32 weeks – growth scan and birth options

This week we had another growth scan and clinic appointment. It was lovely to see the babies again, it’s reassuring to know they’re OK in there, even though I do feel them move lots anyway. They are getting so big that it’s really hard to make anything out on screen, unless you’re a trained sonographer and know what you’re looking for. She pointed out a few things to me and I nodded with a kind of “if you say so” smile.

32 weeks

The main thing is they are growing nicely. Both are still around average size, one slightly longer than the other, meaning their estimated weights are slightly more different from each other than last time with a 10% difference. They are estimated to be around 4-4.5 lbs each, though as I wrote before, scanning at this gestation can be quite inaccurate so these stats have to be taken with a relatively large pinch of salt. There’s a good amount of amniotic fluid around them in each sac, and the placentas look healthy and well positioned at the back of the womb. Their cord blood flow rate is healthy, and they are both very active at scans – all the sonographers that I’ve seen have remarked on this! We produce very active kids it seems. I think it’s for this reason that they have moved position between every scan, never staying in the same place.

Unfortunately their positions are slightly less favourable than at the last scan (where twin 1 was transverse with head nearer the cervix than bottom, and twin 2 was head down). This time twin 1 was properly breech (bottom sitting on the neck of the womb by the cervix!) and twin 2 was transverse, with their heads together near my ribs. Whilst it’s lovely that they have their heads together, I’d rather that their heads were near the cervix. The sonographer said there was still time to turn, and since they’ve turned lots already, I have some reassurance that this is possible. I was slightly dreading then talking to the doctor in clinic about where we would go from here in terms of birth plans. However, it turned out to be a very positive conversation.

I saw a consultant who I haven’t seen before. She seemed very laid back from the start. The usual blood pressure conversation was short, she checked that my machine read high, which it did, and joked with me about there always being one who had white coat hypertension. Then we moved on to how I’d like the babies to be born. I said that I was hoping for a vaginal birth, because I’d had very fast and easy births with my singletons, but that I understood their current positions weren’t very favourable for a vaginal birth.

To my surprise, she then said that if I go into spontaneous labour and I dilate as quickly as, or more quickly than, previous labours, they would be happy to support me in a breech vaginal birth. After I nearly fell off my chair in shock, I replied with something like “oh really! Er… um…. thank you!” When I had previously talked to a registrar about this at our first twin clinic appointment, he said that twin 1 would have to be head down if I wanted a vaginal birth. She said that if it’s fast then better to let it happen naturally than try to intervene surgically, and that they as obstetricians have the expertise to assist with a breech delivery. She then went on to say that if I was dilating more slowly than before, and there was therefore time to consider other options, that they would rather offer me a c-section at a lower dilation with sac and fluid still in tact than wait for me to go slowly to full dilation and then potentially need a c-section once my waters had broken, which was less favourable from their point of view. Although she added that I still wouldn’t need to accept the offer if I’d gone into labour spontaneously and wanted to carry on for a vaginal birth.

I think it was around this point of the discussion that she made a statement that made my ears really prick up because it was very much in line with the two central tenets of the Positive Birth Book (that I have CHOICES and RIGHTS in childbirth). She said “you do have choices in this you know, it’s not just me telling you what you can and can’t do.” Again I nearly fell off my chair in amazement!

Then she went on to talk about what would happen if I don’t go into labour spontaneously. Firstly, she said that they were happy for me to go to 38 weeks as long as all is well at my next scan. They wouldn’t offer induction at that point if twin 1 was still breech. That would mean either a planned c-section before labour starts naturally, or “wait it out” with daily monitoring to check for foetal well-being, and they would talk to me about the risks either way with both of those options if it got to that. Again I was pleased that she seemed to be quite relaxed about the prospect of waiting it out rather than just going straight for a c-section, if all is well. They would offer induction if twin 1 was head down by then, just not if he/she was breech. I’m fairly confident that my body will go into spontaneous labour by 38 weeks, because the boys were born on or just after the 40 week “due date” for singletons. Mums who go longer with twins tend to also go to 41/42 weeks with singletons – we’re all different.

And that was that! A much easier conversation than I was expecting, and a much more positive and mum-centred approach to twin birth than I was expecting from a consultant obstetrician. I feel bad for tarring them all with the same brush in my head now! She said they’d like to see me again in 3 weeks, when I’ll be nearly 36 weeks pregnant, to check the babies’ positions. Initially she said 4 weeks because all was well and the babies are growing beautifully, but then decided a week earlier would be good to give us a bit more time to discuss all options if they are still in awkward positions, which I agree with.

In the mean time, if I have any signs of labour, I have to go straight in to triage to be assessed. They would rather I came in on false alarms and they sent me home again than risk a home/car birth, which I can understand if twin 1 is breech. A twin breech home birth would be one step too far in her opinion, and I have to say that would scare me too I think! This is totally different from when I had the boys – the birth centre didn’t want us getting there too early and nearly sent us away again with Andrew, but thankfully they didn’t as he was born about an hour and a half later, and we only just made it there at all for Joel.

I came out of the appointment feeling much more positive than just after the scan which had made me fear the worst for lack of birth options. I’m praying that at least twin 1 will turn, and there is a team of friends at church who are praying the same. But if this is how it’s meant to be, I’m feeling confident in my ability to breech birth if all goes as quickly as before, and I have a sense of peace surrounding the fact that it’s not in my hands – what happens, happens. The position of twin 2 is less important at this stage because they often turn once twin 1 is out anyway.

So going into this week I’m trying to continue getting the balance right between rest and activity. I hope that swimming, yoga and spending time on all fours using my birth ball for support will give the babies as much room to turn as possible, though I know it’s getting less likely that they will. I’m still feeling nauseous and have to lie down for a rest in the afternoon and evening otherwise I think I’ll be sick. But I’m really holding onto the fact that it’s really not long to go now. If anyone used to watch the comedy quiz show Shooting Stars, I have this line from it in my head: “We don’t know how much time we’ve got, but when the time’s up you’ll hear this noise….. argh!” We’re living life on the edge right now!

