Labor, Delivery & Life Beyond

Pregnancy Health & Complications

Preparing For Your Baby

Stages of Your Pregnancy

Podcast Details:

13.50 MB | 33:42 Min

Experts In This Episode:

Dr. Kenneth Moise is an Obstetrician and Gynecologist who is also a Maternal-Fetal Medicine sub-specialist and an expert in multiple pregnancies and deliveries at the Baylor College of Medicine and the Texas Children’s Hospital Fetal Center.

Transcript:

Welcome to your Pea in the Podcast, I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life as you begin your journey to becoming a mommy.

This week, oh my you’re having multiples.

From the moment you find out…

“He goes there is two and I go two arms and legs? No, there are two babies.”

To the time you deliver…

“They are calling my name, I have to go, they’re going to give me a shot I’m going to have the babies!”

And every moment in between…We have an obstetrician who is an expert in multiples and a multiple mom who has been where you are going. They will walk through what you can expect, the challenges that you might face, and we’ll take a glimpse of the chaotic joy that awaits you when it’s over…

“I can’t imagine not having twins.”

It’s multiples in this Pea in the Podcast.

Multiples. They seem to be everywhere these days. Dr. Kenneth Moise specializes in multiples at the Baylor College of Medicine and he says there are a couple of reasons for that.

“We know things like advanced maternal age and higher level of previous pregnancies are associated with a higher influence of multiples. We see the 20 has gone up both because women are a little bit older when they get pregnant and also because we have more of the IVF multiples.”

Advanced maternal age — a fancy way of saying ‘older moms’ — and fertility treatments, as he said. More twins and triplets and beyond. Of course, multiples do happen spontaneously, too, but Aimee was taking clomid to induce ovulation, and that can increase your likelihood of having twins. But it still came as a surprise to her.

“I was about 6 weeks along when I had a sonogram and the sonogram technician at the end of it said okay I got some news for you and I’m like okay. And she goes there’s two! And I go 2 arms, 2 legs? Oh, okay. And she goes no there’s 2 babies. And I’m like excuse me? And that’s how I found out.”

Dr. Moise says most moms find out at that first ultrasound.

“Clearly by 5 weeks you’ll see 2 sets. We can do…and with these new probes that are available today…you can see 2 sacks pretty easily by 5 or 6 weeks.”

Aimee says despite the surprise she and her husband were thrilled about those 2 tiny babies on the ultrasound.

“I was very excited; I thought it would be cool to have 2 babies at once you know? It was, you know, a 2 for 1 deal, it was kind of exciting to hear that.”

Now that you know that you’re having multiples, it is time to reassess plans for your care during your pregnancy. Dr. Moise says first things first. For twins you need to find out if your babies are fraternal — from two eggs — or from one egg that split in two. Identical.

“Identical twins, in about 2/3rds of cases, share a placenta. They have one afterbirth. That’s a real set up for some problems. Either blood starts moving between the twins, called twin to twin transfusion. It happens about 1 out of 10 times and it can be a very significant disease in those babies, even to loss of pregnancy. Or when the egg splits, it doesn’t split right down the middle and one baby gets a piece of placenta and the other baby gets a bigger piece. And that little baby never grows as fast as its twin and can get into trouble. So you want to find out early, and that can be done by ultrasound looking at the way the sacks are set up whether you have identical twins or you have fraternal twins. And it makes a difference on how you follow the pregnancy after that.”

Twin to twin transfusion is scary, but it is a lot less scary now than it used to be.

“Until about the last 5 or 6 years there wasn’t a whole lot we could do about twin to twin transfusion. We would stick a needle in the big sack and take all of the fluid off and it would come right back. But today in about 14 centers in the US and many centers in Europe we can put a special telescope into the uterus, we can identify the connecting vessels between the babies and we can use lasers to actually spot weld those vessels and separate the placenta if you would into 2 separate circulations. So we can treat twin to twin transfusion now.”

Which is fantastic news for you identical twin mommies out there.

Some of you may have suspected you were carrying twins before your ultrasound confirmed it.

“The pregnancy hormone HCG is higher in twinning because you have either a larger placenta, or 2 placentas, and that has been associated with nausea and vomiting in pregnancy. So women who have twins can have a greater incidence of nausea and vomiting. But other than that I think the other symptoms would be about the same.”

But you may not have more morning sickness. Aimee didn’t. In fact, she only had one early pregnancy symptom but it was enough.

