Double Happiness Multiplied

One the final episode of Season One of Double Happiness Multiplied we discuss the different avenues people take to address their grief when things don’t go the way they hoped during their multiple pregnancies.

Alexa Bigwarfe tells us how she turned to advocacy to help her heal following the passing of one of her twin daughters, just two days after her birth.

Scott Beedie gives us a dad’s perspective of the emotional struggle and turmoil he experienced when he was told one of his twin’s hearts had stopped beating t just 21-weeks’ gestation.

And, Psychologist Dr Gretta Little shares some advice on recognising when it’s time you need to get some professional help to deal with your emotions.

Joy and Sorrow

We’ve spoken about the joys and the sorrows of multiple pregnancies throughout Season One of this podcast, and it’s clear each and every person who’s been touched by multiples find their own way to face their realities, whether it’s coming to terms with carrying more than one, two, or three babies or finding out that you won’t be taking one or both of your twins’ home.

Alexa’s Story

After Alexa Bigwarfe’s twin girls were born, she was certain the medical system would fix her daughter who was extremely affected by twin-to-twin transfusion syndrome, sadly Kathryn passed away just two days after she was born. Her twin sister Charis had a long journey in the NICU, which saw Alexa turn to advocacy to come to terms with the loss.

“In a nutshell, I started blogging both about my grief and about twin-to-twin transfusion syndrome,”

“I started interviewing other parents and talking with them about their stories, and what I found was that so many situations were so similar to mine,”

“Their doctors were either nonchalant about it, never mentioned it, didn’t give them all the information,’’ says Alexa.

Do your Research

During her research, Alexa found that there are a significant number of babies born prematurely between 26-and-30 weeks because of twin-to-twin-transfusion syndrome, which means they’re impacted by all the issue that comes with being pre-term.

“I wanted to really make some noise about it,”

“In the year that I was looking at the research, I found out that more babies died annually from twin-to-twin transfusion syndrome than SIDS,”

“We couldn’t change our story but potentially if someone else got the information in time then they could change theirs,” Alexa says.

The Advocate

It wasn’t long before Alexa found herself acting as an advocate for mothers. She says with doctors being so busy, mums and dads carting multiples have to be their own advocates and their own source of information,” she says.

Alexa admits she never like being the negative person but now if she comes across someone who is pregnant with identical twins, whether she knows them or not, she gives them information about TTTS.

“I say to them, I don’t want to scare you but I’d rather you be scared than go through a situation like I did,”

“I tell them about TTTS, and I tell them where the best resources for information are and I tell them where to find the questions to ask their doctor,

“And I say if your doctor is unwilling, or can’t find answers to these questions, I beg you to go and find another doctor immediately,” insists Alexa.

Purpose

Alexa admits she’s not deterred by the anger from other people when she’s sharing information. She says she feels it’s her purpose to inform people and try and save others from the same heartache she experienced.

“I’d much rather someone be terrified right now and be educated, and aware, and not ignorant,”

“Unfortunately, in our situation by the time they were diagnosed they were so far along that it makes it more difficult to do things to help them,” says Alexa.

Scott’s Story

Scott Beedie was also forced to face a situation he never imagined.

Welcome to Season One, Episode 11 of Double Happiness Multiplied, I’m Sally Barker.

Coming up on this episode, we talk about breast and bottle feeding.

Lactation Consultant Judy Adams, who is also a twin mum, gives us advice about breastfeeding multiples and also shares her story of the pressure she felt to exclusively breastfeed her boys.

Twin mum Rebecca Perrie and mum of Quadruplets Jannelle Snaddon also join us to talk about supplementing with formula to get some rest.

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Lactation Consultant Judy Adams from King Edward Memorial Hospital in Western Australia tells us, the business of breastfeeding multiples isn’t easy and many women feel enormous pressure to exclusively breastfeed their babies, which is often an incredible emotional upheaval especially if the babies are born preterm.

