In the past 3 decades, there’s been a phenomenal rise in the number of multiple births in this country. The twin birth rate rose more than 75% from 1980 through 2015, from 18.9 to 33.5 per 1,000 births, according to the CDC’s National Center for Health Statistics.
Delayed childbearing and the rise in infertility treatments, such as in vitro fertilization or IVF, are most likely to blame.
“Multifetal gestations are more likely to occur naturally as we age,” said Dr. Melissa Mancuso, director of Akron Children’s Hospital’s fetal treatment center. “As we get older, our general health tends to decline. Older women may weigh more, have higher blood pressure or develop diabetes.”
Whether you’re having identical or fraternal twins or 3 or more babies, eating properly, getting enough rest and making regular trips to your doctor are critical measures for staying healthy. Multiple pregnancies come with more variables and increased risks than single births.
The most common risk involved with multiple births is pre-term 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, and the risk of having a premature delivery increases with higher-order multiples. Premature babies can have numerous health challenges, from chronic lung disease to bradycardia, or a decline in the baby’s heart rate, to jaundice.
In addition, the mother has an increased chance of experiencing medical conditions during pregnancy, such as preeclampsia, gestational diabetes, placental and fetal growth problems.
“The best way to be as healthy as possible during a pregnancy is to go into pregnancy as healthy as possible,” she said. “You should also take your prenatals, maintain a healthy weight, avoid smoking and seek regular prenatal care. It’s not very different from a mother of a single pregnancy.”
Knowing what to expect during pregnancy and delivery can help make the journey feel more like a double (or triple) blessing. Dr. Mancuso, herself mother of 11-year-old fraternal twins, offers 5 things moms of multiples should expect for the next 9 months.
Frequent doctor visits
A woman with a multiple pregnancy might be scheduled for more frequent appointments with her obstetrician/gynecologist than a woman who is pregnant with a single fetus.
The need for frequent, intensive prenatal care is of the utmost importance in a multiple pregnancy. Because multiple pregnancies are automatically termed high-risk, the need for specialized health care is vital to ensuring that you and your babies receive the best care available.
Increased nutritional needs
If you’re pregnant with multiples, you should follow general pregnancy nutrition guidelines, including increasing your calcium and folic acid intake. Taking folic acid at least 1 month prior to and throughout the pregnancy will decrease the risk of neural tube defects (such as spina bifida).
Another dietary requirement that needs to be increased if you’re expecting more than one baby is protein to help them grow properly.
During pregnancy, an increased supply of iron is also needed for hemoglobin, the substance in red blood cells that binds oxygen for delivery to the tissues, to avoid a condition known as iron-deficiency anemia.
Relatively common in multiple pregnancies, anemia can cause shortness of breath and extreme fatigue during a pregnancy, as well as a reduced oxygen supply to the developing babies.
Additional fetuses also mean an increased need for all other nutrients (such as zinc, copper, vitamin C and vitamin D). So it’s important to take your prenatal vitamin supplement every day. But just because you’re carrying more than one baby doesn’t mean you should take more than one prenatal vitamin — one is enough and too much can even be harmful.
“Moms with multiples should consume on average an extra 500 to 600 calories per day,” said Dr. Mancuso. “It’s not about weight gain or fat gain, but we need moms to eat healthy extra calories to make sure they’re getting the proper nutrients she and her babies need.”
Additional weight gain
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.
“A healthy weight gain for a mom of multiples is on average 45 to 50 pounds,” said Dr. Mancuso. “But, it’s more important to make sure the babies are growing than watching a number on a scale.”
Of course, expecting multiples means that you’re probably experiencing the typical discomforts of pregnancy more intensely. Nurturing yourself can help ease the stress of pregnancy.
“The biggest thing that helped me during my pregnancy was a maternity support belt to hold my belly up,” said Dr. Mancuso. “It literally went over my shoulders and lifted it up, which saved my back. I tell every mother of multiples to get one of these things. It really makes a difference.”
Expectant partners can help, too. Something as simple as having someone brush your hair can make the discomforts of pregnancy fade momentarily. It helps, too, if your partner remembers that your body is going through tremendous hormonal changes. Communication and understanding can be the keys to truly enjoying this special time in your lives.
It’s important for moms of multiples to have carefully considered a birth plan. To help you be more comfortable with the birth process as it unfolds, you should also discuss the options of vaginal delivery versus cesarean section (C-section) with your doctor well before your due date.
“The delivery depends on the presentation of the twins. If both heads are down, there’s no reason you can’t have them vaginally (assuming there are no other contraindications to vaginal delivery),” said Dr. Mancuso. “It’s perfectly safe and healing is quicker, so it’s easier to take care of those 2 babies.”
Throughout labor, you’ll likely be attached to 2 or more fetal heart-rate monitors so your practitioner can see how each baby is responding to your contractions.
The interval between the birth of each baby delivered vaginally is usually less than 20 to 30 minutes. And here’s one piece of good news: Because multiple-birth babies tend to be smaller than single ones, it’s easier to push them out. Luckily, they only come out one at a time!
In the case of multiples, though, a vaginal delivery may not always be possible. The crowded uterus can cause compression of the placenta or umbilical cord of any of the soon-to-be-born babies during labor. Prolonged compression may put one or more babies at serious risk as labor progresses during attempts at vaginal delivery. So prompt delivery by C-section may be necessary in these cases.
If your doctor needs to perform a C-section, a catheter will be placed in your bladder, you’ll be given anesthesia, 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.
If you go into labor prematurely, you and your unborn babies will be closely monitored for signs of distress. You may have to make decisions on the delivery method and procedures at this time, so consider your options before arriving at the hospital.
Many babies born prematurely will need to go immediately to the NICU for the special care they need because they’re often born earlier and weigh less than singletons.
“Don’t let anyone tell you that you can’t breastfeed twins,” said Dr. Mancuso. “You absolutely can — I did — and it’s easier in the middle of the night, rather than having to make 2 bottles.”