“Extreme exhaustion, like I remember the first 2 weeks I would come home from work and I would pass out on the couch. I didn’t usually take naps at that point, now I do. But at that point I would come home from work and do whatever I did. But I would come home from work and I would literally sit on the couch and pass out, I was so exhausted, but that was the only symptom I had, I never had any morning sickness. I didn’t really have any typical symptoms of first trimester; I never had any of that.”

So don’t worry if you don’t get as sick as a dog. That is normal too.

So how would your doctor proceed with this pregnancy? Dr. Moise says a lot of you can see your regular OB.

“I think if they are identical twins I think there might be a consideration to be referred to a high risk obstetrician at least for the ultrasound. That doesn’t mean that the patient couldn’t stay with their general OBGYN but high risk obstetricians can do the ultrasound part and then refer the patient back to her primary physician, because 9 out of 10 times everything is going to be fine. That’s how we co-manage quite a few of the patients here in Houston. Physicians trained in high risk obstetrics are called either perinatologist or maternal-fetal medicine specialist. We’re board certified in the sub-specialty of high-risk of obstetrics and we do a lot of ultrasounds and we’re very knowledgeable about these complications in pregnancy, and so what I would tell a patient is that if she has identical twins and there is some concern about that she needs to get to a high risk perinatologist or ask for that referral.”

How about if you’re carrying more than 2 in there? Do you need a specialist to help manage your pregnancy?

“I think triplets are the grey zone. Do you stay with your obstetrician or do you see this maternal-fetal medicine specialist? And I would say triplets are in the grey zone. When you get to triplets and above everybody is in agreement you should be in the care of a high risk obstetrician, and that would be a board certified maternal-fetal medicine person. There are a lot of obstetricians that call themselves high risk obstetricians but they have really not done extra training in this area. So triplets probably would stay with the obstetrician, careful ultrasound surveillance, like we talked about, but if you get to higher level multiples you’re looking at talking to a perinatologist.”

if an ultrasound reveals that you are carrying triplets or above your doctor may have a hard conversation with you. They might talk about what is called selective reduction, which is what they call it when they reduce the number of embryos from whatever number you’re carrying to twins. Dr. Moise says triplet pregnancies are a grey area. Sometimes doctors will bring up selective reduction with triplet pregnancies, sometimes they won’t.

Dr. Moise says they certainly will bring it up to a mom and quadruplets. Why?

“She can carry quadruplets, she’s going to probably be on bed rest, she’s probably looking at a very long hospitalization at some point where she is away from her family. She is probably going to deliver at around 30 weeks of gestation. These babies are going to be in the nursery for long periods of time and there is a very high incidence of complications with prematurity related to cerebral palsy, hearing loss, blindness, and poor neuromuscular development. So that with a quadruplet pregnancy even with the best care she is likely to deliver pre-term and she is likely to be in the hospital for a long time on bed rest. If she would reduce to twins her odds of coming down to twins are almost identical to having spontaneous twins. She’s more likely to deliver at the 35 to 36 week range and have term-like babies that do pretty well. So even though she started with quadruplets. If she is reduced with twins she should be approaching the background incidence of complications of spontaneously conceived twins.”

But Dr. Moise says they just offer this, they don’t pressure you. It is your decision. And if you decide not to reduce, they will go down that high order multiples road with you, and give you and your babies the best care available.

You and your doctors will start paying close attention to your diet and nutrition early in your pregnancy.

“She is going to have to probably take in more calories and expect a larger weight gain than if she had a singleton. Probably on the order of a 35lb weight gain. Again, some of it depends on where she starts. A heavy woman is recommended to gain a little less weight than a larger woman but I would say on average about a 35lb weight gain with 35 to 40lb weight gain with twins. So she is going to have to increase her caloric intake a little bit and watch her weight throughout the pregnancy.”

“She is at high risk for anemia and most of us will put them on supplemental iron, and that is because is she making more red blood cells in her own system. When you carry twins you actually have more blood volume circulating in your own body, and then she is making the blood for 2 different babies. So anemia is pretty common in twins and I go ahead and put those moms on additional iron therapy right up front early in the pregnancy, but that is about the only things that we’re going to do different in the beginning.”

Oh, by the way, a multiple pregnancy doesn’t get you out of exercise, mom.