31 weeks – keeping as fit as possible

This week there’s little to report in terms of pregnancy; the main event has been Andrew’s operation to remove his adenoids and insert some grommets. We spent the day in hospital, and thankfully all went well so he was discharged in the evening.

31 weeks

I wasn’t sure how I would feel spending all day in hospital, though admittedly the children’s hospital instead of the women’s hospital, so Tom took the day off work to come with us too, whilst Granny and Grandad looked after Joel and taxied for us. The day turned out to be easier than I thought it would be on pregnant me. It was quite a pleasant day-case ward, and we were able to walk around as well as sit down on hard or soft chairs. We’d taken plenty of drink and snacks to nibble on, and we managed to get some fresh air whilst Andrew was in theatre. I went to bed not long after we got in as I suddenly felt exhausted once it was all over, and the next day I was really tired, but I’m glad I was able to be there with him the whole time. Tom was the one who actually went into the anaesthetic room with him – I thought I might cry or faint or something at that, which wouldn’t have been good for Andrew, who in the end was far more unfazed by it than I was! Probably partly my hormones, as well as the fact I’m not great with hospitals, though I’m getting better with all the exposure recently.

As this week was the first week back to school and toddler groups after the holidays, I’ve had quite a few people who we haven’t seen for a few weeks ask how long I’ve got left and how things are going. I usually respond with “I’m just plodding on, literally!” It’s definitely got to a point where I feel huge, even though lots of others still think I look “neat” for twins. Sitting down is pretty uncomfortable now, because I find the bump squishes my internal bits – you know, like lungs, stomach, intestines and other organs vital to life. So I’m generally lying down on the sofa or sitting on my birth ball which gives me a good position. I’m also trying to do quite a bit of time on all fours, with support from the birth ball.

I’m still managing to walk places as much as I can, carrying on with our normal routines like the daily school runs, the daily post office run and going to a couple of toddler groups in the week. This isn’t uncomfortable yet, though I’m a bit slower. I’ve been swimming once a week for the past month or so, and I find this a lovely way to keep moving whilst feeling weightless. The only slight issue is I don’t think my maternity costume (which I used lots when pregnant with the boys) will fit me much longer! But it seems a bit expensive to buy a new one for the sake of potentially only a few weeks, so I’m hoping to eek it out longer. I’m also doing my pregnancy yoga DVD about once a week, to help with breathing techniques and good positions for my hips and back in particular. Hopefully all this will keep me as fit as possible when carrying twins late in pregnancy.

I wrote last week about starting iron tablets because my last blood tests had shown I’m anaemic, though I don’t feel particularly different from how I have throughout pregnancy. I’m pleased that the tablets don’t seem to be having any adverse side effects on me, like nausea (which is no worse than usual), so this is positive. It will be interesting to see how my haemoglobin level is next week at my 32 week scan and clinic appointment.

I’m looking forward to seeing the babies again next week at the scan, and I’m hoping they are now in a good position for a vaginal birth. I think however they are positioned the doctor I see will want to start discussing birth options, so we will see what comes of that.


29-30 weeks – rest and getting prepared

There wasn’t really much to write about for 29 weeks. We were away for the long Easter weekend, down with Tom’s parents in Devon. It was good to get away, and I’m glad all is going well with the pregnancy so far, which meant that we were able to go that far, even if sitting in the car wasn’t that comfortable – we had an extra stop compared to normal.

30 weeks

The last time I blogged I had just had my 28 week growth scan and blood tests, including one to check for ICP (intrahepatic cholestasis of pregnancy). I didn’t hear anything back about this, which means it must have been negative, so I’m pleased about that. The tingling/itching hasn’t got any worse, and if anything I noticed it even less when we were away.

However, when we got back home, I opened a letter from the hospital which said that my blood test for iron level showed that I am anaemic. This isn’t hugely surprising for a twin pregnancy, as lots of mums expecting multiples find their iron stores are depleted more quickly from growing two or more babies. I don’t particularly feel any different from how I have all pregnancy in terms of tiredness – one of the major symptoms. I don’t get that out of breath, though I can feel it’s starting to become harder work walking and going up stairs, for example, with the extra weight I’m carrying. When I looked up anaemia on the NHS website it did say that one of the less common symptoms is itching/tingling though, which is interesting. After a short delay in my GP receiving the letter from the hospital due to the bank holidays, I got some iron tablets and have just started taking them. I’m slightly apprehensive about the potential side effects of nausea and constipation that are common with iron tablets, but I’ll have to see how it goes.

We’ve also started to get organised this week with preparations for the twins’ arrival. I have packed my hospital bag except for a couple of additions that I need to buy (snacks and drinks). It’s been so long since I did it that I had to remind myself what we need in the bag! We were in the birth centre for less than 12 hours last time, so hardly needed anything that I’d packed. I expect we will be in for longer with twins, even if they get to term (37 weeks), because they are likely to be quite small compared to the boys, which may cause issues with starting feeding, for example. And of course this time we need double of all the baby bits. If I need a c-section, I personally will also need to be in longer than after a vaginal delivery. We don’t live very far at all from the hospital, so I’m sure we can top up with anything that we don’t have enough of pretty easily between Tom and other visitors such as our parents.

We have very kindly been given this week plenty of tiny newborn baby clothes, as we didn’t have any smaller than 0-3m ones for the boys who were born average weight for singletons. So we’ve put most of these into the drawers in the boys’ room and some have gone into the hospital bag. We’ve moved all the feeding equipment into the kitchen and found a place for it – steriliser, several SNS (supplemental nursing systems – made from bottles and thin NG tubing) and formula.

I’m sure there are a few more bits and bobs to sort out, but I feel like we are pretty prepared for them to arrive whenever (well, as much as one can ever be prepared for the arrival of twins!) Even if they were born in the next few weeks, we wouldn’t be home straight away as they’d need time in special care, so there’s still time to sort out anything here that needs doing.