When you have three babies, breastfeeding is another story. Judy explains that in this situation, some mums often choose to twin feed and then give expressed breast milk to the third baby, while other mums choose to do replacement feeds with expressed breast milk.

Is it important to introduce the bottle as well as the breast?

Judy says she tries to be very open-minded about it, and part of being a preterm baby means that you have to have bottles, you can’t go home unless you can suck all of your feeds. However, creating an individualised plan with the mum as to what the maximum amount of breastfeeding she can do is the best strategy.

If the babies are still in the Neonatal Intensive Care Unit at 37-weeks’ gestation, Judy says specialised teats are used to help make the baby suck.

Supplementing with formula

The baby has to be able to grow, that’s the bottom line. So, if mum hasn’t got enough breast milk then you don’t have any option and formula is a necessity. And, if the baby isn’t thriving then you’re running into all sorts of other problem, explains Judy. 

“As hard as it is, I know very well myself, I burst into tears when I first bought formula, and I ended up throwing it out anyway,”

“But it’s very emotional, you’re in the supermarket and you reach for it, and then you put it back, and then you reach for it again, and I thought I better have some just in case,” says Judy.

Some mums don’t have a choice. Whether for health reasons or some other complication, some mums can’t provide milk for their baby, and they shouldn’t feel guilty that they’re giving their babies formula.

We’ve spoken about nutrition during your pregnancy on Episode Three of this season, but Judy tells us it’s just as important to monitor your diet while you’re breastfeeding.

Water is incredibly important when you’re breastfeeding and the best guide is to drink to your thirst, however, if you’re not someone who gets thirsty you should aim for about two-litres of water per day.

Foods to avoid

There are all sorts of myths about fried onions and broccoli and all sorts of things but Judy says you should eat a normal diet, in moderation.

So,  if you love chocolate, Judy says it’s okay to have a bit but just don’t eat the entire bar in one sitting.

The rule of thumb is to stick to your normal triangle of fruit, veg, and cereals.

And remember, if it upsets you it’ll probably upset the babies.

Rebecca’s Story

Rebecca Perrie says having gestational diabetes during her twin pregnancy meant her girls needed some nutritional support after they were born. She admits that after breastfeeding her daughter two years earlier, attempting to breastfeed two babies at once was a whole different story.

“They were tube fed on the first day even because their sugars dropped a little bit. So, we always had formula there as part of their lives from the very beginning,”

“I breastfed with my first child until she was four-months but she lost quite a bit of weight and I hadn’t noticed, so we also introduced formula to my eldest one...

 

On this episode, we discuss taking care of your children while you have babies in the Neonatal Intensive Care Unit (NICU).

Psychologist Dr Monique Robinson has some tips to help normalise the situation as much as possible.

Joanne Beedie shares her heartbreaking story of grieving for her baby boy who died inutero while watching her surviving twin fight for his life in the NICU.

And, Senior Social Worker Clare Dimer explains the pressures facing families in this situation.

 

Psychologist Dr Monique Robinson tells us that when you’re going through your NICU journey you will need support, however, asking for help doesn’t come easily to some people and it’s okay to feel overwhelmed and not completely in control.

The Reality of NICU

Even if you knew leading up to the birth your babies were going to come early, there can often be a sense of this isn’t what I was expecting. This is not what I signed up for, this is not what I imagined having twins would be.

 

 

Dr Robinson says it’s normal to feel overwhelmed and to accept that this is your reality for a while. And, that it’s going to be really tough, really tough.

“But, if you’re finding that suddenly getting out of bed in the morning isn’t coming that easy to you, that’s when you need to ask for support,”

Joanne’s Story

You might remember on Episode Nine, we heard from Joanne Beedie who gave birth to her twins at 27-weeks’ gestation, sadly one of her boys had passed away inutero at 21-weeks’ gestation due to twin-to-twin transfusion syndrome.