“Swimming is the best. You’re flat. You’re using the buoyancy of the water, and I try to get moms to swim. Walking is probably okay, although I tell them particularly with twins of triplets as they get further into the pregnancy, 26 weeks or so, their balance is going to be so far off that they have to be very careful walking on city streets and all that. I wouldn’t want a mom on an elliptical with triplets. I wouldn’t want her on a treadmill everyday bouncing around, but I encourage swimming is one of the best exercises a pregnant woman can do even with multiples.”

Swimming may also help ease the aches and pains that plague a multiple mom-to-be, and there will be many of them.

“If you have this much uterus and it is trying to pull forward, if you would, it pulls on the ligaments, one on either side called the round ligaments that are expanding very rapidly, and they have to stretch tremendously in pregnancy, and so the more you are on your feet, particularly standing, the more those ligaments are going to pull and the more discomfort that a woman is going to have. There are some belts and harnesses if you would or sort of support garments that can be worn to try to keep the uterus in a better position and that helps some women but in others it is just sort of getting off your feet and lying down as much as you can when things start to get uncomfortable.”

Dr. Moise mentioned you will have many ultrasounds. Really, you’ll have a lot more than a singleton mom will.

“Somewhere around 16-18 weeks they should have an ultrasound for birth defects because twinning in general is associated with more birth defects. Both fraternal and identical twins have more birth defects than having one baby. So that is sort of a given at 16-18 weeks everyone gets what we call an anatomical scan. If they are fraternal twins they can be followed once a month and just checking the growth of the babies. Once a month ultrasound just make sure they are growing okay. If they are identical twins there is data beginning to come out of Europe that they probably should be looked at with a quickie ultrasound if you would about every 2 weeks and have their big ultrasound for growth once a month, just like the fraternal twins. And the reason for the quickie ultrasound if you would every 2 weeks if you can begin to pick up early signs of twin-twin by just looking at the fluid in the 2 sacks. And if you begin seeing too much fluid in 1 sack and not enough in the other that is a warning sign that things are beginning to go the route of twin-twin transfusion.”

And doctors will use an ultrasound to keep an eye on your cervix. Your cervix is the narrow portion of your uterus where it joins with your vagina. It is sealed up tight during pregnancy. It opens or dilates when you are in labor. But sometimes it opens too soon, and this happens more often with multiple moms. This is called incompetent cervix.

“Incompetent cervix is a very difficult diagnosis to make. It is made by history basically. There is no test that you can do for it. You can’t draw blood and test it. We do know it occurs. Some people present probably with premature labor and delivery and other people have miscarriages at 16 or 18 weeks in the classic definition form. With multiples we know the cervix is shorter than with singletons because there is probably more pressure from above and we know the shorter your cervix the more likely you are to go into premature labor.”

So this is when ultrasound comes into play.

“Most of us will look at the cervix with a special ultrasound, again a vaginal probe ultrasound to look at how long the cervix is, to look at cervix lining and there is pretty good data to suggest if that if the cervix is normal length the likelihood of a pre-term delivery in these multiples gestation is more. So I actually use that in my practice to prescribe bed rest or not. If I do that ultrasound at say 23-24 weeks and the cervix is nice and normal, usually about 2.5 centimeters — that’s an inch — then I say you’re likelihood to preterm delivery is lower. You can continue to work. I don’t want you jogging around the corner or riding a bike, but take it easy. So hopefully you’re not standing up all day, you’re at a sit down job, but continue doing what you’re doing as long as you’re not having any symptoms of contractions or anything. Now if I put that vaginal probe in at 24 weeks and her cervix is 15 millimeters at 1.5 centimeters I am going to say you know you need to take off of work, probably lay around the house keep an eye on things here. Let’s kind of back off a bit.”

In some instances, particularly when women have had recurrent miscarriages after 15 weeks or so, their doctor will put a stitch in the cervix hoping that will keep it closed. That is called a cerclage, so your doctor is going to ask you to pay extra close attention to the symptoms of pre-term labor, but that can be harder for you than it would be for a singleton mom-to-be, too.

“All multiples are going to have contractions. It’s the uterus expanding more quickly than it would with a more quickly than it would with a singleton baby inside, but if she has symptoms more than 6 intense contractions per hour or if she notices an excessive amount of mucus discharge that might be associated with her cervix dilating because of loss of mucus plug, she needs to see her obstetrician. And one of the toughest things I’ve found in obstetrics is try to sort out who is having premature contractions, and who is having premature contractions that result in delivery. There are 2 tests. One is the vaginal probe ultrasound that we talked about earlier that you can measure the cervical length, the other is something called a fibronectin test which is a swab looking for special protein that comes through the cervix into the vagina when these contractions are real, if you would. These tests aren’t perfect, but there are some additional tools that the obstetrician can use to try to discern is this real or is this just some background contractions that will go away.”