28 weeks – growth scan

This week we had our second growth scan. I get routine scans every 4 weeks now, so this is 4 weeks since the last one. I can tell they’re growing as I’m getting a lot bigger, but the hospital are mainly checking that they are growing at a similar rate and that one isn’t taking more nutrition from me than the other.

28 weeks

It was all good news. Both twins are still average size for their gestation, with an estimated weight of around 2lbs 12oz each (though this is really tricky to get very accurately from a scan, so has to be taken with a rather large pinch of salt, but it’s a rough figure at least). And the main thing is they are only 0.4% different in size, which is great. Both look healthy and are moving lots.

I was also pleased to see that they have both turned from being breech! Twin two is now head down, and twin one is lying across, or transverse as the doctors call it. Whilst transverse isn’t a good position for labour, and would mean a c-section, I’m encouraged that they have at least moved and hopefully twin one will carry on the turn and go (and stay!) head down soon.

The sonographer was lovely, and she made sure that I know that this configuration of twin pregnancy (DCDA – two sacs and two placentas) could still mean identical twins, though more likely non-identical. Tom worked out from twin stats that we found online that there’s about a 14% chance that they are identical. But lots of people, including health professionals that I’ve met in hospital, have automatically referred to them as non-identical because they are DCDA. If they are identical, it just means the splitting of the fertilised egg was really early, about 1-3 days after conception. Later splits result in just one placenta, and either two sacs or one (the latter being very rare, only 1% of identical twins).

This was before she scanned, so she had no idea if they were boys, girls or one of each. I looked away for quite a lot of the scan as I was worried I’d see something that would indicate it to me! I also told her it was OK to refer to each of them as “it”, because last time the sonographer referred to one of them as “he”, though in the context I think she was probably just defaulting to he because she didn’t like to say “it”, I’m not even sure she’d scanned down between the legs at that point.

After the scan I went to clinic as usual. We had the usual blood pressure conversation and actually my machine read higher than theirs (it’s usually slightly lower), so the registrar was happy that it can read high in hospital and that I’m monitoring well at home. It’s still on the lower side at home, which is good. She also checked with the consultant, and he was happy to not see me for another 4 weeks.

The only slightly weird thing this week is that my skin has started to feel a bit tingly/itchy. It’s really hard to describe. It’s not the pain of pins and needles, nor anything like that intense. It’s also not like I really need to scratch it. I will occasionally scratch, but not noticeably more than usual. I know that itching can be a sign of obstetric cholestasis, or the more recent term for it is intrahepatic cholestasis of pregnancy (ICP), which is a potentially serious liver condition of pregnancy, so I mentioned it.

According to the NHS website, ICP affects 1 in 140 pregnant women in the UK each year. Normally, bile acids flow from your liver to your gut to help you digest food. In ICP, the bile acids don’t flow properly and build up in your body instead, which is what they think causes the itching at the skin. It’s more common in multiple pregnancies than in singleton pregnancies. There’s no cure for ICP, but it can be treated to some extent with a drug until birth, which is when it ultimately gets better as the body gets back to normal. There is an increased risk of preterm birth and stillbirth in severe cases, so careful monitoring of bile acid levels from blood tests and foetal movements would be necessary, and induction of labour or an emergency c-section if there is any concern.

The doctor agreed that it would be sensible to run some blood tests to check my liver function and bile acid level, even though it’s not severe (yet), and I have no other symptoms such as jaundice or vomiting (nausea still, but that’s normal for me). If those show anything abnormal then they will ring me next week and I would start on a drug to treat it, and this would then also involve more monitoring. So we will see what comes of that.

It’s also entirely possible that skin tingling and sensitivity is simply down to my increased blood volume (which is huge with third trimester twins!) and therefore blood flowing nearer the skin. Increased pregnancy hormones could also cause skin conditions that I wouldn’t normally get, though I don’t appear to have many other physical signs such as spots, other than a few on my legs, and some dryness on my hands and face, which I do get sometimes anyway. It’s also very normal for stretched skin on my bump to itch.

It feels so good to have got to the third trimester! We really are on the homeward straight now, as I keep telling myself when I’m feeling sick and tired.

27 weeks – positive birth thoughts

It’s been another fairly uneventful week really, which is good! I’m concentrating on resting as much as possible still, whilst still getting out and about for exercise and looking after the boys.

27 weeks
Fab top from Colour Me Baby – facebook.com/colourmebabyclothing

The result of the glucose tolerance test that I had at the end of last week was negative, so I don’t have gestational diabetes. I didn’t think it was that likely, but it’s great to have this confirmed and means I don’t have the stress of having to change my already fairly restricted diet. So that was a big relief. My blood pressure still seems to be sticking around the same readings, still the lower end of normal, and I checked that my machine is still capable of reading high in hospital when I had the GTT.

comparison 26-39
Lots of people are still saying I don’t look very big for twins. I decided to do this comparison of last week’s bump shot with the same from 4 days before Joel was born! As you can see, I feel big now! I think what they mean is it’s still “neat” or all at the front, which is just the way I am when pregnant, we are all different.

On Monday I had the delivery of a fantastic new book that I ordered last week – the Positive Birth Book. I’ve been reading it lots this week and I’m very impressed. I didn’t read loads or research excessively about birth before I went into labour with Andrew – the biggest preparation I did was attend yoga classes where we learned good labouring positions and breathing techniques. I was blessed with an uncomplicated pregnancy, and a lovely, fast, positive birth in a midwife-led birth centre. I felt that my animal instinct took over during labour, and I didn’t fear at all what would happen, I just got into the zone and did what felt natural to me. I would even go as far to say that I enjoyed it.

So when the time came to think about options for my second birth experience, it was easy, as I’d had such a good experience before and another uncomplicated pregnancy. Again I decided on the birth centre, mainly because I wasn’t sure about potentially giving birth in front of a toddler at home, and our flat was tiny! My midwife at the time was actually very pro home birth, and tried to convince me to stay at home. And we did have supplies of old towels ready in case I didn’t make it to the birth centre given my previous fast labour, but in the end we did just about make it, only because it was the middle of the night and there weren’t the usual daytime in Cambridge traffic jams. Again I had a very positive and even faster experience. I’ve learned this week that labours under 3 hours like mine have been even have a recognised term – precipitous labour.

