Edward-Elmhurst Health: What to expect with twins and multiples

Multiple births are more common than they used to be. Now, about one in 30 babies born in the U.S. is a twin. More frequent use of infertility treatments and assisted reproductive technology, like in vitro fertilization, has likely contributed to this increase.

Twins can be identical (from a single fertilized egg) or, more commonly, fraternal (from two separate eggs that are fertilized at the same time). Triplets, quadruplets and other multiples can be identical, fraternal or a combination of both.

Having twins or any other multiple presents special challenges for parents. First, find a physician and hospital with experience in multiples and high-risk pregnancies. Now, what can parents expect?

• More frequent prenatal care visits. Preeclampsia, gestational diabetes, placental and fetal growth problems are more likely with multiples. People may have more frequent prenatal care visits with their OB-GYN, including special tests and regular ultrasounds, so their doctor can monitor the pregnancy and track how the babies are growing.
• Weight gain during pregnancy. Mothers carrying multiples are expected to gain more weight during pregnancy than mothers carrying a single baby.
• A healthy diet is important. During pregnancy, the growing babies will need certain nutrients. Doctors may recommend increasing calcium, folic acid and protein intake. Doctors may also prescribe an iron supplement, as low red blood cell count is common in multiple pregnancies.
• Exercise in moderation. Staying active during multiple pregnancy is important, but people may need to avoid strenuous exercise or avoid it altogether if problems arise.
• A C-section may be needed. The chance of cesarean birth is higher with multiples. Sometimes twins can be delivered by vaginal birth, but a C-section may be needed to help keep the babies safe. Most triplets and other multiples are born by C-section.
• Preterm (or early) labor is a possibility. The most common complication of multiple pregnancy is preterm birth (before 37 weeks). A typical, single pregnancy lasts about 40 weeks, but a twin pregnancy often lasts between 35 to 37 weeks, with more than half of all twins born preterm. Triplets and other multiples are almost always born preterm.
• A NICU may be needed. Preemies are usually placed in a NICU for special care after delivery. Find a hospital with a specialized NICU in case of early labor or if the babies need special care after they are born.
• More frequent check-ups. Because they are often born early, twins and other multiples tend to be smaller or have growth problems compared to the average newborn.
• Be on the lookout for postpartum depression and anxiety. If someone has intense feelings of sadness, anxiety or despair that keep them from normal activities, talk with a doctor about resources for support.

The first days, weeks and months are often the most difficult for parents of multiples. The babies’ pediatrician or primary care physician can provide advice and strategies for how to cope with the special parenting challenges involved, including feedings and sleep. Here are some tips for raising multiples:

1. Join a support group for parents of multiples. Talking to other families and learning what worked for them can be very helpful.
2. Enlist help. Ask family, friends and neighbors for help with household chores and daily tasks.
3. Treat them as individuals. Even identical twins have individual personalities. It’s important to recognize children as unique, separate individuals from the beginning.
4. Support their differences. Try not to constantly compare the children or force them to do the same activities as they grow up.
5. Begin separating them occasionally as early as possible. Twins often choose to play only with each other and are not always happy about being apart. Try to occasionally separate them and encourage them to play individually with other children.
6. Spend one-on-one time with each of them so they get some individualized attention.
7. Practice self-care. Raising multiples can be much more physically and emotionally demanding than having one baby. Self-care is essential.

At Edward-Elmhurst Health, our physicians are experienced in handling high-risk pregnancies and provide expert care, close to home. Edward-Elmhurst Health is also fully equipped to handle high-risk deliveries and care for newborns who require special attention, with Edward Hospital’s Level III Newborn Intensive Care Unit and Elmhurst Hospital’s Level IIe Special Care Nursery.

Learn more at www.eehealth.org/services/pregnancy-baby.