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Pros/Cons of Early Ultrasound Discovery of Twins (UPDATED: RESULTS)

post #1 of 36
Thread Starter 
Hi all,
I have some significant physical and spiritual reasons for believing I am around 7 weeks pregnant with twins, and I'd like to learn the pros and cons of having an early ultrasound to learn the truth. My homebirth midwife gave me an article on the unsung risks of ultrasound which is quite compelling, and urged me to wait until around 16-20 weeks instead of doing it now because the babies will be at a less vulnerable stage developmentally by then. She also argued that even if we discover there are twins now, with as many as 1 in 8 pregnancies estimated as beginning as twins, we'd have to have a later ultrasound anyway to confirm both survived. So, she said, why not just find a way to live with the mystery for now and do only one ultrasound in mid-pregnancy? (She, by the way, does also feel strongly that there are twins in there.)

My question is, are there other reasons I should put on the scale of decision here? I feel like I read one of you saying that an early ultrasound was better for determining mono vs di and if mono how much is shared? If that can be discovered now and not as well later, then should we try to get this knowledge to help guide our decisions in the birth (given that we are planning a home waterbirth)? Is there anything else other than just satisfying my "need to know" personality?

Thank you and much respect to you all.
post #2 of 36
Satisfyingly that "need to know" is a very personal decision. I was also planning a homebirth and had NO reason to suspect twins but still had a STRONG feeling that I needed an ultrasound despite my midwife's strong opposition to them. At 9 weeks I went into an OB's office for US and poof, 2 babies. I feel like my compulsion for an US was for a reason and I trusted my mothering voice. I guess that is what I think it comes down to. Why are you going to start now not trusting your voice?

On that note, a twin pregnancy is VERY different than a singleton pregnancy. Early weight gain is a lot of work and crucial to positive outcomes for twins. I was also still nursing and would have defiantly continued through a singleton pregnancy which even Ina May strongly recommends against. Knowing early, I could take the first 4 1/2 months to very slowly wean my daughter instead of a quick and dirty painful weaning.

Midwifes are a gift to us and have so much wisdom. I think the most important thing mine helped me do was to trust myself. Feel empowered either way....

Good luck with your pregnancy!!

DS 6, DD 2, Twin DDs 9 mos
post #3 of 36
Thread Starter 
Thank you for these words of support and your perspective. I didn't know early weight gain in twin pregnancies was crucial, or that nursing in pregnancy is frowned upon by Ina May. I'm nursing two right now - and I've lost weight the past 3 weeks, from the nausea/aversions. Keeping my milk supply up is also certainly affecting my ability to gain weight. However, I would definitely not wean my toddlers for a singleton pregnancy. These are important things to consider. Where can I find Ina May's writing on this?
post #4 of 36
I know that Karen Gromada (Mothering multiples author)was the first one who told me that I should not be nursing during a twin pregnancy when I first posted here. she gave me a long compelling argument. Then I purchased Adventures in Tandem Nursing to prepare myself and looked up twins in the index. The "Twins" page is basically all of the reasons that you shouldn't nurse while pregnant with twins. They even quote Karen there. Quite honestly, even though in my heart I wanted to continue nursing her, by then end of my twin pregnancy, my body could not have handled it anyways. I feel like I pushed it to its amazing limit and nursing would have been too much for me. I do know that a couple of mamas here did.....ask them for a different perspective.

FOR the early weight gain data, look at Babrara Luke's When You are Expecting Twins, Triplets, or Quads. It was not written as a very crunchy book but I loved it because it gave me the power to do everything I could to have a healthy twin pregnancy and not be part of the "waiting for bad things to happen in a twin pregnancy group" I know that tricky things can happen anyways, but I at least had tools to know that I had done everything in my power to avoid them. I REALLY struggled to gain weight while I was still nursing so I feel your concern.

These are all important things that made me happy I knew early....

post #5 of 36
Honestly, even if you know there's something wrong early on, what can anyone DO about it anyway? So why expose vulnerable first trimester babies to unnecessary ultrasound? The only argument in favor that I can see for first trimester ultrasound are 1. if you would choose to terminate the pregnancy and 2. if you know you are having twins, you can be sure that your nutrition is adequate.

If you already suspect twins, well, you go ahead and eat right for twins and all will be well.

