Use the second trimester (which will probably be your most comfortable one-and the easiest one for you to do some serious chowing down in) as your chance to load up on the nutrition your babies need to grow. If you gained no weight during the first trimester (or if you lost weight due to severe nausea and vomiting), your practitioner may want you to gain 1 to 2 pounds per week during this period for twins or 2 to 2 per week for triplets. (If you've been gaining steadily through the first trimester, you'll only have to aim for 1 pounds a week for twins or 2 per week for triplets.) That may seem like a lot of weight in a short time, and you're right-it is. But it's weight that's important to gain. Supercharge your eating plan with extra servings of protein, calcium, and whole grains. Heartburn and indigestion starting to cramp your eating style? Spread your nutrients out over those six (or more) mini meals.

What to Gain When You're Gaining for Two or More Pregnancy Status First-Trimester Weight Gain Second-Trimester Weight Gain Third-Trimester Weight Gain Total Weight Gain Normal with Twins 34 pounds 34 pounds 2022 pounds 2022 pounds 1419+ pounds 1419+ pounds 3754 pounds 3754 pounds Overweight with Twins 12 pounds 12 pounds 1722 pounds 1722 pounds 1319+ pounds 1319+ pounds 3150 pounds 3150 pounds Triplets 45 pounds 45 pounds 30+ pounds 30+ pounds 1115 pounds 1115 pounds 45+ pounds 45+ pounds

Multiple Time Line Already counting down your 40 weeks? You might not have to count that high after all. A twin pregnancy may be considered full-term a full 3 weeks earlier, at 37 weeks, which is certainly reason to celebrate (3 weeks less of puffiness, heartburn-and waiting!). But just as 95 percent of all singletons fail to arrive on their due date, multiples keep their moms and dads (and practitioners) guessing, too. They might just stay put until 39 weeks (or longer)-or they might make their appearance before they've clocked in the full 37 weeks. In fact, the average multiple pregnancy lasts 35 weeks.

If your babies do end up overstaying their 37-week term, your practitioner may elect to induce at 38 weeks, depending on how they're doing and how you're doing, as well as his or her practice preferences. Be sure to have an end-game discussion with your practitioner long before the end is near, because many differ on how they typically handle the late stages of a multiple pregnancy.

As you head into the home stretch (aka, the third trimester), reach for a goal of 1 to 2 pounds per week through your seventh month. By 32 weeks, your babies may be 4 pounds each, which won't leave much room in your crowded-out stomach for food. Still, even though you'll be feeling plenty bulky already, your babies will have to bulk up quite a bit more-and they'll appreciate the nutrition a well-balanced diet provides. So focus on quality over quantity, and expect to taper down to a pound a week or less in the eighth month and just a pound or so total during the ninth. (This makes more sense when you remember that most multiple pregnancies don't make it to 40 weeks.) Exercise "I'm a runner, but now that I'm pregnant with twins, can I keep on exercising?"

Exercise can benefit most pregnancies, but when you're staying fit for three, you'll have to work out with care. If your practitioner green-lights exercise during the first and second trimesters (do be sure to ask), he or she will probably steer you toward more gentle options than running. You'll definitely be advised to avoid any workout that puts a lot of downward pressure on your cervix or raises your body temperature significantly. ACOG recommends that moms-to-be of multiples stay away from high-impact aerobic exercise (which would include running) because it can increase the risk of preterm labor for them. This holds true for experienced runners, too.

Looking for a more sensible fitness routine for the three of you? Good options include swimming or pregnancy water aerobics, stretching, prenatal yoga, light weight training, and riding a stationary bicycle, all exercises that don't require you to be on your feet while you do them. And don't forget your Kegels, the anywhere-anytime exercise designed to strengthen your pelvic floor (which needs extra reinforcement when there are extra babies inside).

No matter what you're doing during your workout, if the exertion is causing Braxton Hicks contractions or any other red flags listed on page 223 page 223, stop immediately, rest, drink some water, and call your practitioner if they don't subside in 20 minutes or more.

Mixed Feelings "Everybody thinks it's so exciting that we're going to have twins, except us. We're disappointed and scared. What's wrong with us?"

Absolutely nothing. Prenatal daydreams don't usually include two cribs, two high chairs, two strollers, or two babies. You prepare yourself psychologically, as well as physically and financially, for the arrival of one baby-and when you suddenly discover you're having two, feelings of disappointment aren't unusual. Neither is trepidation. The impending responsibilities of caring for one new infant are plenty daunting without having them doubled.

While some expectant parents are happy to hear they're expecting more than one, others take some time getting used to the news. It's just as common to feel initial shock as initial joy-to experience a sense of loss for the intimacy and normalcy of the one-on-one relationship you'd have with a single baby but can't immediately see yourselves having with two. Instead of picturing yourselves rocking, feeding, and cuddling that one baby, you may have a hard time coming to terms with the thought of life with two newborns. You may also be flooded by conflicted emotions-first asking "Why us?" then feeling guilty about questioning your double blessing (especially if becoming pregnant was a struggle to begin with). All of these feelings (and the others you might be experiencing) are a completely normal reaction to the news that your pregnancy and your lives are taking an unexpected and very special turn.

So accept the fact that you're ambivalent about the dual arrivals, and don't saddle yourselves with guilt (since your feelings are normal and understandable, there's absolutely nothing to feel guilty about). Instead, use the months before delivery to get used to the idea that you'll be having twins (believe it or not, you will get used to it-and you will become happy about it!). Talk openly and honestly to each other (the more you let your feelings out, the less they'll weigh you down and the faster you'll work through them). Talk to anyone you know who has twins, and if you don't know anyone, seek them out through groups and message boards. Sharing your feelings with others who've felt them, and recognizing that you're not the first expectant parents to experience them, will help you accept and, in time, become excited about this pregnancy and the two beautiful babies you'll be holding one day soon. Twins, you'll find, may be double the effort at first, but they're also double the pleasure down the road.

Insensitive Comments "I can't believe it, but when I told my friends that we're expecting twins, one of them said to me, 'Better you than me.' I thought she'd be happy for me-why would she make such a nasty comment?"

That might be the first insensitive comment you've been ambushed by during your multiple pregnancy, but it probably won't be the last. From coworkers to family members to friends to those perfect (make that not-so-perfect) strangers in the supermarket, you'll be amazed at the remarkably rude things people feel completely comfortable saying to an expectant mom of multiples, ranging from "Wow, you're so huge-you must have a litter in there!" to "Boy, you're in for it!" to "I could never manage more than one at a time."

