Common Questions About Twins and Other Multiple Pregnancies

Pregnant Hispanic woman looking at ultrasound monitor
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Being pregnant with twins, triplets, or other multiples can raise a lot of questions for the mother and for everyone around her. Being pregnant with more than one baby is called a multiple pregnancy. Here are some of the most common questions. You can be prepared to answer friendly queries and satisfy your own curiosity.

How do multiples happen?

Twins and other multiples can happen naturally in two ways.

The first is when an egg splits after fertilization, creating identical or monozygotic twins. The second is when two or more eggs are fertilized at the same time (dizygotic). Fertility drugs can increase the likelihood of more than one baby being conceived. For example, the likelihood of having twins when using Clomid is 10 percent. Other fertility treatments, like in vitro fertilization (IVF), can also result in twin or higher order multiple pregnancies.

What are the odds of having twins?

The incidence of twin births in the general U.S. population is about 3 percent or 33.5 twin births per 1000, according to the CDC. But that does not take into account your individual factors, which can be significant in increasing your chances of having twins, triplets, or other multiples. 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 by science.

How are multiple pregnancies diagnosed?

Typically, multiple pregnancies are diagnosed via ultrasound. You might have a routine screening with ultrasound or have one because you had fertility treatments or a pregnancy complication. Very few multiple pregnancies go undiagnosed until birth.

Occasionally multiples will be considered when:

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

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 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, sometimes all at once. 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, with some moms finding they aren't hungry or that they get full quickly.

Small, frequent meals help. You might also find that you have trouble with maternity clothes. Fetal movement may more than with a singleton your doctor may ask you to report and fetal kick counts.

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 are possible, though twins and other multiples can more often 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 percent of the time, triplets 90 percent, and nearly 100 percent for all the higher order multiples. Much has to do with the length of pregnancy and position of babies.

What might you expect after the birth?

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, especially if you can get help from your family and friends. You may also want to connect with other parents who have multiples to learn how they cope.

Postpartum depression can be more prevalent among mothers of multiples. Be sure you, your partner or spouse, family, and friends know the signs and symptoms, as well as where you can turn for help.

Can you breastfeed multiples?

There are many mothers 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.

Sources:

Multiple Births. Centers for Disease Control. https://www.cdc.gov/nchs/fastats/multiple.htm.

Multiple Pregnancy. The American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Multiple-Pregnancy.

Twins, Triplets, Multiple Births. MedlinePlus. https://medlineplus.gov/twinstripletsmultiplebirths.html.

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