I don't know much about nursing while pg with twins; my oldest was already weaned when I got pregnant. But I do agree that a twin pregnancy requires significant aggressive nutrition for a positive outcome.
post #6 of 36
Thread Starter 
Thank you again, Tassy. I will look into these resources. I had "Adventures" at home while I was pg w/#2 and nursing #1, but skipped the multiples section! I will pick it up again. I've done some research to find Ina May's writing on it but haven't found any. If you or someone else can point me to it, that would be very helpful. I do know my body can't maintain a supply while pregnant with one, let alone two. My milk was gone by ~13 weeks last time, and I am noticing a drop off already now at 7 weeks. So maybe my body will take care of that itself.

I also want to note that I would like to do more reading about early ultrasound's ability to determine the exact nature of the twins (mono vs di, how much is shared if mono) and the advantages of that knowledge for managing the birth. I think I just read someone in passing mention it here but I feel like I need confirmation of that before getting an ultrasound now with that as part of the reasoning. Can anyone help with that?
post #7 of 36
I didn't suspect twins and wanted very much to avoid the typical medicalization of pregnancy so I didn't have an u/s until 21 wks. The twins were a big surprise. Luckily I had gained about 20 lbs by that time and was working with a midwife who didn't discourage my weight gain the way a typical OB might have during the first trimester.

Really, you have to trust your own heart. I do believe there are risks with u/s particularly in the early weeks. And there's no question that once twins are discovered there is huge pressure for ongoing u/s and other testing. But again, you need to do what feels right to you.

BTW, twin pregnancy can be w/o complication. Read the Elizabeth Noble book if you'd like a more positive perspective. But the PP is right that Barbara Luke's book is good for diet. I also found the Brewer diet adapted for twins to be really helpful. It can be found at www.blueribbonbabies.com.

In any case good luck and best wishes for a gentle birth.
post #8 of 36
I'm for early discovery, so that you can immediately get on an appropriate eating plan--it's not just merely more intake of what you'd eat with a singleton. Depending on the circumstances, you may not gain much weight, but it is important if you can to have those extra nutrients/protein available. Will it be a catastrophe if you don't? No. But sometimes in "unusual" circumstances you have to make a hard decision as to ideals vs. information. It's not all or nothing, you can choose each individual time and situation. (For example, having a 7 week ultrasound but not the level II they'll offer later, or asking for a level II at 20 weeks instead of getting the preliminary one, so you're exposing the baby(ies) to less U/S, or getting of one the placental screens--and not doing the u/s unless it's out of whack.)

As to nursing through the pregnancy--I nursed my daughter with the full blessing and encouragement of my perinatologist through my entire (High stress, TTTS) pregnancy. Yet by following Dr. DeLia's advice the TTTS symptoms slowed/didn't advance later on in the pregnancy (very unsusal), and it was all nutrition based. I don't think you have to beat yourself up if you have an ideal for nursing during pregnancy but have to cut it off because you can't deal with it or something happens physiologically (like non-Brax contractions--I never had a problem with that). But I don't think you have to rule it out either, if it's a source of comfort to you.

One thing, if you are truly pregnant with twins, that you're going to have constantly in your face (both spiritually, emotionally, and physically) is learning how to deal with flexibility, to be content/thrive in situations that you wouldn't have chosen, to let go of a few ultimate ideals (especially in regards to message-board style AP) but also to gain a few new ones that will make you proud.

I don't think there are any pros or cons that would apply to everyone. After my personal experience, I personally would want to know early...because I would be driving myself crazy without that information. If you can be at peace without that info, then don't let anyone push you into something else. If you have a gut feeling about multiples, then you can always start the extra nutrition anyway, until you can find out more info by a less invasive method later.
post #9 of 36
We didn't know we were having twins until 26 weeks. All along, I'd been eating more (because my body was demanding more--I get morning sickness when my stomach is empty, and it was emptying much faster). I think the PPs have given you a lot of good reasons to evaluate if knowing earlier would be helpful for you. It wasn't crucial for me to know because I was instinctively eating more and I was not nursing at the time.