Multiple Connections As a multiples mother-to-be, you're about to join a special club already filled with thousands of women just like you-women who are also expecting double the delight and, no doubt, experiencing double the anxiety. Never been a joiner? Membership in this particular club does come with plenty of rewards. By talking to other moms-to-be of multiples, you'll be able to share your fears, your joy, your symptoms, your funny stories (the ones nobody else would get) with women who know just how you're feeling. You'll also be able to score reassuring advice from other expectant moms who have more than one on the way (as well as from those who've already had their multistork delivery). Join a discussion group online (check out whattoexpect.com for a multiples message board) or ask your practitioner to hook you up with other pregnant-with-multiples women in his or her practice and start your own group. There are also national organizations that can provide you with contact information for local clubs, including the National Organization of Mothers of Twins Clubs, for a multiples message board) or ask your practitioner to hook you up with other pregnant-with-multiples women in his or her practice and start your own group. There are also national organizations that can provide you with contact information for local clubs, including the National Organization of Mothers of Twins Clubs, nomotc.org, or you can use an online search engine to find a local multiples chapter. You can also check out online sites that cater specifically to parents of multiples: mothersof multiples.com; twinstuff.com.

What's up with the lack of tact? The truth is, many people don't know how to react to the news that you're carrying multiples. Sure, a simple "Congratulations!" might be in order, but most people assume that twins are special (they are) and therefore need to be recognized with a "special" comment. Curious about what it must be like to be pregnant with twins, in awe of what you'll be going through once they're born, they're clueless about the right response-so they dish out the completely wrong one. Their intentions are good, but their follow-through stinks.

The best way to react to the rudeness? Don't take it personally, and don't take it too seriously. Realize that even as your friend opened her mouth and inserted her foot, she was almost certainly trying to wish you well (and she probably has no idea that she offended you, so try not to take offense). Remember, too, that you're the best spokeswoman for moms of twins everywhere-and you'll have lots of chances to spread the wonderful word on multiples.

"People keep on asking me if twins run in my family or if I had fertility treatment. I'm not ashamed that I conceived my babies using a fertility drug, but it's also not something I want to share with strangers."

A pregnant woman brings out the nosy like no one else, but a woman expecting multiples becomes everybody's business. Suddenly, your pregnancy goes public-with people you hardly know (or don't know at all) prying into your personal life (and bedroom habits) and prodding you for personal information without thinking twice. But that's just the point-these people aren't really thinking twice-or even once. They're not asking to be intrusive, they're just curious (multiples are fascinating stuff, after all), and they haven't been educated in the fine art of twin etiquette. If you're open to spilling the juicy details, then by all means, go for it ("Well, first we tried Clomid, and when that didn't work we tried IVF, which means that my husband and I went to a fertility clinic ..."). By the time you're halfway done with your story, the questioner will probably be bored to tears and looking for the nearest exit. Or, you can try one of these responses the next time someone asks about the conception of your twins: [image] "They were a big surprise." This can be true whether you've conceived with or without fertility help. "They were a big surprise." This can be true whether you've conceived with or without fertility help.[image] "Twins run in the family-now." This will shut them up while keeping them guessing. "Twins run in the family-now." This will shut them up while keeping them guessing.[image] "We had sex twice in one night." Who hasn't at some point? Even if the last time was on your honeymoon, it's not a lie-and it'll be the end of the line for their line of questioning. "We had sex twice in one night." Who hasn't at some point? Even if the last time was on your honeymoon, it's not a lie-and it'll be the end of the line for their line of questioning.[image] "They were conceived with love." Well, that's a given, no matter what-and where do they go from there? "They were conceived with love." Well, that's a given, no matter what-and where do they go from there?[image] "Why do you ask?" If they're TTC (trying to conceive) themselves, then maybe it'll open up a conversation that could help them (infertility can be a lonely road, as you probably know). If not, it could stop them in their nosy tracks. After all, they're not nearly as interested in talking about their own lives as they are about yours. "Why do you ask?" If they're TTC (trying to conceive) themselves, then maybe it'll open up a conversation that could help them (infertility can be a lonely road, as you probably know). If not, it could stop them in their nosy tracks. After all, they're not nearly as interested in talking about their own lives as they are about yours.

Not in the mood for a witty retort-or to even respond at all (especially after you've been asked the same question five times in a single day)? There's nothing wrong with letting the questioner know that the answer is none of her business, which it isn't. "That's a personal matter" says it all.

Safety in Numbers "We'd barely adjusted to the fact that I was pregnant when we found out I'm carrying twins. Are there any extra risks for them, or for me?"

Extra babies do come with some extra risks, but not as many as you'd think. In fact, not all twin pregnancies are classified as "high risk" (though higher-order multiples definitely fall into that category), and most expectant mothers of multiples can expect to have relatively uneventful pregnancies (at least in terms of complications). Plus, entering your twin pregnancy armed with a little knowledge about the potential risks and complications can help you avoid many, and will prepare you should you encounter any. So relax (twin pregnancies are really safe), but read up.

For the babies, the potential risks include: Early delivery. Multiples tend to arrive earlier than singletons. More than half of twins (59 percent of them), most triplets (93 percent), and practically all quadruplets are born premature. While women pregnant with only one fetus deliver, on average, at 39 weeks, twin delivery, on average, occurs at 35 to 36 weeks. Triplets usually come (again, on average) at 32 weeks, and quadruplets at 30 weeks. (Keep in mind that term for twins is considered 37 weeks, not 40.) After all, as cozy as it can be for your little ones in the uterus, it can also get pretty crowded as they grow. Be sure you know the signs of premature labor, and don't hesitate to call your practitioner right away if you're experiencing any of them (see Multiples tend to arrive earlier than singletons. More than half of twins (59 percent of them), most triplets (93 percent), and practically all quadruplets are born premature. While women pregnant with only one fetus deliver, on average, at 39 weeks, twin delivery, on average, occurs at 35 to 36 weeks. Triplets usually come (again, on average) at 32 weeks, and quadruplets at 30 weeks. (Keep in mind that term for twins is considered 37 weeks, not 40.) After all, as cozy as it can be for your little ones in the uterus, it can also get pretty crowded as they grow. Be sure you know the signs of premature labor, and don't hesitate to call your practitioner right away if you're experiencing any of them (see page 300 page 300).

