Finding out you're pregnant with one baby is a joyous and somewhat nerve wracking experience, but imagine finding out you're pregnant with TWO! Or even more! The concept isn't as rare as you may think, as twin pregnancies and multiple births are now much more commonplace than they were years ago. There are various reasons why the nation is now seeing an influx of twins, triplets, quads, and most Americans are familiar with the "Octo-Mom", ranging from the mundane to the downright crazy, but multiple births are not without risks. In fact, research consistently concludes that carrying more than one baby is much riskier for both Mom and babies than carrying just one fetus.
Why Multiple Births Are Soaring
Years ago, twins were somewhat of a rarity, with fraternal twins created when a woman releases two eggs during one ovulation cycle, where both eggs are fertilized, and identical twins created when a single egg splits into two. However, with the recent surge in reproductive technologies available around the world, twins are now a much more common occurrence. Firstly, we have drugs such as clomiphene which stimulate ovulation. In women who aren't ovulating naturally or with any regularity, these drugs can encourage release of an egg by introducing higher levels of follicle-stimulating hormone (FSH) into the body. A side effect of this is that multiple follicles are stimulated simultaneously, increasing the chance of more than one egg being released.
Secondly, we have assisted reproductive techniques, many of which culminate with in vitro fertilization (IVF). IVF is a costly technology that is both emotionally and physically draining, so the fewer rounds of IVF couples are subjected to the better. For this reason, Doctors generally transfer more than one embryo into the uterus to increase the chance that one of the embryos will imbed into the uterine wall. Sometimes, none of the eggs will "take", but other times they may all be successful. A double egg transfer is thought to increase the chance of twins by 30%.
Finally, we have a recent and somewhat disturbing trend emerging in the United States whereby women are specifically requesting IVF for twin births. It's all part of the "designer baby" fashion that is becoming more and more popular. Couples partaking in this twin trend cite advancing age as a primary factor in their decision, claiming that they'd be too old to complete their families if they were to have just one baby at a time. Whether you agree with this notion or not, fashion and trends are one of the main reasons why multiple birth rates in the west are soaring.
Risk Factors For Baby
Looking at the risk factors of multiple pregnancies for babies, it seems ludicrous that some women might even consider purposefully putting their unborn babies in danger. That isn't to say that multiple pregnancies are guaranteed to have complications, but there is consistent research that demonstrates the significant differences in risk between singletons and multiples. Complications range from minimal concerns such as lower APGAR scores and low birth weights to more severe problems such as hypoglycemia and even death. Stillbirth rates are thought to be 50% higher in cases of multiple babies, with breathing problems being a leading cause of death in the womb, and malnutrition being a leading cause within the first 72 hours after birth. In cases where one twin dies in utero, the risk of irreversible neurological impairment increases by 20% for the remaining twin. However, what should be remembered is that the majority of complications for babies are associated more with premature births than with the concept of twinning itself, particularly birth weight. Fortunately, around 70% of twins and multiples are born within the "ideal" window of 35 and 38 weeks, so many babies aren't affected by these prematurity-related issues.
Risk factors are increased further as the number of babies increases. A lack of room in the uterus, the sharing of placental nutrition between the fetuses, and increased pressure on the body in general means that triplets are generally born earlier, at an average of 32 weeks rather than the norm of 35 weeks for twins, and much lighter at an average of 3 lbs compared to the average 4.5 lb twin.
Risk Factors For Mom
Pregnancy is a difficult time for the female body even when carrying just one baby, so the pressure on Moms-to-be when carrying two or more is even greater. Moms expecting multiple babies are believed to be four times more likely to develop preeclampsia than Moms expecting a single baby, regardless of age or health. This means that while the risk of the disease in singleton pregnancies can be significantly reduced by maintaining a healthy weight and not smoking, it's more difficult to prevent in multiple pregnancies.
High blood pressure is also a major issue affecting Moms with two or more unborn babies. While the risk of pregnancy-related hypertension is roughly 13% is healthy women with singleton pregnancies, this figure rises to roughly 21% in multiple pregnancies. Bed rest, especially during the later stages of pregnancy, may be recommended to alleviate some of the pressure on the body, but some studies do suggest that bed rest could increase the risk of premature labor.
When thinking of twin or multiple births, you probably automatically think of cesareans, right? It's normal to do so, as the majority of twins are born in this way, but it's not the only option. Vaginal births are thought to be just as safe for multiples as they are for singletons, the problem is that due to limited room in the uterus, multiple babies are usually lying in very awkward positions, the only positions they can get themselves into, which make it more difficult to give birth naturally. There's a high number of breech babies in multiple pregnancies, meaning they lie with their bums down and heads up, and also high rates of problematic cord locations, which could pose issues when trying to deliver naturally. For this reason, cesareans are the preferred method of birth in many cases, but just because you're carrying twins doesn't mean you'll inevitably need a surgical birth.