Teresa, sounds like you have a lot of adventure ahead of you!:

<This is a timely subject for me, as I just finished reading "Having
Twins"
last night after finding out a week ago today that I'm having twins!>

< One of the chapters I read last night did
talk about this, so I'm a bit confused. It stated that where Singletons
usually don't start to slow down in growing until around 36 weeks? I
think,
that multiples are there at about 30 weeks? and triplets around 26-28.
Those
weeks might be a bit off, but it's basically along those lines, which
made me
also wonder this exact thing. Are triplets considered full term earier
than twins?>

I want to add a new consideration to this thread. Time is not the only
determinant. The size and health and efficiency of the placenta(s) is a
very important factor in the rate of fetal growth and development.

So "full term" and "x # of weeks or months (or moons)" are really rather
primitive concepts that do not take into account the possibility of
placental insufficiency.

(It is even possible for the placental arteries of multiples to encroach
upon each other and intertwine in such a way as to allow "twin to twin"
transfusion, whereby 1-2 baby(s) grow larger at the expense of the
other.)

Unfortunately, counting off days (even from an unknown date of
conception) on a calendar is much simpler than guesstimating how healthy,
how large, and how efficient placenta(s) are, and whether or not
deterioration (scarring, etc.) is beginning to take place as placental
aging occurs.

A placenta is an organ whose normal life cycle is only about 40-42 weeks,
but some placentas begin to age before then for various reasons having to
do with either environmental factors (smoking, etc.), maternal
(pre-eclampsia, abruptio placenta, etc.) or fetal health.

In a worst case scenario, a baby can go the usual 40-42 weeks in utero
and slow down the rate of gain, and eventually even begin to lose weight
because so little nutrition is getting across an inefficient placenta
that the baby must begin using stored nutrients for heartbeat, etc.

This is one reason that babies can be born SGA (Small for Gestational
Age), for instance. They may have gone x amount of time in utero, but not
enough nutrition was able to transfer across the placenta for them to
build up either fat or a supply of reserve glycogen in the liver, etc.
That makes them especially prone to hypoglycemia and other problems after
birth.

In addition, a placenta inadequate to keep up with the nutritional needs
of a fetus, or two or three fet(i???) is probably also inadequate to keep
up with the oxygen transfer from mother and cell waste transfer to mother
needed for several little brains to grow without relative neurological
developmental deficit.

This is one reason that multiples need appropriate and careful
observation in the newborn period to assure optimal conditions for
"catch-up" development. This often translates into the need for special
management of early breastfeeding.

I was an OB nurse for years before perinatal medicine insights,
ultrasounds and many other tests were developed. (It was only about 31
years ago, in February, 1971 that my hospital sent me to an intensive 3
week course on Perinatal Medicine at the University of Colorado. There
were virtually no seminars, etc. at that time. The hospital prepared me
this way with the express understanding that I would come back and begin
re-training the maternity nurses to update many procedures rather than
unquestioningly continue conventional OB routines.)

I know from clinical experience way back then that some babies actually
starved to death in utero, because there was simply no way to assess
either the fetus or the placenta as accurately as is now possible.

Assessment and prediction nowadays are by no means perfect. When all is
going well, especially with the placenta, the natural course of events
usually leads to beautiful outcomes.

But so much more is now understood about placental function and fetal
growth and development, and possible deviations from normal than was
known 30+ years ago.

Of course, that can be a double edge sword. The more that is known about
risks, the more temptation there may be for intervening when the total of
risk factors begins to mount.

No trained professional is willing to take chances (morally, and
medico-legally) on allowing a fetus to suffer potential damage from known
risks when they calculate that it's possible to "beat the odds" by
skillful intervention.

There are truly some times when "rescue" from the uterus and placental
insufficiency, and into a NICU incubator at an earlier gestational age is
safer than allowing the pregnancy to continue to some set # of weeks in
an "baby-unfriendly uterine environment."

This being said, I want to assure you that at this moment in time, you
have the very best incubator in the whole world for your babies. If you
haven't already read it, I recommend Karen Kirkhoff Gromada's "Mothering
Multiples". Best wishes on your new adventure!

Jean
************
K. Jean Cotterman RNC, IBCLC'
Dayton, Ohio USA

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