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Twins, Triplets and Other Multiple Pregnancies

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Triplet Ultrasound - 8 Weeks Pregnant - 3D Photo © C. Smiley

How do multiples happen?:

Multiples are when there are more than one baby in the womb at a time. This can happen naturally when an egg splits creating identical or monozygotic twins or when two or more eggs are fertilized at the same time (dizygotic). There are also fertility drugs that can increase the likelihood of more than one baby being conceived. For example, using Clomid the likelihood of having twins is 10%. Other fertility treatments, like IVF can also result in twin or higher order multiple pregnancies.

What are the odds I'll have twins?:

There are reasons that may increase your chances of having twins, triplets or other multiples, with twins being the most likely to occur spontaneously. These include:

  • your age
  • your family history of twinning
  • medications you are taking

Some people claim that there are other things you can do to increase your chances of twins, but they are mostly not backed up by science.

How are multiple pregnancies diagnosed?:

Typically multiple pregnancies are diagnosed via ultrasound. Having an ultrasound may happen because you are known to be at risk for multiples, such as in the case of fertility treatments, because you are having another complication that requires ultrasound or a at a routine screening with ultrasound.

Occasionally multiples will be considered when:

  • the pregnancy hormone, hCG, is excessively high
  • the growth of the uterus is more than expected
  • the mother feels excessive movement
  • the practitioner hears more than one heart beat

In this day and age, very few multiple pregnancies go undiagnosed until birth.

How is a multiple pregnancy different from a singleton pregnancy?:

Since there is more risk with a multiple pregnancy you will have more visits with your doctor. Some women will choose to stay with their regular OB/GYN if they are having twins, most women with triplets or more will be seen by a perinatologist, a high risk pregnancy specialist.

Being at high risk for preterm labor and other complications means that you will also be offered more testing, including ultrasound screening more frequently. Your practitioner can tell you about other additional testing that you may need.

What is it like being pregnant with more than one baby?:

Having multiples is a whirlwind of emotions - happy, scared, nervous and more. Your uterus grows more quickly and expands beyond what it would normally do with one baby. For example, at week 28 of pregnancy a twin mom is the same size as most 40 week pregnant singleton moms.

Comfort can be a real issue in a multiple pregnancy. Eating can be different too. Some moms find they aren't hungry or get full quickly. Small frequent meals help. You might also find that you have trouble with maternity clothes. Fetal movement may be a lot and fetal kick counts required by your doctor.

How is labor different with multiples?:

Most multiples are born earlier than singletons. The number of babies increases the amount of time pregnancy is cut short. For example, twins are typically born at 38 weeks, whereas triplets typically come around 34 weeks.

Labor and vaginal birth is possible. Though twins and other multiples can more easily be in positions other than head down. This and other factors mean that multiples have a much higher cesarean rate. Twins are born surgically about 50% of the time, triplets 90% and nearly 100% for all the higher order multiples. Much has to do with the length of pregnancy and position of babies.

Multiple Babies:

Once your babies are here, you may need to spend some time in the neonatal intensive care (NICU) if they were early or have problems. Once home life can be hectic but manageable. Finding other parents who have multiples can be a big help as can asking for help from your family and friends.

Postpartum depression can be more prevalent among mothers of multiples. So be sure to know the signs and symptoms as well as where you can turn for help.

Breastfeeding Multiples:

There are many parents who choose to breastfeed their multiples with varying degrees of success. Find a good lactation consultant and begin working with her in pregnancy to form your breastfeeding plan.

Fun for Multiples:

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