Nancy Bowers- “Multiples Birth Update” – My Notes

Nancy Bowers spoke on the updated information on multiple births at the CAPPA 2014 conference. Here are my notes- not a full overview of her talk but instead the things that I was most impacted by- thanks!


She discussed the different types of twins:

  • Monozygotic- identical twins and the four ways they may share amniotic sacs
  • Dizygotic twins

Did you know the majority of twins share a placenta regardless of the type of twin? {I am sure this is what my notes say- but I wonder if this is because twins often have fused placentas… “Though fraternal twins have their own separate placentas, sometimes the two fertilized eggs implant close to each other in the uterus, which can result in their placentas fusing. The two fused placentas look like one placenta, causing them to be mistaken for identical twins.}

She asked a few questions and shared her answers:

  1. Are twins high risk?  Yes because everything is in twos so risks are increased. There is a increase of twin to twin syndrome with identicals where 1/2 of all twins can have one baby that is less than 10% of the growth of the other twin. Low birth weight becomes an issue causing risks. There is also a higher risk of cerebral palsy with multiples. Early and ongoing education is recommended.
  2. How long is it safe to carry twins?  The outcomes seem to be best for the twins and moms if they give birth by 38 weeks. The studies show the longer the pregnancy is after 38 weeks increases the risk of death therefore surveillance is needed to make sure they are doing okay. Older moms actually have better outcomes with multiples than young moms. The recommendation for weight gain is for a normal weight mom- 37 to 54 pounds, overweight moms should gain 31 to 50 pounds, ovese moms should gain only 25 to 42 pounds and underweight moms need to gain more!
  3. Can preterm birth be prevented?  Yes and no… many of the things that were once considered standard care are not evidenced based and may cause harm- bed rest, prophylactic tocolytics, cervical cerclage and 17a hydroxy-progesterone caproate. Terbutaline and magnesium sulfate actually increase the risk of pulmonary edema in the mom. 60% of twins come preterm.The average weight of twins is 5 pounds 2 ounces.
  4. When is a cesarean birth indicated?  And this really is determined by the skill and comfort of the care provider- breech is something some care providers see as a variation of normal. But there is a reason for the birth to be surgical in some situations. 43% of twins are both vertex (head down), 38% have the presenting baby vertex. 19% are other presentations. sadi that vaginal births should be attempted if the presenting baby is vertex. I would suggest if you find out you have twins- make sure you have a provider who provides the most options to you!
  5. Is breastfeeding multiples realistic?  YES but often twins do not show hunger cues as obviously as a single baby. Getting the babies to the moms early and regularly is the key. Getting a pump to the mom who can not get her babies within 6 hours of the birth is essential. And pumping eight times within 24 hours is necessary. Kangaroo care is so helpful. Simultaneous nursing when at least one of the babies knows what she is doing is helpful- this can take several weeks. Skin to skin time is precious time. Get lots of help with latch and positioning.
  6. What do new parents of multiples need in the first months? HELP! Bonding is a process. Spend time alone with each baby. Focus on the differences in them. Respond to them individually and uniquely. Use their names – not “the babies.”  In the first three weeks all the mom needs to be doing is eating, sleeping and feeding her babies. She needs help with all other responsibilities.
  7. Co-bedding multiples at home, is it safe? Co bedding studies for multiples in the NICU shows great benefits to doing so. But the AAP says that low birth weights, prematurity, overheating, rebreathing, size discordance and folks putting their twins on their sides are reasons why co bedding is discouraged. But studies showed twins who slept together stayed in their parents room longer, had sleep synchronicity and could be safe with healthy twins. The same rules for safe co sleeping should be used if you choose to co bed.

My experiences with twins are a bit differing from Nancy’s recommendations. I think it is imperative to get great ongoing education and support when you are carrying multiples. I think it is important to ask your provider a ton of questions about their practice for managing twins as I have seen very different approaches to the care of the mom and babies. So know all of your options.