Twins and Multiple Pregnancies
Discovering that you’re pregnant can be one of the happiest and most exciting times in a couple’s life, but if the ultrasound showed two, three, or more little bodies floating around in there, you might be wondering, what comes next? With the advent of various fertility treatments, particularly IVF, multiple births are more common than ever before, and while they can be a little scary, the key to successfully navigating your multiple pregnancy and birth is knowledge and organization.
How Much Weight Will I Gain?
In single pregnancies, a mother can expect to gain 25 to 35 pounds if she was a healthy weight before pregnancy, 28 to 40 pounds if she was underweight and 15 to 25 pounds if she was overweight. In pregnancies involving multiple babies, though, weight gain will probably increase by about 35 to 45 pounds, but there is no hard and fast rule. Weight gain should be discussed with your doctor; only she will be able to tell if you’re gaining the correct amount.
How Many Extra Calories do I Need?
In every pregnancy, you will need to eat an extra 300 calories per baby. So if you’re carrying twins, you should eat an extra 600, triplets 900 and so on. During this time, your prenatal diet should be trying to increase the amount of protein, calcium, fruits, vegetables and whole grains that you consume. This will help to ensure the health of you and your babies. You should also increase your water intake at this time to ensure that you remain well hydrated.
Will My Prenatal Care be Different?
Throughout their entire pregnancy, mothers of twins and multiples are encouraged to see a board certified obstetrician instead of a general practitioner. Women experiencing complications in multiple pregnancies will probably also be referred to a perinatologist, who has special training for dealing with pregnancy complications. You may or may not have to attend more frequent doctor appointments than mothers of singles, but it is likely that you will be offered more prenatal tests. You will likely have more ultrasounds than you otherwise would. These more frequent ultrasounds will help to check on the development of each baby. You will also have to have your blood glucose levels checked.
Will the Birthing Experience be Different?
When you give birth to twins or multiples, the birthing experience will be different from that of an uncomplicated single delivery. For one, there will be more people in the room. Even if you have a vaginal birth, there will be about twelve people in the room with you: one or two obstetricians, an anesthetist (in case you need a c-section), two midwives and two pediatricians, plus your partner or birthing coach. It is also common for students to observe multiple births. If you prefer to keep the number of people in the room low, let them know beforehand.
Vaginal Delivery or Caesarian Section?
You do not automatically have to have a c-section if you are pregnant with multiples, but the odds that you will need one are increased. Many twin pregnancies are delivered vaginally without complications. The more babies there are, the better the chances that one will be turned the wrong way, or that you’ll experience any of the complications that can also affect single births. Your choice of doctor can also effect whether or not you have a c-section. If you have a strong preference either way, discuss it with potential doctors to see if your beliefs match up.
Common Complications for the Mothers
When you’re pregnant with twins or multiples, there is a much greater risk of complications arising at some point during your pregnancy. Some of the more common problems that can occur include:
- Premature labor requiring prolonged bed rest or hospitalization.
- Preeclampsia, also know as pregnancy-induced hypertension or toxemia, is three to five times more likely to occur in multiple pregnancies. Preeclampsia can cause elevated blood pressure and swelling in the mother, and can prevent enough blood from getting to the placenta. Most mothers with preeclampsia give birth to healthy babies. Treatments include induced labor (in cases where the fetus is mature enough), bed rest and blood pressure lowering medication.
- Gestational diabetes, a rising in the blood glucose levels of the mother, is more likely to occur, along with anemia (blood iron deficiency) and polyhydamnios (excess amniotic fluid). All are treatable, but will need to be monitored by your doctor.
- Placental abnormalities associated with maternal hemorrhage
Common Complications for Babies
Just as with mothers, babies also have a greater chance of experiencing problems during their nine months in the womb.
- Preterm birth occurs in over 50% of twin pregnancies, 90% of triplet pregnancies and almost all quadruplet pregnancies. Preterm refers to birth prior to 37 weeks gestation.
- Multiple birth babies are more likely to be born small for gestational age. The average twin weighs around 5 ¼ pounds at birth and the average triplet will weigh around 3 ¼ pounds. The average singleton weighs about 7 ½ pounds.
- Premature births are associated with increased risks of respiratory distress syndrome (RDS), intracranial hemorrhage, blindness, cerebral palsy and neonatal morbidity and mortality. RDS accounts for 50% of all neonatal deaths associated with premature birth.
- The odds of retaining life-long disability is over 25% for babies born weighing less than 2lbs, 3oz.
- Intrauterine growth restriction, miscarriage, congenital anomalies and intrauterine death are all more common in multiple pregnancies.
How Many Multiple Births are Caused by Fertility Treatments?
In general, the chances of having a multiple birth are increased if you undergo fertility treatment. However, not all infertility treatments are the same. For instance, undergoing IUI without ovulation stimulation is not nearly as likely to result in a multiple birth as IUI with Clomid. IVF is especially known for resulting in twin and multiple pregnancies because multiple embryos are transferred. However, as ART techniques have improved, the number of transferred embryos necessary for pregnancy have decreased with many couples only having one or two embryos transferred instead of the four or five of yesteryear.
That being said, in 2000, the number of twins conceived in the United States using ART was 444.6 per every 1000 live birth. The number of triplets was significantly lower, only 98.7 out of every 1000 live births. The percent of multiple births resulting from all ART treatments was 13.6%.
Selective Reduction
Because of the increased risk of complications to both mother and baby, women having multiple pregnancies may be offered a selective abortion to reduce the number of fetus’ they are carrying. Many women do not feel comfortable with this, though, and choose not to have the procedure.
Getting Pregnant
