UCSF to Serve Growing Number of Twin Births in U.S.
With advances in infertility treatments and more women who choose to wait a few years before having children, today’s new parents are much more likely to welcome two bundles of joy than ever before.
As these parents quickly realize, the challenges associated with caring for twins – from conception through delivery and beyond – are much bigger than two diapers to change at the same time or two babies to breastfeed.
To accommodate the growing number of twin pregnancies and highly specialized care that often is necessary for these mothers and babies, UCSF is creating the nation’s first fully comprehensive twins center of excellence.
The center, which will open in early 2013 and incorporate the best in clinical care, research and training, will be called EMBRACE, or Evaluating Multiple Births Through Research and Care. EMBRACE will provide patient-centered coordinated services over the entire course of pregnancy, from preconception through the postnatal period.
An image showing an early diagnosis of twins.
“Our state-of-the-art facilities are inspired by the world-class clinical programs that will be offered at the new UCSF Medical Center at Mission Bay, and this center is a perfect example of that,” said Larry Rand, MD, the Marc and Lynne Benioff Endowed Chair in Maternal-Fetal Medicine and an obstetrician-gynecologist who specializes in high-risk twin pregnancies. Rand is overseeing development of EMBRACE and will be its director.
EMBRACE will open at Mission Bay, and mothers from the program will be able to begin delivering babies at the new UCSF Medical Center at Mission Bay when the hospital complex opens in early 2015. The center will be housed within the Division of Maternal-Fetal Medicine and will bring together experts from a variety of disciplines.
“We are committed to providing state-of-the art, patient-centered, multidisciplinary care to achieve the best outcomes before and after birth. Our plan to launch EMBRACE at our Mission Bay campus reinforces our commitment to addressing the needs of Bay Area mothers and their growing families now and in the future,” said Mari-Paule Thiet, MD, chief of obstetrics at UCSF Medical Center and director of the Division of Maternal-Fetal Medicine.
Centralizing Care to Serve Explosion of Twin Births
Many specialists are involved in caring for twin pregnancies, including general obstetricians-gynecologists, geneticists, perinatologists, neonatologists, and ultrasound experts. Mothers of twins also need supplemental services like nutrition counseling and breastfeeding support. All of this makes a coordinated team approach crucial to providing the best care for patients.
"Twin pregnancies have their unique set of challenges that are best served by a multidisciplinary team," said Linda Giudice, MD, PhD, chair of Obstetrics, Gynecology and Reproductive Sciences at the UCSF School of Medicine. "Dr. Rand's vision for the new center includes preventing and minimizing complications and working with the patient and her family as partners, and providing emotional support."
Twin pregnancies have exploded in this country and certainly in the Bay Area, and we absolutely need a centralized umbrella of care for families, according to Rand.
The explosion of twin pregnancies is underscored by a recent report from the U.S. Centers for Disease Control and Prevention (CDC) that found the number of twin births in the United States has more than doubled in the last three decades. According to the January 2012 CDC report, one in every 30 babies born in this country in 2009 was a twin, compared with one in every 53 in 1980. About one-third of the rise in twin births can be attributed to the increasingly older age of mothers, while the rest is due to more widespread use of infertility treatments like in vitro fertilization.
This illustration shows normal monochorionic twins, in which a single placenta is shared by two fetuses and no complications are present. The umbilical cord of each twin inserts anywhere into the placenta. Each twin has its own amniotic sac with a normal amount of amniotic fluid.
Any woman who has given birth and followed the typical schedule of prenatal care can attest to the substantial time spent juggling routine check-ups, ultrasounds and necessary follow-up appointments. But for mothers of twins, the standard care is much more involved. For example, while uncomplicated single pregnancies require two or three ultrasounds, women carrying twins have at least 15. According to Rand, the numerous appointments at different locations can be confusing for parents, which can negatively affect the efficiency and quality of care.
“There is definitely a lot of running around, and I would have loved to have everything coordinated through one center. It just makes so much sense,” said San Francisco resident Megan Taylor, a mother who delivered healthy twin baby girls at UCSF Benioff Children’s Hospital on Dec. 28, 2011. “The experience is so different from a singleton pregnancy and the sooner you are helped to understand that, the sooner you can enjoy pregnancy and feel fully prepared for all it entails.”
Coordinating Care for Higher Risk Patients
More extensive care for twin pregnancies reflects the higher risk of complications for both the mother and babies. Mothers of twins are more likely to go into preterm labor and deliver prematurely, and low birth-weight babies are at risk for developing lifelong complications, from mild developmental delays to cerebral palsy.
EMBRACE’s expertise will cover the entire span of twin pregnancies, from the lower-risk mothers, like Megan Taylor, to the highest-risk cases in which both babies are nourished through a single placenta – known as monochorionic twins. Monochorionic twins are much more likely to develop abnormalities and therefore require the full gamut of prenatal care; but with appropriate planning, monitoring and timing of delivery, complications can be prevented or mitigated.
“What we intend to do at EMBRACE is to take all the pressure off the patient,” Rand said. “Carrying twins is hard enough as it is, and when these mothers have to be responsible for coordinating every aspect of their care, things are more likely to get off track and complications are picked up too late.”
Every family at EMBRACE will be assigned to a nurse coordinator who will provide support for the duration of the pregnancy.The coordinator will play a critical role communicating the plan of care, facilitating smooth hand-offs between offices and helping patients navigate community resources. After delivery, babies who need to be admitted to the intensive care nursery at the new UCSF Benioff Children’s Hospital at Mission Bay will stay in rooms specially designed to accommodate twins. EMBRACE also will collaborate with mental health experts to ensure families receive the emotional support they need.
“When it comes to having twins, everything is amplified. Two babies bring double the love, but also double the worry,” said Kim Norman, MD, a UCSF psychiatrist who directs the Young Adult and Family Center and is an EMBRACE collaborator. “We will help parents navigate the process and give them tools for raising twins to be indescribably close but with separate, independent identities.
Focus on Health-Outcomes Research
Another key component of EMBRACE will be the center’s focus on research. By maintaining close relationships with patients, Rand anticipates that the center will be the first to gather solid long-term data on health outcomes for twins. He hopes to follow twins born at the center for a minimum of two years to evaluate such factors as neurological development in low birth-weight babies.A second major research project will seek better ways to treat the complications that arise in monochorionic pregnancies.
“It’s important to remember that pregnancy is not an illness. It’s a state of health and families should have a great experience,” Rand said. “We will help patients navigate this exciting time and enjoy it through and through. This is what EMBRACE is all about.”