She says coming to terms with the loss of her baby, having another baby in the NICU fighting for his life, and a toddler at home was a lot to cope with and the guilt was crippling.

“I think if it wasn’t for the fact that my husband’s and my parents flew in from Scotland to help us, I’m really not sure how we would have done it,” says Joanne.

Joanne says for her son Archie, he knew mummy had a baby in her tummy and then suddenly mummy went to the hospital and didn’t come back, and then there was no baby, but mummy’s tummy had gone.

“I remember the feelings of guilt, Archie he was only two-and-a-quarter when Lewis was born so he hadn’t even fully comprehended that he was going to have brothers,”

“I would try and spend between 8-and-3 in the hospital with Lewis and then I would try and get home and have time with Archie and have his dinner with him, get him to bed, and go back to the hospital for evening cares,” recalls Joanne.

Juggling

Like most parents who have babies in the NICU and other children to care for at home, Joanne says you can’t be in two places at once, but that’s exactly what you want to be able to do.

 

“The pressure of trying to juggle the two of them, it was just guilt,” says Joanne.

 

Archie had his own NICU journey. And, Joanne says she’s sure he’ll have his own memories of it.

“The best memories, I have from the NICU was the day Lewis came home and Archie got to meet him, of all places in the waiting area,”

 

 

Pressure

Senior NICU Social Worker at King Edward Memorial Hospital Clare Dimer says there are many social implications that come with having babies in the NICU and other siblings to care for at home. She says the biggest pressure is children under five.

“It’s a huge stress for families when they have other children at home, and they’re trying to navigate and negotiate with lots of different people and lots of different caregivers,”

“That’s a real struggle for families with multiples in the nursery, particularly around non-school aged children,” explains Clare.

Clare says 90 percent of parents’ stress levels when they have babies in the NICU and other children at home is worrying about who is taking care of their children.

“The children at home can regress in behaviours,

ANGEL BABIES

From joy to heartbreak.

On episode Nine, of Double Happiness Multiplied, we honour the families who sadly didn’t get to take one or more of their babies’ home.

Alexa Bigwarfe shares her story of grief following the loss of one of her twins, due to twin-to-twin transfusion syndrome.

Psychologist Dr Monique Robinson talks about the importance of grieving and reaching out and speaking to others who have experienced the loss of a multiple.

And, Joanne Beedie tells us of her devastation at being told the heart of one of her twins had stopped at just 21-weeks’ gestation.

They’re known as Angel Babies. They’re the precious souls who didn’t make it into the world alive, or they were only here long enough to exhale a few short breaths of love before passing away.

The sad reality of multiple births is that compared with singletons, babies from multiple pregnancies have a substantially higher rate of perinatal death. This higher rate of loss is largely due to preterm birth.

It’s not uncommon for one or two babies from a multiple pregnancy to die Inutero and the more embryos you have the more likely you are to have a loss.

The emotional pain and the strain on the family unit after losing one or more babies from a multiple pregnancy is undeniably excruciating.

Alexa Bigwarfe was has lived this very reality. She was diagnosed with twin-to-twin-transfusion syndrome when she was 20-weeks’ pregnant with her identical twin girls. By the time the condition was detected, the disease had progressed to stage 3, which made treatment options less effective.

“There was emotion overload just all the time, and I wanted to be happy and I wanted to have faith and believe, and I still believed when they were both born and they were both alive, I still believed the medical system was going to fix her, that it was still going to be okay,”

“So, when they told us it was time to turn off the machines, I didn’t believe it,” says Alexa

Alexa explains how difficult it was to try and grieve one child while she had another one who was still trying to survive. She says the hardest part was trying to bond with her surviving twin.

“It was really difficult to bond with her for multiple reasons, I didn’t even get to hold her until she was about a week old, and then I was scared of bonding with her because I wasn’t sure that she was going to live either,” admits Alexa.

Empty arms

Alexa explains that she understood the pain that comes with the loss of a baby but she just couldn’t understand the whole empty arms concept because her arms weren’t empty.

