Surviving the NICU with Twins

Go to any twin mom club, Facebook group, or baby board, and the most commonly asked question by expectant twin moms is:

Your chances of preterm labor and delivery increase with each additional baby you are growing, as well as your type of twin pregnancy (mono/mono, mono/di, di/di).

Preterm labor is defined as delivery before 37 weeks and most doctors will not let a multiple birth go past 38 weeks. Nearly 60 percent of all twins, and more than 90 percent of triplets, are born prematurely (before 37 weeks). WHOA.

On average, twin pregnancies last 35 weeks, triplet pregnancies last 33 weeks and quad pregnancies last 29 weeks. Remember these are averages, so there are definitely MOMs out there that went all 40 weeks (or beyond 😮), and others that delivered earlier.

Most of this is out of your control, so there is no use in stressing over it. Just be sure to take care of yourself: lots of rest, fluids, and frequent healthy snacks.

And if you don’t have to, then you’ll be pleasantly surprised 🙂

Preterm Birth Milestones

I know some of this stuff is scary to read about, but this is life with multiples. Most people enjoy having this info, but if you’d rather not know (we understand!), skip over this section…

• 23 weeks is considered to be the age of viability; over half of the babies born at this time will survive past the NICU. These micro preemies will need help breathing and support to finish developing their body’s systems. They will most likely need to stay in the NICU for several months.
• At 27 weeks babies are no longer micro preemies! They are now “very premature” and have a much higher rate of survival – 95%. Their eyelids are no longer fused and their lungs are more developed (although they still might need help breathing). They have developed the startle reflex and have coordinated sleep/awake cycles.
• At 32 weeks babies are now “moderately preterm”. This week babies can mostly control their own body temperatures. They might still need help eating or breathing on their own, which are milestones required for NICU discharge. On average, babies born at 32 weeks will stay in the NICU for about a month. Making it to 32 weeks was my first “goal”, since babies born on or past this point have less chance of life-threatening complications. 32 week-ers have a 98% survival rate.
• 34 weeks was my next “goal”. Most doctors will not stop preterm labor at 34 weeks or later. These babies are in their final stages of lung development, and are fine-tuning the suck-swallow-breathe reflex needed for successful eating. This means that babies born at 34 weeks may not need much, or any, assistance breathing or eating.
• At 36 weeks, “late preterm” babies might only need a little help growing and feeding. These babies may only be in the NICU for a few weeks, until they can maintain their body temperatures, master feeding and breathing simultaneously, and breathe on their own.

The NICU [pronounced NICK-you]:
Neonatal Intensive Care Unit

Now that you know the milestones, let’s talk about what to expect in the NICU.

Usually, no matter how you deliver (vaginally or via c-section), if the babies are preterm, your OB will likely first show them to you (Yay! Hi babies!), and then they will be whisked away to get checked out by the neonatal staff. The staff are usually in the delivery or an adjacent room, and if the babies don’t require oxygen or any kind of immediate help, once they are assessed, the neonatal staff will bring them back to you.

If they do need immediate intervention, your partner can go with the babies while your OB finishes up with you. Plan for who will go where ahead of time so you’re not stressing about it in the moment. Keep in mind that both babies may not have the same prognosis; many times, one baby will need to go to the NICU while the other can stay with mom.

For an uplifting and beautiful book that helps families navigate and document their NICU journeys, check out Our NICU Journey: Tiny Keepsake for Tiny Miracles.This book also serves as a lovely reminder to families with babies in the NICU that they are most definitely not alone. 

NICU tips:

• Depending on your condition, you may not be able to go see your babies right away in the NICU. Send your partner to keep you updated and informed.
• The nurses are your best friends. Ask them all the questions you have and tell them your concerns. They will help you in every way possible and be your daily support system.
• Be clear on your wishes. All of our doctors and nurses knew I was pumping; the girls were to have my breast milk first, and then formula if needed. We wanted to be there for every feeding so, if possible, they would wait for us to arrive.
• Don’t forget to take care of yourself. The best gift we got in the hospital was a snack care package: almonds, cookies, granola bars and fruit. It got us (mostly me) through the few days we we had to camp out at the hospital. I needed to eat all the time to help build my breast milk supply. I also brought my HUGE water bottle from pregnancy with to make sure I stayed hydrated. The nurses were very insistent about making sure we slept. They encouraged us to get some rest even if it meant missing a feeding. They helped us realize that we needed to put our own “oxygen masks” on first before we could care for our babies.
• The entire experience will probably be emotionally difficult. You might feel helpless and worried, but you will get through it.
• NICU nurses sing, rock the babies, and comfort them when you are not there. It is important to remember your babies are being cared for while you are unable to be there.
• Call the NICU as much as you want. You won’t be bothering them and they are happy to talk with you about how your baby is doing. You can even call when you are up pumping at 3 am.
• Be prepared for separation: you from the babies, and the babies from each other.
• Take care of yourself. Did I say this already? The NICU is hard. You have no control, you feel like you can’t help, and that you are useless as a parent. It was the most stressful, overwhelming, difficult time in my life. Not to mention your body is already whacked from all your hormones after giving birth. So give yourself a break; have a good cry and just remember that you can do this. If you are feeling too overwhelmed, talk to your doctor or the nurses. They are there to help you.
• Don’t worry about anyone else. I was in no shape to be updating everyone on FB or via text. I called my mom when I could. She shared the information with my close family and friends. Don’t let anyone make you feel guilty. If your MIL or Grandma is upset because they want an update, then they need to reach out and be ready to wait for a response. If you say “no visitors”, they need to suck it up and respect that. The nurses are a great help here: if you don’t want to be the “bad guy”, they will tell your sister she can’t come in, or that the baby is sleeping, so no visitors. NICU’s usually won’t allow anyone in without a parent present, and have a strict limit of how many visitors can be there at one time. Special Nurseries may not allow visitors at all. Children are usually not allowed in the NICU, especially for the higher levels of care. Prepare for this if you have older children.
• Finally, remember that this too shall pass. Though hard to believe when you’re going through it, your NICU stay is a small blip in your vast lifetime with your babies. There will come a day when you will all be home and back together again. Keep that perspective in mind.

Don’t stress, parents, you’ve got this!!
— the Lucie’s List team

Read a singleton mom’s NICU experience here.

Did you miss?

• Recognizing Preeclampsia
• Gestational Diabetes