Michelle G.
post #10 of 36
It is true that in alot of cases they can more easily tell the zygosity of twins by early ultrasound and you can then be watched more closely for TTTS. If you plan on eating more and weaning your little ones anyways, then it isn't as necessary to find out now. TTTS is usually diagnosed in the second trimester through level 2 u/s. (I looked it up on the internet.) Waiting until 20 weeks probably isn't a good idea if you are pretty sure it is twins, but waiting until the 1st trimester is over could be a good idea. Like the previous posters said, you have to do what your mommy instinct tells you. If you wait, then definitely be sure to eat for twins.
post #11 of 36
I would suggest early ultrasound... one by like 10-12 weeks to determine not only if they are twins, but to determine if they share an amnion and/or chorion. MZ twins are at very high risk for a number of issues and generally need to be closely monitored. At about 10-12 weeks you can tell how closely you would need to be monitored or if you need to at all. I think 7 weeks is Def too early. My 7 week U/S showed Mono/Mono twins, but at 12 weeks we found the membrane of the amnionic sacs and the single chorion. If you wait too much later though, It can be hard to tell if they are MZ and you might get the wrong treatment (too few or too many U/S).

As for breastfeeding, I nursed my son for the first 14 weeks or so and slow weaned him during that time. I don't think there is any harm in continuing if you feel ok, are eating enough and aren't contracting alot when you do nurse.
post #12 of 36
Thread Starter 
Excellent suggestions and perspectives, from all. Thank you for taking the time to share this with me. It *will* affect my decision. I'm leaning towards a compromise position of waiting until 12-13 weeks rather than 16-20 weeks so that the embryonic phase is over and the risk of vanishing twin is lessened, but that the ultrasound tech can tell what's going on with the placentas/sacs. Dh and I will have to discuss it. Until then, I'll just assume there are two and begin the twin diet. No harm done with that! I wonder if the more pronounced nausea may be due to me not being able to keep on top of my body's needs for nutrients. As soon as I get a little hungry I get sick and then can't eat. I will investigate these diets and get on track so we all will grow-grow-grow!
post #13 of 36
I didn't find out I was having twins til 18w, and they were dx with TTTS that same day. (I also talked to Dr. DeLia and followed his nutritional plan, and the TTTS never got any worse for me either, although it was scary for the whole pregnancy.)

I think your compromise is a good one. At 7w, I don't think they could see how many sacs/placentas the babies have. At 12w they probably could.

Like others have said, a twin pregnancy can be more complicated -- or not. I'd feel that a DZ pregnancy was just a "normal" pregnancy that happened to include two babies! MZ twins is when things can get a little complicated. Or a lot.
post #14 of 36
I personally didn't find out til 26 weeks but would have been happy not to have officially known at all. However, potential TTTS *is* a good reason for u/s, so your plan to have one in the 12-13 range is sound. However, I'm kind of shocked to hear so much negativity surrounding the concept of nursing during a twin pregnancy. I know 1 woman here who did it and had her twins at home at 40+ weeks, big and healthy. I know of a triplet mom here who nursed all the way through (and beyond) her trip pregnancy too. I'm sure they aren't the only ones. I know Karen Gromada is sort of looked up to, and I'm thrilled that she prompts an AP lifestyle for even us parents of multiples, but I'm pretty sure she speaks out against homebirth for twins and just may err a little on the conservative side. So does Ina May, as much as I adore her work in general (doesn't mean I agree with 100% of what she believes). As for early weight gain, I'm not totally convinced of this. I am convinced that good nutrition is crucial, but I'm not so sure about weight gain, per se. We all handle things differently and it's just such a blanket statement to say (as Dr. Luke does) that you must reach 26 lbs by 26 weeks (or whatever the number is). I sure didn't - I couldn't! - and my babes were born full term at just shy of 7 & 8 lbs each. I actually only gained a total of 36 lbs. I literally couldn't stomach much, especially in early pregnancy, so gaining that much just couldn't happen for me (I would have thrown up from forcing what I simply could not fit). So please bear in mind that we're all different and we should act accordingly. I guess what I'm trying to say here is, take everyone's word (including mine ) with a grain of salt and do whatever *you* feel is right for you & your children. Can't wait to hear though if you ARE carrying twins in there!
post #15 of 36
The early weight gain would probably be the most crucial reason to know. Hopefully your body will tell you this anyway. My morning sickness was worse if I didn't eat every 2 hours. I'm 17 weeks with fraternal twins.

