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Preventing Premature Multiple Birth

Reprinted with permission from Twin Services,
Parenting Education Handout # 110

Premature or pre-term birth is the biggest reason for the high casualty and death rate among twins. Babies born too early - before the normal 37 to 40 week' gestation - tend to have low birth weights. Often, their vital organs are not sufficiently developed to support life outside the womb. Over 30 percent of twin deliveries occur between 20 to 37 weeks gestation, whereas less than eight percent of single births in this country are premature.

While we are not sure what causes pre-term birth, current research has linked it to such factors as poor nutrition, heavy work, anxiety, cigarettes, alcohol and drugs. Women with medical histories of previous abortion or miscarriage, DDS exposure, uterine anomalies, kidney disease, or with current pregnancy conditions such as hypertension, hemorrhage, surgery, fever or multiple gestation are also at risk. And very young mothers (under 16) and those over 40 are at grater risk for pre-term birth.

If an expectant mother has any of the above risk factors, she may re quire some specialized prenatal care and will need more than the average amount of rest. Her doctor may order bed rest, either at home or in the hospital, for the last weeks or months of her pregnancy. Listed below are the signs and symptoms of pre-term labor. If you are pregnant, especially if you know or suspect it's a twin pregnancy, and you have one or more of these signs, talk to your physician immediately. Be aware of changes in your condition, and the development in your condition, and the development additional symptoms. If you are having contractions, even completely painless ones, time them to see if they occur at regular intervals. Remember, pre-term labor contractions are usually painless and therefore difficult to detect.


If you have any of the following signs, sit or lie down and place your hand on your lower abdomen to feel for hardening of the muscles over your uterus. Then call your doctor.

 * Dull low back ache

 * Pelvic pressure

 * Abdominal cramping with or without diarrhea

 * Increase or change in vaginal discharge

 * Possible contractions

 * "Feeling bad"


If you have any of the following danger signs, go to your hospital emergency or admitting room immediately.

* Water leaking or gushing from the vagina.

* Bleeding from the vagina.

* Contractions that some every ten minutes of less for one hour.


Several specialists in high-risk pregnancy and pre-term labor prevention have developed methods which they have found fairly effective for bringing plural pregnancies to full term. Here are some of them:

*To pick up early warning signals of pre-term labor, some obstetricians train pregnant women to monitor their uterine activity on a daily basis and keep track of increased contractions. Dr. Michael Kate, Director of a pre-term birth prevention project at Children's Hospital in San Francisco, has developed an external monitoring device which records uterine contractions in women at risk for pre-term labor. To use this device a woman wears the belt-like monitor around her abdomen and calls in daily to the nearest monitoring center for a read-out of her uterine activity, which is transmitted by telephone to her doctor's office. The use of a monitor is especially helpful in multiple pregnancies because with muscles stretched so tautly, a woman expecting multiples cannot feel contractions as easily as mothers carrying only one baby. Recommendations about rest, activity, diet and medications can be made on the basis of the daily monitor information.

* Another approach to prematurity prevention is used by Dr. Emile Papiernik, a French pediatrician who operates a clinic for multiple pregnancies. His program is based on reduction of the patient's physical activity and avoidance of activities which, for her, seem to trigger uterine activity. Important components of this program, which includes education and regular exams, are early maternity leave from work, reduced physical exertion and, sometimes, the prescription of bed rest. Papiernik reports that his multi-faceted approach has been quite successful in extending gestation time in multiple pregnancies and improving the rate of healthy multiple birth babies.

* Elizabeth Noble, physical therapist, child birth educator and author of Having Twins, recommends a high protein diet developed by Gail Brewer and Dr. Thomas Brewer, in combination with frequent rest.

* The Prematurity Prevention Project at Habor/UCLA medical Center is Los Angeles suggests these preventive measures:

 1. Drink 8 to 10 glasses of water per day to prevent urinary tract infraction and dehydration.

 2. Avoid heavy work, long commutes, or moving place of residence during pregnancy.

 3. Get plenty of rent; do not become overly tired. Resting three times a day for one hour on your left side is thought to be beneficial.

 4. Do not let the stresses of life build up inside. Talk to a friend or counselor. Take a stress reduction class.

While researchers agree on the importance of frequent, thorough exams (including blood pressure and urine tests), reduced physical activity and a high-quality diet, their general consensus seems to be that bed rest is not always necessary to prevent pre-term births of twins. Certainly, however, any woman expecting multiples who has had previous miscarriages or is having vaginal discharge, bleeding or frequent contractions is a candidate for bed rest.


The term "pre-term labor" is misleading. "Labor" implies pain and pre-term labor symptoms are more subtle than that. Pre-term labor is often difficult to recognize, both for parents and for obstetricians. It's especially difficult to detect in twin pregnancy, because all the normal symptoms of pregnancy - fatigue, nausea, headache, change in vaginal discharge - are increased. And, many of these symptoms can also be signs of early labor. Women in their first pregnancy have no experience to tell them that anything out of the ordinary is happening. And, surprisingly, even women who have given birth before and are familiar with labor and delivery are often not able to recognize pre-term labor, since it doesn't feel like regular, full term labor.

 Women who express concern about early contractions are someimes told by well-meaning friends and health care professionals, "Don't worry, it's just Braxton-Hicks" (false labor). This is not helpful advice for anyone at risk for pre-term labor. The only difference between so-called Braxton-Hicks contractions and pre-term labor is that the former come at irregular intervals and eventually go away, and the latter is more regular and results in premature birth. By the time you can tell which is which, it could be too late. Treatment of pre-term labor with medications and rest is most effective when it is begun before the labor becomes very advances, so it's important to recognize it early, before cervical changes occur. Waiting for the symptoms to go away and delaying the call for help could result in premature birth. A woman who knows she's carrying twins has the advantage of realizing that she faces the possibility of pre-term labor and can be on the alert for early warning signs listed above.

Sometimes, however, women pregnant with twins don't want to acknowledge that their pregnancies, like all multiple pregnancies, are routinely classified as "high risk." They may already be worried because their doctors are gibing their pregnancy much more attention than they had expected. Because of their desire to "carry on as usual," they may be reluctant to acknowledge additional, seemingly minor symptoms that may indicate problems. It's a good idea to discuss pre-term labor in depth with your obstetrician. Ask your doctor what you can expect at normal uterine activity for twins or triplets compared with that for a single baby. Learn what you can do to become aware of and keep track of your uterine activity. And, most importantly, report to your doctor whenever you experience any of the symptoms described above.

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The information in this article is not a substitute for professional medical or psychological advice. Please consult with your health care advisor about specific questions or problems.

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