Multiple Pregnancy and Birth

As more women delay childbearing and as reproductive technology advances, the number of multiple births in the U.S. has been rising significantly.

• Twins occur in one in 32 live births and account for 95% of all multiple births.
• About half of triplets and higher-order multiples (four or more babies) are conceived through fertility treatments.

Added demands of multiple pregnancy
Being pregnant with more than one baby puts extra physical and emotional demands on you. Eating right, watching your weight, managing discomforts and getting enough rest become even more challenging than with a "singleton" pregnancy.

• You need more calories and fluids.
• You need to gain more weight.
• Discomforts begin earlier and are more pronounced.
• You need more rest, and you'll have more limits on your activities.

You'll probably see your doctor more often. He or she will work with you closely to manage your care throughout your multiple pregnancy.

Risks with multiple pregnancy
There are some risks associated with multiple pregnancy and birth. Understanding these will help you be prepared if any problems arise. Your doctor will discuss the risks and any concerns you may have.

• Pre-term labor (before the 37th week) 
  Pre-term or premature labor is one of the most common risks. It usually can be treated with medication, bed rest and monitoring of contractions. If you go into pre-term labor, early detection is the key to delaying birth. Signs of pre-term labor include:
  • Four or more contractions in one hour
  • Menstrual-like cramps
  • Low backache or pressure low in your pelvis that may spread to your back and thighs
  • Nausea or diarrhea
  • Vaginal discharge of mucus, water or blood
    
    
• Other risks
  • Gestational hypertension (preeclampsia)
  • Gestational diabetes
  • Too much amniotic fluid (polyhydramnios) or too little (oligohydramnios)
  • Placenta problems such as placenta previa or placental abruption.
  • Fetal growth restriction (FGR)

Complications of premature birth
More than half of twins and over 90 percent of triplets are born prematurely and need special care. Many problems occur because premature babies' systems have not matured. Some of these include:

• Respiratory distress syndrome (RDS)
• Bleeding in the brain
• Immature immune system
• Feeding problems
• Long-term health problems such as chronic lung disease, learning disabilities and cerebral palsy

Labor and delivery of multiples
Labor for a twin birth typically lasts no longer than labor for a single baby. More precautions will be taken during labor and delivery, and more staff will be on hand to assure a safe birth. When you are admitted to the hospital or birthing center:

• An electronic (internal) fetal monitor will be put in place to track your contractions and the babies' heart rates during labor. This allows quicker response if the babies show signs of fetal distress.
• You'll receive intravenous fluids to keep you hydrated.

Vaginal birth is possible with many twin pregnancies. However, the uterus is often so stretched that it can't contract strongly enough. Medication can increase the strength and frequency of contractions. If labor doesn't progress, or if the babies show signs of fetal distress, you may have to deliver by cesarean birth.

Triplets and higher-order multiples almost always are delivered by cesarean birth.