest the occurrence of twins, but an accurate medical diagnosis is needed to rule out other possibilities.
Florien had a history of twins in her family and because of this, she always believed that she would have twins: "I had every reason in the world to think it would happen to me. My mother is a fraternal twin. My father had fraternal twin sisters, and I am a Gemini, the astrological sign of the twins. As a child, I drew pictures of a mommy, a daddy, and twins, sometimes two sets!"
During her pregnancy, Debra also had an inkling that she was carrying twins. "In my previous pregnancies, I had been able to tap into some inner knowledge and know that each child was a boy. So far in this pregnancy I had been unable to get a fix on this baby, until one night, a thought bubbled to the surface. 'Maybe I was having a boy and a girl!'"
Perhaps these experiences seem a bit unusual, but when a pregnant woman has premonitions and dreams about having twins, she should not quickly dismiss them, especially if she has other symptoms of a twin pregnancy. Some common symptoms are: rapid weight gain not associated with overeating or retained water, uterus size which is larger than expected for the stage of pregnancy, and the awareness by the pregnant woman of fetal movement in several areas of her abdomen at the same time.
All of us had symptoms such as these. Debbie, who conceived by in vitro fertilization, was suspicious of a twin pregnancy early in her first trimester. "I got much bigger so much faster than I had in my first pregnancy that I just knew I must be pregnant with twins! By eight weeks, I already needed to wear loose-fitting skirts and maternity pants."
For the rest of us, our suspicions grew over a longer period of time. Linda remembers her first pregnancy: "After three months of morning sickness and weight loss, my waistline began to expand at an incredible rate and I gained weight rapidly. My doctor mentioned that twins were one explanation for these rapid changes, but he was also concerned that he had miscalculated my due date or that a medical condition was complicating my pregnancy. He scheduled an ultrasound during my fourth month to check on the condition of my 'baby.'"
When Florien was about five months pregnant, her midwife scheduled an ultrasound because Florien was feeling flutters of movement all over her abdomen and her uterus was consistently measuring 4 to 5 centimeters larger than expected. With similar symptoms at six and a half months into her pregnancy, Debra's midwife grew suspicious. During the examination, the midwife believed that she heard two heartbeats and that she felt two babies. To be sure, she scheduled Debra for an ultrasound.
Twins, however, were not on Sheri's mind when she went to her prenatal appointments. So, even though her uterus measured larger than was expected, she didn't think much of it. It was the alpha fetal protein (AFP) test that eventually led to the discovery of her twins.
The AFP is a simple blood test done on the mother in the sixteenth to eighteenth week of pregnancy. It measures levels of alpha fetal protein, which is produced by the developing baby. Levels that fall above and below a specific range may indicate a problem with the pregnancy. The most common reason for very high levels of the protein is simply that the pregnancy is beyond the eighteenth week. But not to be overlooked is the possibility that the mother is carrying twins or that her baby has particular medical problems. Sheri recalls her reaction when she got news that her AFP level was high: "It was late on a Friday. The receptionist at my doctor's office tried to reassure me by saying that I was probably just farther along than we had thought. Or maybe I was having twins. She wanted to schedule an ultrasound to be sure the baby was okay, but it couldn't be done until Monday. That was the longest weekend of my life!"
The most common method of confirming suspicions of a twin pregnancy is an ultrasound exam. Not too many years ago, obstetrical ultrasound procedures were used only in the most advanced medical practices to manage the most difficult pregnancies. Now they are routinely offered with many obstetrical services.
Ultrasound allows for early, noninvasive, accurate monitoring of the baby during pregnancy; to date no risk to the baby or mother has been detected. Although an accurate diagnostic tool, it is not foolproof: There are occasions of a baby's misdiagnosed sex, or the later discovery of a twin that wasn't seen on the first ultrasound.
Debbie describes her experience: "I was nine weeks pregnant when I had my first ultrasound. I was instructed to drink a quart of water one hour before the ultrasound and I was told not to urinate, so that I would have a full bladder for the test. I took my husband, Dale, and my seven-year-old son, Chris, with me when I went to have the ultrasound because I wanted them to be there to 'meet' our babies for the very first time. I remember how uncomfortable it was to lie on my back with a full bladder while the technician got me ready for the scan. She squirted a few teaspoons of gooey conducting jelly on my abdomen. The technician skidded a rodlike device, called a transducer, across my abdomen and pictures of my uterus were flashed onto the monitor. Everything looked gray-black and blotchy to me, but soon she pointed out a small shrimplike form surrounded by a dark gray circle. That was one of our babies in its amniotic sac! She showed us the heartbeat, which at this stage just looked like small pulsations coming from the center of the baby. Moments later, she pointed out another baby. That heartbeat looked good, too. After continued searching, she found a third sac. Triplets? Looking from various angles, she could find no baby; the sac was empty, an 'almost' baby that never developed. She could find no evidence of the fourth egg that had been implanted. I was relieved and sad at the same time, but soon refocused on the fact that I was having twins! We all left the office on cloud nine."
Although ultrasound procedures are often routine, they can still be an emotional event for the woman who is full of wonder and worry. During Linda's first pregnancy, two technicians were scanning her abdomen and whispering to each other until one of them casually said to Linda, "Do twins run in your family?"
Linda sat straight up. "Why?"
She replied, "The only thing we are allowed to tell a patient is that she is going to have twins. Look, right here are two heads!"
