Welcome to Season One, Episode Two of Double Happiness Multiplied.

On this episode, we’re joined by Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell who will give us some tips on what you should be asking during your appointments with your Specialist or Obstetrician.

Sonographer Sam Ward explains what to expect at your ultrasound appointments at each stage of your pregnancy.

And, Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson offers guidance about choosing the right support team for your pregnancy.

The shock

Finding out your expecting multiples can be quite a shock and can throw you into a world of confusion and anxiety. Knowing what questions to ask your obstetrician, midwife, or sonographer and when you should ask specific questions isn’t easy to navigate, especially for a first-time parent.

A few questions you’ll want to ask your obstetrician are:

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What type of placentation do my babies have?

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What tests and procedures will I have to have?

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What is your philosophy on delivering twins?

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How many multiples have you delivered in the past few years,

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And, how do I get in touch with you if needed?

To guide you further, Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell has this advice:

The first question you should ask your Obstetrician is what do I have to do in a twin pregnancy that is different from a singleton pregnancy?

There are many things that are different in a multiple pregnancy than in a singleton pregnancy, for example:

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You’ll be seen more frequently

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You’ll have more ultrasound scans

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The vitamin supplementation is a lot more important

Associate Professor Pennell says the second question you should ask is what type of placenta do my multiples have, which means are your twins identical or non-identical?

“The risk in Dichorionic Diamniotic or non-identical twins, outside of prematurity, are very similar to singleton pregnancies,”

“Whereas, if you have identical twins, depending on the type, those risks can go up from a few per cent up to 20 or 30 per cent of pregnancies having adverse outcomes.

“So, you really want to know if you are a low-risk twin pregnancy, a moderate-risk twin pregnancy, or very high-risk twin pregnancy,” says Associate Professor Pennell.

The care that you will get and your expectations will be very different depending what group you are in.

Time of delivery

With modern obstetric care and based on the most recent data, most twin pregnancies are delivered by the end of their 37th week.

“With Dichorionic Diamniotic twins, if the woman hasn’t gone into labour by 37-weeks, then they will be induced or they have a planned caesarean section,”

“The reason for that is the rate of stillbirth starts to increase dramatically.  That’s where that window of 37-weeks comes from,” says Associate Professor Pennell.

Recommended times to deliver twins:

* Dichorionic-Diamniotic twins – 37-weeks’ gestation.

* Monochorionic – twins 36-weeks’ gestation.

* Monoamniotic twins – 30-32 weeks or as early as 28 weeks’ gestation.

Multiple pregnancy protocols

Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson says after having a singleton pregnancy and birth, and then a twin pregnancy and birth she noticed a lot more protocols in place for multiple pregnancies, and oftentimes those protocols might not be relevant to you and your babies.

“I think a lot of the time especially for multiple births, but also for even just for singletons, we go into the hospital system and we’re put on a little conveyor belt and we just go through that system, travel through and all of the protocols are told ...

On this episode of Double Happiness Multiplied we discuss Higher Order Multiples (HOM).

We hear from Chair in Obstetrics and Gynaecology and Professor Fetal Medicine, Head of Discipline Obstetrics and Gynaecology at the University of Newcastle and John Hunter Hospital Professor Craig Pennell who explains the different types of Higher Order Multiples and what to expect from your pregnancy.

Triplet mum Laura Sarubin talks about her experience of finding out she was having triplets and how she tried to normalise the pregnancy as much as possible.

And, Jannelle Snaddon shares her story of infertility, her journey with IVF, and how she was hoping for one baby and ended up with four – Quadruplets.

Types of HOMs

Professor Pennell explains the three patterns of combinations with triplets.

* Three eggs that are fertilised by three different sperm known as a Trichorionic Triamniotic pregnancy.

* Monochorionic twins and a singleton, known as a Dichorionic Triamniotic pregnancy.

* Monochorionic triplets, known as a Monochorionic Triamniotic.

For quadruplet pregnancies, most are where four eggs are fertilised by four different sperm, known as a Quadrachorionic Quadramniotic pregnancy, however, you can also have twins and two singletons. It’s also theoretically possible to have two sets of identical twins but it’s extremely rare, according to Professor Craig Pennell.

