Double Trouble: Twins and How to Survive Them
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Just to confuse you further…
As well as the simple and straightforward combinations, there are small differences that will really make you confused. I don’t recommend you venture into conversation with any old women in the supermarket about the following subjects.
Mirror-image twins
About a third of all identical twins are ‘mirror-image twins’. If the one egg that splits does so later in the pregnancy, after the seventh day, then sometimes the twins have mirror-image traits – such as one is left-handed, the other right-handed. As they grow, you might notice one sprouting a tooth on one side, while the other does so on the other side, or different hair whorls curling in opposite ways. No-one is exactly sure what causes this effect, but it all adds to the mythology surrounding identical twins.
Identical twins who don’t look alike
Because some identicals share a placenta, and don’t always have equal access to the nutrition because of how they are lying in the womb, they may have quite different birth weights. The weight soon equalizes after birth, however, but the changes in the shape of the face or bodily difference may stay for life. Identicals may also have slightly different hair colour and birthmarks.
Twins that result from superfecundation
Superfecundation describes the fertilization of two eggs after two or more bouts of sex during the same menstrual cycle. Given the small window of ovulation and the short lifetime of a sperm, these bouts of sex have to take place quite close together. Very interesting. Could this be you? (unlikely if you have any other children in the house).
Superfecundation gives rise to the possibility of twins with two different fathers, for women who might wave their husbands off to work and then open the back door to the milkman. Rare incidents of mixed-race twins where one baby is born black and the other white can also happen in normal twin conception with the same father, as in the case of the twins Karen and Cheryl Grant from Essex, now 19.
IVF or natural? Who cares?
I’ve included the question of whether your twins are ‘IVF’ or ‘natural’ because you’d be amazed at how many people think it is their business. You have probably already been asked this, usually by Ms Nosey Parker.
My view, whether you conceived with the help of IVF or not, is to tell people a lie. Anyone tactless enough to ask deserves to be led astray. As long as those who conceived naturally are quick to answer ‘naturally’, as if there is something inherently better about this answer, then people will continue to ask. Perhaps you could ask a question back to Ms Parker, such as ‘What is IVF exactly?’ and then nod interestedly as she attempts to explain. Then ask her, regardless of whether she’s had children or not, whether she’s had IVF herself, because she seems such an authority on the subject.
Men and the assisted conception business
When my husband told a West Indian client that his wife was expecting twins, the client slapped him on the back and shouted, ‘Congratulations! Mon, you shoot with double barrel, never miss – Bam! Bam!’ The Jamaican summed up the view that all men secretly share – that twins are an expression of a man’s (not a woman’s) fertility. I haven’t met a single father of twins who hasn’t puffed up his chest when remembering his own important walk-on part in the twin drama.
Of course, all women know that this Woody Allen view of sperm is ridiculous, and that all sorts of complicated factors are involved to make conception possible. However, there is no harm in encouraging this virile fantasy (and if that means suppressing the information that they are IVF, just carry on lying) because a swaggering partner in the early days is more likely to be a helpful one later on. All women know this instinctively, so you don’t really need to be told.
The IVF twin mix-up stories
The ‘mix-up-in-the-lab’ story is recycled again and again whenever the latest fertility scare happens. This is a variation on every woman’s irrational fear that her baby will be switched by mistake when the nurses are chatting abstractedly over a cup of tea. This fear is as old as the hills. My mother admits to being so scared by it that she insisted on having a home birth for her first born, back in 1961. When my 11lb (ouch!) big brother finally appeared, I think few would have mixed him up with some 5lb weakling.
There are three twin mix-up tales in the IVF history books. The first was when a white mother gave birth to black twins in the summer of 2002 here in Britain. The sperm was wrongly mixed with the woman’s eggs after a laboratory error in an NHS clinic, and the legal outcome determining who are the parents has yet to be settled.
