Taking care of yourself during a multiple pregnancy starts with eating well – except that little research has been done on what that means for a mother carrying multiples.

In the absence of any real science, it’s probably best to aim for healthy, balanced meals. You will need to drink plenty of fluid, ideally eight large glasses of water a day as a minimum. It’s worth bearing in mind that sugary snacks can give you highs and lows which may be unpleasant. Slow-burning foods such as whole grain breads and crackers, vegetables, beans, oats, brown rice and whole grain pasta will tend to keep your blood sugar more stable and may satisfy you for longer.

You will need more protein, calcium, iron, folic acid and Vitamin B12 than in a singleton pregnancy, so make sure you have a varied diet. Try to eat little and often. Fresh foods are likely to give your body more of what it needs nutritionally than foods that have been processed. Taking a pregnancy supplement is also a good idea.

How big will I get?

Expectant mothers vary in size as in any pregnancy, but you can certainly expect to gain more weight than women carrying a singleton. In addition to the extra baby or babies, multiples mums carry extra placentas, amniotic fluid and maternal body fluid.

As the babies grow, keeping physically comfortable can be a challenge. It’s probably best not to plan a huge amount of activity for the last few weeks of pregnancy – getting in and out of cars as well as negotiating seatbelts can become difficult, and you will probably be more tired with all the extra work your body is doing. It can help to swap tips with other pregnant mums (as well as share experiences and get a little sisterly support)

Boring but important, pelvic floor exercises do minimise the risk of a prolapsed uterus later in life, as well as help your pelvic floor return to normal after the babies are born. To do them, tighten the muscles around your vagina and anus (it feels like stopping the flow of urine) and count to five before relaxing the muscles. Do this ten times, repeating the whole routine five times a day. It can help if you put a discreet note somewhere you’ll see it regularly (such as inside your purse) reminding you to do a set. No one need know…

Gentle exercise during pregnancy can ease tension and help your muscle tone. Don’t do anything where balance is key as your centre of gravity will be changing as your belly grows. Low-impact sports like walking and swimming suit many people. Whatever you choose, start slowly and stop if you feel any cramping, pain or shortness of breath.

Try to look after your emotional wellbeing as well as physical health. The extra hormones can sometimes make you feel emotional and overwhelmed. This is normal, even though it may surprise or upset you when it happens, especially if it isn’t how you usually react.

If you feel stressed or anxious, talk to a health professional or family member.

Preparing for the arrival of your twins, triplets or more!

The prospect of birth can be such a daunting one that many parents find it hard to think beyond that miraculous and improbable event.

Try to bear in mind that once your babies are here, you will be very busy. The time before they arrive is a great opportunity to research some of the practical issues ahead of you, reading up on everything from what happens in a multiple birth to twin/triplet sleep routines.

Go out to teas in your area and meet other multiple parents.

There is nothing like meeting other parents who already have young twins, triplets or more for finding out what you really need to know – such as which equipment you will need extra sets of. You may even be able to pick up some useful items second-hand. SAMBA has a fantastic second hand Facebook page, Moms of Multiples Resale JHB.

Attend Expectant Parents seminar hosted by SAMBA. These seminars will prepare you for the birth of your multiples and give you tips on how to breastfeed, sleep routines, a dads perspective and more.

Bonding

All mothers respond to their babies in different ways, whether they have one baby or four. Some are immediately besotted with them, others initially indifferent. Both of these responses are normal.

Some mothers worry that they will not be able to bond with more than one baby at a time – or that they will have a favourite. And some babies appear more loveable than others.

However you feel at the beginning, your babies will grow on you. Try to make time to cuddle and get to know each of them individually. Bonding with higher multiples can be especially difficult as you have proportionately less time with each baby.

Try roping in some help. Even if it is only once a week, ask a trusted family member or friend to take one or more babies out for a stroll in the pram while you have some special time with just one. Switch babies each time so they all get a turn.

If you are separated from one or more babies – for example, if they are in neonatal care – you may find it hard to believe that the babies are really yours. This can make you feel a little detached, but try not to worry. When you start to look after the babies yourself it will begin to feel real. In the meantime, display photographs of the babies in your home and show photographs to friends.

Common Symptoms

Your body will go on an incredible journey as you nurture the babies developing in your uterus to the point where they can exist outside. Inevitably, there are aches, pains and discomforts along the way because of the sheer scale of the task you are accomplishing. If any symptoms worry you, talk to your doctor or midwife so they can reassure you or do further investigations. Here are some of the most common problems.

Nausea

Morning sickness is badly named. While some women do get a bout of acute nausea in the mornings, others get it in the evenings or even all day. A lucky few don’t suffer it at all.

Higher hormone levels in a multiple pregnancy do make you more likely to suffer nausea, but there are things you can do about it. The main cause is low blood sugar, so try to eat little and often. Some women find regular nibbles of dry biscuits help. Others have found relief by wearing a travel sickness band.