Normally, your calories would be going towards the new babies. If you are still breastfeeding, a significant amount of your calories are required to make milk. Believe me, it's hard enough making yourself eat as much as you need to for optimal birth weight twins.

If you don't want to wean unnecessarily, I would go for the ultrasound.
post #16 of 36
I found out at 12 weeks. I was so glad I did. I was totally exhausted and breastfeeding was so draining. I had planned on breastfeeding during the pregnancy and I just couldn't keep up and didn't understand why. I gained no weight until I slowly started weaning, which is was not what I wanted.

I also knew to immediately change my diet to way more protein and that extra water and sleep were needed. I had more time to line up help.

Knowing that mine had their own sacs also helped to know what kind of risks the babies would have. I could plan out a little better what kind of care I wanted to do. I knew I wanted a normal pregnancy and had time to read up and make decisions.
post #17 of 36
Originally Posted by HennaLady View Post
I wonder if the more pronounced nausea may be due to me not being able to keep on top of my body's needs for nutrients. As soon as I get a little hungry I get sick and then can't eat.
With all my pregnancies, I always felt sick if I got hungry. The very food that sounded good 10 minutes before would make me feel nauseous when I had it prepared (though for me, if I forced myself to eat a little, I'd feel better soon and be able to eat more).

It helped me to have good nutritious foods (such as stews with lots of veggies and meat, but little starch) ready to reheat quickly. If you like hardboiled eggs, keep some cooked and ready to eat in the fridge (or even make them into devilled eggs--when you're pregnant with twins the extra calories can be helpful). Make two protein smoothies at once, so you can have the second in the fridge ready to eat at a moment's notice. I'm sure others have other ideas of quick high protein snacks if you'd like them.
post #18 of 36
A lot of this has been talked around already, but here's my take on it:

I would not have an early ultrasound (prior to 12 weeks) unless I was very concerned that my intentions of nutrition with twins in mind would flop without the certainty of knowing two were on board. "Vanishing twin" is common in early pregnancy. Few complications can be addressed medically that early in the pregnancy. In my mind, the risks of ultrasound don't outweigh any benefits at that point.

I would have an ultrasound at 12-14 weeks to confirm twins as this is a good window to determine whether there are two placentas and two amniotic sacs. (If yes, it's either fraternal twins, or identicals that each have their own placenta = less prone to complications). If the ultrasound clearly showed that each baby had own placenta, I would not have further ultrasounds, given the tendency that twin pregnancies get overmedicalized even more than singleton pregnancies. YumaDoula said it best: A DZ pregnancy is a lot like "normal" but with two babies on board.

The ultrasound technician looks for the Lambda sign, which is a T-shape where the membrane that divides the two amniotic sacs joins the placenta. If they can't find one at all, it's a sign of the very high-risk mono-mono twin pregnancy (both babes in one amniotic sac - very rare). As I've been told, as the pregnancy advances, it gets very difficult to see if the placenta is a single one, or two that have fused. 14-weeks sounds to be about the end of the timeframe to see this clearly. The reason it is significant is that a shared placenta puts the pregnancy at risk of TTTS or IUGR.

Although 12-14 weeks is still early in a pregnancy, I am glad to have had an ultrasound then and several more that followed. For my husband and I, the risks of ultrasound were not as compelling as the benefit of ultrasound in monitoring for TTTS. TTTS has a high mortality rate if undiagnosed, but if diagnosed, can be managed in various ways to get those babies into your arms!

So if I were you, I'd:
1. eat for twins anyway and not have a 7week ultrasound
2. have a 12-14 week ultrasound.
3. if 2 placentas, carry on like a singleton pregnancy (but with the extra nutrition and rest focus, naturally)
4. if shared placenta, have bi-weekly ultrasounds after 16 weeks (more if something like TTTS developed, obviously)
. . . just my two-cents worth.
post #19 of 36
^^^ That's exactly what we did.
post #20 of 36
Originally Posted by Tigerchild View Post
One thing, if you are truly pregnant with twins, that you're going to have constantly in your face (both spiritually, emotionally, and physically) is learning how to deal with flexibility, to be content/thrive in situations that you wouldn't have chosen, to let go of a few ultimate ideals (especially in regards to message-board style AP) but also to gain a few new ones that will make you proud.
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