The other two happened elsewhere in the world. The first was in 1993 in Holland where twin boys, one white and one black, were born to Willem and Wilma Stuart after two samples of sperm became accidentally mixed before being used to fertilize Wilma’s eggs. The biological father made no attempts to gain custody of his twin, but the family keeps in touch in the event that his biological son may want to meet him one day.
The second case happened in 1998 in New York when two lots of embryos were mixed and both women, Donna Fasano and Deborah Rogers, were implanted with what they took to be their own embryos. Only one of the pregnancies turned out to be successful, and the mother had one black and one white twin. There followed a difficult legal battle, leading to the black twin being handed over to his biological mother. Despite the recrimination between the parents and the hospital, the now four-year-old twins still visit each other.
Natural or not so natural?
The folic acid factor
New research2 also suggests that women who take folic acid are nearly twice as likely to give birth to twins as women who do not. A higher rate of twin births in relation to folic acid was first noticed in an earlier Hungarian trial. The recent Swedish research team examined Swedish records since 1994. The scientists found that among 2,569 women who had used folic acid supplements, the rate of twin births was 2.8 per cent – nearly double the normal level of 1.5 per cent. They are unsure why folic acid might be responsible for producing more twins. It is possible that folic acid encourages multiple ovulations or the implantation of more than one egg. It might also prevent the spontaneous abortion of one or more foetuses occurring in women who do not take folic acid.
The official advice is still for women to take 400mcg of supplemented folic acid before conception and for the first three months of pregnancy (see also www.hsis.org – Health Supplements Information Service).
I took 12 times the recommended dosage because my first baby was born with a cleft lip and palate, so I read the study with interest. But, then again, I also fell into all of the other categories that made me more likely to have twins: I was over 35, taller and heavier (charming) than your average British mother, a twin myself who had already had one child.
TWIN PREGNANCY VITAL STATISTICS3
Natural conception:
Assisted conception:
THREE Eating and Exercising for Three
Make no mistake: one good thing about a twin pregnancy is that you get to eat a lot, and most of the weight will go on the babies. All of us who have had guilt issues surrounding food can now look forward to nine months of bingeing, and even longer if you hope to breastfeed. For a twin pregnancy, you are not only invited to eat one-and-a-half times more than for a singleton pregnancy, it is practically a responsibility.1
There is also enough evidence now to support the welcome news that in a twin pregnancy there is a direct correlation between higher maternal weight gain and better birth outcomes.2 So, what are you waiting for? Order that Fortnum & Mason hamper now. This should be the rekindling of a long love affair with food.
During my own twin pregnancy, which was remarkably trouble-free and ran the whole course to term at 40 weeks, I went food mad. I decided to allow myself absolutely no restrictions on the amount of food I ate, and arrived at work having visited the deli with two plastic bags from the greengrocer and the baker en route. For all my no-holds-barred approach, I was very picky about the type and quality of food I ate. In my first pregnancy, I had put on a lot of weight by eating badly, pretending that my penchant for crisps, cider and Maltesers was a craving. It took me 18 months to shift the excess stone (or two).
Second time around, I had learnt my lesson about office vending machines and was careful about the type of food I ate. I would bring in as much fruit and raw veg as I could carry – carrots, cucumber, tomatoes, cauliflower, apples, bananas and grapes. Added to this would be a mixture of cheese, quiches and whatever else shouted ‘eat me!’ from the deli that day. Should anyone ever question you on the size of that cheese sandwich you are about to put in your mouth, just remind them that you are ‘eating for three’.
The first three months
The most important eating time is the first three months, when the babies are, literally, being created. This is when the nutrient factor is most crucial. Do not fret if you are among the many twin mothers who suffer from morning sickness. Multiple mothers tend to have a higher level of pregnancy hormone in their blood so they experience more nausea and vomiting than their singleton friends.3 Paradoxically, if you suffer from bad morning sickness and can’t keep the food down for long, this won’t affect the babies’ eventual birth weight. It’s the nutrients they are after, not the fat. And they will take the nutrients from your own body’s supply if you don’t provide them (get used to it, it goes with the territory). Mothers with morning sickness should be heartened by the research showing that sufferers have babies with better overall outcomes. Studies suggest that vomiting may stimulate early placental growth.