So I never imagined that I would find myself buying a book about positive birth for my third experience. After all, I have the personal experience myself. That was until I’ve struggled with the medicalisation of a twin pregnancy. One of the registrars I saw at twin clinic a while ago couldn’t really understand how I’d never seen a doctor in hospital in my previous pregnancies. But I didn’t, because there was no need, I was having a “low risk” pregnancy each time. The only health professionals I saw were midwives, in pregnancy and labour.

Fundamentally I still believe, as I did before, that my body is capable of giving birth without complications, even to twins – it’s “just two babies” I keep thinking – I don’t doubt this and I don’t fear giving birth in itself. The problem is that I fear how I will react if/when I am advised by doctors to plan a certain type of birth or do certain things in labour due to the fact that this pregnancy is “high risk”, which I find a really unhelpful term. Loads of pregnant women are automatically lumped into this category, but actually it covers a huge range of individual circumstances. So I have only one risk factor – twins. The rest of me is healthy and fit – I have a normal BMI, I have no underlying health conditions, I’m under 35, I have a good history of uncomplicated pregnancies and labours, I’m as active as I can be for pregnancy etc. Yet I fall in the same category as a woman who is 45, is obese, is inactive, has diabetes, has had complications in a previous pregnancy or no previous pregnancy, has high blood pressure, and smokes (for example). We have vastly different pregnancy profiles to be lumped into the same “high risk” category.

Of course I’m not against modern medicine and the fantastic cases in which it can save lives and improve outcomes for mum and babies. If I need it, I will gladly turn to it for help. But it’s not like humans aren’t at all capable of multiple pregnancy without medical intervention. My grandad, who would have been 91 this coming week, was a twin, born at a time without ultrasound scans and c-sections, and they both survived, thrived and lived to a good old age.

The positive birth book, or what I’ve read of it so far at least, is helping me to understand how I can help myself stay positive in the midst of all the talk of “risk” and medical management. There are two main tenets that underpin the rest of the book, that is that I have RIGHTS and I have CHOICES as a pregnant woman. No medical professional can do anything to me without my consent and without explaining to me the benefits and risks involved, engaging in a two-way conversation and answering my questions. It doesn’t matter if I’m labelled “one of those” for questioning them, I have the right to do this and make my own choices, of course based on any advice I am given from sources I trust.

The book also makes clear that it’s important for me to have a really clear birth plan, or more specifically birth plans (B, C even D in case A doesn’t happen), and have chance to discuss with doctors and midwives what I would like to happen in advance. So this is something I will work on in the coming weeks. As I already know, birth happens most effectively when we, as mammals, are in an environment where we feel warm, cosy and safe. I’m convinced this helped me before, and it can help me again. The problem is I will probably have to go through labour in a brightly lit and unfamiliar hospital room with several people present, which doesn’t exactly lead to such a conducive environment. There are things that I and Tom can do to mitigate against this though, and Tom has read the section about being my “guardian of oxytocin” – the most important hormone in labour. These are the kind of things I can discuss with respect to my birth plan.

I can’t quite believe that I’m about to enter the third trimester at 28 weeks. The first seemed so long with the incessant vomiting, but the past 10 or so weeks have gone much more quickly. Now it really seems like we’re on the homeward straight.

26 weeks – glucose tolerance test

This week has been fairly quiet again in terms of pregnancy – not much to report. I’m still feeling pretty much the same, with no major changes.

26 weeks

I’ve been doing some pregnancy yoga once a week using a DVD that I bought. I found this helped me relax, learn breathing techniques and keep my hips and back as comfortable as possible in previous pregnancies. I’ve also been trying to spend time on all fours and doing some gentle hip rocking, concentrating on this specific yoga position, because it should be helpful in trying to get the twins to turn to be head down. I think one of them has moved, because I am getting some higher up kicks nearer my ribs instead of lower down nearer my hips. But I think it’s probably twin 2, which is less helpful than twin 1 being head down, as this needs to happen for the doctors to allow me to have a vaginal birth. There’s still time yet, but I’m hoping to try and get them to be head down soon!

I actually spent more time at the children’s hospital than the women’s hospital this week. We had a follow up appointment with the ENT consultant about Andrew’s repeatedly failed hearing tests and constant snot throughout over half the year for the past two years. The doctor suggested that now was a good time to remove his adenoids and put some grommets in. I asked what sort of timescale we’re looking at, and he said early May. I told him I’m due to have twins at the end of May, so he said they’d do their best to give us as early a date as possible. We’ve just had an offer of the last week of April, which I’m really pleased about! This should give us a fair amount of time before the twins are born, unless they come very early.

I did spend a few hours at the women’s hospital on Friday morning for my glucose tolerance test, to check if I have gestational diabetes. I automatically have one of these in pregnancy because my dad is a type 1(.5) diabetic, which means I have a risk factor. This time I have the added risk factor of a multiple pregnancy, though no others such as being overweight, having previous big babies or being of certain ethnicities. I also had a small trace of glucose in my urine at my last clinic appointment, though the consultant said this was entirely normal for this gestation of twins and wasn’t an indication of gestational diabetes in itself, but simply that my kidneys could be a bit leaky with the extra pressure they are under at the moment. In my previous pregnancies the test was negative. This time, if I hear nothing by 5pm on Monday, I don’t have gestational diabetes, but if I do, then I will get a call from the diabetes specialist midwife to discuss how they will treat me.

I don’t really want to have to change my diet as it’s already pretty limited to bland foods, though I do eat a lot of protein, and carbs would be fairly easy to cut down, particularly as I don’t feel like eating sweet things anyway. But of course I will if I need to, and we are on the homeward straight now, so it’s not like doing it for the whole pregnancy.