Different foods trigger nausea in different women. The commonest culprits are oily or spicy foods and foods with strong odours. Avoid these if it helps. You can also try eating foods rich in zinc (dairy products, meat, eggs, fish, ginger, maize, nuts and pulses), which has been found to help combat morning sickness. If you vomit three times a day for three days, contact your doctor or midwife for some help so that your body doesn’t start to miss out on important minerals and fluid.

Help with indigestion

Indigestion often gets worse when you are hungry, so eat little and often. Some foods make it worse: try avoiding cheese, spicy foods, tomatoes, chocolate and (if you aren’t avoiding it already) alcohol. A glass of milk before bed can help to neutralise acid in the stomach. You can also try sleeping in a more upright position, either by propping yourself up with pillows or by sticking some books under the bed at the head end. Gentle exercise such as yoga helps some, while others swear by hot drinks like peppermint, ginger and fruit teas. If all else fails, get Gaviscon.

Foot and knee trouble

More fluid circulates round your body in pregnancy and, owing to gravity, some of it collects in your feet. If they swell up, avoid tight-fitting socks or shoes, and sit down with your feet up as often as possible. Gentle exercise such as walking and swimming can help disperse the fluids.

Extra supplies of the hormone relaxin can also leave you with aching knee joints. Again, rest up and support your knees where possible. Although swelling is normal, if it appears suddenly and is accompanied by swelling in your hands and/or face, it may be a sign of preeclampsia. Tell your doctor or midwife if this happens at once so they can rule this out or make sure you get appropriate monitoring.

Varicose veins

The extra blood needed to nurture your babies can put pressure on your veins. Varicose veins are swollen veins just below the skin, and they can become uncomfortable towards the end of pregnancy. A doctor can prescribe support tights or stockings. Shoes with a small heel (not flat and not too high) may reduce the onset of varicose veins. It also helps to put your feet up and avoid long periods of standing.

Birth Plan

The average length of a pregnancy depends on how many babies you are expecting. Twins usually arrive around 37 weeks, triplets at 34 weeks, and quadruplets at 31 weeks, weighing in at an average 5.5lbs (2.49kg) for twins, 4lb (1.8kg) for triplets and 3lb (1.4kg) for quadruplets.

Make sure you have packed your hospital bag and finished antenatal classes well in advance of these dates, as multiples are more likely to come early than most.

Though a birth plan can be helpful, please remember that labour and birth are unpredictable. You will need to be flexible and be prepared to do things differently if complications arise.

Caesarean section

There are lots of reasons why you and your doctor may decide a caesarean is best. Among these, it may be that the babies are lying in the breech position (feet, knees or buttocks down) or transverse position (across your uterus) making a vaginal birth difficult. Or you may have a condition such as placenta praaevia, where the placenta covers the cervix. In these cases you will be booked in for a planned caesarean.

An emergency caesarean is done when a problem occurs during labour and it is necessary to get the babies out. Again, there are many reasons why this can happen, including the babies moving into a difficult position, concerns regarding foetal well-being, high blood pressure that doesn’t respond to treatment, slow progress, or where an assisted delivery (forceps or ventouse) does not work.

Very occasionally, a first baby is born vaginally but the second becomes distressed and has to be delivered by caesarean section. This happens in less than 5 percent of twin births.

Vaginal birth

60% of twin pregnancies result in spontaneous birth before 37 weeks. 75% of triplet pregnancies before 35 weeks. Women with uncomplicated monochorionic (share one placenta) twin pregnancies are offered an elective birth from 36 weeks, continuing uncomplicated twin pregnancies beyond 38 weeks increases the risk of foetal death. Women who decline elective birth must be monitored very closely with weekly scans, weekly biophysical profiles and fortnightly growth scans.

It’s a good idea to write a birth plan expressing your wishes on pain relief, who will be present at the birth, positions for delivery, and whether you want zygosity testing to see if the babies are identical (the placentas will be examined and cord blood sent for analysis, for which you may have to pay), as well as anything else that’s important to you. Bear in mind that the plan will need to be flexible, taking account of how your labour goes. Multiples are nearly always monitored during vaginal birth, even when they haven’t been induced. Your midwife or doctor will strap a thick belt with small pads and sensors onto your abdomen to assess your babies’ heartbeats and the intensity and frequency of contractions. You should still be able to move into different positions as you labour. If external monitors can’t pick up the heartbeats, the first baby will be monitored internally using a foetal scalp electrode attached to the babies’ scalp.

The first stage of labour consists of uterine contractions that open the cervix. Once it is 10cm dilated, you are ready for the second stage: pushing them out. Some hospitals will automatically transfer you to an operating theatre at this point, or your doctor or midwife may think it a good idea. The number of people in the room will vary, but usually includes an obstetrician, anaesthetist, two midwives, one paediatrician for each baby, as well as students and junior staff. If you feel strongly that you don’t want lots of people present, ask for all non-essential staff to wait outside the room until they are needed.