If you feel tired and sluggish in the first three months, but not nauseous, remember that your body is making two babies and extra blood volume. For twins you can expect a 75 per cent increase in your blood volume (for triplets there’s a 100 per cent increase).4 Add to this the fact that a mother pregnant with twins can carry up to 20 pints of water more than a mother of a singleton during her pregnancy, and you can see why you have a perfect excuse to take to your bed at 8pm. Things will ease up in the second trimester, your metabolism will go into high gear, and the weight you gain will all go towards making healthy babies.
Just say ‘no!’ to the calorie counters
Personally, as a poor maths student, the calorie-counting view of the world has never appealed. It turns a sensuous experience, eating, into a tax return. Also, for twin pregnancies, I’ve noticed that the number of calories suggested by ‘experts’ varies wildly. In my own twin book library, the figures range from 2,700 calories to 3,500 per day. However, if calorie counting helps you to feel in control, aim for somewhere in the middle.
My main beef against calorie counting is that it puts you in the frame of mind of dieting, which is the wrong thing to do when pregnant. Also, anything that limits your intake of food (‘I’ve eaten my 3,500 calories today, I should stop now and just drink water’) should be avoided. This is your time for growing the babies, so enjoy it. No other vices are possible in pregnancy (you may get away with lust for a few weeks, but the wolf whistles will disappear by that last trimester), so you may as well indulge in gluttony.
One mother of twins was told by a nurse that she was gaining weight too fast and should stop drinking milk. When she told her husband, he opened the fridge door, took out a two-pint carton and handed it to her. She drank the whole lot on the spot. Don’t listen to any jealous nurses or doctors on the subject. Listen to your body. If you are hungry, it is for a good reason.
Never weigh yourself during pregnancy
Another trick in pregnancy is to never ever weigh yourself. If the midwife wanted to weigh me at the checkup, I asked her to put it in kilos, and my mathematical dyslexia ensured that it stayed a mystery. I found the best place to put my scales was in the loft until the babies’ first birthday. And if you plan to breastfeed for longer, chuck the scales out and buy some new ones when you are ready.
If, however, you are wedded to weight-gain issues, American charts suggest the following:
Use these figures only if they help you feel more comfortable about your weight gain.
Why tons of fruit and veg are a good idea
Recent research6 also suggests that eating plenty of fruit and veg before and during pregnancy may protect against pre-eclampsia. This condition, which is a little more common in twin pregnancies and often appears in the final stages of pregnancy, is characterized by high blood pressure and swelling (my midwife always used to tell me ‘if you can’t get your wedding band off, call me’). Pre-eclampsia is a treatable but serious concern for pregnant mothers, and can sometimes necessitate an early delivery. It has to be monitored because, left untreated, it can eventually affect the function of liver and kidneys. Routine urine tests during pregnancy check for a type of protein which indicates pre-eclampsia.
New research shows that an underlying factor in pre-eclampsia is damage to blood vessels caused by destructive molecules called free radicals. In theory, upping the intake of nutrients that combat free-radical damage – such as vitamin C, found naturally in fruit and veg – may help to reduce the risk of pre-eclampsia. Another reason to gorge yourself at the greengrocers.
Why fish is also good
There is no dispute that well-fed women seem to make healthier babies with higher birth weights. What is news is recent research from Danish scientists reported in the British Medical Journal which suggests that women who eat a diet rich in fish are nearly four times less likely to give birth prematurely. Among 8,700 pregnant women surveyed, 7.1 per cent who never ate fish had a premature delivery, yet only 1.9 per cent of fish-eaters did. This is quite a significant finding for twin mothers, whose babies are usually assumed to be premature. So get baking that fish pie.
What can’t I eat?