Low birthweight. Since many multiple pregnancies end early, most babies born of multiple pregnancies arrive weighing less than 5 pounds, which is considered low birthweight. Most 5-pounders end up doing just fine healthwise, thanks to advances in caring for these small newborns, but babies born weighing less than 3 pounds are at increased risk for health complications as newborns, as well as for long-term disabilities. Making sure your prenatal health is in top-notch condition and your diet contains plenty of nutrients (including the right amount of calories) can help get your babies to a bigger birthweight. (See Since many multiple pregnancies end early, most babies born of multiple pregnancies arrive weighing less than 5 pounds, which is considered low birthweight. Most 5-pounders end up doing just fine healthwise, thanks to advances in caring for these small newborns, but babies born weighing less than 3 pounds are at increased risk for health complications as newborns, as well as for long-term disabilities. Making sure your prenatal health is in top-notch condition and your diet contains plenty of nutrients (including the right amount of calories) can help get your babies to a bigger birthweight. (See What to Expect the First Year What to Expect the First Year for more on premature babies.) for more on premature babies.) Twin-to-Twin Transfusion Syndrome (TTTS). This in utero condition, which happens in about 15 percent of identical twin pregnancies in which the placenta is shared (fraternal twins are almost never affected because they never share a placenta), occurs when blood vessels in their shared placenta cross, resulting in one baby getting too much blood flow and the other too little. This condition is dangerous for the babies, though not to the mother. If it's detected in your pregnancy, your practitioner may opt to use amniocentesis to drain off excess fluid, which improves blood flow in the placenta and reduces the risk of preterm labor. Laser surgery to seal off the connection between the blood vessels is another option your practitioner may use. If you're dealing with TTTS, check out This in utero condition, which happens in about 15 percent of identical twin pregnancies in which the placenta is shared (fraternal twins are almost never affected because they never share a placenta), occurs when blood vessels in their shared placenta cross, resulting in one baby getting too much blood flow and the other too little. This condition is dangerous for the babies, though not to the mother. If it's detected in your pregnancy, your practitioner may opt to use amniocentesis to drain off excess fluid, which improves blood flow in the placenta and reduces the risk of preterm labor. Laser surgery to seal off the connection between the blood vessels is another option your practitioner may use. If you're dealing with TTTS, check out fetalhope.org for more information and resources. for more information and resources.

Multiple Benefits Good news! There's never been a safer time to conceive, carry, and give birth to more than one baby, and for lots of reassuring reasons. Here's what you have going for you as a mom-to-be of multiples these days: [image] A heads-up. Since the discovery that you're carrying multiples almost always comes early on in pregnancy these days, you've got extra time for planning and preparing for your babies, plus plenty of time to get the best possible prenatal care. And good prenatal care is the ticket to a healthy pregnancy-doubly so in a multiple pregnancy. A heads-up. Since the discovery that you're carrying multiples almost always comes early on in pregnancy these days, you've got extra time for planning and preparing for your babies, plus plenty of time to get the best possible prenatal care. And good prenatal care is the ticket to a healthy pregnancy-doubly so in a multiple pregnancy.[image] Lots more practitioner visits. Good prenatal care starts with more frequent practitioner visits. You'll likely be seen every two to three weeks (rather than every four) up until your seventh month and more frequently after that. And those visits may get more in-depth as your pregnancy progresses. You'll get all the tests singleton moms get, but you may also get internal exams earlier than a singleton mom-to-be would get (to check for signs of preterm labor). Lots more practitioner visits. Good prenatal care starts with more frequent practitioner visits. You'll likely be seen every two to three weeks (rather than every four) up until your seventh month and more frequently after that. And those visits may get more in-depth as your pregnancy progresses. You'll get all the tests singleton moms get, but you may also get internal exams earlier than a singleton mom-to-be would get (to check for signs of preterm labor).[image] Pictures, pictures, pictures. Of your babies, that is. You'll get extra ultrasounds to monitor your babies and make sure their development and growth is on track and the pregnancy is healthy. Which means extra reassurance, plus extra pictures for your baby book. Pictures, pictures, pictures. Of your babies, that is. You'll get extra ultrasounds to monitor your babies and make sure their development and growth is on track and the pregnancy is healthy. Which means extra reassurance, plus extra pictures for your baby book.[image] Extra attention. Good prenatal care also means extra attention to your health to reduce your risk of certain pregnancy complications (like hypertension, anemia, placenta abruption, and preterm labor, which are all more common in multiple pregnancies). With all that extra attention, any problem that develops will be treated quickly. Extra attention. Good prenatal care also means extra attention to your health to reduce your risk of certain pregnancy complications (like hypertension, anemia, placenta abruption, and preterm labor, which are all more common in multiple pregnancies). With all that extra attention, any problem that develops will be treated quickly.

A multiple pregnancy can also impact the health of the mother-to-be: Preeclampsia. The more babies you're carrying, the more placenta you've got on board. This added placenta (along with the added hormones that come with two babies) can sometimes lead to high blood pressure, which may in turn progress to preeclampsia. Preeclampsia affects one in four mothers of twins and usually is caught early, thanks to careful monitoring by your practitioner. For more on the condition and treatment options, see The more babies you're carrying, the more placenta you've got on board. This added placenta (along with the added hormones that come with two babies) can sometimes lead to high blood pressure, which may in turn progress to preeclampsia. Preeclampsia affects one in four mothers of twins and usually is caught early, thanks to careful monitoring by your practitioner. For more on the condition and treatment options, see page 548 page 548.

Gestational diabetes. Expectant multiple moms are slightly more likely to have gestational diabetes than a singleton mom. That's probably because higher hormone levels can interfere with a mother's ability to process insulin. Diet can usually control (or even prevent) this condition, but sometimes extra insulin is needed (see Expectant multiple moms are slightly more likely to have gestational diabetes than a singleton mom. That's probably because higher hormone levels can interfere with a mother's ability to process insulin. Diet can usually control (or even prevent) this condition, but sometimes extra insulin is needed (see page 546 page 546 for more). for more).

Placental problems. Women pregnant with multiples are at a somewhat higher risk for complications such as placenta previa (low-lying placenta) or placental abruption (premature separation of the placenta). Fortunately, careful monitoring (which you'll be getting) can detect previa long before it poses any significant risk. Abruption can't be detected before it happens, but because your pregnancy is being carefully watched, steps can be taken to avoid further complications should an abruption occur. Women pregnant with multiples are at a somewhat higher risk for complications such as placenta previa (low-lying placenta) or placental abruption (premature separation of the placenta). Fortunately, careful monitoring (which you'll be getting) can detect previa long before it poses any significant risk. Abruption can't be detected before it happens, but because your pregnancy is being carefully watched, steps can be taken to avoid further complications should an abruption occur.