“So, then I would feel guilt that I felt so sad because at least I had one,”

“And I had multiple people tell me at least one came home,”

“Just don’t say that, don’t say that to somebody who’s lost one of their twins,” she says.

Coming up to the anniversary of the birth of her twins, and then the passing two days later of one of the babies, Alexa had time to reflect on what is and what could have been.

“To be honest with you, if she had survived in the state that she was in, our lives would have been really difficult,”

“So, in some ways, I can look at it as a blessing that she was released from this world because when we talked to the cardio specialists they told us that at a minimum she would have to go through three, potentially four open heart surgeries through her life,”

“We didn’t know what level of brain damage she had suffered due to the fluid on her brain, her lungs were all kinds of underdeveloped because of all the fluid that had grown in her abdomen, just all kinds of things,” explains Alexa.

Grieving

Grieving is a natural process following a loss, however, Alexa admits that with two small children who needed her, and a baby still fighting for her life in hospital, there simply wasn’t time.

“I never had that opportunity to spend two-or-three days i...

On this episode of Double Happiness Multiplied, we talk with Consultant Neonatologist Doctor Patricia Woods from King Edward Memorial Hospital in Western Australia about what to expect when you have babies in the Neonatal Intensive Care Unit (NICU).

Mum of quadruplets Jannelle Snaddon walks us through her NICU journey.

Psychologist Doctor Monique Robinson offers practical advice about taking care of your emotional wellbeing when you have babies in NICU.

I’ll share my NICU story with you and I’ll read a moving letter from a micro-premmie mum written to other parents of premature babies.

What does pre-term mean?

A Preterm or Premmie baby is defined as being born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, however, based on gestational age:

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Extremely preterm, or micro premmies, are born at less than 28-weeks’ gestation,

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Very preterm are those babies born between 28 and 32-weeks’ gestation,

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And, moderate to late preterm, which are babies born after 32 weeks and before 37-weeks’ gestation.

Why does preterm birth happen?

There are many reasons preterm births occur, the most common causes include multiple pregnancies, infections, and chronic conditions such as diabetes and high blood pressure. However, oftentimes no cause is identified but may be due to genetic influences.

Pre-term birth facts

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Worldwide, an estimated 15 million babies are born too early every year. That’s more than one in every 10 babies. Sadly, of these babies, approximately 1 million will die each year due to complications of their preterm birth.

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Prematurity is the leading cause of death in children under the age of 5 years, globally.

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In almost all countries with reliable data, preterm birth rates are increasing, with stark inequalities in survival rates around the world.

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In low-income settings, half of all babies born at or below 32 weeks die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties.

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In contrast, babies born at or below 32-weeks in high-income countries will almost always survive.

Where and when does preterm birth happen?

Preterm birth is a global problem despite more than 60 per cent of preterm births occurring in Africa and South Asia. In lower-income countries, on average, 12 per cent of babies are born too early compared with 9 per cent in higher-income countries.

There is also a dramatic difference in survival rates of premature babies depending on where they’re born. For example, more than 90 per cent of extremely preterm babies born in low-income countries die within the first few days of life; yet less than 10 per cent of extremely preterm babies die in high-income settings.

These statistics are interesting and for some will offer reassurance and a glimmer of hope during this time of immense emotional turmoil, however, as Consultant Neonatologist Doctor Patricia Woods explains, it can be quite confronting.

The Neonatal Intensive Care Unit (NICU)

“I think the Neonatal Intensive Care Unit is a terrifying place for families. It’s extremely confronting to walk into, it’s very alien, parents have rarely experienced anything like this before, and we really recognise that struggle that some families might be coping with,”

“Having babies born preterm can be an absolute crisis for many families, something they hadn’t expected or anticipated and sometimes we are meeting them on what could possibly be the worst day of their lives,” says Dr Woods.