Raw fish, such as sushi, is to be avoided. It increases your risk of exposure to salmonella, parasites and hepatitis A infection that can damage your liver. Similarly, you should avoid uncooked eggs and unpasteurized cheeses. Finally, peanuts (which aren’t actually nuts but beans) are still a controversial food item, because some experts believe that including them in your diet sensitizes the baby to peanut allergy. There is no definitive study to show this, but it’s best to avoid them and err on the side of caution.
If you do eat or have already eaten any of the above by mistake, as I have during both my pregnancies, do not panic. Remember that you come from a long line of genetically-fit ancestors, and your pregnant forebears probably feasted happily on Stilton crawling with maggots and boiled boar’s head.
What the experts say
Suzannah Olivier, author of Eating for a Perfect Pregnancy (Simon & Schuster Pocket Books) has the following advice to offer twin mothers:
‘The important thing in any pregnancy, particularly a twin pregnancy, is to eat ‘nutrient dense’ food. Everything provides nutrients, bar sugar, which is empty calories and gives energy without providing nutrients.
‘The other thing is to have more calories than normal. You are going to put on extra weight because of that extra placenta and amniotic fluid. For nutrient-dense food, think of half an avocado rather than extra butter on your bread.
‘Remember, you need these nutrients for yourself as well as the baby in the post-natal stage. To get through those first six months, you need to build up your reserves. You are going to lose a lot of iron, zinc and essential fats in the last trimester and from the birth and the early months of breastfeeding.
‘Food-wise, nuts – tree nuts such as almonds and walnuts – seeds, pulses and oily fish are all good. Zinc is found in any protein-rich food, like red meat.
‘In the third trimester, zinc and essential fats are particularly important for growth. If there’s not enough in the diet the baby will take it from the mother’s reserves (a lot of postnatal depression may be linked in part to the mother’s depletion of zinc and essential fatty acids). Good nutrients also help your own energy levels and stabilize your moods after birth. Often eczema in the mother while breastfeeding is triggered by not having enough essential fats. If you take linseed flax oil, it works very quickly to improve your condition.
‘Two other key nutrients are calcium-rich foods and antioxidant-rich foods, found in fruit and veg. We tend to take a sledgehammer approach to calcium and just drink milk (yoghurt is also good because it is predigested by bacteria), but there are swathes of people who are lactose intolerant. Many people don’t realize that there is plenty of calcium and magnesium in green, leafy veg such as spinach, cabbage, pumpkin seeds, pine nuts and sunflower seeds. Raisins and dried apricots are also unexpected sources of calcium, magnesium, potassium and iron – all needed for bone health.
‘Finally, I would strongly advise every mother pregnant with multiples to take a specially formulated prenatal supplement all through the pregnancy. You can buy them at any chemist, and it’s never too late to start.’
Here is what four triplet (heroine) mothers ate during pregnancy to produce three healthy babies.
‘I ate a lot of toast and Vegemite (my favourite), apples and cheese and lots of red meat (which I found pretty horrible!).’
Susi Gorbey, mother of Abigail, Lucille and Manon, went to 38 weeks with her triplets (‘Don’t let the doctors bully you into delivering early’)
‘I’m a vegetarian, and ate organic food as much as possible during my pregnancy. I ate plenty of fresh foods, but nausea restricted me a lot. I wanted to eat “comfort food”—pies, quiches, potatos, savoury carbohydrates. I avoided caffeine, alcohol, aspartame/phenylalanine as found in fizzy drinks.’
Tracy Alter, mother of Jake, Luke and Daniel
‘I didn’t change much of my diet during pregnancy as we eat a fairly healthy diet in any event. The only change was not drinking alcohol at all and starting every morning with a good breakfast that included flax seed – which I swear kept me extremely well throughout my pregnancy. I didn’t really have a favourite food and didn’t have any cravings.’
Marion Davies, mother of Thomas, Helen and Emma
‘I was either sick or nauseous throughout my entire pregnancy, so ate a lot of whatever didn’t come back up. I steered clear of complex carbohydrates. What I liked best was ice cubes!’
Alex Salmon, mother of Freddy, Lulu and Alexander
Exercise for the permanently tired