Bed Rest "Will I have to be on bed rest just because I'm carrying twins?"

To bed rest or not to bed rest? That is the question many moms-to-be of multiples ask, and many practitioners don't always have an easy answer. That's because there really isn't an easy answer. The obstetrical jury is still out on whether bed rest helps prevent the kinds of complications sometimes associated with a multiple pregnancy (such as preterm labor and preeclampsia). So in the meantime, until more is known, some practitioners prescribe it in some cases. The more babies in a pregnancy, the more likely it will be prescribed, since the risk of complications increases with each additional fetus.

Be sure to have a discussion with your practitioner early in your pregnancy about his or her philosophy on bed rest. Some practitioners prescribe it routinely for all expectant mothers of multiples (often beginning between 24 and 28 weeks); more and more do it on a case-by-case basis, taking a wait-and-see approach.

If you are put on bed rest, see page 571 page 571 for tips on coping with it. And keep in mind that even if you aren't sent to bed, your practitioner will probably still advise you to take it easy, cut back on work, and stay off your feet as much as possible during the latter half of your pregnancy-so get ready to rest up. for tips on coping with it. And keep in mind that even if you aren't sent to bed, your practitioner will probably still advise you to take it easy, cut back on work, and stay off your feet as much as possible during the latter half of your pregnancy-so get ready to rest up.

Vanishing Twin Syndrome "I've heard of vanishing twin syndrome. What is it?"

Detecting multiple pregnancies early using ultrasound technology has many benefits, because the sooner you and your practitioner discover you've got two (or more) babies to care for, the better care you'll be able to get. But there's sometimes a downside to knowing so soon. Identifying twin pregnancies earlier than ever also reveals losses that went undetected before the days of early ultrasound.

The loss of one twin during pregnancy can occur in the first trimester (often before the mother even knows she's carrying twins) or, less commonly, later in the pregnancy. During a first-trimester loss, the tissue of the miscarried twin is usually reabsorbed by the mother. This phenomenon, called vanishing twin syndrome, occurs in about 20 to 30 percent of multiple pregnancies. Documentation of vanishing twin syndrome has grown significantly over the past few decades, as early ultrasounds-the only way to be sure early in pregnancy that you're carrying twins-have become routine. Researchers report more cases of vanishing twin syndrome in women older than 30, though that may be because older mothers in general have higher rates of multiple pregnancies, especially with the use of fertility treatments.

There are rarely any symptoms when the early loss of one twin occurs, though some mothers experience mild cramping, bleeding, or pelvic pain, similar to a miscarriage (though none of those symptoms is a sure sign of such a loss). Decreasing hormone levels (as detected by blood tests) may also indicate that one fetus has been miscarried.

The good news is that when vanishing twin syndrome occurs in the first trimester, the mother usually goes on to experience a normal pregnancy and delivers the single healthy baby without complication or intervention. In the much less likely case that a twin dies in the second or third trimester, the remaining baby may be at an increased risk of intrauterine growth restriction, and the mother may be at risk of preterm labor, infection, or bleeding. The remaining baby would then be watched carefully and the rest of the pregnancy monitored for complications.

For help coping with the loss of a twin in utero, see page 583 page 583.

Multiple Childbirth You're probably spending a lot of time wondering (okay, maybe you've been obsessing) about the day you'll actually give birth to your bundles of joy. Every delivery day is an unforgettable one, but if you're carrying twins (or more), yours probably won't be the typical birth story you've heard from moms who've delivered just one. Not surprisingly, things can get a little more complicated when you've got two babies or more heading for the exit-and a lot more interesting.

Will your labor and delivery be twice the effort? What will be the ideal way to deliver your multiple newborns into your two arms? The answers can depend on a lot of factors, such as fetal position, your health, the safety of the babies, and so on. Multiple births have more variables-and more surprises-than single births. But since you'll be getting two (or more) for the price of one labor, your multiple childbirth will be a pretty good deal no matter how it ends up playing out. And remember that whatever route your babies take from your snug womb to your even snugger embrace, the best way is the one that is the healthiest and safest for them-and for you.

Laboring with Twins or More How will your labor differ from the labor of a mother-of-one? Here are a few ways: [image] It could be shorter. Will you have to endure double the pain to end up cuddling double the pleasure? Nope. In fact, when it comes to labor, you're likely to catch a really nice break (for once). The first stage of labor is often shorter with multiples-which means that it may take less time to get to the point where you can start pushing, if you'll be delivering vaginally. The catch? You'll be hitting the harder part of labor sooner. It could be shorter. Will you have to endure double the pain to end up cuddling double the pleasure? Nope. In fact, when it comes to labor, you're likely to catch a really nice break (for once). The first stage of labor is often shorter with multiples-which means that it may take less time to get to the point where you can start pushing, if you'll be delivering vaginally. The catch? You'll be hitting the harder part of labor sooner.[image] Or it could be longer. Because a multiples mom's uterus is overstretched, contractions are sometimes weaker. And weaker contractions could mean that it might take longer to become fully dilated. Or it could be longer. Because a multiples mom's uterus is overstretched, contractions are sometimes weaker. And weaker contractions could mean that it might take longer to become fully dilated.[image] It'll be watched more closely. Because your medical team will have to be twice as careful during your multiple delivery, you'll be monitored more during labor than most moms of singletons. Throughout labor, you'll likely be attached to two (or more) fetal monitors so your practitioner can see how each baby is responding to your contractions. Early on, the babies' heartbeats may be monitored with external belt monitors; this could allow you to go off the monitors periodically so you can walk around or hit the whirlpool tub to help ease your pain (if you're so inclined). In the latter stages of labor, Baby A (the one closest to the exit) may be monitored internally with a scalp electrode while Baby B is still monitored externally. This will put an end to any wandering because you'll be tethered to a machine (but by this time, you may be well past the point of wanting to move around anyway). Be sure to discuss fetal monitoring and how it will affect your mobility with your practitioner. It'll be watched more closely. Because your medical team will have to be twice as careful during your multiple delivery, you'll be monitored more during labor than most moms of singletons. Throughout labor, you'll likely be attached to two (or more) fetal monitors so your practitioner can see how each baby is responding to your contractions. Early on, the babies' heartbeats may be monitored with external belt monitors; this could allow you to go off the monitors periodically so you can walk around or hit the whirlpool tub to help ease your pain (if you're so inclined). In the latter stages of labor, Baby A (the one closest to the exit) may be monitored internally with a scalp electrode while Baby B is still monitored externally. This will put an end to any wandering because you'll be tethered to a machine (but by this time, you may be well past the point of wanting to move around anyway). Be sure to discuss fetal monitoring and how it will affect your mobility with your practitioner.[image] You'll probably have an epidural. If you've had your heart set on one anyway, you'll be happy to hear that epidurals are strongly encouraged-or even required-with multiple deliveries, in case an emergency C-section becomes necessary to deliver one or all of your babies. If you'd like to avoid an epidural, talk to your practitioner, because practitioner and hospital policies differ on this topic. You'll probably have an epidural. If you've had your heart set on one anyway, you'll be happy to hear that epidurals are strongly encouraged-or even required-with multiple deliveries, in case an emergency C-section becomes necessary to deliver one or all of your babies. If you'd like to avoid an epidural, talk to your practitioner, because practitioner and hospital policies differ on this topic.[image] You'll probably deliver in an operating room. Most hospitals require this, just to be on the safe side (and in case an emergency C-section becomes necessary), so ask ahead. Chances are you'll be able to labor in one of those comfy rooms with the pretty curtains and relaxing prints, but when it's time to push, you'll likely be wheeled into the OR. You'll probably deliver in an operating room. Most hospitals require this, just to be on the safe side (and in case an emergency C-section becomes necessary), so ask ahead. Chances are you'll be able to labor in one of those comfy rooms with the pretty curtains and relaxing prints, but when it's time to push, you'll likely be wheeled into the OR.