Enjoy Your Pregnancy and Ask For Help

The trick with HOMs is that you want to do as much as you can early on. You’ll want to sort out the type of HOM you’ve got, make sure you’ve got great care and great imaging, and that you’re optimising the situation in terms of your haemoglobin, so ensuring you have enough iron, calcium, and vitamins.

Enjoy your second trimester and during that time take as much help from your friends as possible.

“My advice is to buy a second or third freezer and whenever someone offers to help you say it would be great if you could make me a few frozen casseroles, and you just fill those freezers up such that you’ve got all these resources for later,”

“If you’re in a good situation physically and metabolically by the time you get to 22-24 weeks, and you’re being cared for by a great team then you can feel confident that you will get through the situation,” says Professor Pennell.

Professor Pennell insists that if you’re one of the unlucky people who starts contracting early, bleeding, or has some complications, seek medical help quickly. In this situation, you will be transferred to a tertiary centre, if you’re not already there, and you’ll be given steroids which optimises the outcomes for each of the babies.

“The benefit of being administered corticosteroid at 23-weeks reduces the mortality by 50 percent,”

It’s important to be realistic and understand that there will be tough times. You are going to have good days and bad days.

"If you are showing signs of post-natal depression, get onto it, get it treated, seek help, see a psychologist, start taking medication if you need it,” urges Professor Pennell.

Key Points

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Monochorionic Triamniotic, or identical triplets, are delivered around 32-34 weeks.

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In terms of quads and quins, the aim is to get as close to 30-weeks’ gestation as possible.

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The benefit of being administered corticosteroid at 23-weeks’ gestation is that it reduces the mortality by 50 percent.

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Between 8-and-12 weeks’ gestation is the best time to formally classify Higher Order Multiples.

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There is a greater chance of miscarrying one or all of the babies in a HOM pregnancy than a twin pregnancy, simply because there are more embryos to lose.

Remember, there are some great FREE downloads on the Double Happ...

Welcome to Season One of Double Happiness Multiplied.

On Episode One, Part One, we get clear on what type of multiple you’re carrying and what that means for your pregnancy.

We hear from Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell who clears up some of the misconceptions surrounding whether your babies are identical or not, and how oftentimes your sonographer or obstetrician might give you a misdiagnosis.

Rebecca Perrie shares her story of going through her twin pregnancy thinking she was carrying fraternal, or non-identical twins, to only find out later on that her girls are in fact identical.

Jodie Wiren takes us on her journey with one of the rarest types of multiples – Monochorionic Monoamniotic twins or MoMos.

Also, Hypnobirthing Practitioner and Doula Elyse Jamieson tell us how when she found out she was expecting fraternal twins, she was determined to learn everything she could in order to make confident decisions that were specific to her situation.

And, I share my story about the shock of learning that I was carrying identical twins and that there were serious complications.

On part two of this episode, we’ll focus on Higher Order Multiples. Laura Sarubin tells us about her journey with identical triplet girls and Jannelle Snaddon explains how she had to grow a uterus to have a baby and ended up with quadruplets.

By the end of Episode One, you’ll be quite familiar with terms like Zygosity, Chorionicity, and Placentation so you’ll have the knowledge you’ll need to be proactive when attending your medical appointments.

 

Key Points:

* A zygote is a fertilised egg.

* Fraternal twins are Dizygotic, which means two eggs have been fertilised by two sperm.

* Monozygotic twins are where one egg is fertilised by one sperm and then that egg divides at some stage in the first two weeks after fertilisation.

* You can get Dichorionic Diamniotic twins where some are identical and some are non-identical.

* Monochorionic Diamniotic twins sharing a placenta are always identical.

* The rate of identical twins is fixed across the world at 1-in-every 285 pregnancies.

* Of those, just 1-percent are the rarest type, which is Monochorionic Monoamniotic.

* Monochorionic Monoamniotic twins are also identical, however, they share the same amniotic sac, which poses increased risks during pregnancy and requires significant monitoring.

