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Chapter 1

How Different Can Having Twins Be?

You've just learned the news. You're having twins! You're euphoric, exhilarated, and rightly so. Learning that you will have twins is exciting. Although a lot of people do seem to be having twins these days, it's still a pretty exclusive club, and you will be guaranteed to get extra attention from family, friends, and even total strangers from the moment you tell the world.

So how different can having twins be? After all, it's not like it's rocket science—they're just babies. And if you've already had one child or two, then you've got some experience. Conventional wisdom suggests that having twins is twice as hard as having a single baby. You basically have to do everything twice and buy twice as much of everything. But the truth is, a twin pregnancy is unlike a singleton pregnancy from the get-go, and parenting twins demands more time, energy, and resources than parents of singletons or any new parent can imagine. It's not just that you have two babies; it's that those two babies make some of life's most basic tasks, things you now take for granted, like getting dressed or taking care of errands, a virtual Olympian challenge! And the challenges just keep coming as your twins grow.

Things are different from the start. During pregnancy, expect more doctors' visits and more tests. During delivery, expect far more people in the delivery room. Also, say good-bye to your money, because twins are definitely more expensive, from the food you feed them to the kind of car you buy for transporting your new, larger family. And say good-bye to your free time, because caring for twins is hard, physical work and you will have far less time for yourself, or for anything beyond the babies, in the initial few months. In addition, you may have to deal with your babies' special health issues, and you may have special health issues of your own. That's why knowledge and preparation are key.

Financial Considerations

Accept that having twins will be more expensive.

Borrow what you need.

Save early, save often.

Explore flexible spending accounts or health savings accounts.

Make big purchases with your twins in mind.

During Pregnancy

Prepare for more visits to the doctor.

Make special arrangements to accommodate visits to the doctor.

Expect more medical tests.

Think about prenatal testing.

Take specialized pregnancy classes for twins or multiples.

Get informed about preemies.

Anticipate bed rest.

Fight boredom.

Get Internet service; go wireless.

In the Hospital

Expect to be wheeled into an operating room.

Expect a crowd.

Prepare to bottle-feed.

At Home Afterward

Arrange for help.

Stock up on necessities.

Say good-bye to free time for the time being.

Say yes to babysitting.

Special Challenges: C-Section Complications

Don't be too hard on yourself.

Use photos or video to keep involved and share special moments.

Special Challenges: Caring for Preemies

Arm yourself with knowledge.

Communicate with hospital staff.

Be persistent.

Find an advocate.

Get a night nurse.

Seek emotional support.

FINANCIAL CONSIDERATIONS

It's no secret that having kids is expensive, but having twins means you have an even greater need to plan for the financial challenges ahead.

Accept That Having Twins Will Be More Expensive

From the moment you become pregnant, a twin pregnancy seems to require more money. You grow out of your maternity clothes at warp speed and have to buy more and more clothes just to keep your belly covered. If your health insurance requires co-pays, you will have to pay for more doctors' visits and tests. And, of course, you need beds, mattresses, bassinets, car seats, diaper bags, and the like, in plural!

Borrow What You Need

Sure, it's nice to have new things, especially if these are your first babies. But twins require so much stuff, and so much of it is immediately outgrown, that borrowing from friends and family is a smart option.

Save Early, Save Often

Save early, save often means buying things like diapers and wipes in bulk. It also means saving for your babies. Investigate savings options for your twins, such as higher-interest savings accounts like ING's Orange Account, or purchase low-cost stocks through companies like Sharebuilder.com.

Explore Flexible Spending Accounts or Health Savings Accounts

Ideally, you set up and use flexible spending or health savings accounts for your medical expenses before you get pregnant, but even if you set them up while you're pregnant or when your twins are born, you will offset medical expenses by tapping into pretax funds.

Make Big Purchases with Your Twins in Mind

A perfect example of a big purchase you'll need to make in advance of your twins' arrival is the family car. A car that is fine for a family with one child, or even one older child and a baby, is not really great for a family with twins. Even if you can fit your twins into the backseat of your midsize car, once you think about all the gear you'll have to carry for the next several years, such as strollers, diaper bags, baby carriers, clothes, and wagons, many "roomy" cars become as cramped as matchboxes. Plan accordingly.

DURING PREGNANCY

Twin pregnancies differ from singleton pregnancies from the first doctor's visit—expect more medical management, more time spent at appointments, and more tests.

Prepare for More Visits to the Doctor

It's a given that pregnancy-related doctors' visits take up a lot of time, especially if you have to factor in a long commute. In a typical singleton pregnancy, a woman may see her obstetrician roughly twelve to fifteen times before delivering her baby. For the first six months, she will see her doctor once a month, then twice a month for months seven and eight, and finally once a week for the last two to four weeks of her pregnancy. Contrast that with a woman who is pregnant with twins. While your initial visit may take place in the same time frame as a woman carrying a single baby (anywhere from the week you find out you are pregnant to several weeks out, depending on your practice), as soon as your doctor confirms you are having twins, you are likely to immediately start seeing the doctor twice a month, and then once a week from week 32 on. That's roughly 30 percent more doctor visits for moms of twins.

