A pregnant woman is often elated to begin her search for the perfect crib, stroller blanket, and celebrity-toted diaper bag. Rarely does it initially occur to her that she may need two of the aforementioned necessities. Whether she’s aware of the increased possibility of multiples having undergone infertility treatment, or merely daydreams about how cool it might be to cradle a baby in each arm, a woman’s body may provide subtle hints that she is carrying more than one bundle of joy.
By and large, women expecting more than one baby do have a different pregnancy experience than those expecting one. “When you’re pregnant with twins, you not only have two babies . . . you also have two placentas, two cords, extra fluid, and extra hormones,” notes Dr. Susan Warhus, an obstetrician in Scottsdale, Arizona, and author of Countdown to Baby: Answers to the Top 100 Questions About Pregnancy and Childbirth. “It’s no wonder that your body undergoes more drastic changes than the singleton pregnant woman.”
Please Pass the Airsickness Bag
I felt a bit icky when I was pregnant with my daughter, but when I got pregnant with twins two years later, it was a different story altogether. For the first 16 weeks, I relied heavily—day and night—on Sea Bands, typically used for motion sickness. Anyone who thought I was exaggerating was given a peek at the semi-permanent indentations created on the insides of my wrists from the plastic studs which applied constant pressure to my P6 point.
When expecting more than one baby, “It’s very normal to be sicker and feel queasier than women carrying just one baby, due to higher levels of hormones,” reassures Warhus. Lisa Bowers, who is expecting twins in August, experienced no nausea during her first two singleton pregnancies, but was nauseous 24 hours a day for the first ten weeks of this pregnancy. “I was just under the impression that this time it was a girl,” she admits. Turns out she was right—twice over!
“During the first trimester of my pregnancy I drove my husband crazy because I was on a constant emotional roller coaster,” commented Brenna Hardin, whose has nine-month-old boy/girl twins. “I was a little moody with my singleton pregnancy, but nothing like this! It was anyone’s guess what would set me off, and how I would react in any given situation.”
Indeed, friends and family of the expectant mom may wonder what (or who) has so radically altered the demeanor of a previously calm, collected being who suddenly cannot seem to tolerate the word “Hi” if delivered a decibel higher or a second later than she deems appropriate at that particular moment. For those on the receiving end of this undulating behavior, it could be a long nine months. For the mom-to-be, while she may not understand her sudden tendency to want to lunge at the paper boy for barely reaching her curb with the haphazardly tossed morning paper (which he’s been doing for years without eliciting such reaction one way or another), she at least has an excuse at the ready with which no intelligent individual will argue.
All Swollen Up
Even in the early weeks, women expecting more than one baby may experience more swelling due to the extra fluid coursing through their bodies. “I definitely experienced pressure in my lower abdomen more quickly with this pregnancy than I did with my daughter,” comments Gina Lester, who is expecting twins in September. Bowers agrees, “I felt much bigger much quicker this time around. I even asked my doctor at ten weeks if he was sure there was only one baby. He told me ‘Yes,’ and assured me that [my size] was merely due to it being my third pregnancy. He was surprised to see my 12-week ultrasound!”
Even though a woman may appear to be showing more quickly than normal, doctors usually can’t confirm a multiple gestation right off the bat without doing an ultrasound. “It’s very normal for a woman carrying twins to have a larger uterus than expected,” notes Warhus, “but there can still be some difficulty hearing the heart beats because the babies are small.” A twin gestation at eight weeks may create a uterus that looks to be at twelve or more weeks, but two heart beats can’t be detected via Doptone because it’s almost impossible to hear fetal heart tones prior to ten weeks.
Is It Bedtime Yet?
According to Warhus, “Nearly every pregnant woman experiences fatigue to some degree, but it is often more intense in a woman carrying multiples.” When I was expecting my twins, I felt like I was dragging all of the time. The first thing I did upon rolling out of bed each morning was calculate the number of minutes until naptime.
Of course, women who are expecting twins as their first children don’t have a previous pregnancy to which to compare their exhaustion; and women in subsequent pregnancies often have a hard time differentiating between increased pregnancy-related exhaustion and the exhaustion caused by chasing their other kids around all day.
Remembers Karen Jahnke, who has a 12-year-old, a nine-year-old, and a four-month-old in addition to her one-year-old twins, “I started to spot early on, which my doctor said was more common when carrying multiples. My hormone levels continued to rise even while I was spotting, alleviating any fears of miscarriage.”
Dr. Warhus confirms, “Occasionally spotting may be a sign of [multiples]. Early on, there is a somewhat higher chance of miscarriage. But even if no miscarriage occurs, early twin pregnancies may spot more than early singleton pregnancies.”
Abnormal Test Results
Many women opt to have the AFP (alpha fetal protein) test midway through their pregnancies to check for fetal abnormalities, and it may be at this point that a multiple gestation is suspected.
Warhus notes that, “Mothers with twins often have abnormal AFP results. The AFP test is typically done between 15 and 18 weeks gestation, often before an ultrasound. The hormonal laboratory parameters are designed for one baby. So if you have two or more and you don’t know it, but have the AFP test anyway, there is a good chance that the results will come back abnormal. Fortunately, the first thing you do when you get an abnormal AFP result is get an ultrasound, and in the case of [multiples], you’d have your diagnosis right there.”
Many women’s hormone levels are off the charts early on. Doctors often put two and two together and opt to do an early ultrasound, at which time they discover a multiple gestation. This was the case for Jahnke, who, after multiple bouts of spotting and higher than normal hormone levels for her estimated week of gestation, was given an ultrasound. It was at that point that the cause of her spotting and elevated lab results was determined.
Years ago, many parents didn’t find out that they were expecting more than one baby until they got into the delivery room. These days the diagnosis is most often made long before that blessed event. Thankfully, this allows parents much more time to adjust, not to mention decorate a nursery that is fit for a king (or two).