Thank you for listening to Part One of Episode One, Season ONE of Double Happiness Multiplied. There are some great FREE downloads on the Double Happiness Multiplied website with diagrams that explain the types of Higher Order Multiples we’ve learned about in this episode.

On Part Two of Episode One, we’ll explore Higher Order Multiples including a mum of triplets and a woman who had to grow a uterus to have a baby and ended up with quadruplets.

LINKS:

 Double Happiness Multiplied

www.doublehappinessmultiplied.com

Elyse Jamieson

Hypnobirthing Australia™ Practitioner & Doula, Soma Birth

http://www.somabirth.com.au

Mono-Mono Twin Support Group

https://www.facebook.com/pg/momomommies/about/

Helping Little Hands

https://www.facebook.com/helpinglittlehandsAustralia/

http://www.helpinglittlehands.org

Australian Multiple Birth Association

Welcome to Double Happiness Multiplied – with host Sally Barker.

Sally Barker is the mum of identical twin girls who were born at 28-weeks’ gestation due to Intrauterine Growth Restriction or IUGR. Needless to say, the journey was rough and full of many highs and plenty of lows, too.

Over the next 12 episodes, Sally talks with experts in the fields of Maternal Fetal Medicine, Nutrition, Birthing, Mental Health, Breastfeeding, and much more. You’ll also hear from women who share their stories of having twins, triplets, and quads.

The Book

One of those experts you’ll learn from is Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell.

Associate Professor Pennell has generously spent not only months working on this podcast with Sally, to ensure you receive the most up to date information, but for several years, she has been calling on him as the co-author of the book Double Happiness Multiplied – What You Need to Know About Having Twins, Triplets, or Quads. 

Different Journeys

Throughout season one of Double Happiness Multiplied, we’ll hear about multiple pregnancies, types of delivery, time spent in the neonatal intensive care unit, and we honour those families who sadly didn’t get to take their babies home.

Educate

Sally’s goal is to give you all the information you need to ask informed questions when you attend your medical appointments, so you can make decisions that are right for you, your family, and your pregnancy.

You’ll notice that, throughout the podcast, Sally advocates finding a team that specialises in multiple births to manage your pregnancy, even when you’re searching for a doula or a hypnobirthing practitioner. Whether you’re in the public or the private system, you want to be with people who know what they’re doing and treat your pregnancy as an individual case, not merely a replica of some statistics that have been quickly read in a textbook.

Low, Medium, or High Risk

Having twins, triplets, or quadruplets is often referred to as High-Risk simply because having multiples is very different to having a singleton and each type of multiple carries its own set of variables and possible complications, often resulting in your babies spending the first weeks or months of their lives in the Neonatal Intensive Care Unit … or NICU…

Your Pregnancy, Your Birth

Every pregnancy is different, and some of you will have a relatively uneventful multiple pregnancy and will deliver your babies vaginally and without pain medication, however, many of you will have challenges throughout your pregnancy, which will lead to your babies being born via caesarean section much earlier than was hoped for.

Many women aren’t mentally prepared for this to happen, so it’s to be aware of the possibility as many women beat themselves up because they didn’t get the birth they wanted. Sally even had a chap tell her she wasn’t a real woman and didn’t birth her babies because they entered the world via C-section. He went on to say his wife ACTUALLY gave birth to four babies, which made her a real woman. Of course, he didn’t know the story behind why Sally’s babies came into the world the way they did, but his comments made her feel pretty awful for a while, even though she knew the way they were birthed saved their lives.

Breast or Bottle

It’s no surprise that some of you will have no problem breastfeeding your multiples, while some of you will struggle. When Sally was expecting her girls, another twin mum, who was successfully feeding her twins, told her that the only reason women aren’t successful in this area is because they’re simply lazy. You can imagine the pressure she felt after this comment. It’s absolutely not true by the way, and it’s important to know that if you need to supplement with formula to grow healthy babies then that’s your choice. Go for it!

Couple Bond

Let’s be honest,