Twin Timing Just how far apart will your multiples be born? With vaginal deliveries, most babies are born 10 to 30 minutes apart. With C-sections, it can be just seconds, or up to a minute or two, between births.

Position, Position, Position Quick ... flip a coin. Heads (up) or tails (down)? Or maybe a combination of both? How multiples will end up at delivery time (and how you'll end up delivering) is anybody's guess. Here's a look at the possible ways your twins may be presenting and the likely delivery scenarios for each situation.

Vertex/vertex. This is the most cooperative position that twins can wind up in on delivery day, and they wind up in it about 40 percent of the time. If both your babies are vertex (heads down), you'll likely be able to go into labor naturally and attempt a vaginal birth. Keep in mind, however, that even perfectly positioned singletons sometimes need to be delivered by C-section. This goes double for twins. This is the most cooperative position that twins can wind up in on delivery day, and they wind up in it about 40 percent of the time. If both your babies are vertex (heads down), you'll likely be able to go into labor naturally and attempt a vaginal birth. Keep in mind, however, that even perfectly positioned singletons sometimes need to be delivered by C-section. This goes double for twins.

Vertex/breech. The second best-case scenario if you're hoping for a vaginal birth for your twins is the vertex/breech setup. This means that if Baby A is head down and well positioned for delivery, it may be possible for your practitioner to manipulate Baby B from the breech position to vertex after Baby A is born. This can be done either by applying manual pressure to your abdomen (external version) or literally reaching inside your uterus to turn Baby B (internal version). The internal version sounds much more complicated than it is; because Baby A has essentially warmed up and stretched out the birth canal already, the procedure's over pretty quickly. If Baby B remains stubbornly breech, your practitioner may do a breech extraction, in which your baby is pulled feet first right out the door. The second best-case scenario if you're hoping for a vaginal birth for your twins is the vertex/breech setup. This means that if Baby A is head down and well positioned for delivery, it may be possible for your practitioner to manipulate Baby B from the breech position to vertex after Baby A is born. This can be done either by applying manual pressure to your abdomen (external version) or literally reaching inside your uterus to turn Baby B (internal version). The internal version sounds much more complicated than it is; because Baby A has essentially warmed up and stretched out the birth canal already, the procedure's over pretty quickly. If Baby B remains stubbornly breech, your practitioner may do a breech extraction, in which your baby is pulled feet first right out the door.

Breech/vertex or breech/breech. If Baby A is breech or if both your babies are bottoms down, your physician will almost certainly recommend a C-section. Though external version is commonplace for breech singletons (and can work in the above-mentioned vertex/breech multiple pregnancy), it's considered too risky in this scenario. If Baby A is breech or if both your babies are bottoms down, your physician will almost certainly recommend a C-section. Though external version is commonplace for breech singletons (and can work in the above-mentioned vertex/breech multiple pregnancy), it's considered too risky in this scenario.

Baby A oblique. Who knew there were so many positions for babies to lie in? When Baby A is oblique, it means his or her head is pointed down, but toward either of your hips rather than squarely on your cervix. In a singleton pregnancy with oblique presentation, a practitioner would probably try external version to bring the baby's head where it needs to be (facing the exit), but that's risky with twins. In this case, two things can happen: An oblique presentation can correct itself as contractions progress, resulting in a vaginal birth, or more likely, your practitioner will recommend a C-section to avoid a long, drawn-out labor that may or may not lead to a vaginal birth. Who knew there were so many positions for babies to lie in? When Baby A is oblique, it means his or her head is pointed down, but toward either of your hips rather than squarely on your cervix. In a singleton pregnancy with oblique presentation, a practitioner would probably try external version to bring the baby's head where it needs to be (facing the exit), but that's risky with twins. In this case, two things can happen: An oblique presentation can correct itself as contractions progress, resulting in a vaginal birth, or more likely, your practitioner will recommend a C-section to avoid a long, drawn-out labor that may or may not lead to a vaginal birth.

Transverse/transverse. In this setup, both babies are lying horizontally across your uterus. A double transverse almost always results in a C-section. In this setup, both babies are lying horizontally across your uterus. A double transverse almost always results in a C-section.