Dr Woods explains that in an intensive care environment babies are cared for in their own unique spot, where they have their own incubator and all the support they could possibl...

On episode seven of Double Happiness Multiplied we explore birthing options for multiples.

We’ll be talking to Maternal Fetal Medicine Specialist Associate Professor Craig Pennell about the types of twins that will require a caesarean delivery and those that can be safely delivered vaginally.

Founder of Rockstar Birth Magazine and Rockstar Birth Radio, Shalome Stone explains why a birthing plan is important.

Hypnobirthing Practitioner and Birthing Doula Elysee Jamieson shares her experience of birthing breech fraternal twins.

And, I’ll tell you why my girls were delivered by Caesarean section.

By the end of this episode, you’ll be armed with all the information you’ll need to make educated decisions about the birth of your babies.

Talking About Birth

Birth. The topic can get as heated as bringing up politics, religion, or vaccinations at a dinner party. There are many people who have incredibly strong opinions on the matter, oftentimes formed on the basis of misguided information.

You’ve probably heard people say things along the lines of, ‘women have been giving birth to babies in the open fields for centuries and they always did fine’, well they often didn’t and the mortality rate was exceptionally high.

However, pregnancy and birth have become incredibly medicalised and it’s often difficult to find a middle ground as such.

So, whether you’re someone who holds dear to your plans of a drug-free vaginal delivery or you surrender yourself to an attitude of going-with-flow, it’s important to be educated on the possibility that your ideal birth plans might need to be altered.

Let’s face it, many multiples wouldn’t cope with the journey down the birth canal and without medical intervention those precious babies wouldn’t survive.

On the other hand, if you have an uncomplicated multiple pregnancy, and under the guidance of a team with experience in multiple births, Associate Professor Craig Pennell assures us that in most cases you can achieve a vaginal delivery.

As Associate Professor Pennell explains there are many things that need to be considered in planning the most appropriate form of delivery for a twin pregnancy.

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Type of twins;

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Monochorionic Monoamniotic twins will always be delivered by caesarean section,

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Monochorionic Diamniotic twins have a high rate of caesarean birth due to common complications,

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Dichorionic-Diamniotic – more likely to achieve vaginal births.

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Parity of the mother – delivery of twins is technically more difficult for a first-time mum than a woman who has had one or more vaginal births.

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Complications in the pregnancy.

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Gestation – delivering a set of twins at 24-weeks is very different to delivering twins at 37-weeks.

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Location – smaller hospitals might not be equipped to cater for the vaginal delivery of twins.

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And, the experience of your obstetrician.

“To put all this in perspective, if you are in the public hospital system in Australia or the United Kingdom, and you have an uncomplicated set of Dichorionic Diamniotic twins and the first baby is coming head first then it would be the normal approach to consider a vaginal delivery,”

“Similarly, in Australia and The United Kingdom if there was severe growth discordance, where the first twin was small and the second twin was large and the mother was unwell, in that situation it’s much more likely that you would have a caesarean delivery,” says Associate Professor Pennell.

When Do You Discuss Birthing Options?

Associate Professor Pennell goes on to say that the discussion about the type of birth you’d like should happen early on in the pregnancy, such that your obstetrician can present you the risks and benefits of each option.

Your Couple Bond & Your Multiple Pregnancy

How to recognise when your relationship is in trouble

On this episode, we discuss your couple relationship and why it’s important to nurture it before, during, and after your multiple pregnancy.

We hear from Psychologist Dr Gretta Little, who offers some practical tips to help keep you on track, and warning signs to look out for that might indicate you need to get some outside help.

Rebecca Perrie and Jannelle Snaddon share their stories of the ups-and-downs they had in their relationships while carrying their multiples, and after they were born.

And, I talk about the pressure the complications in my twin pregnancy put on my couple relationship.

Pressure

It’s no secret that carrying more than one baby at a time puts enormous pressure on your couple relationship. And with multiples, there’s the increased risk of complications along with being concerned about how your family unit is going to operate when you take home more than one baby.