The test itself was pretty challenging for me due to the nausea. I usually have to eat something soon after getting up, to keep the sickness at bay, but I had to fast from 9pm the night before until I was given a glucose drink at 9am, just after the nurse took my first blood sample. I didn’t feel great, but I survived, and the drink wasn’t as sickly as I thought it would be – it was quite a long drink, so I guess fairly weak with that amount of liquid, more like weak squash in consistency than the stickiness of coke or lucozade which I can’t stand at the best of times! I had to wait in a waiting room for 2 hours until my next blood sample, and that was just about OK until the last half hour which I found really hard with feeling sick. But I gritted my teeth and was determined to keep it down, because it would have been a total waste of time if I’d have thrown the drink back up. I think the usual hospital adrenaline rush (which sends my BP up – I even checked that my home machine got a high reading there!) kept me going, and then I felt the relief from that when I got home (my BP was back down to normal). At least I was able to eat a few savoury snacks later in the day.

So now it’s just a case of wait and see what happens with the result next week.

25 weeks – babywearing and breastfeeding preparation

This week has been fairly quiet, which is good, because last week was quite busy, as far as busy for me goes these days anyway. As well as our first growth scan on Thursday last week, which was the main topic of last week’s blog post, I also went to my first La Leche League (LLL) South Birmingham meeting and had a sling consultation to learn how to wrap newborn twins. Normally all these things in a week wouldn’t be that much effort, but they are exhausting for me in pregnancy. I’m still feeling constantly nauseous and need to rest on the sofa a lot. My work hours are still about half what they normally would be. I’m in bed before the boys every night, though I’m not always asleep straight away, just lying down and browsing social media or writing blog posts on my phone is better than staying up and risking being sick. I expect this is what it’ll be like until the end now, it was in my last full term pregnancy, and the nausea went as soon as I delivered the placenta after Joel.

25 weeks

Although I really felt exhausted last weekend after our busy week, I was glad that it had all gone well and it was a useful week in terms of preparation for the twins’ arrival. I was pleased to make a connection with the local LLL group. I spent a lot of time at LLL Cambridge meetings between Andrew’s birth and when we left to move to Birmingham. I made some great friends and got a massive amount of support in our breastfeeding journey. I honestly don’t think I’d have persevered as long as I did in the face of supply issues had I not felt welcomed and supported by this fantastic group of mums. I’ve blogged a lot about my breastfeeding journey with the boys before, but here’s a summary of my situation…

I have mamary hypoplasia – basically underdeveloped breasts. They never changed much in puberty or in any of my pregnancies, as they should do due to hormonal changes. I don’t really know why, but it could be to do with the fact that I was overweight in my early teens when the hormonal changes of puberty were occurring. I then flipped to being underweight in my late teens and early twenties, but have been in the normal healthy BMI range for about the past 10 years. The effect of this hypoplasia means I have insufficient glandular tissue (or IGT) – glandular tissue is milk-making tissue in the breasts. It’s not just about size, but also shape of breasts. It’s possible to have small breasts and still have sufficient glandular tissue, or indeed large breasts but not a high enough ratio of glandular to fatty tissue.

This doesn’t mean I can’t breastfeed at all, it just means I will probably never have enough tissue to exclusively breastfeed a baby without supplementation, though the amount should increase with each subsequent pregnancy (I’m NOT going to keep having kids to see how long it would take to increase my tissue enough by the way!) I certainly found that I produced more milk for Joel as a baby than I did for Andrew – I had to give him less formula and Joel’s poos were very breastfed in appearance. This could also be partly explained by the fact I knew what I was doing from the start, and so had been able to prepare much more for breastfeeding with IGT. It’s hard to put a figure on how much milk I provided for the boys because you can’t see how much breastmilk is transferred to them at the nipple, but I estimate based on supplemented formula amounts that I gave Andrew in the region of 50% of his intake in his first 6 months and Joel in the region of 70%.

Due to a very handy device called an SNS (supplemental nursing system), we managed to establish and maintain a breastfeeding relationship despite the supplements, because the boys were fed at the breast, with the formula coming through a small tube that they sucked on at the same time. Once they were eating solid food after 6 months, the amount of supplement gradually decreased, until we dropped it all together and they continued to nurse well into toddlerhood. I wanted to let them self wean – they did so pretty much at the same time, a gradual decrease in nursing that ended at just over 4 years for Andrew and at 2 and a half years for Joel.

It will be interesting to see how much milk I produce for the twins. It should be more overall than I did for Joel – partly because it’s another subsequent pregnancy and partly because I’ll have two babies removing as much milk from me as they can (the more milk taken, the more is then produced). Of course there will be two mouths to feed though, so they will need to share the supply. I have been encouraged by the fact that I’ve already been leaking a little colostrum (the first milk suckled after birth for a few days) for a number of weeks.

I spoke about a lot of this with the LLL group and leader last week. It was good to meet them so that when the babies arrive I will already know a support group to turn to, who know our situation. I’m not saying they will have all the answers, because breastfeeding twins with IGT is probably quite a rare occurrence! But just to be surrounded by other breastfeeding mums who understand why I want to do it and why it’s important to me, that will be invaluable, just as it was in Cambridge. To me breastfeeding is less about food in a purely calorific sense (because formula is actually pretty good at that in a case like ours where my milk alone is insufficient), but more about the things in breastmilk that are not in formula (such as antibodies), and, most importantly, what the relationship that nursing my children brings to us (which is why I love that the SNS allows this to happen). I don’t want the twins to miss out on any of this just because there are two of them. And despite what society would have us believe, it IS perfectly possible to breastfeed twins. Many ladies I have met online have done it, with no underlying conditions like mine.

