Twins coming a little earlier than thought - what should I expect?

[tilly2019]

Hiya,

Found out Friday that my DCDA twins are going to be delivered next week at 34+4 due partly to higher doppler and one being small (he is on or just under 3rd centile)
Boy was 4lbs at scan 2 days ago. Girl twin was 5lbs 3oz, so she's average.
I think they may gain around 5 ounces by the time they arrive (an ounce a day?).

Anyone know what I can expect in terms of them needing extra care or not? Not sure what to expect. They were hoping to get me to 37 weeks originally, so not sure how much difference those few weeks will make?

Thanks all x

It's hard to call at 34weeks, but I'd assume soem short term breathing help (nasal cannula) and maybe some feeding help (NG tube)
Are they being delivered by c sec? C Sec babies can be a bit "wet" as they don't get the squeeze out vaginal delivery provides so possible a but of C Pap (I think that's the right name) so a little mask to provide higher pressure o2.

However, it's possible they come out little but we'll and need little to no to no.

Is there time for you to have the steroid injections?

Also, good luck. Twins are a... Blessing 😂😍😍

The nicu team spoke to me ahead of delivery. Unable to maintain temp, stabilise blood sugars, feeding and the ‘wet’ thing mentioned above are what they said to me ahead of delivery. T2 was fine, T1 needed a couple of days in nicu to shift the fluid. Good luck!

Hi. My twins were born at 36 weeks and both needed a little help. Ds stayed in special care for 3cdays and dd for 5 days and she needed a little help with breathing. Good luck!

My twins were born at 34 weeks due to pre-eclampsia. Girl 4lb 7oz and boy 5 lb. Girl twin needed a little oxygen and was tube fed for a day before starting breastfeeding. Boy twin needed help with breathing and feeding for about six days (nurses said boys tend to be lazier ). In total mine were in scbu for ten days. Girl could have gone home earlier but they kept them in together. I stayed in a room on the unit for the last couple of nights to take care of them with support - mainly so they could check feeding established (suspect this wouldn't be allowed now with covid). Both were very small and boy struggled to put on weight but no long term health issues. Good luck!

@SleepingStandingUp

It's hard to call at 34weeks, but I'd assume soem short term breathing help (nasal cannula) and maybe some feeding help (NG tube) Are they being delivered by c sec? C Sec babies can be a bit "wet" as they don't get the squeeze out vaginal delivery provides so possible a but of C Pap (I think that's the right name) so a little mask to provide higher pressure o2.

However, it's possible they come out little but we'll and need little to no to no.

Is there time for you to have the steroid injections?

Thanks everyone so far for your replies, it's helping to ready me a bit!

Yes they're due to be delivered by c section due to presenting twin being breech (she has been the whole way through pregnancy!) so I'll make note of the 'wet' thing, I did think this might be the case.

And yes, I had steroid injections on Xmas eve and Xmas day (lucky me! Lol) so I'm hoping that will have helped their lungs lots!

I did hear from my consultant too that premmie girls tend to be a lot stronger than boys, you'd think it might be the other way round! So as our boy is the small one I guess I should expect him to potentially need a bit more help!

Any other advice welcome xx

Hi, yes my DC was born at 34w with severe IUGR and weighed 1.1kg at birth so extremely small. 0.3 percentile so off the chart.
Was on ventilator just one night but came quickly off. They said it was more of a precaution really. Spent two nights on NICU and 7 weeks in SCBU. Feeding tube for quite a few weeks after as needed to learn to suckle. I wasn't able to breast feed directly but I was pumping and feeding that through the tube the whole time. Then breast milk in bottle after we progressed to feeding directly. We had some issues with stabilising blood sugars which is why the stay was much longer than usual I think. They say this normally rectifies quickly in preemies but his was abnormal. Also because of how incredibly monitored his feeds had to be I was never actually allowed to feed at the breast either which was sad, but I totally understood why. We did a few sessions but I pumped the rest. Generally DC did much better than expected, no issues once the boood sugar stabilised and they came home. Is now a bouncing, wilful toddler that you'd never guess when born fit into the palm of my hand

Good luck

Yes @tilly2019 I'd def put different expectations on them because of their sex. Boys def need a bit more help on average.
Are you on Facebook? There's a good premmie group that has lots of twin Mom's on and tons of twin Mom grouos

Mine were a similar weight. No issues were expected but one went straight to NICU with mild breathing difficulties straight from delivery. It was very scary for me at the time because I wasn't expecting it but they just needed some extra help for a few days.

