Multiple Births in the Second Trimester

You will be able to feel your babies move and hear their hearts beat during this trimester.

Taking Care of Yourself

• Keep your prenatal care appointments. Because you are expecting multiples, you will probably see your health care provider twice a month during this trimester.

• Sign up for childbirth classes, particularly those aimed at parents of multiples.

• Involve your partner.

• Take care of yourself. There are limits on your energy, so limit your activities. Take time to relax and take naps when you can.

• Tell people at work that you are pregnant.

Changes in You

Your Body

Your body is changing quickly in this trimester. To meet the demands of your multiple pregnancy, your body is gaining weight. Being at a healthy weight is important for you and your babies.  The weight you gain now is not just extra fat. The important thing is that your weight gain is steady, with no sudden increase or decrease. How much you should gain depends on your weight before getting pregnant. Check with your health care provider to find out what is right for you.

As the weeks go by, your growing uterus pushes on other organs and you will feel more pressure on your bladder and stomach.

Your Moods

Mood swings are normal. They could be due to shifts in hormone levels. Or they might reflect all the changes in your life right now. Talk to your friends about your feelings. Seek out women friends or relatives. Spend time alone with your partner. Limit sugar and caffeine. Stay active, but get plenty of rest.

Second Trimester Visits

During this trimester, you will probably see your health care provider twice a month. It's important to keep your provider appointments to ensure that you are getting the best prenatal care possible.

Second Trimester Tests

During this trimester, your health care provider may order several prenatal tests:

AFP and triple marker tests.  You may have an AFP (alpha-fetoprotein) or a Triple Marker Test. These screen your growing babies for signs of certain birth defects. If the results are higher or lower than normal, other tests such as amniocentesis or ultrasound may be needed. This also may be the first indication that you are carrying multiples.

Amniocentesis.  Amniocentesis tests for genetic problems and certain birth defects. A sample of fluid that surrounds your babies (amniotic fluid) is removed and tested. Your provider will talk to you about the risks of this procedure.

Ultrasound.  During this harmless test, sound waves are bounced off your babies' bodies. The echo of the returning waves creates an image of the growing children. If you and your provider don't yet know you are having multiples, this test will show that there is more than one baby. Regular ultrasound tests are done during a multiple pregnancy to check on how well the babies are growing. Growth differences can be a sign of a problem.

RH factor.  If you are Rh negative you will be given a second blood test near your 28th week. If you have not formed Rh antibodies, you will be given an injection of RhoGam. This medication prevents Rh antibodies from forming. You will be treated every time fetal blood might mix with yours (for instance, after an amniocentesis or after the birth of your babies).

Blood glucose screening.  Blood glucose screening is a test for gestational diabetes, which is more common in a multiple pregnancy. If you have gestational diabetes, changes in your body during pregnancy cause there to be too much sugar in your blood. This can be controlled with diet and, if needed, medicine.

Monitoring for Preterm Labor and Preeclampsia

Beginning around the 20^th week of pregnancy, your provider will monitor you for preterm labor. An internal exam or a vaginal ultrasound will show whether your cervix is shortening, which may indicate that labor may begin soon.

Your provider will also check your blood pressure regularly for preeclampsia a condition that may occur during pregnancy. This condition is associated with high blood pressure and is is three to five times more likely in a woman carrying multiples.

Adapting Your Lifestyle

Work

Because carrying multiples is so demanding on your body, your health care provider may recommend that you take an early leave from work during this trimester.

Travel

Because a multiple pregnancy is considered high risk, you may need to curtail travel plans during this trimester and the next. Talk to your health care provider if you have questions about traveling, but generally a woman carrying multiples should avoid air travel. For other types of travel, always:

• Wear a seat belt when you ride in a motor vehicle. Fasten the lap part under your belly. Wear the shoulder part also.

• Take frequent breaks during long trips. Move around to stretch your legs.

• Avoid hot climates or high altitudes if you are not used to them.

• Avoid places where the food and water might make you sick.