As the technician summoned the doctor to verify the discovery, Linda couldn't help thinking, "How do they know it isn't one two-headed baby?"
Sheri, too, had her concerns. She and her husband, Steve, waited and worried over a weekend about the outcome of the ultrasound she would have: "I was so upset. I took long showers, crying and praying out loud. In my mind, I ruled out twins and thought the worst. When Monday morning finally came, with our hands clasped tightly, Steve and I watched the ultrasound screen intently. The technician said the baby looked all right. Then she said, 'Whoops! There goes another head.' We looked at each other with tears in our eyes and sighed in relief."
In Florien's case, the tables were turned. "I remember that the radiologist said the purpose of my ultrasound was to confirm a single pregnancy. When I told her of my absolute belief that I was carrying twins, the technician only shrugged, stating confidently that only one of out of a hundred ultrasounds confirmed multiples. She, not I, was surprised when the images revealed I was pregnant with twins. I was thrilled! She looked for the amniotic membranes and placenta. She found that they shared one placenta and the chorion, but not the amnion. They were destined to be identical. The technician was reluctant to say so, but it was obvious from the ultrasound that the twins were boys. I didn't mind knowing this ahead of time. What was most important to me was that they were both strong and healthy."
When Debra's ultrasound confirmed the midwife's suspicions, her reactions were mixed. "At first I didn't feel anything because I had been so upset and was hoping that the midwife was wrong. When the radiologist said I was definitely having twins, I just went emotionally numb, although intellectually I was intrigued by what I was seeing on the screen. The radiologist handed me pictures to keep. I felt like a robot until I reached the sanctuary of my car. As I sat there staring at the images, reality sank in. It was a 25-mile cry as I drove home."
"I, too, just started crying when I saw two heads on the ultrasound screen," Linda says about her second pregnancy. "For weeks. I had dreamed about how wonderful and easy it would be to take care of one baby after having twins. My husband and relatives had been teasing me about having two boys this time. I was so sure that the ultrasound would prove them wrong. My husband, Todd, was totally excited and I was totally hysterical!"
As the days passed and the idea of having twins became more real, new questions and feelings emerged. Debbie's reaction is a good example of this: "During my ultrasound procedure, the technician had casually mentioned that the second baby had a smaller amniotic sac than the first baby. I didn't think anything of this at the time, but then I started to wonder. Was the second baby's sac smaller because he was sick and going to die like the third and fourth ones that had been implanted? I worried about this, fought back the worries, and then worried some more. This would be my style throughout my whole pregnancy: worry, joy, worry, joy, worry, joy."
Sheri remembers, "We were so thrilled about having healthy babies that it took a week for the concept of twins to hit home. Then I began to feel overwhelmed. All the confidence and security I'd felt about parenting my second child went out the window. I felt like a first-time parent all over again."
Florien had little difficulty adjusting to the idea. "I became fully aware of my responsibility to the new lives I was carrying. I did not feel threatened or nervous about, perhaps, one of the most important challenges I would ever face. Of course, there were financial concerns. We needed a bigger house and a bigger car. But carrying two healthy babies to term became the goal my husband, Devin, and I worked toward together."
"Each of my experiences was so different," Linda comments. "The first time I found out I was having twins, Todd was out of town and I was dying to share the news with someone, so I called my mother. She said that a day before this, she had received a fortune cookie that read, 'A happy, blessed event will happen soon in your immediate family.' That made me feel so special. When Todd called later that evening, I teased him that the two children he desired to have were coming all at once. It was very festive around here for days. As the euphoria began to wear off, I grew concerned about the health of the babies. With my second pregnancy, this worry resurfaced even more strongly than before because I knew how difficult my first pregnancy had been. I cried for days, in spite of everyone else's excitement and consolation. Gradually, I came to realize that having two sets of twins was special and unique. But at first it was disappointing to lose the dream of being pregnant with and caring for one baby."
Debra had a different set of worries. "I had great confidence in my body's ability to produce healthy, full-term babies. It was all the other aspects of my life that felt so threatened; I didn't feel like celebrating at all. My marriage was going through rocky times; we were already having financial difficulties and living in a very small house. It was painful to think about the special closeness I shared with my three-year-old, Mehalic, having to change. And my older son, Jason, would have to take on so much more responsibility during his teen years. I wondered how I would possibly cope with my extended family living so far away. Then, thinking of them, I realized that I was the first in the generation of fifty-four grandchildren to have twins. With that, a little pride found its way into my inner turmoil. It took a few days to pull out of that initial hopelessness. I couldn't help feeling guilty for reacting so negatively to what others might have considered good news. It was just hard to feel fortunate about the timing."
Thoughts and Reflections
Mixed feelings are a normal part of a woman's adjustment to learning she is pregnant with twins; unfortunately, not everyone is conscious of this. Friends, relatives, other mothers, even health care professionals may be unaware of how strongly, and at times negatively, a twin pregnancy impacts a family.
It is important to seek the support you need. Ask the questions that you need to have answered, and accept without shame any negative feelings you might have. If you need counseling to make sense of your life, get it! Taking good care of your emotional and physical self isn't selfish. It's sensible, and the best way to get yourself ready for the difficult, but rewarding, experience of having, giving birth to, and raising twins.
Copyright © 1993 by Linda Albi, Donna Florien Deurloo, Deborah Johnson, Debra Catlin and Sheryll Greatwood