The other twin was with me for 24 hours and then got taken into NICU for a couple of days too also with mild breathing difficulties/not feeding (probably due to breathing issues) and a mild infection

Both were home within 4 days of birth and off all oxygen

I wish so much that someone had prepared me for what could happen. I was simply told that I couldn't be induced until there were 2 free spaces in the NICU just incase, and that it was normal protocol for twin births. I was in a terrible state of shock when they ended up there but it really was more precautionary rather than them actually having serious problems. That definitely should have been explained to me in advance

Mine were 33+1 when I had them. Waters broke so it wasn’t a medical reason for them coming early. They didn’t managed to give me the 2nd steroids for their lungs in time. They were 5 for the boy and 4-2 for the girl. They stayed in SCBU for 3 weeks and a day. I would go onto the ward at 7-8am and be there until 6-7pm when husband came after work and we would bath them and feed them then put them down to bed. I would then go home and eat, express and sleep. I would take a pack up lunch and the hospital had a flat where all mums could use the kitchen, living room, bedrooms and bathroom during the day. First 10 days they were in incubators as they were jaundice and they didn’t want them to loose weight so had them under heat lamps. They also had the apnoea machines on them for again the first week. They had feeding tubes which went straight into their stomachs and milk would be syringed into the tubes as we’re wearing themselves out too much by breastfeeding. This caused them to loose weight. We went down the expressing and using the tubes then bottles. Then when home just used formula. They are both strong healthy taller-than-me teenagers now. Hope all goes well.

Hi OP, my twins were born at 35+0, should've been 34+5 but no space.

Boy was 1.6kg and girl 4lbs 15oz, sorry for mixed economy but that is how I always remember their weights!

Neither needed help breathing although DS was born blue and needed resus - but thereafter, no vent.

Both had trouble maintaining temp and too weak to digest milk so were fed on some type of dextrose solution first, then BM and special hi-cal formula in a naso gastric (NG) tube.

In NICU for 2 w, then out with support from a special nursing team that visited the house every 24,-48h at first, moving to 48-72h after a fortnight or so. This kept up for around 6-7w, then they were strong enough to go outside.

Some things I was not prepared for -

Zero postnatal support. This was pre pandemic. This was bc the special nursing team were there instead of the usual HV team but obviously they were neonatal nurses so had no maternal support role. The twins could not leave the house as not strong enough and needed an adult who knew infant resus/how to sort their tubes at all times - so I couldn't go out to the GP. This meant literally no help with anything, i.e. stitches suspected infection etc. You might suss out what it's like where you are.

You often cannot hold prem babies as holding them stresses them. I could only hold mine after they were about a week old and then only to feed.

Even if they are small and have NG tubes they may learn to BF if that matters to you. Mine went from dextrose solution to NG tube to bottle fed to mixed bottle and BFing. We BF till almost a year.

You may need to be assertive with "regular" medical professionals ie the ones you see after the NICU. For example many don't know how to plot a growth chart for a premie baby or may advise you to do things early if they are not correcting the baby's age rightly.

My twins had a rough start - as well as the above they caught chicken pox at 5w old and had to be re-hospitalised - but today they are nearly four. That tiny boy is a strong, lively preschooler who loves maths and his sister is a fearless little scrapper. You will get there

Just to say congratulations and hope all goes all goes well.
Twins are just amazing! Mine started school this year and are the best of friends!

I think everyone's experience is different. Mine were much earlier but their journey in NICU / SCBU was straightforward. Yes boys tend to be less strong than girls, and apart from the first few days, I was allowed to hold them every day, encouraged to breast feed (I put them to the breast when they were being tube fed to associate a full tummy with the breast), and had amazing support from all medical staff involved on the unit and follow up care. I did have a bad experience with community health visitors though.

Mine were born at 34 weeks

Little twin 3lb odd and big twin over 6lb

1 week in NICU and then moved to SCBU at different hospital for another 2 weeks

Things to prepare for

• you will likely be discharged after 2 nights and sent home without them which means arranging to get to hospital every day to see them

• they may be moved hospitals - mine were moved 40 mins away which was horrific but they Could have been sent hundreds of miles. There is no obligation on the hospital to provide accommodation or transport for you

• you will need preemie clothes and nappies - but hospitals usually get lots of knitted blankets donated

• they will be tube fed until either breastfeeding or bottle can be established. But that takes times. If you want them home quicker then you can see if they'll let you home with their nasal tubes in but you have to pass a little "course" on tube feeding.