You’d think that would be enough to worry about, but no. Multiple moms are also at greater risk for preeclampsia, a disorder characterized by high blood pressure and protein in your urine. It can be very dangerous to both you and your baby. Why are you at greater risk?

“We think it is related to placenta. We know the more placentas you have and the more placental mass you have higher incidence of preeclampsia. I believe when you get to triplets it runs on the order of 50-75% of women get some element of preeclampsia. Don’t know what causes it, still haven’t solved that. Don’t really have any treatment for it. We don’t have any preventative treatment for it, there’s no pill to take to prevent it. We just have to watch for it. Once you get it, which is usually signified by increasing blood pressures and then the offset of protein in urine, the only treatment is delivery, and, of course, now we have a tough decision to make. We have to weigh prematurity against mom’s health and typically we will be very conservative, particularly if the baby is very premature and we will maybe place the mom on bed rest, maybe have to hospitalize her but try to take out this pregnancy as far as you can.”

Oh yeah, you’re at greater risk for gestational diabetes, too.

“The placenta, the afterbirth produces hormones to make a woman a diabetic. It is trying to do that, now why would it do that? Well glucose or sugar is the number one food source for the baby. So if you have 2 babies inside and you have a big placenta or 2 placentas you’re making more of these hormones to make you more likely to be an overt diabetic. So you may not be a diabetic when you’re not pregnant, but given these 2 placentas — or a large placenta — there is enough hormones being pumped out of this placenta to work against your pancreas and you just can’t keep up, you can’t make enough insulin, so your blood sugar rises. And high blood sugars are associated with lots of complications in babies: everything from large sizes, to low blood sugar after birth, to poor lung development and many other issues.”

“So pretty much all pregnancies, not just twins will have some sort of sugar tests done to evaluate the possibility of gestational diabetes and then based on those results a woman might be put on a special diet and then if that doesn’t keep her blood sugars in control because she will be checking them at home she may end up on a pill or even on insulin shots depending on how bad her sugars end up looking.”

They monitored Aimee very closely for these complications, including gestational diabetes. Doctors usually screen singleton mom for gestational diabetes with a 1 hour glucose tolerance test.

“They pretty much said okay forget the 1 hour, we’re not even doing the 1 hour with you. We’re going right to the 3 hour. I guess that is the more sensitive I guess, I’m not sure. But they pretty much said the 1 hour you’d probably fail it. You’ll probably need the 3 hour anyhow so let’s just do the 3 hour and get it out of the way. And I did pass that, so there was really no big deal with that. Because it was twins I was at the doctor’s office a lot more a lot earlier than most average singleton pregnancies. So they were monitoring blood pressure, I don’t remember ever it being high and I wasn’t on blood pressure medication, before then. I was on blood pressure medication after that.”

Okay so you get it, your pregnancy may have its challenges. It doesn’t have to though. Lots of multiple moms sail through their pregnancies with nice, tight cervixes, no gestational diabetes, and no preeclampsia. Like Aimee.

So let’s talk about the babies. Baby A and Baby B.

“Well we sort of give out the A and B as an ultrasound diagnosis and unfortunately everybody picks up on it until they pick up some names. A typically is the lower baby, the one that would be the first out if the baby were born at the time that we do the ultrasound, but these babies don’t just lie in the same place. They move all over the uterus and, particularly early in gestation, they can flip back to being vice versa. So whoever is lowest we call A and the other baby is B, but typically further to the gestation they’ll sort of tuck in and stay on one side or the other and mom will notice clearly different personalities being expressed even inside of the uterus. Where this baby moves a whole lot, this baby is quieter or this baby starts a lot of movement and all of the sudden this baby wakes up because his brother or sister is kicking the dickens out of him, waking him up there inside. So personalities start even inside and moms pick names, and they know. And I’ve been at cesarean sections and moms saying now who did you just deliver. Did you deliver Jenna? Did you deliver Jackie? Tell me who you just delivered. They begin to pick out names for these babies based on their personalities and their experience of what they’ve been feeling inside.”

Aimee knew who was kicking her.