Delivering Twins Here's what you can expect when delivering your twins: Vaginal delivery. About half of all twins born these days come into the world the old-fashioned way, but that doesn't mean the birthing experience is the same as it is for singleton moms. Once you're fully dilated, delivery of Baby A may be a cinch ("Three pushes was all it took!") or a protracted ordeal ("It took three hours!"). Though that latter scenario is far from a given, some research has shown that the pushing phase (stage two) is usually longer in a twin delivery than in a singleton delivery. The second twin in a vaginal delivery usually comes within 10 to 30 minutes of the first, and most mothers report that delivering Baby B is a snap compared to Baby A. Depending on the position of Baby B, he or she may need some help from the doctor, who can either reach in and move the baby into the birth canal (internal version) or use vacuum extraction to speed the delivery. The possibility of this kind of intervention is yet another reason why many doctors strongly recommend epidurals for multiple moms. (An arm reaching up into your uterus to pull out a baby isn't pretty without pain meds.) About half of all twins born these days come into the world the old-fashioned way, but that doesn't mean the birthing experience is the same as it is for singleton moms. Once you're fully dilated, delivery of Baby A may be a cinch ("Three pushes was all it took!") or a protracted ordeal ("It took three hours!"). Though that latter scenario is far from a given, some research has shown that the pushing phase (stage two) is usually longer in a twin delivery than in a singleton delivery. The second twin in a vaginal delivery usually comes within 10 to 30 minutes of the first, and most mothers report that delivering Baby B is a snap compared to Baby A. Depending on the position of Baby B, he or she may need some help from the doctor, who can either reach in and move the baby into the birth canal (internal version) or use vacuum extraction to speed the delivery. The possibility of this kind of intervention is yet another reason why many doctors strongly recommend epidurals for multiple moms. (An arm reaching up into your uterus to pull out a baby isn't pretty without pain meds.) Mixed delivery. In rare cases (very rare cases), Baby B must be delivered by C-section after Baby A has been delivered vaginally. This is usually done only when an emergency situation has come up that puts Baby B at risk, such as placental abruption or cord prolapse. (Those all-important fetal monitors tell your doctor just how well Baby B is doing after Baby A's arrival.) A mixed delivery is not fun for mom; in the moment, of course, it can be very scary, and after the babies are born, it means recovery from both a vaginal birth and major abdominal surgery, a big double ouch. But when it's necessary, it can be a baby-saving procedure, well worth the added recovery time. In rare cases (very rare cases), Baby B must be delivered by C-section after Baby A has been delivered vaginally. This is usually done only when an emergency situation has come up that puts Baby B at risk, such as placental abruption or cord prolapse. (Those all-important fetal monitors tell your doctor just how well Baby B is doing after Baby A's arrival.) A mixed delivery is not fun for mom; in the moment, of course, it can be very scary, and after the babies are born, it means recovery from both a vaginal birth and major abdominal surgery, a big double ouch. But when it's necessary, it can be a baby-saving procedure, well worth the added recovery time.

Planned C-section. A scheduled C-section is discussed with your doctor in advance and a date is set. Possible reasons for this plan include a previous C-section (a VBAC is not common practice for multiples), placenta previa or other obstetrical or medical issues, or fetal positions that make vaginal delivery unsafe. With most planned C-sections, your spouse, partner, or coach can accompany you into the operating room, where you will probably be given a spinal block-a pumped-up version of the epidural used to block pain in a vaginal birth. You may be surprised by how fast it all goes after you're numb: Baby A's and Baby B's birth times will be separated by anywhere from seconds to just a minute or two. A scheduled C-section is discussed with your doctor in advance and a date is set. Possible reasons for this plan include a previous C-section (a VBAC is not common practice for multiples), placenta previa or other obstetrical or medical issues, or fetal positions that make vaginal delivery unsafe. With most planned C-sections, your spouse, partner, or coach can accompany you into the operating room, where you will probably be given a spinal block-a pumped-up version of the epidural used to block pain in a vaginal birth. You may be surprised by how fast it all goes after you're numb: Baby A's and Baby B's birth times will be separated by anywhere from seconds to just a minute or two.

Recovery from a Multiple Delivery Besides having your hands twice as full, your recovery from a multiple delivery will be very similar to that of a singleton delivery, so be sure to read through Chapters 17 and 18. You can also expect these postpartum differences: [image] It'll likely take longer for your belly to return to normal size (it was stretched out more, after all). You'll likely have more extra skin to contend with, too, after all that stretching. It'll likely take longer for your belly to return to normal size (it was stretched out more, after all). You'll likely have more extra skin to contend with, too, after all that stretching.[image] You may experience more lochia (vaginal bleeding) for a longer period of time. That's because more blood was stored up in your uterus during your pregnancy, and it all has to go now. You may experience more lochia (vaginal bleeding) for a longer period of time. That's because more blood was stored up in your uterus during your pregnancy, and it all has to go now.[image] Getting back into shape will take longer-mostly because you were probably pretty inactive for the last three months of your pregnancy (no matter how physically fit, or not, you were before your pregnancy). Getting back into shape will take longer-mostly because you were probably pretty inactive for the last three months of your pregnancy (no matter how physically fit, or not, you were before your pregnancy).[image] You'll be achier for longer because of all the extra weight you carried around during pregnancy. Not to mention all the extra carrying around you'll be doing after delivery. You'll be achier for longer because of all the extra weight you carried around during pregnancy. Not to mention all the extra carrying around you'll be doing after delivery.

Breastfeeding for Two Is Good for Mom, Too You probably already know that breastfeeding is the best for your babies (see page 447 page 447 for tips on breastfeeding multiples). But did you know that it also does your postpartum body good? Breastfeeding releases hormones (oxytocin) that help your uterus contract to its normal size (and remember, yours was especially stretched). This in turn will also stem the flow of lochia, so you'll lose less blood. And if you're concerned about losing weight, just consider those little nurslings to be nature's liposuction machines: Breastfeeding two babies will burn fat and calories twice as fast, which means you'll also have license to continue eating more. Nurse three (or more) and the calorie bonuses multiply. for tips on breastfeeding multiples). But did you know that it also does your postpartum body good? Breastfeeding releases hormones (oxytocin) that help your uterus contract to its normal size (and remember, yours was especially stretched). This in turn will also stem the flow of lochia, so you'll lose less blood. And if you're concerned about losing weight, just consider those little nurslings to be nature's liposuction machines: Breastfeeding two babies will burn fat and calories twice as fast, which means you'll also have license to continue eating more. Nurse three (or more) and the calorie bonuses multiply.

If your newborns are in the NICU, you probably won't be able to nurse them directly at first, but they'll benefit greatly from the ideal nutrition only you can provide (especially if they're preemies). So cozy up to an electric pump (they can likely be fed with the expressed milk), and continue pumping until they're released and ready to cozy up to your breasts.