Moving on to slings…. I had a fantastic consultation with Gillian at Coventry Slings, who is also pregnant with twins, just a little ahead of us. She was such a good teacher, and I felt I learned so much in our two hours together. It is possible to watch videos of mums wrapping twins on YouTube, but this isn’t a patch on getting professional expertise tailored to me, guiding me through the process as I try it, giving tips based on what I have a tendency to do incorrectly or not optimally.

sling practice 1

I came away with a lot of info and an urge to practise lots before the babies arrive – though this is actually quite tricky with a growing bump in the way! The more I do it, the more I realise what I can do better. Although it seems complicated at first, it is getting easier already as it starts to feel more automatic. Of course I don’t have real live (i.e. wriggly and potentially loud) babies to try in there yet, but I’m gaining confidence that tandem babywearing will be a handy tool for us. The thought of pushing a double pram around with two older boys to keep an eye on too, particularly on the school run twice a day, is enough to make me want tandem babywearing to work for us – it’s far more practical. I also found that neither of our boys liked being in the pram, and once I’d figured out wrapping when Joel came along, he was very content to go everywhere in the sling, so was rarely pushed anywhere.  Unfortunately I didn’t know about the variety of slings available when Andrew was a baby and struggled with an uncomfortable narrow-based buckle sling which didn’t entice me to carry him. We haven’t ruled out the possibility of a single pram/buggy, to have the option of one twin in there and one carried, but we are waiting until they are here and we have tried out what works for us before committing to a particular model.

sling practise 2

The carries that I have been practising this week (and taking lots of selfies of!) are suitable from birth. The dolls I practised with at the consultation with were weighted to be around 4 months old. Once the twins get to around this age or maybe a bit older, about 6 months, it will be possible to carry them one on my front and one on my back. I will be going back to Coventry Slings for more advice as they get older. I couldn’t have taken any more info in for one session, it was so helpfully detailed, and I doubt my brain will remember back through the newborn fog to now by the time they are old enough for different carries!

I’m sure I will continue wrapping my practice teddies into next week and beyond….

24 weeks – first growth scan

This week has involved our first growth scan, and our first meeting with a consultant (as opposed to registrars) at the hospital. It’s also an important milestone to reach in pregnancy, because this is when a foetus is deemed “viable” – a baby born at 24 weeks has a 55% chance of survival, compared to just 15% at 23 weeks (according to Tommy’s). Obviously we want our babies to stay in a lot longer yet, as long as possible, but this is a reassuring milestone to reach.

24 weeks

It is normal for twins to be born slightly earlier than singletons, mainly because their combined size gets to the threshold that the individual mum’s body can cope with sooner and triggers labour. Of course there are other reasons for premature birth of twins too, just as there are for singletons. On average, singleton pregnancies last 39 weeks and twin pregnancies 36 weeks (according to Tommy’s). It would be great if we get to 36 weeks, or even 37/38 weeks as this is classed as “term” for any baby. But there are complications that could arise which could lead to premature birth, either spontaneous premature labour or a decision to end the pregnancy with a c-section due to concern for the babies and/or me. I think I’m more aware of potential complications this time than I was in previous pregnancies, even though I don’t have any risk factors personally other than the fact there are two babies in there instead of one. We are praying that all will be well.

At the other extreme of birth timing from prematurity is what would happen if they didn’t arrive spontaneously by 37 weeks. It was interesting to hear about induction of labour at the antenatal day that Tom and I went to last week. The midwife said that they generally like to start the induction process at 37 weeks for twins, though they would allow me to go until 38 weeks if there were no complications. The biggest risk they perceive is that the placentas stop functioning well enough to support the babies. As both our boys were born spontaneously at 40 weeks (Andrew at 40+4 and Joel on his due date at 40+0), I’m pretty confident that my body is good at timing and will go into spontaneous labour by 38 weeks with twins, providing there are no complications that arise between now and then. So I’m not overly concerned with the supposed “need” for induction.

It was lovely to see the babies again this week, though as they get bigger the clarity of what you can see on the scan is decreasing. They are growing just nicely – pretty much bang on average size for the three measurements taken: head circumference, abdomen circumference and femur (thigh bone) length. The boys were born average weight (7lbs 11oz and 7lbs 9oz) so I expect the twins will be average weight for twins (around 5.5lbs at term). So there are no concerns about them being “too big” or “too small” at the moment, and they are a very similar size to each other (twin 2 is 2% bigger overall).

1st growth scan 1
The way they are both lying (breech) means that their heads are right next to each other currently. The sonographer said it looks like they are plotting something with their heads together!
1st growth scan 2
A lovely little foot from twin 1

They were being very active at the time of the scan, both playing with their cords and limbs whilst the sonographer was trying to measure them. This made it hard to get a good measurement of the blood flow through the cords, so it took a bit longer to scan as she had to come back to this a few different times to eventually get a good enough position with the probe. This sounds entirely accurate for our children – both the boys have always been very active! And I can certainly feel the babies kicking a lot, especially when I’m working at my sewing machines, so they must be able to hear the noise.

As I suspected from the positions of the kicks, both babies are currently in a breech position – bottom down. This is not the position that is favourable for birth, but the sonographer reassured us that there is still plenty of time and space for them to turn to be head down. Usually twins get into their birth position by 32-34 weeks. It’s mainly twin 1 who needs to do this, as twin 2 tends to turn anyway once they have half a womb’s more space to spin about in after the birth of twin 1!

After the scan we had to go to the twins antenatal clinic as usual. First up was the usual blood pressure and urine test. The nurse clearly remembers me now, and tried to make me feel relaxed with various topics of small talk like the weather. It was probably working to some extent, though I couldn’t help feeling she was going a tad over the top, until she told me whilst the machine was measuring my BP that my urine test showed a small amount (1+) of glucose. The BP reading was inevitably high, though I have had higher ones in hospital. So I expected to have to talk both the BP and glucose through with the doctor.

After a short wait, we were called in. This was the first time I got to talk with a consultant, which is standard at 24 weeks in the twins clinic. He was actually more laid back than I expected. He wasn’t at all bothered about the glucose result – he just said a tiny amount like that is neither here nor there at this stage of gestation of twins. He did check that I have a glucose tolerance fasting blood test booked, which I do. I’ve had these even in my singleton pregnancies because my dad is a type 1(.5) diabetic, so I have a risk factor for gestational diabetes, and this time I have two risk factors, the other being twins. I have never had gestational diabetes myself though. So we will see what comes of that test in a couple of weeks.