“Baby A which is my Lina. She was low. I could tell she was the one kicking me in the inside of my crotch. And Francesca, who was Baby B, was the one kicking me in my ribs. I think Lina kicked less, I think, but she was more aggressive I think in her kicking. That would be prove me true now too. And Frankie would just kick every once in a while it wasn’t any, feel it pop out a little and go ‘oh she wants to make sure I know she is here, I guess.’”

Although Aimee’s pregnancy was uncomplicated, for most of the time, like many multiple moms-to-be her pregnancy got complicated quickly as she headed into the third trimester.

“You know probably 28 weeks or so the techs that were doing my sonograms weren’t getting great reads off of it, especially Baby A, which is Lina, and they were like they told the OB what was going on. The OB said I want you to go see a specialist; she was a special doctor that did sonograms so I went to her 2 times. And she was still having issues, so then they sent me to a special specialist in multiples and stuff like that at the local children’s hospital and she saw me at 31 weeks, and she measured them up, and she said okay come back in 2 weeks and if Baby A has not grown exponentially along a curve, so to speak, they would be delivering me. So I went back 2 weeks later and Baby A had not grown in a good curve, she barely had gained anything and so they said okay we’re giving you steroid shots and you’re going to be delivering in the next couple of days. I was like, what? Again more shock. So we had a shock in the beginning and the end of the pregnancy. The middle was uneventful.”

Aimee’s Baby A, little Lina, was struggling to grow inside the womb. Even though the babies would be quite premature, they were going to be born.

“They really just told me if you don’t deliver it could be worse. Because what was happening to Lina was her, they weren’t sure, but they thought that her placenta could be failing. Most people think ‘oh they had twin-twin transfusion’, which is what you were talking about with identicals. That doesn’t happen when they have separate placentas, but her placenta could have been failing, so the longer that they left her in there the more chance that she is not getting more and more nutrients, she’s not getting oxygen properly and all of the stuff like that. Whereas if they delivered, they take her out they can give her everything she needs.”

That’s cold comfort for a terrified mama as they sent her to get her shot of steroid that help prepare a premature baby’s lungs for premature delivery.

“They sent me down to get my steroid shot. I’m in shock now in the waiting room waiting to get called in. I didn’t know whether to call my husband or not and then I was waiting and waiting and waiting I’m waiting forever I’m going to call him. So I call him, I get a hold of him. I start telling him what is going on and of course that is when they call my name. He doesn’t know what is going on I’m trying to explain ‘they are calling my name I have to go, they’re going to give me a shot, I’m going to have the babies.’ It was very nerve-wracking. I didn’t know exactly what was going to happen. I was so scared that my little girls…something is going to be wrong.”

Dr. Moise says it is not at all uncommon for multiple moms to have to make this call. Likely none of you will have the standard 40 week pregnancy.

“I think the average now for triplets is 35, 33-35. You’re looking at 37 for twins, 36-37 compared to 40 weeks for singletons. But again each pregnancy is a little bit different. I don’t let twins go past 38 weeks, most women are miserable past 38 weeks and I personally induce twins by 38 weeks. Clearly by 40 weeks twins probably shouldn’t stay inside, it is time to get out. That they are going to out grow their placenta because that is probably overdue for twins, if you would.”

Aimee was 33 weeks, 1 day when doctors decided her twins needed to be born. According to their measurements, Lina wasn’t going to be much more than 2lbs. Too tiny and too weak for a vaginal birth. So she would have a c-section. Dr. Moise says surgical births are very common for multiple moms.

“Say in years past your chances of a vaginal birth of twins is very high. I would bet that half of twins today are being sectioned. Typically the first baby has to be head first and then the second baby can be any number of things, it can be breach, head first or sideways and it sort of depends on the skills of the obstetrician and their comfort level as to what they do with that second baby. Many obstetricians will say that the second baby is head first. That is great we’ll have a vaginal birth. If the second baby is crosswise — transverse — then have a cesarean section, but that is sort of left to the discretion of the obstetrician as to how to deliver those twins.”

So they prepared Aimee for surgery and brought her girls into the world.