It can take anything up to two hours to deliver the first baby. Sometimes mothers are encouraged to give birth on their backs. It’s worth discussing your options on different birth positions and hospital policy beforehand. With support from your midwives, it is possible to deliver twins safely in different positions, including standing, squatting and on all fours.

If the second stage is going on a bit or there is a risk of the babies becoming distressed, you may be advised to have an assisted delivery using forceps or ventouse (a vacuum device that attaches to the baby’s head). Both procedures involve an episiotomy (small cut to the vaginal wall) which is done under local anaesthetic if you haven’t already had an epidural.

After the first baby is born, the doctor will check the position of the second. It may be necessary to manually move the baby into a head down position. This can be done externally, but it may be necessary to pull the baby out by its feet or to turn the baby internally, which requires pain relief if you haven’t already had it.

It may only be a few minutes before the second baby is born, and it is usually less than 20 minutes. Second babies usually deliver more quickly and easily than first babies.

You should have an opportunity to cuddle your babies before the third and final stage of birth, when you expel the placenta. Waiting to deliver the placenta naturally can take up to an hour, and is not recommended with twins because the larger placentas carry a greater risk of bleeding. Your midwife will probably recommend you have an injection of a drug (Syntocinon or Syntometrine) to contract the uterus and help the placenta deliver quickly, usually within ten minutes. This means you don’t need to push and you will lose less blood.

Work and Finance

Bear in mind that twins, triplets or more are physically demanding, though. It’s a good idea to leave a period for rest and relaxation at the end of your pregnancy, and most people who’ve been there recommend stopping work at some time between 28 and 30 weeks.

There’s no universally agreed date by which you should start maternity leave. How long you continue at work will depend on the kind of tasks you do there, your health and how the pregnancy is going, how flexible your employer can be if you have one, and how you feel.

If you are carrying more than two babies, or have any health complications, you may need to stop working before this.

Maternity leave: useful facts

The most fundamental protection, under The Basic Conditions of Employment Act, is that all pregnant women are entitled to four months’ unpaid maternity leave. This period of leave may start from four weeks before the date the baby is due, or when a doctor or midwife certifies that leave is necessary for the sake of the health of the mother or the child.

Pregnant employees should inform their bosses in writing of when they anticipate beginning their maternity leave. It is worth noting that an employee may not work until six weeks after giving birth, unless her doctor or midwife says she is fit to do so.

Nursing and nightshift

While a woman is nursing a baby, the employer may not ask her to do work that could put her or the child in danger nor can the employer demand that she works a nightshift. Illness of a newborn baby also entitles the employee to take time off work to look after the child until he or she is well again.

If a woman has a miscarriage during the last three months of pregnancy or bears a stillborn child, she is entitled to maternity leave, whether or not she has started her maternity leave period when this event takes place..

Money matters

The employer is not obliged to pay a women her salary while she is on maternity leave – so some companies offer paid maternity leave and others don’t. If the company does offer some paid maternity leave, the information should be in the employment contract.

However, an employee on maternity leave may claim from the Unemployment Insurance Fund (UIF) if she has contributed to the fund for more than four months. The Fund pays between 30% and 58% of the wage or salary that she earned while she was contributing to the fund, depending on her salary. Women on maternity leave may only claim UIF for up to 121 days.

Paternity Leave

What the law says when it comes to paternity leave in South Africa The Basic Conditions of Employment Act (No 75 of 1997), as amended, includes a provision for family responsibility leave in section 27.

Subsection 27(2)(a) determines that an employee is entitled to family responsibility leave when his or her child is born. Therefore, a father is included.

“Paternity leave” is merely a term that is sometimes used to refer to this subsection of the Act, although the Act uses the term “family responsibility leave”.

Nothing prohibits an employer from including an additional special category of leave in the company’s leave policy.

Such categories are quite common in the leave policies of foreign companies.

An employee who has been employed for at least four months and who works at least four days a week for the same employer may take at least three days of paid family responsibility leave during each leave cycle. Family responsibility leave is granted only when an employee’s child is born or is sick, or in the event of the death of an employee’s spouse, life partner, parent, adoptive parent, grandparent, child, adopted child or grandchild, or an employee’s sibling.

An employer may request an employee to provide reasonable proof of events such as these before the employee is paid. In other words, after the employee’s child is born a birth certificate and, possibly, proof of paternity should be provided to the employer.

An employee may take family responsibility leave for a whole day or part of a day.

The leave expires at the end of the annual leave cycle and cannot be accrued.

When an employee takes family responsibility leave, he or she must be paid the usual wages for the day or days in question on the normal payday. — Phil Davel, Solidarity Legal Services

Closing words

You have been blessed with multiples, enjoy every moment of it. Dont be shy to ask for help, there are many pairs of hands out there that would love to help you.