Taking Time to Relax

Carrying multiples may make you feel more uncomfortable than carrying a single child because your uterus grows larger. A multiple pregnancy also may leave you feeling more tired. Make sure you get at least eight hours of sleep at night and periods of rest during the day. You don't have to nap; sitting and relaxing is fine. Avoid sleeping or lying on your back; instead lie on your side and switch sides often. Limit your tasks and activities for the times of day when you have the most energy.

Intimacy

Talk to your health care provider about the risks of sex during this trimester. In a high-risk pregnancy such as a multiple pregnancy, you may have to forego sex because orgasm can cause mild uterine contractions. These contractions may lead to premature labor.

A Safe Environment

• When you clean house or use scented products, follow these precautions:

• Wear gloves when using cleaning products.

• Open windows to let in fresh air.

• Avoid secondhand smoke.

• Don't breathe fumes from nail polish, hair spray, cleansers or other chemicals.

Nutrition

When you are pregnant with multiples, you need extra iron. Iron-deficiency anemia is common in multiple pregnancies, so you should continue to take the iron supplement prescribed by your health care provider. Anemia may make take away your appetite and make you feel extremely tired. Iron is absorbed more easily when you take your supplement with foods high in acid or vitamin C.

In addition to iron, you should make sure you get enough calories. You need about 300 extra calories each day when you are carrying multiples. These extra calories should come in the form of one extra serving of protein, one extra serving of calcium and one extra serving of whole grains.

You should drink at least eight 8-ounce glasses of fluids daily. You and your growing babies need fluids. Fluids decrease your chance of constipation, help the body remove toxins and waste, limit swelling and reduce your risk for bladder infection.

If You Gain Too Much

Gaining too much weight might cause you to feel tired. You could also have a harder pregnancy or birth. If you and your health care provider decide you're gaining too much:

• Eat fewer fats and sugars. Instead, eat fruit, vegetables and whole-grain foods.

• Drink plenty of water between meals.

• Don't diet. You might not get enough of the nutrients you or your babies need.

If You're Not Gaining Enough

One risk in a multiple pregnancy is having low birth-weight babies. That's why it's especially important to gain enough weight. To make sure your weight gain continues:

• Eat many types of foods. Make sure you get enough calcium, protein and carbohydrates.

• Don't skip meals.

• Eat healthy snacks.

• See a dietitian for help.

Exercise and Rest

Toward the end of this trimester, your health care provider may recommend that you cut back on your activities. You may need more bed rest, as well. If you are expecting more than two babies, you may need to restrict your activities even sooner. You should aim for at least eight hours of rest each night, as well as periods of rest during the day. Your provider may recommend that you get help with housework.

Kegel Exercises

Kegel exercises strengthen the pelvic muscles. Doing Kegels daily helps prepare these muscles for delivery. Kegels also help ease your recovery. You exercise these muscles by tightening, holding, then relaxing them. To do one type of Kegel exercise, follow the steps below:

• Contract as if you were stopping your urine stream (but do it when you're not urinating).

• Hold for 10 seconds, then repeat 10 times. Do this a few times a day.

Backaches

You may start to have backaches in this trimester. If you have backaches:

• Practice good posture. Stand with your ears, shoulder, and hips in a line. Try to tighten your abdominal muscles.

• Do pelvic tilts at least twice a day: Pelvic tilts help strengthen your abdominal muscles and low back. Do them on your hands and knees. Here’s how to do them:

  • Relax the back of your neck.

  • Pull your abdomen in until your low back flattens.

  • Hold for 30 seconds.

  • Release.

  • Repeat 10 times.

  • Lift correctly; lower your body by bending your knees and rise by pushing up with your thighs.

• When you go to sleep, rest on your side instead of your back. Try different positions to support your body. You could lie on your side with your knees slightly bent. You could put a pillow between your knees and another beneath your belly.

Swelling in Your Legs

You may notice swelling in your feet and legs. To help reduce this swelling:

• Sit with your feet raised as often as you can and don't cross your legs.

• Move around when you're on your feet. Shift your weight often.

• Put one foot up on a step or stool when standing in one place.