Preparing for Multiple Births

What Are Multiple Births?

A multiple birth is when a mother is pregnant with more than one baby. This may mean a twin pregnancy, triplet pregnancy, or more.

What Are the Types of Multiple Births?

There are two types of twins: monozygotic (identical) and dizygotic (fraternal).

Identical twins result from a single fertilized egg dividing into separate halves and continuing to develop into two separate but identical babies. These twins are genetically identical, with the same chromosomes and similar physical characteristics. They're the same sex and have the same blood type, hair, and eye color.

Fraternal twins come from two eggs that are fertilized by two separate sperm and are no more alike than other siblings born to the same parents. They may or may not be the same sex. This type of twins is much more common.

"Supertwins" is a common term for triplets and other higher-order multiple births, such as quadruplets or quintuplets. These babies can be identical, fraternal, or a combination of both.

What Are the Risks of Multiple Births?

Risks that can come with carrying multiple babies include:

• Pre-term (or early) labor resulting in premature births. A typical, single pregnancy lasts about 40 weeks, but a twin pregnancy often lasts between 35 to 37 weeks. More than half of all twins are born prematurely (before 37 weeks), and the risk of premature delivery increases with higher-order multiples.
  Premature babies (preemies) can have health challenges. Their risk increases the earlier they're born. Because the care of premature babies is so different from that of full-term infants, preemies are usually placed in a neonatal intensive care unit (NICU) after delivery.
• Other conditions during pregnancy. Preeclampsia, gestational diabetes, placental problems, and fetal growth problems are more likely with multiple pregnancies. Because of this, moms who are pregnant with multiples are followed very closely by their doctor.
• Long-term problems. Developmental delays and cerebral palsy are more likely as the number of multiples increases.

How Can I Stay Healthy During a Multiple Pregnancy?

Eating properly, getting enough rest, and regular prenatal care are ways for any expectant mother to stay healthy.

It's important to find health care professionals who have experience with multiple births, and to see your health care provider as he or she recommends. This is so that the doctor can be on the lookout for problems and treat them as needed.

Ask your doctor to recommend a facility that specializes in multiple births. You should be part of a pre-term birth prevention program at your hospital and have immediate access to a specialized NICU should you go into early labor or if one of your babies is born with a health problem.

What Should I Eat if I'm Pregnant With Multiples?

If you're pregnant with multiples, you should follow general pregnancy nutrition guidelines, including increasing your calcium and folic acid intake.

Another dietary requirement that must be increased if you're expecting more than one baby is protein. Getting enough protein can help your babies grow properly.

During pregnancy, an increased supply of iron is needed to make enough healthy red blood cells. Low numbers of red blood cells are common in multiple pregnancies. Your doctor will probably prescribe an iron supplement, as your requirement for this mineral usually can't be met by diet alone. Iron is absorbed more easily when combined with foods that have high amounts of vitamin C, like orange juice.

The doctor will also tell you what vitamins to take to get the nutrients your growing babies need.

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How Much Weight Should I Gain if I'm Pregnant With Multiples?

Mothers carrying multiples are expected to gain more weight during pregnancy than mothers carrying a single fetus. But exactly how much weight you should gain depends on your pre-pregnancy weight and the number of fetuses, so make sure to talk to your doctor.

In general, though, you should consume about 300 additional calories a day for each fetus. It might be tough to eat a lot when your abdomen is full of babies, so try to eat smaller, more frequent meals.

How Should I Prepare for Delivery?

Getting ready for a multiple birth may seem overwhelming, especially with concerns about pre-term labor. But know that you have a network of support around you: capable doctors, a caring hospital staff, and a partner, family members, and/or friends.

Discuss the options of vaginal delivery versus cesarean section (C-section) with your doctor well before your due date. Even if you and your doctor agree to attempt a vaginal delivery, things may happen during labor or delivery that make a C-section necessary.

You may choose to have additional birthing attendants in the room during labor and birth. For example, midwives are becoming more common. For multiples, it's usually recommended that a midwife work with a doctor, rather than alone.

Hiring a doula is another option. Doulas offer support services to women during the birth, as well as after delivery, by assisting with infant care and household chores.

What Will Delivery Be Like?

As labor begins, you'll be connected to a fetal monitor so your doctor can check each baby's progress.

If you're hoping for a vaginal delivery, remember that with multiples this isn't always possible. Sometimes, a C-section is needed to help keep the babies safe. Most triplets and other higher-order multiples are born by C-section.

If your doctor needs to do a C-section, a catheter will be placed in your bladder, you'll be given medicine so that you don't feel pain, and an incision will be made in your abdomen and uterus. The doctor will then deliver your babies through the incision. The babies will be delivered within just a few minutes of each other with this approach. The incision will then be closed.

Many babies born prematurely will need to go immediately to the NICU for the special care they need.

What Else Should I Know?

The first days, weeks, and months are often the most difficult for parents of multiples, as everyone gets used to the frequent feedings, lack of sleep, and lack of personal time.

It can help to join a support group for parents of multiples. Hearing what has worked well for others can help you find solutions to problems you come across.

Enlist whatever help you can — from neighbors, family members, and friends — for household chores and daily tasks. Having extra hands around not only will make feedings easier and help you rest and recover from delivery; it also will give you the precious time you need to get to know your babies.