Common Questions About Multiple Pregnancies

Being pregnant with twins, triplets, or higher-order multiples can raise a lot of questions both for the pregnant person and for everyone around them. Being pregnant with more than one baby is called a multiple pregnancy. Here are the answers to 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 (clomiphene) is 10%. Other fertility treatments, like in vitro fertilization (IVF), can also result in twin, triplet, or other 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% or 33.5 twin births per 1000, according to the Centers for Disease Control (CDC). But those statistics don't take into account individual factors that can have a significant impact on your personal chances of having twins, triplets, or other multiples.

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 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 or the growth of your uterus is more than expected. Multiples also might be considered if the pregnant person feels excessive movement or the practitioner hears more than one heartbeat.

How Is a Multiple Pregnancy Different From a Singleton Pregnancy?

Because there is more risk with a multiple pregnancy, you will have more prenatal visits with a healthcare provider. Some people will choose to work with a regular OB-GYN. Others, particularly those carrying triplets or more or who have other risk factors affecting their pregnancy, will be referred to a perinatologist, an obstetrician who specializes in maternal-fetal medicine and high-risk pregnancy.

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 may cause whirlwind of emotions. For instance, some people report feeling happy, scared, nervous, and more. Your uterus also grows more quickly and expands beyond the size it would normally reach with one baby. For example, at week 28 of pregnancy, a person pregnant with twins typically is the same size as most people 40-weeks pregnant with singletons.

Comfort also can be an issue in a multiple pregnancy. Eating can be different too. Some people find they aren't hungry or get full quickly. Small frequent meals help. You might also find that you have trouble with maternity clothes. Fetal movement may be a lot and fetal kick counts may be required by your prenatal healthcare provider.

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% of the time, triplets 90%, and nearly 100% for all the higher-order multiples. Much has to do with the length of pregnancy and the 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. Finding other parents who have multiples can be a big help as can asking for help from your family and friends.

Postpartum depression also can be more prevalent among parents of multiples. Be sure you know the signs and symptoms as well as where you can turn for help.

Can You Breastfeed Multiples?

There are many parents who choose to breastfeed their multiples with varying degrees of success. If you desire to breastfeed, find a good lactation consultant and begin working with them in pregnancy to form your breastfeeding plan.