Psychologist Gretta Little says it’s important to share your feelings about what’s happening and use your pregnancy to reflect on how you’d like things to be when you take the babies home.

“If you can talk about how you want to be parents of multiples, how you were parented yourself, what you want to do the same, what you want to do differently, and how the two of you might have common ground in that and how you might support each other in going about that,”

Dealing with complications

When complications arise in your pregnancy, it’s important to be realistic about what’s achievable for your relationship and not having high expectations of your partner and what they’re going to be able to bring to the relationship.

“It’s good to think about how you’re going to handle conflict together and how you’re going to be able to talk things through about that,”

“But, realistically there may be times where that’s not always possible and that might just have to wait until the babies are a little bit older or more-well,”

“I don’t think anyone ever really expects to have more than one baby, so it can be a bit of a shock,” says Dr Little.

Dr Little suggests joining the Multiple Births Association where you get to meet other people who are parents with multiples, which can help normalise the experience and help you realise that people have done this before and that it is achievable.

Warning signs your relationship is in trouble

When you’ve been through months of the emotional upheaval of coming to terms with being the parent of multiples, you might have fallen into the trap of neglecting not only yourself but your partner. If issues aren’t addressed, your relationship could be headed for crisis point. Dr Little says there are some clear signs to look out for before you get to this point.

“Warning signs would be increased conflict in the relationship or not talking to each other,”

“And, if you’re having frequent feelings of anger or disappointment about your partner, that would be an indication that it would be good to get some help,” says Dr Little.

Rebecca’s Story

Rebecca Perrie admits it took her a while to come to terms with being told she was having twins and that put a strain on her relationship with her husband.

“It didn’t have an effect on the relationship at the beginning, I think it was more on myself. I really struggled to come to terms with it, I had a plan in place of what my life was going to be like,”

“My first one was heading towards two, and in my mind, she could play or be sitting at a table and I could be happily holding the other baby,”

“And when they told me I was having two, my whole plans for the future were not going the way I had envisaged,”

“That’s where the toll on our relationship maybe came along as it went through the pregnancy, just me coming to terms with the fact I was having twins,...

On Episode Five, we discuss the seven most common complications that can arise in a multiple pregnancy.

Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell explains certain conditions to be aware of, what to look out for, and what do when you receive a diagnosis you’re not expecting.

Author Alexa Bigwarfe talks about twin-to-twin transfusion syndrome, and I share my story of intrauterine growth restriction.

By the end of this episode, you’ll have an in-depth understanding of the many possibilities that could affect your pregnancy, but hopefully, you’ll be reassured that if you’re in the right hands those obstacles can be surmounted and you’ll be able to enjoy your pregnancy.

The risks of having a multiple pregnancy

Once you’ve been diagnosed with a multiple pregnancy, there is so much to learn that falls outside what you might already know about pregnancy. When you’re carrying twins, triplets, or quadruplet babies the risk for complications rises and depending on what type of multiples you have on board will determine the level of that risk, and what treatment options are available to you.

Maternal-Fetal Medicine Specialist Professor Craig Pennell says even though there are increased risks involved with multiple pregnancies that doesn’t mean you can’t enjoy your pregnancy.

“The things that can go wrong in multiple pregnancies are divided into those that can happen to all multiples and those that are specific to particular multiples,”

“For example, Monochorionic Monoamniotic twins, also known as MoMos, account for just one-percent of identical twins and they’re the type of twins where cord entanglement can cause problems, which is associated with a loss rate in the pregnancy of up to 50 percent,”

“In all the other types of twins where there is a membrane between them so those conditions can’t occur,” explains Associate Professor Pennell.

If we look at twins, in general, some of the things that can occur are:

Hyperemesis

Severe nausea and vomiting are very common in a multiple pregnancy, according to Associate Professor Pennell.

