Women who are pregnant with twins are at a higher risk than those who are carrying a single baby. This means they go for more frequent monitoring, measurements, and maternal fetal medicine appointments.
They'll keep a close eye on you and your babies to, hopefully, catch any issues before they become problematic, and they'll offer advice and guidance to, hopefully, prevent preterm delivery.
But, sometimes, you can only do so much, and you may face the reality that your twins may be born prematurely.
If your twins are born before 37 weeks' gestation, they're considered premature and are at a higher chance for adverse outcomes and long-term health problems.
What kind of health problems?
I'm a twin. I was born 10.5 weeks early and had to spend more than two months in the neonatal intensive care unit (NICU). I couldn't maintain my temperature, so I spent a long time in an incubator.
I also needed help breathing for a while, and I just recently found out that during my NICU stay, I had to be intubated and my lungs collapsed with each breath I took—a common problem when you're born too early and your body hasn't yet produced enough surfactant for your lungs to work properly. When this happens, the tiny air sacs fail to stay open, leading to Respiratory Distress Syndrome.
Other complications from being born that early can include things that have happened to other twins who I know, like: being unable to keep feeds down; sudden drops in blood oxygen level (desaturation) and / or sudden drops in heart rate (bradycardia), jaundice caused by bilirubin build-up from immature livers, which can lead to brain damage if left untreated; having a hole in their heart that can let extra blood flow to the lungs, cause shortness of breath, or slow weight gain and requires surgery to fix; or suffering a brain bleed (intraventricular hemorrhage) that cause a lifelong neurological disorder such as Cerebral Palsy.
These are just some of the complications that small but mighty preemies face.
The different stages of prematurity
When I was pregnant with our twins, we found out at 27 weeks along that they could be born any day. To us, as parents, that idea was terrifying because at that point, they each weighed barely one pound.
We knew that was too early and hoped it would be several weeks before we met our babies. Our medical team told us the goal was to make it to 32 weeks' along, but they sounded doubtful we'd make it that far.
There are different stages of prematurity, depending on when your babies are delivered:
Very preterm: Babies born between 26 and 32 weeks' gestation.
Moderately preterm: Babies born between 32 and 34 weeks' gestation.
Late preterm: Babies born between 34 and 36 weeks' gestation.
In my family, there are three sets of twins, all born prematurely. My twin brother and I were born very preterm (10.5 weeks early), my sister's twins (fraternal) were born moderately preterm (6.5 weeks early), and my own twins (identical) were born moderately preterm, 6.5 weeks early at 33 weeks and five days along.
Give it your best shot
If you're pregnant with twins, you're already at a higher risk for developing complications.
Things can be going well, but they can change very quickly. My twin pregnancy went well for 26.5 weeks, and then in a matter of days, things changed—subtly, but what felt subtle to me and barely worth mentioning to my maternal fetal medicine team was discovered to be a major medical issue that put us at a sudden risk of delivering anytime.
As soon as I walked out of that appointment with my maternal fetal medicine team, I walked across the hall to my OB-GYN, who'd already been updated, and I was immediately given steroid shots—a course of betamethasone to help with our twins' lung development in case they came as early as the doctors thought they might.
If your doctor tells you you're at risk for delivering prematurely, there are two things you can ask your doctor about doing before giving birth to give your babies' their best shot at avoiding adverse outcomes and reducing long-term health problems.
If your doctor tells you you're at risk for delivering prematurely, there are two things you can ask your doctor about doing before giving birth to give your babies' their best shot at avoiding adverse outcomes and reducing long-term health problems:
Steroid shots for lung development, and
Magnesium sulfate shot for neuroprotection.
Steroid shots to aid lung development
If you're between 24 and 34 weeks' pregnant with twins and find out you could be delivering soon (before 37 weeks'), ask your doctor or OB-GYN about steroid shots to help with your babies' lung development.
The course of steroids is given to the mother in two doses that have to be done 24 hours apart, so if it's an emergency situation, there may not be time to give steroids.
But if you're on a "wait-and-see-when-they-come" timeline, steroid shots, like betamethasone, can speed up fetal lung development and reduce respiratory distress, brain bleeds, intestinal issues, and infection risks for your babies.
Betamethasone is an antenatal corticosteroid that matures your babies' lungs by triggering surfactant production (surfactant lubricates your lungs), reducing Respiratory Distress Syndrome, improving breathing, and reducing the need for ventilators.
Magnesium sulfate to prevent brain injury
If you're at risk for very preterm delivery (before 32 weeks' along), ask your doctor or OB-GYN about getting a magnesium sulfate shot to provide neuroprotection for your babies.
Magnesium sulfate is a neuroprotective agent that can protect your babies' brains from injury and damage if they're born very preterm. It stabilizes blood vessels and reduces inflammation in the fetal brain, significantly reducing the risk of Cerebral Palsy, other neurological issues, and death
Improving outcomes for your premature twins
Depending on how far along you are, you may not need these interventions, but it's worth asking your doctor, OB-GYN, or maternal fetal medicine team about betamethasone and magnesium sulfate shots if you're at risk of delivering early (before 37 weeks along).
Every pregnancy is different, and every baby is different. You may need one or both of these treatments, or you may not need either. Ask about these treatments and listen to your doctor's advice.
In certain situations, these shots can be beneficial for your babies, if there's time for you to receive them before your babies are born. They target different complications, with steroids aiding in lung development and magnesium sulfate helping to prevent injury to the brain.
These shots can give your babies their best shot to finish developing essential organs, and they can improve survival rates and reduce long-term health problems for your sweet, little ones.
Did you deliver your twins prematurely? Were you offered steroid shots or magnesium sulfate to help your twins before they were born? Let us know in the Comments section below or connect with us on Instagram to share your thoughts!
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