“I got a spinal which I was very nervous about because I had heard stories. Mine went absolutely fine. It was hard to get in the position that they want you to be in to get this thing in you but it wasn’t painful or anything. You know I just remember laying there and it felt like they were just jostling me around in the inside. I felt like I was all being pushed around inside. It was weird. It seemed fairly short. They got Lina out. She was screaming a storm up and they brought her over and I saw her and everything and my husband took pictures and then they got Frankie out — Fancesca — like within 5 minutes. They were born within 5 minutes of each other. But she wasn’t crying, and I’m like ‘why isn’t she crying? what’s going on”‘ and she was actually the one with the problem. She was, like…she didn’t want to come out and she didn’t want to breathe when she got out. So they had to give her a little bit of help and a little bit of oxygen and stuff. I’m worried about Lina, I’m worried about Lina and all of the sudden Frankie is giving me a problem, which is such as it is now, too. You worry about one of them and the other one is giving you a problem. So it was a little touch and go and a little nervous there. They had her on oxygen until 5 o’clock that evening, and I really think it was just a matter of she was like ‘excuse me I am supposed to be in here for a little while longer where do you think you’re taking me?’”

Lina was tiny — 2lbs 4oz. — and so was her much bigger sister Frankie. 4lbs 7oz. And they went to the neonatal intensive care unit.

“I didn’t even see Francesca actually. I didn’t even see her, I only saw Lina because, like I said, they were taking her and dealing with her oxygen and stuff. So I never even got to see Francesca and Raymond never got to take a picture until she got up to the NICU. So I saw Lina for like 3 seconds, gave her a kiss and then they wrapped her up and brought her up to the NICU to make sure she got what she needed, and you know it was tough but I knew they were, I just had it in my mind that they had to be taken care of and that was more important than me kissing and cuddling with them. They weren’t regular babies, they were special. They were twins and they were small and they needed care so you kind of have to get over yourself.”

Your babies may have to spend some time in the NICU, too, and that can be very hard. You’ll need to start setting up a support system now, just in case.

“I went to the hospital every day but I think 1 that whole month. I had a lot of friends and family who would watch the girls….watch Frankie while I went over to see Lina. I can’t even remember a time when they were apart from each other. You know I got up there every day for at least a little while. Then after a while I could drive myself so I would be up there. My mother-in-law would stay with the girls, or my husband would stay with girls, stay with Frankie while I went to see Lina.”

And then the day you’ve been waiting for. You bring some or all of your babies home.

Then what?

Dr. Moise says baby boot camp for you will be a little more rigorous than it is for your singleton mommy friends.

“Obviously moms are going to have a little more sleep deprivation trying to keep up with the babies at home and feed 2 babies. I think many women can breastfeed twins and do very well breastfeeding twins. When you get to triplets it becomes a little more difficult to keep up with breastfeeding and that much milk production. But it is possible. You sort of have to mark them and say who is on first and go breast, breast, bottle, breast, breast, bottle and keep rotating, but I know of women who have successfully breastfed triplets. Twins are clearly easy to breastfeed if you decide to do that. But I think the recovery period from the delivery itself is about the same as singletons, although the sleep deprivation is probably a little bit higher.”

Aimee’s breasts were full.

“I worried about things like what do I do about them eating. And do I wake them up to feed them? Because you’re not supposed to wake up a baby to feed them but my kids they were so small that you had to. What do you do with them in the middle of the night? And do you wake them up, do you wake this one up when the other wakes up? Do I wait? It was all of those kinds of little things that you’re trying to figure out in your head and how do I get them to sleep at the same time and that kind of thing. But I really just knew that — this what my husband always says — this is the way it is, you got to deal with it. How do you do it? You just do it. You don’t really have any other choice; I mean what are you going to do just throw up your hands and leave? No, no you just got to step up to the plate and do what you’re supposed to do.”

So if you’re carrying multiples, your journey to becoming a mommy will not be without its challenges. Dr. Moise has a quote he keeps in mind.

“The woman is designed to carry 1 baby at a time with any degree of biological grace. That was a great line and it is absolutely true. We were built to have 1 baby at a time, and the more you put in there the more chances that that uterus is not going to act like it is supposed to. And there are a lot of discomforts and a lot of complications that can occur with that. And as long as a woman understands what she is getting into and acts appropriately she should have a pretty good outcome.”

Like Aimee’s outcome. It may not have been graceful, but she’s got two rambunctious, healthy and exuberant little girls.

“They make me crazy. They are nuts. They feed off each other and I love them to pieces.”

No, it may not be biologically graceful, but as a mom-to-be to multiples, in the end you’re multiply blessed.

We hope you’ve enjoyed this Pea in the Podcast: Multiples. Please visit our website PeaInThePodcast.com for more information about our experts, to find links and transcripts and to register to get tailored week by week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie. Thanks for listening.

A Special Thanks To…

Aimee in New York for sharing the wild ride of her twin pregnancy with us for this podcast.