For Twins or More: What to Consider in Your Third Trimester

Now that you're in your third trimester and pregnant with multiples, you're likely getting easily fatigued. Your body is working hard to help carry and nourish you and your babies.

While you may have a million things you feel you need to do, it’s crucial that you take care of yourself over these next few weeks. Limit your activities, relax, and get the rest you need. Ask your healthcare provider when you should stop working. 

To help you tackle one thing at time, keep this to-do list. This will keep you from getting overwhelmed. If you have any questions about what to expect or watch for in your third trimester, talk to your healthcare provider.

Stay in tune with your weight

Remember, weight gain varies from one woman to the next. But a healthy weight gain lowers the risk of having a low birth weight baby.  Expect to gain around 1.5 pounds per week during the third trimester. 

Keep up with your prenatal visits

You’ll have checkups more often in the third trimester. You’ll see your healthcare provider once each week. You may even see him or her twice in one week. He or she will check the health of you and your babies.

During this trimester, you may need more tests. These may include an ultrasound to check on your babies' growth and amniotic fluid. You may also need a non-stress test. This test checks your babies' heartbeat and how they are moving. At your visits, ask your healthcare provider any questions about your pregnancy, labor, and birth.

Explore childbirth classes

If you haven't already attended childbirth classes, try doing so right away. Because you’re at high risk for preterm labor, you should take your classes early. You may also need to be put on bed rest, so take classes now.

Some of the information won’t apply to you because you’re having more than one baby. Ask your healthcare provider if there’s a nurse educator you could meet with. He or she may offer tips on delivering multiples. Or look for childbirth classes made for mothers of multiples.

Make breastfeeding decisions

Ask your healthcare provider the best way to feed your babies. Your body can make enough milk to feed more than one baby if you choose to breastfeed.

Get breastfeeding help from a lactation consultant and a pediatrician. They can help you with positioning your babies, feeding schedules, and pumping breast milk. Breastfeeding offers many health benefits for your babies.

But keep in mind the decision to breastfeed or bottle-feed is yours. No one should make you feel guilty for your choice. Other mothers of multiples may offer helpful advice based on their experience.

Learn signs of preterm labor

Because you’re carrying multiples, you’re at risk for preterm birth. This means giving birth before 37 weeks.

If you have preterm labor, your healthcare provider may put you on bed rest. Or he or she may give you medicine to stop labor. If your provider thinks labor cannot be stopped, you may receive medicines to help your babies’ lungs form. This can reduce the chances of other health problems at birth.

Call your healthcare provider if you have any signs of preterm labor. Symptoms may include the following:

  • More than four to five contractions per hour  

  • Regular contractions that happen more often

  • Rhythmic pelvic pain or pain that doesn’t go away

  • Cramps that feel like menstrual pain

  • Constant low back pain

  • Stomach pain. You may also have diarrhea.

  • A change in vaginal discharge

  • Vaginal bleeding

  • Uneasy or urgent sense that something is wrong

Be aware of preeclampsia symptoms

Mothers of multiples are at high risk for preeclampsia. This is a type of high blood pressure that happens during pregnancy. Your healthcare provider will watch you closely for any signs of this issue. Symptoms may include a rise in your blood pressure or protein in your urine. 

Other symptoms your healthcare provider will look for include the following. You should look out for these symptoms, too:

  • Puffiness or swelling in your face, hands or feet

  • Gaining more than two pounds in a week or one pound in a day

  • Shortness of breath

  • Blurred vision

  • Severe headache

  • Dizziness

Get clear directions about bed rest

Your healthcare provider may order bed rest if there’s a concern you’re developing preeclampsia or preterm labor. You need to understand exactly what your provider means by bed rest. Sometimes bed rest means frequent rest. But more often, bed rest means staying in bed all the time.

If you must be on bed rest, plan to have someone help you with your responsibilities. If needed, make plans with your employer to take time off from work. Being on bed rest may leave you feeling overwhelmed, frustrated, anxious, or down.  Remember that this is temporary. You’re doing what’s best for your babies.

Meet with pediatricians

Now is the time to choose a pediatrician. This is the doctor who will care for your babies. Ask for pediatrician recommendations from friends or your insurance plan. Make a list of pediatricians and make an appointment to speak with them.

Some multiples are born with health issues. They may need to see their pediatrician often. So, choose an office close to your home.

When interviewing pediatricians, ask them the following questions:

  • How many pediatricians are in your practice? Who will see my babies if one or more is sick?

  • Who speaks with me when I call with a question? How long should it take before someone calls me back?

  • What hospitals are you affiliated with?

  • Do you support breastfeeding multiples?

  • Who can I call if my baby is sick in the middle of the night?

  • How many other sets of multiples do you treat?

Talk with siblings

If you have other children at home, their life is going to change in a big way. This transition may be tricky. Talk with siblings about the babies. Involve them in some decisions, like what color to paint the babies' room or where to put the high chairs. Try to prepare siblings for the amount of attention the babies will need. Be aware of possible behavior changes in siblings when the babies come home.

Online Medical Reviewer: Bowers, Nancy, RN, BSN, MPHFoley, Maryann, RN, BSN

Date Last Reviewed: 5/1/2016

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