Week 25: Twins

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This is your Pea in the Podcast for week 25 of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician with Houston Women's Care Associates in Houston, Texas.

Well, momma, you're starting to attract attention. People can really tell there is a baby on board, "you can't tell hardly at all in the first trimester and even most of the second trimester the uterus doesn't necessarily look that much more impressive. But at 25 weeks sure, she's starting to look seriously pregnant." Be prepared as your belly grows, somehow it becomes public property. Perfect strangers will come up and touch you; they'll rub your abdomen and talk to you. Some women don't mind, so enjoy. Others hate it and they generally have some witty line ready for when someone comes up with their hand outstretched or they become really good at dodging the rubs.

But as you start looking seriously pregnant, with the uterus the size of a soccer ball, you may be starting to feel seriously pregnant too. For example, reflux may be burning you up inside. Why is that Dr. Swaim? "There's sphincter, it's not really a sphincter but we call it a sphincter, it's called the lower esophageal sphincter and it basically connects from between the esophagus and the stomach. There's no real like I said 'sphincter muscle' there but pregnancy causes this to be somewhat lax, this area. Also the pressure from the uterus sort of causes the stomach to rise up a bit more so those are both recipes for the gastric contents being squirted back up the esophagus and so that's why it hurts." But the doctor says you shouldn't suffer, she says it's not good for you to have acid burning up your throat so talk to your doctor about getting some relief. "Many of the medications that are available are fine to use in pregnancy. Over the counter Pepcid and Zantac and then a lot the other medications that are H2 blockers, Nexium and that kind of stuff." Other than that you should still be feeling pretty good right now, pretty energetic. If you're not, you might want to mention it to your doctor or midwife. Pregnant women are at a greater risk for anemia, now this is because you require so much more iron to make the hemoglobin in all of that additional blood you're pumping around. Your iron level is likely to be at its lowest level of your pregnancy over the next several weeks as your blood volume spikes and then things will level off. You can increase your iron stores through diet including red meats, liver, egg yokes, dried fruits, legumes like chick peas, green leafy vegetables and iron fortified cereals too. If you doctor finds your levels are low enough to cause concerns, they may suggest supplements or other dietary additions.

Now we've spent most of our time week-by-week talking about your singleton pregnancy but multiple moms are starting to have some unique concerns in the late second trimester, "The biggest thing I become concerned about at week 25 of multiple gestation is, besides all the usual stuff, her weight gain and anemia, preterm birth and preterm risk factors, that's also something we review a lot these are women who we examine if not weekly then every other week. We talk with them about the signs and symptoms of premature contractions and what have you. Then the other thing is the growth of the baby, I know mom is growing, I know her stomach is getting bigger but I don't know if both babies are growing at the rate at which they should be and so frankly that's why women with twins have more ultrasounds than women with singletons. So we know who's happy in there. Are both their fluids are normal, etc., etc. That's the number one thing."

So what are the signs of preterm labor? There is what is described as a sense of pelvic fullness or pelvic pressure which is the feeling that the baby's pushing down in your pelvis. Also recurrent contractions that may or may not be painful at a rate of about 6 an hour, you'll want to call your doctor if that happens. You'll also want to pay attention to menstrual like cramping, now any of this may be accompanied by a low dull backache. You're also looking for vaginal discharge, unusual vaginal discharge. Of course you have vaginal discharge during pregnancy but this would be yellow, watery, maybe bloody. Also pay attention for unusual leaking or wetness that could signal ruptured membranes. Any of this you'll want to call your doctor. Now some multiple moms spend the later portion of their pregnancies flat on their backs. Dr. Swaim says bed rest is really rarely needed and it is unpleasant for mom. "It is not fun and it's also very costly. Now with the electronic age we have found that there are a lot of women who can work from home and not have to pick up their disability insurance. I have a patient right now who's got hypertension. Is it terrible? No. But it turns out when she's up running around it isn't so great. So her company said she's fine, she's an accountant, she can work from home. That way she sort of rests at the same time she's getting work done, she doesn't have to park her car and walk three blocks and all that kind of stuff. So that's been pretty helpful." But bed rest, as we said, is hard on mom and there are some websites out there that offer support for bed resting moms, you can get those at our website peainthepodcast.com.

Your baby this week weighs just over a pound and a half and is just 8.8 inches long or so. They're moving all over the place, you are feeling it. They're dancing when you're trying to sleep and when you're up and busy you're rocking them to sleep. The structure of the spine is forming now, 33 rings, 150 joints and 1,000 ligaments. Your boy's testicles are in the proper place and your girl's vagina is now finished. Your baby's tiny hands are now perfect, individual little fingerprints and all. This week their nostrils will open. Your baby may also begin this week edging its way toward a nice head down position, the ideal position for birth. Some babies like their breech position though and they will stay that way for many, many weeks to come. There aren't as many weeks to come though as there have been, as we count down toward 'labor day'. Right now you are 25 weeks pregnant, there are just 15 weeks to go until week 40.

That's your Pea in the Podcast for week 25 of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week. For a transcript of any of our Pea in the Podcasts go to our website peainthepodcast.com. For Pea in the Podcast, I'm Bonnie Petrie, thanks for listening.