Make Special Arrangements to Accommodate Visits to the Doctor

Be sure to arrange for extra time off from your employer or arrange for childcare to accommodate your schedule. And remember you will have to find time in your schedule to work in extra medical tests as well!

Expect More Medical Tests

If you became pregnant with medical help, then you are likely to know that you're having twins early on. If your pregnancy is a surprise, it may take some time and several visits to the doctor to learn that you're having twins. Either way, women who are pregnant with multiples are subject to more tests, including earlier and more frequent ultrasounds (often at every single visit); fetal heart monitoring as the pregnancy progresses; and, frequently, genetic testing.

Think About Prenatal Testing

Women of advanced maternal age, defined in this context as thirty-five or older, are generally offered the option of genetic testing to screen their babies for Down syndrome or other genetic problems. Older women typically undergo amniocentesis between sixteen and twenty weeks. However, if you are carrying twins, your doctor may prefer that you undergo a test called chorionic villus sampling, or CVS. Unlike amniocentesis, this test is done much earlier, generally between eleven and twelve weeks of pregnancy. (Many testing centers will not do the test after week 12.) So if you are interested in prenatal screening or anticipate that your doctor will recommend it, talk to your doctor early during your pregnancy, so you are fully prepared to make the right decision for you.

Take Specialized Pregnancy Classes for Twins or Multiples

Specialized pregnancy classes are great at familiarizing you with the delivery and hospital experience, and they are especially targeted to parents of multiples. For example, the classes often will show a film of a twin delivery and include a tour of the neonatal intensive care unit (NICU). Be sure to schedule the class early on in your pregnancy, as early as sixteen weeks. In many cases, women who plan to take the classes later miss out because they end up on bed rest.

Get Informed About Preemies

If your twins are born prior to thirty-six weeks, there's a good chance they will be admitted to the NICU. They may even stay in the hospital after you're discharged. This is simultaneously a joyful yet stressful time. On the one hand, your long-awaited babies are here. On the other, their health is at issue and you may have to leave them. Help yourself manage this emotional firestorm by preparing ahead of time: Read, ask questions, and familiarize yourself with what happens if your babies are born prematurely, so that you can be assured that you are doing what is best for them.

Anticipate Bed Rest

Many women carrying twins (and other multiples) find that they are forced to go on bed rest, even if they thought they were in optimal health. It's just a reality: Twin pregnancies carry more risks for the babies and for the mother-to-be. Twins have a higher likelihood of being born prematurely (before thirty-six weeks for twins is considered premature). To prevent this, many women are put on bed rest by their physicians, either as a precaution or in response to preterm labor. Even if your babies are in ideal health, there are numerous sources of physical and emotional stress—such as having other children to care for, working full-time, or caring for family members—that can take a toll on your body and have a negative impact on your pregnancy. Your doctor may put you on bed rest for a short two-week period at the end of your pregnancy, or you may find that you have to be on bed rest for three or four months of your pregnancy. It's best to prepare yourself emotionally for this challenge ahead of time (when you first learn you're pregnant or in the first trimester) and plan on how you might handle several weeks or months when your activities are severely restricted.

Anticipating bed rest is one thing, but planning for extended bed rest is another. If you have the luxury of working for a large employer who offers sick time and medical leave, then do your utmost to stay on bed rest after your babies' birth. But many women may feel they are forced to work, even if they have a medical reason not to. It could be for financial reasons or because a small company depends on them to keep the business going. (Companies that employ fewer than fifty people are not required to abide by the Family and Medical Leave Act, which grants eligible employees twelve weeks of unpaid time off for the birth of a child.) How can you work and still abide by your doctor's orders? Talk with your employer in advance about its expectations. Check to see if telecommuting is an option; perhaps arrange a step-down schedule in which you initially work from home and gradually do less and less work while on bed rest. The key is to plan to be out of work.

Fight Boredom

The blunt truth is that bed rest is boring. There's only so much television you can watch and only so many books or magazines you can read. Plan projects that can be done while reclining—for example, creating and addressing baby announcements, crafts like knitting and crocheting, organizing those photos you've been meaning to—but do not expect you will get anything done that requires standing, sitting for extended periods, bending, or walking. That includes cooking and working on the babies' room. Forget about it and lay back down.

Get Internet Service; Go Wireless

Go online, check out the twins forums, and read about women going through the same experience you are. Learn about caring for preemies. Update your blog. Having access to the Internet will make you feel more connected to the world while you're on bed rest; having a wireless Internet connection gives you options for "exploring" other areas of your house besides the bedroom.