Unplanned C-section. An unplanned C-section is the other possible way your babies might enter the world. In this case, you may walk into your usual weekly prenatal appointment and find out that you're going to meet your babies the same day. Best to be prepared, so in those later weeks of pregnancy, be sure to get your bag packed and ready to go. Reasons for a surprise cesarean delivery include such conditions as intrauterine growth restriction (where the babies run out of room to grow) or a sharp rise in your blood pressure (preeclampsia). Another unplanned C-section scenario may arise if you labor for a very long time and don't progress at all. A uterus holding 10 or more pounds of babies may be too stretched to contract effectively, so a cesarean delivery might be the only way out. An unplanned C-section is the other possible way your babies might enter the world. In this case, you may walk into your usual weekly prenatal appointment and find out that you're going to meet your babies the same day. Best to be prepared, so in those later weeks of pregnancy, be sure to get your bag packed and ready to go. Reasons for a surprise cesarean delivery include such conditions as intrauterine growth restriction (where the babies run out of room to grow) or a sharp rise in your blood pressure (preeclampsia). Another unplanned C-section scenario may arise if you labor for a very long time and don't progress at all. A uterus holding 10 or more pounds of babies may be too stretched to contract effectively, so a cesarean delivery might be the only way out.

Delivering Triplets Wondering if your triplets are destined to take the abdominal route out? Cesarean delivery is most often used for triplets-not only because it's usually safest, but because C-sections are more common in high-risk deliveries (a category triplets always fall into) and because they're more common among older moms (who give birth to the majority of triplets). But some doctors say that vaginal delivery can be an option if Triplet A (the one nearest the "exit") is in a head-down presentation and there are no other complicating factors (such as preeclampsia in the mother or fetal distress in one or more of the babies). In some rare cases, the first baby or the first and second may be delivered vaginally, and the final one may require a cesarean delivery. Of course, more important than having all three of your babies exit vaginally is having all four of you leaving the delivery room in good condition-and any route to that outcome will be a successful one.

PART 4.

After the Baby Is Born

CHAPTER 17.

Postpartum: The First Week.

CONGRATULATIONS! THE MOMENT you've awaited for 40 (or so) weeks has finally arrived. You've put months of pregnancy and long hours of childbirth behind you, and you're officially a mother, with a new bundle of joy in your arms instead of in your belly. But the transition from pregnancy to postpartum comes with more than just a baby. It also comes with a variety of new symptoms (good-bye pregnancy aches, pains, and discomforts, hello postpartum ones) and a variety of new questions (Why am I sweating so much? Why am I having contractions if I've already delivered? Will I ever be able to sit again? Why do I still look six months pregnant? Whose breasts are these anyway?). Hopefully, you'll have a chance to read up on these and many more pertinent postpartum topics in advance. Once you're on full-time mom duty, finding the time to read anything (never mind use the toilet) won't be easy. you've awaited for 40 (or so) weeks has finally arrived. You've put months of pregnancy and long hours of childbirth behind you, and you're officially a mother, with a new bundle of joy in your arms instead of in your belly. But the transition from pregnancy to postpartum comes with more than just a baby. It also comes with a variety of new symptoms (good-bye pregnancy aches, pains, and discomforts, hello postpartum ones) and a variety of new questions (Why am I sweating so much? Why am I having contractions if I've already delivered? Will I ever be able to sit again? Why do I still look six months pregnant? Whose breasts are these anyway?). Hopefully, you'll have a chance to read up on these and many more pertinent postpartum topics in advance. Once you're on full-time mom duty, finding the time to read anything (never mind use the toilet) won't be easy.

What You May Be Feeling During the first week postpartum, depending on the type of delivery you had (easy or difficult, vaginal or cesarean) and other individual factors, you may experience all, or only some, of the following: Physically [image] Vaginal bleeding (lochia) similar to your period Vaginal bleeding (lochia) similar to your period[image] Abdominal cramps (afterpains) as your uterus contracts Abdominal cramps (afterpains) as your uterus contracts[image] Exhaustion Exhaustion[image] Perineal discomfort, pain, numbness, if you had a vaginal delivery (especially if you had stitches) Perineal discomfort, pain, numbness, if you had a vaginal delivery (especially if you had stitches)[image] Some perineal discomfort if you had a C-section Some perineal discomfort if you had a C-section[image] Pain around the incision and, later, numbness in the area, if you had a C-section (especially a first one) Pain around the incision and, later, numbness in the area, if you had a C-section (especially a first one)[image] Discomfort sitting and walking if you had an episiotomy, a repair of a tear, or a cesarean delivery Discomfort sitting and walking if you had an episiotomy, a repair of a tear, or a cesarean delivery[image] Difficulty urinating for a day or two Difficulty urinating for a day or two[image] Constipation; discomfort with bowel movements for the first few days Constipation; discomfort with bowel movements for the first few days[image] Hemorrhoids, continued from pregnancy, or new from pushing Hemorrhoids, continued from pregnancy, or new from pushing[image] All-over achiness, especially if you did a lot of pushing All-over achiness, especially if you did a lot of pushing[image] Bloodshot eyes; black-and-blue marks around eyes, on cheeks, elsewhere, from too-vigorous pushing Bloodshot eyes; black-and-blue marks around eyes, on cheeks, elsewhere, from too-vigorous pushing[image] Sweating, and lots of it, particularly at night Sweating, and lots of it, particularly at night[image] Breast discomfort and engorgement beginning around the third or fourth day postpartum Breast discomfort and engorgement beginning around the third or fourth day postpartum[image] Sore or cracked nipples, if you're breastfeeding Sore or cracked nipples, if you're breastfeeding Emotionally [image] Elation, blues, or swings between the two Elation, blues, or swings between the two[image] New-mom jitters; trepidation about caring for your new baby, especially if you're a first timer New-mom jitters; trepidation about caring for your new baby, especially if you're a first timer[image] Frustration, if you're having a hard time getting started breastfeeding Frustration, if you're having a hard time getting started breastfeeding[image] A feeling of being overwhelmed by the physical, emotional, and logistical challenges facing you A feeling of being overwhelmed by the physical, emotional, and logistical challenges facing you[image] Excitement about starting your new life with your new baby Excitement about starting your new life with your new baby What You May Be Wondering About Bleeding "I expected some bleeding after delivery, but when I got out of bed for the first time and saw the blood running down my legs, I was a little freaked out."

Grab a pile of pads, and relax. This discharge of leftover blood, mucus, and tissue from your uterus, known as lochia, is normally as heavy as (and often heavier than) a menstrual period for the first three to ten postpartum days. It may total up to 2 cups before it begins to taper off, and at times it may seem pretty profuse. A sudden gush when you stand up in the first few days is normal-it's just the flow that accumulates when you've been lying down or sitting. Because blood and an occasional blood clot are the predominant ingredients of lochia during the immediate postpartum period, your discharge can be quite red for anywhere from five days to three weeks, gradually turning to a watery pink, then to brown, and finally to a yellowish white. Maxipads, not tampons, should be used to absorb the flow, which may continue on and off for just a couple of weeks or as long as six weeks. In some women, light bleeding continues for three months. The flow is different for everyone.