He also wanted to talk through my BP history and my home monitoring. He agreed that I didn’t currently need to be on the drug to lower BP, and wanted reassurance that I know what I’m doing with testing myself, which I seemed to give him. My monitor reads a bit lower than the static hospital machines, but it did read significantly higher than my home readings last time we did it alongside the hospital ones, so it clearly can detect high BP. Even if I add 10 mm/Hg onto each reading on my machine, they still don’t come out as hypertensive when I’m at home. I told him that I’m a research scientist by training, so he said that I should understand the concept of a fair test with controlled variables, by testing my machine against theirs when I’m in hospital, to check it’s not just my machine reading lower all the time and nothing to do with the fact of being at home. He said to make sure I always bring it with me to appointments, so they can keep checking that it does read higher in hospital, and to call them if I start seeing higher readings at home, which is exactly what I would do, so that’s fine. He was happy to not see me for another 4 weeks, which will be our next growth scan – this is standard for twins. So I’m relieved about that.

So all in all it’s been a good week. I also had a sling consultation to learn how to wrap newborn twins a couple of different ways. I’ll say more about that next week.

22-23 weeks – twins antenatal class

Last week we were away for half term with family, which was a lovely time for us all, particularly for me to rest as well as do some swimming – non-weight-bearing exercise is good. There wasn’t much to write about in terms of pregnancy. I’m continuing to monitor my blood pressure – it is staying at around 105/65 at home, and it went up a little to around 110/70 last week when away, but it’s back down this week. This is still pretty low for me personally and for being pregnant with twins.

23 weeks

There’s more to write about this week at 23 weeks. On Sunday Tom and I attended an all-day twins antenatal class. The twins specialist midwife, whom I’ve seen every time I’ve been to twins clinic, had invited us and said that it was focussed on specifically twin labour, delivery and early postnatal care in hospital, rather than general things you’d learn about at antenatal classes, which as third time parents we really don’t need. We’d done the NHS classes in Cambridge when pregnant with Andrew, and found them rather useless – nothing I hadn’t read about already and the assumption that birth should be medicalised. I’d also done an NCT antenatal refresher course when pregnant with Joel, which was more useful in a non-medicalised approach for us, though I mainly did it to meet local mums with toddlers who were having another baby around the same time as me, from a social perspective.

The twins antenatal day also included a tour of the delivery suite (including the entrances to the operating theatres and SCBU, and the transitional care ward) at the Birmingham Women’s Hospital. This is what really sold it to me, because I have never given birth in a hospital room, and not in this hospital at all. Andrew and Joel were born in the midwife led birth centre in Cambridge – with lovely homely rooms that look nothing like a hospital, with no monitoring equipment, a birth pool, a normal bed, low level lights etc. Well actually, Joel was nearly born in the reception area, but we just made it into a room! I found it very reassuring to see where I will be giving birth this time.

Before we found out it was twins, I’d decided we would stay at home for the birth, because I’d only just made it to the birth centre last time, and having done labour twice before with no pain relief or complications, I now had confidence that my body can do it. Both my labours have followed similar patterns – some sporadic, irregular, non-painful but uncomfortable tightenings/Braxton Hicks for a few hours, then a sudden gushing of the waters breaking, followed by a quick ramp up in strong, painful and regular contractions until pushing and then delivery. The time from waters breaking to delivery was about 3 hours with Andrew and about 1 hour with Joel. However, twins is automatically considered “high risk”, so I’m “not allowed” to have a home birth or go to the birth centre. Though actually, as the home birth coordinator midwife pointed out to me when I rang her to tell of the twins news and that I’d no longer need to meet with her, there’s no legal reason why I can’t ignore the doctors and have a home birth, it is ultimately my choice. I just feel this is one step too far in going against medical advice, so we will try to get to the hospital. I wouldn’t be at all surprised though if we ended up with an accidental home birth, because quite frankly I’d rather have a home birth than a car birth!

This is, however, assuming that twin 1 is in a head down position by around 32-34 weeks, after which point they are unlikely to turn due to lack of space. At the antenatal class the midwife showed us a diagram of the various permutations of twin positions. There were 6 in total, and only for 2 of them would I “be allowed” to attempt a vaginal delivery, the other 4 would automatically mean a planned c-section. Basically twin 1 has to be head down, and twin 2 can be bottom down or head down – twin 2 is likely to move anyway once twin 1 is born and he/she suddenly has half a womb’s more space to spin about in! If twin 1 is bottom down, or if either/both of them are transverse (lying horizontal instead of vertical), that would mean a c-section. So I am hoping that twin 1 gets head down at the right time, though if not I will do my own research on the risks of attempting a breech (bottom first) birth, particularly with my good delivery history, rather than simply going along with what the doctors demand without question. They seem happy enough that twin 2 can have a breech vaginal birth, just once twin 1’s head has paved the way. I asked what would happen if twin 1 was bottom first and I went into a spontaneous and fast labour before a planned c-section date – the answer was an immediate emergency c-section, which would be a race between doctors and babies I think.

When we were hearing about these birth options in the class, the midwife posed the question – who decides how the babies will be born? I answered “me!”, because ultimately I know it’s my body and my decision, and I think she already knows from seeing me in clinic that I’m going to be “one of those” who doesn’t just go along with what the doctors say without question. They talk of what is and isn’t “allowed” – but what they really mean in most cases is what is and isn’t advised in their professional opinion, and even that can differ between individual doctors. What she actually was trying to get at though is that the babies themselves determine how they will be born, depending on their position before and during labour. I see her point, and I’m not against having a c-section if it ensures that the babies and I survive any threat to our lives. Of course I’m glad that medical intervention exists when it is needed. But I am aware that it does come with risks itself, not to mention the recovery from surgery.