Associate Professor Pennell reassures us that the condition usually goes away at the end of the first trimester, so around 13-or-14 weeks, however, in about 10 percent of women it continues throughout the pregnancy.

Miscarriage

According to Associate Professor Pennell, the other thing that is more common in the first trimester of a multiple pregnancy is a miscarriage. He says the rate of miscarriage in twins is at least double, if not higher, than the rate in singletons. And, it’s often not noticed or simply missed depending on when you have your first ultrasound.

“If you’re having scans from five-weeks, you may see what starts as a twin pregnancy that then ends as a singleton somewhere between six-and-12 weeks, whereas if your first scan is at nine-weeks, you may not realise that it started as a twin,”

Not surprisingly, the rate of miscarriage in Higher Order Multiples is again higher. This is somewhere in the order of 30-50 percent where you would lose at least one of the embryos in the first trimester, according to Associate Professor Pennell.

Structural Anomalies

All babies have the chance of having a structural problem (about five-percent), which includes such things as a clubbed foot, an extra finger, cleft-lip-and-palette, a hole in the heart, or an issue with the kidneys.

“With Dichorionic twins, the rate is double that of a singleton,”

“With Monochorionic twins, the rate is even higher than that because Monochorionic twins in itself is an anomaly,” says Associate Professor Pennell.

He goes on to explain that if you have an early blastocyst splitting into two embryos there’s an increased risk of issues in structural development.  The more severe anomalies can be picked up at the 11-13-week scan, however,

Gestational Diabetes

Surprising facts about a common pregnancy complication.

On episode four, of Double Happiness Multiplied, we discuss Gestational Diabetes (GDM) and why it’s important for women carrying more than one baby to understand how it might impact their pregnancy.

The good news is, with the right exercise and nutrition program you can avoid any adverse effects of the condition. More importantly, for 95 percent of women diagnosed with GDM the condition resolves once the babies are born.

It’s a fact of life that pregnancy causes a diabetic state in every woman. About 90 percent of pregnant women can cope with it, while 10 percent can’t. It’s this latter group who get GDM.

What is Gestational Diabetes?

Diabetes Educator, Nurse Practitioner, and Midwife Marina Mickleson has spent more than twenty years explaining this to pregnant women. She says quite simply GDM is diabetes that is picked up for the first time in pregnancy.

“What this means is that the woman hasn’t had a prior diabetes diagnosis and the condition has been picked up during routine testing, which shows the woman has glucose intolerance in the pregnancy,” explains Marina.

What’s more, the percentage of women diagnosed with GDM varies depending on the population. On average, about 10 percent of the Caucasian population will get GDM, but if you add in the Indian, Asian, Indigenous, and African population, it can be up to 20 percent of the population who get GDM, according to Marina.

“These women are more at risk just because of mainly the food they’re eating,”

“Compared to what they’d be eating for three or four generations in their communities, it’s the Western diet their bodies aren’t able to cope with,” says Marina.

Unfortunately, as Marina explains women who are carrying multiples are also at a higher risk of developing GDM due to the larger placenta, and GDM has a lot to do with placental hormones. So, the more babies you’re carrying, the more placental hormones you’ll be producing, which increases the chances of developing GDM.

Testing

There are two ways to be tested for GDM:

* A fasting blood glucose test, usually done in the first 12-weeks of pregnancy for women considered at high-risk of developing GDM. If this fasting level is elevated, then you will get a positive diagnosis and further testing isn’t required.

* The two-hour glucose tolerance test – this is where after an initial blood test you drink 75 grams of glucose syrup, which is followed by two more blood tests to see how your body reacts to the glucose load. This test is ideally given at 26-to-28-weeks’ gestation, however, if there has been a GDM diagnosis in a previous pregnancy or there is a family history of Type 1 or Type 2 diabetes, the test will be done at around 20-22-weeks’ gestation.

Deb Howe is an identical twin and just gave birth to identical twins. She invited us along to her Glucose Tolerance Test at 26-weeks’ gestation. Deb was considered a high-risk because her twin sister has Type 1 diabetes.