• speak to breastfeeding support as soon as possible if You want to establish breastfeeding. I was sent home with an electric pump and I pumped every 3-4 hours night and day and took the milk in with me.

• you'll be "expected" to be there daily - i definitely felt like mums like me who were there all day every day and took an active part in tube feeding and changing were seen/treated more positively than those that dropped in for an hour here or there

• due to covid you have to wear masks all the time around the babies - I found this really difficult emotionally as I just wanted to smell and kiss them but my hospital was really strict on it

Sorry if that sounds all rather scary - it's good to be prepared mentally and emotionally for what's to come. But I had mine during lockdown and restrictions might have eased since x

But OP it is so important to talk to your team as it's different everywhere.

Eg my local hosp has a system where you can "room in" with your NICU babies, so I stayed in for 2w with them. It was a good job they did, as it was the 2018 Beast From The East and the hospital was snowed in some days! The nursing team we had is also not universal. They were very good though.

Equally, my hosp had a very old-fashioned and conservative obstetrics team who (I realised later) were not actually following contemporary NICE guidance but some older rules so they had loads of weird 1980s style rules for what you were meant to do.

It will differ everywhere so maybe use this thread to see "what you know you don't know" and ask your team?

Very best of luck.
I have b/g twins and twins are just amazing.

I didn't have twins but I had a boy at 28w and a boy at 32w. Typical issues you might encounter in the first few weeks are:

• they struggle to maintain body heat when they are under 5lbs so may need some help in an incubator until they get big and strong enough. Sometimes babies lose weight in the first week or two so it can feel slow to make progress at first.
• after a few days they can get jaundice, this soon settles down, but might mean they have blue light treatment while naked in which case it's back into an incubator for a day or two while the lights do their job.
• you can breastfeed if you want to but you will need to be very clear about this with nurses. Whether you are supported or not depends a great deal on the nurses and that's not entirely in your control. I breastfed both mine entirely but for one the nurses helped and were kind, for the other they had me in tears. Be kind to yourself and your best is all your baby needs.
• the sucking reflex doesn't really turn on until 34 weeks, and it's slower for boys, so you may find one of your babies learns to feed before the other. That's ok, they all get there in the end!
• hospitals take blood tests. Its ok to ask what these are for and to ask for them to be minimised if that's what you think is best. You are still the mum and the ultimate champion for your babies, even if the nurses know the care routines.
• if your babies need some extra oxygen to help start them off, they might have CPAP or little oxygen tubes which will then be gradually reduced over time. If your babies need help to feed they might have a tube through their nose. All these little tubes make it tricky to hold a prem baby but don't give up. Skin to skin contact is wonderful for them. They love to hear your heart beat. The nurses will help you with this so wear something easy to access from the front like a button up shirt so you can maximise opportunities. You can also order prem baby grows with easy access sides to accommodate wires and tubes etc if needed online.

I hope it all goes ok for you and don't stress. It's a good age, and you will have deliciously tiny babies for extra long. What a treat.

Hi guys, thought I would update you all.
Twins were born at 34+6 in the end on NYE! We got bumped a day because they couldn't ensure they had NICU space available

DD born 5lb 12oz on 53rd centile. DS born 4lb 3oz on 0.4th centile - so defo glad we evicted them when we did!

Both went to NICU, DD needed some oxygen for first 24hrs, both incubated and monitored. Moved to cots about half a week later. They're still in Hospital now but doing well, although both lost a lot of weight (DD down to 5lb 3oz, DS down to 3lb 14oz). DD a good week or so ahead of her brother, is now bf and taking a bottle. DS gets tired on the bottle or breast so he still requires more tube feeds than his sister.

Once we do 24hrs without tubes, and gaining weight, will be allowed home! NICU is hard, especially juggling an almost 2yr old at home bless her, but I hope we will be out within the 2 week mark!

Congratulations! Just read the whole thread, glad to see they are doing well.

Aah congratulations 💐

Congratulations! Sounds like they are doing great. Hope you all get home soon.