I did feel a little on my own amongst the mums at the class for really wanting to have a vaginal twin birth. We were all carrying “DCDA” twins – two placentas and two amniotic sacs, so the least risky in terms of likelihood of complications, and the only kind for which we are “allowed” to attempt a vaginal birth at this hospital. Three had already chosen a planned c-section – because they had had one with their older singleton, and even I’m not sure I would want to attempt a twin VBAC (vaginal birth after caesarean). One was a first time mum and was still unsure what she wanted, and one had previously had an emergency c-section and a VBAC with her two singletons, so was probably going to attempt a second VBAC since the first had gone well. It made me very aware of how blessed I’ve been with uncomplicated labours and deliveries, which sets me up well, both mentally and physically, for doing it again with twins. I’m also aware that all of these thoughts about birth are based on my pregnancy staying uncomplicated and the twins not arriving early or needing to be delivered prematurely for whatever reason. I’ll write more about that next week, along with what happens in the case of the other extreme of timing – potential induction of labour if the twins arrive “late”.

As well as the information from the midwife about labour and delivery at the hospital, she had invited three families with twins of different ages to come along and chat to us about their experiences. All of them only had the twins, no older or younger singletons. It was interesting to hear from them, but a lot of what we ended up talking about I either knew from having had babies before, or I’ve seen from other twin mums online in the twins groups on Facebook that I’ve joined. For example – the lack of knowledgeable breastfeeding support from the NHS and the fact that babies don’t sleep for very long at a time. Some of their tips were of a different parenting style from ours, so they weren’t something I would take on board. And I think Tom felt a bit left out when the dads were discussing the pros and cons of different brands of double pram, as we aren’t getting one!

I think that’s probably enough writing for one week. Next week I will write more about the potential timing of birth that we discussed in the class, as this is related to the fact that 24 weeks is an important milestone in any pregnancy – it is the point at which a foetus is thought to be “viable”, with just over 50% chance of survival if born in the 24th week, providing there is intensive medical care available.

21 weeks – twin comments

This week has been fairly quiet, so I’ve had my head down concentrating on getting a fair amount of work done before we go away next week for half term.


My working hours are still quite reduced compared to what they were, due to the ongoing nausea. Before this pregnancy, I usually worked when Joel was at his 15 hours of free nursery (two mornings and one afternoon), and for an hour or so each evening whilst Tom did the bedtime routine with the boys, plus Saturday mornings. I can’t work in the afternoons and evenings still, because that’s when the nausea gets worse so I have to rest or risk vomiting. This week Tom’s mum has been staying with us, so she’s been looking after Joel, and I’ve had more time in the mornings to work when I’m feeling at my best. I’m very grateful for this! My income has been reduced these past few months, and although we don’t rely on it for our monthly budget, it’s nice to be able to contribute what I can for extras and savings. There’s no sick pay when you’re self employed, unlike when I had to have time off work in my previous pregnancies as an employee.

I thought I’d also write this week about the various comments that I’m finding people make once they know I’m expecting twins. It’s like being pregnant with twins means people think they can openly voice all their questions and opinions when talking to you. Or maybe they just don’t think, and open their mouths to say exactly what’s on their mind. It’s not everyone by any means, but often people I barely know or complete strangers.

There have been plenty of comments along the lines of “wow that’ll be hard work” or “oh you’ll have your hands full then”. Well actually I’m planning on using slings as much as possible, like I did when I had two singletons under 2 years old, so I don’t plan on literally having my hands full all the time. But yes, life will be busy for us, I have no doubt about that. We didn’t plan twins, but we are happy to have been given this blessing, and grateful that we have a good support network of family and friends in place. Comments about how hard it will be aren’t very helpful. They focus on the negatives, rather than on the positives of how rewarding and special it is to experience parenting twins. I’m told by other twin parents that comments like this are pretty common, in pregnancy, the baby and toddler years, and beyond.

Some comments have been related to the babies’ sex, which, as I explained last week, we won’t be finding out until birth. Since we already have two boys, some people have expressed concern over us having two more boys. I think the “best” (read: made me most speechless) comment so far has been “what will you do if they’re both boys?” I didn’t quite know what to say to that! In my head I felt like saying “well what would you suggest? Send them back?! Chop their willies off and pretend they’re girls?!” I mean seriously what is that supposed to mean?! I have no issue with four boys, or three boys and a girl or two of each for that matter. As long as they are healthy, I will be happy, and I won’t need to “do” anything if they’re both boys .

A few people have ventured as far as asking me if they are “natural” or IVF babies. Whilst I’ve been very open on the blog about how we got here, conceiving them fairly quickly after a miscarriage, this has all been shared on my terms in as much detail as I am comfortable with. I find it really rude to be asked  this straight out by people I hardly/don’t know. The question is basically enquiring about two things – whether we have enough money to afford IVF treatment (since we already have children, it wouldn’t be free on the NHS), and/or what Tom and I get up to in private. Both of these are sensitive information, but somehow when it comes to twins, some people find it acceptable to ask about them!

Anyway, I’m sure I’ll get used to these comments, it sounds like I’ll have to. This little graphic I saw online this week made me laugh, there are some great come backs here to the question “are they twins?” that I’ll have to remember.


On a more positive note, I won a set of cloth nappies this week in a giveaway on Facebook! I’m so excited by this, mainly because I never win anything. I sorted out our cloth nappy stash a couple of weeks ago, and whilst most of it is still functional, lots of them are looking a little tired after having been used on two or more kids, so it will be lovely for the twins to have some brand new nappies amongst all the hand-me-downs. I’m sure we will get comments about how on earth is it possible to cloth nappy twins?! I’m not daunted by this – we’ve done 9 months of two kids in full time cloth nappies before, and another year of one full time plus one night time, and that was in a tiny flat with limited drying space. I certainly don’t want two babies worth of disposables filling up our bins and going to landfill, or spending a fortune on disposables for two!

These are the “Real Easy” all in one nappies that I won. Such cute prints!

Next week we are off for a relaxing break with family, so I may or may not write next week, depending on whether there’s anything pregnancy related to report.