Breastfeeding-and/or intravenous Pitocin (oxytocin), which is routinely ordered by some doctors following delivery-may reduce the flow of lochia by encouraging uterine contractions. These postdelivery contractions help shrink the uterus back to its normal size more quickly while pinching off exposed blood vessels at the site where the placenta separated from the uterus. For more about these contractions, see the next question.

If you're in the hospital or birthing center and you think your bleeding may be excessive, notify a nurse. If you experience what seems to be abnormally heavy bleeding (see page 569 page 569) once you're home, call your practitioner without delay; if you can't reach him or her, go to the emergency room (in the hospital where you delivered, if possible).

Afterpains "I've been having crampy pains in my abdomen, especially when I'm nursing. What's that about?"

Thought you'd felt the last of those contractions? Unfortunately, they don't end immediately with delivery-and neither does the discomfort they cause. Those so-called afterpains are triggered by the contractions of the uterus as it shrinks (from about 21/3 pounds to just a couple of ounces) and makes its normal descent back into the pelvis following the birth of your baby. You can keep track of the shrinking size of your uterus by pressing lightly below your navel. By the end of six weeks, you probably won't feel it at all. pounds to just a couple of ounces) and makes its normal descent back into the pelvis following the birth of your baby. You can keep track of the shrinking size of your uterus by pressing lightly below your navel. By the end of six weeks, you probably won't feel it at all.

Afterpains can definitely be a pain, but they do good work. Besides helping the uterus find its way back to its usual size and location, those contractions help slow normal postpartum bleeding. They're likely to be more of a pain in women whose uterine muscles are lacking in tone because of previous births or excessive stretching (as with a multiple pregnancy). Afterpains can be more pronounced during nursing, when contraction-stimulating oxytocin is released (a good thing, actually, since it means your uterus is shrinking faster) and/or if you've had intravenous Pitocin (oxytocin) following delivery.

The pains should subside naturally within four to seven days. In the meantime, acetaminophen (Tylenol) should provide relief. If it doesn't, or if the pains persist for more than a week, see your practitioner to rule out other postpartum problems, including infection.

Perineal Pain "I didn't have an episiotomy, and I didn't tear. Why am I so sore down below?"

You can't expect some 7 pounds of baby to pass unnoticed. Even if your perineum was left neatly intact during the baby's arrival, that area has still been stretched, bruised, and generally traumatized, and discomfort, ranging from mild to not so mild, is the very normal result. The pain may be worse when you cough or sneeze, and you may even find that it hurts to sit down for a few days. You can try the same tips given in the next answer for women with post-tear pain.

It's also possible that in pushing your baby out, you developed hemorrhoids and, possibly, anal fissures, which can range from uncomfortable to extremely painful. See page 272 page 272 for tips on dealing with hemorrhoids. for tips on dealing with hemorrhoids.

"I tore during delivery and now I'm incredibly sore. Could my stitches be infected?"

Everyone who delivers vaginally (and sometimes those who have a lengthy labor before delivering via cesarean) can expect some perineal pain. But, not surprisingly, that pain's likely to be compounded if the perineum was torn or surgically cut (aka an episiotomy). Like any freshly repaired wound, the site of a laceration or episiotomy will take time to heal, usually 7 to 10 days. Pain alone during this time, unless it is very severe, is not an indication that you've developed an infection.

What's more, infection (though possible) is really very unlikely if your perineal area has been well cared for since delivery. While you're in the hospital or birthing center, a nurse will check your perineum at least once daily to be certain there is no inflammation or other indication of infection. She'll also instruct you in postpartum perineal hygiene, which is important in preventing infection not only of the repair site but of the genital tract as well (germs can get around). For this reason, the same precautions apply for those who delivered completely intact. Here's the self-care plan for a healthy postpartum perineum: [image] Use a fresh maxipad at least every four to six hours. Use a fresh maxipad at least every four to six hours.[image] Pour or squirt warm water (or an antiseptic solution, if one was recommended by your practitioner or nurse) over your perineum while you pee to ease burning, and after you're done on the toilet, to keep the area clean. Pat dry with gauze pads or with the paper wipes that come with some hospital-provided sanitary pads, always from front to back. Gently does it-no rubbing. Pour or squirt warm water (or an antiseptic solution, if one was recommended by your practitioner or nurse) over your perineum while you pee to ease burning, and after you're done on the toilet, to keep the area clean. Pat dry with gauze pads or with the paper wipes that come with some hospital-provided sanitary pads, always from front to back. Gently does it-no rubbing.[image] Keep your hands off the area until healing is complete. Keep your hands off the area until healing is complete.

Though discomfort is likely to be greater if you've had a repair (with itchiness around the stitches possibly accompanying soreness), the suggestions below will likely be welcome no matter how you delivered. To relieve perineal pain: Ice it. To reduce swelling and bring soothing relief, use chilled witch hazel pads, a surgical glove filled with crushed ice, or a maxipad with a built-in cold pack, applied to the site every couple of hours during the first 24 hours following delivery. To reduce swelling and bring soothing relief, use chilled witch hazel pads, a surgical glove filled with crushed ice, or a maxipad with a built-in cold pack, applied to the site every couple of hours during the first 24 hours following delivery.

Heat it. Warm sitz baths (a bath in which only your hips and buttocks are submerged) for 20 minutes a few times a day or hot compresses will ease discomfort. Warm sitz baths (a bath in which only your hips and buttocks are submerged) for 20 minutes a few times a day or hot compresses will ease discomfort.

Numb it. Use local anesthetics in the form of sprays, creams, ointments, or pads recommended by your practitioner. Acetaminophen (Tylenol) may also help. Use local anesthetics in the form of sprays, creams, ointments, or pads recommended by your practitioner. Acetaminophen (Tylenol) may also help.

Keep off it. To keep the pressure off your sore perineum, lie on your side when possible, and avoid long periods of standing or sitting. Sitting on a pillow (especially one with an opening in the center) or inflated tube (usually marketed to hemorrhoid sufferers) may also help, as can tightening your buttocks before sitting. To keep the pressure off your sore perineum, lie on your side when possible, and avoid long periods of standing or sitting. Sitting on a pillow (especially one with an opening in the center) or inflated tube (usually marketed to hemorrhoid sufferers) may also help, as can tightening your buttocks before sitting.