After fasting for 10-hours, Deb had her first blood test and was given a 300ml bottle of liquid to drink, which contained the 75 grams of glucose syrup.

Everything was going well until about 20-minutes after Deb consumed the sweet liquid, she started to feel a bit lightheaded, the babies were kicking a lot, and she felt a tiny bit of nausea.

Deb admits she was worried that she had developed gestational diabetes because before falling pregnant she was following a low carb high-fat diet. When she started getting morning sickness, all she craved was carbohydrate foods and she gained a lot of weight in the first trimester.

Another two blood tests later and Deb was given to all clear to go home and wait a few days for the results.

The good news is, that apart from having low iron Deb appears to have passed the GTT,

On this episode, we tackle the problem of hyperemesis in multiple pregnancies and explain how to maximise your nutrition when you’re too ill to keep anything down, or there’s simply no room left for food.

Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell explains what happens to your body when you’re supplying nutrients to more than one baby at a time, and what supplements are required to ensure your vitamin and mineral needs are catered for.

Pregnancy Dietician and Nutritionist Jessica Ruescher offers some practical advice on the types and amounts of foods you’ll need to eat, to maintain adequate weight gain during your pregnancy.

Also, twin mum Elyse Jamieson and I talk about our experiences with hyperemesis, while mum of quadruplets Jannelle Snaddon shares her struggle with nutrition towards the end of her pregnancy when she was running out of room for food.

Vitamin supplements

As a woman carrying more than one baby, your energy and protein requirements are dramatically increased. This is because your resting energy expenditure is much greater than that of a woman carrying a singleton. What this means is that due to the increased maternal tissue you’re carrying you’ll burn more calories at rest.

And, this, of course, affects your vitamin and mineral levels, which have a significant impact on the growth and development of your babies.

Maternal-Fetal Medicine Specialist Professor Craig Pennell explains that vitamin supplementation is a lot more important in twins than in singletons, and it’s actually not for the baby it’s more for the mother. He says the babies will take what they need from the mother almost always, which leads to the mother losing calcium from her bones. She will also lose iron because she’s making an extra litre-and-a-half to two-litres of maternal blood, plus two placentas, plus two baby blood volumes, all of which uses up iron.

Associate Professor Pennell advises all women carrying multiples to take a good pregnancy multivitamin, more folate than normal, iron, and calcium in a preventable manner at the very beginning of their pregnancy.

“When the vast majority of women become iron deficient in pregnancy, and when we know it’s going to happen to all twins, the best thing to do is to start supplementing early,”

“That way if you get side effects from the iron, missing a few days here and there isn’t an issue when you’re looking at it over a seven-or-eight-month period,”

“Whereas if you’re trying to cram all of your iron in at 30-weeks to have it fixed before your delivery then it becomes a much bigger problem,” he says.

Hyperemesis

It’s no secret that vomiting and hyperemesis are much more common in multiple pregnancies because you have two, three, or even four times the pregnancy hormones.

Associate Professor Craig Pennell tells us that the first trimester is usually the most challenging and the best advice, if this is the case, is to keep down whatever you can and not be too worried about it, with water being the most important thing.

Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson was hospitalised with hyperemesis in her first trimester and struggled to eat anything substantial for the first 18 weeks of her twin pregnancy. She even had a short stay in the hospital to get some intravenous fluids in.

“The main thing for me was managing my life with the hyperemesis,”

“I was fairly well bedridden for a large chunk of my pregnancy,” admits Elyse.

Elyse says that simply keeping hydrated and trying to eat any food was a struggle and there was a period where she couldn’t even keep water down.

“I’m the kind of person who eats organic food and eats the rainbow of vegetables and things but I couldn’t stomach most things for weeks at a time,” says Elyse.

Despite being quite a small person Elyse didn’t lose any weight during the height of her hyperemesis.