If you’re expecting more than one baby or think you might end up with multiples due to beginning fertility medication or treatment, you’ll want to listen in.

Jade Elliott is joined by Dr. Helen Feltovich, a maternal fetal medicine physician with Intermountain Healthcare who specializes in high-risk pregnancies to answer common questions about expecting multiples.

Is the Number of Twins and Multiples Increasing?

Actually, the number of multiples being born has decreased slightly in recent years, probably due to responsible assisted reproductive technologies.

What Increases Your Chances of Having Twins or Multiples?

While fertility medication or in vitro fertilization may increase your chance for carrying multiples, there are other factors, like genetics or demographics that can come into play.

• Family history of twins or multiples
  
• Over age 35
  
• Previous pregnancy
  
• Taller than average
  
• Obesity – Body mass index of 30 or higher
  
• African American women are slightly more likely to have twins
  

If you have multiple factors, your odds of having multiples, multiplies!

Types of Twins

Identical twins is the common name for “monochorionic” twins, which means one placenta. These twins result from the fertilization of a single egg that splits in two. Identical twins share all of their genes and are of the same sex.

Fraternal twins is the common name for “dichorionic” twins, which means two placentas. These twins result from the fertilization of two separate eggs during the same pregnancy. They share genes just like any other siblings. Fraternal twins can be of the same or different sexes.

The only way to really know if your twins are identical is through genetic testing. In some very rare cases, there can be identical twins that are different in some important ways, like sex.

With Good Prenatal Care, Most Twin Pregnancies Result in Healthy Babies

Most twins are delivered past 36 weeks. The estimated due date is at 40 weeks of pregnancy, and 37 weeks is considered term. Half of twins are delivered after 36 weeks, and half before then, either because of spontaneous labor or because of a maternal or fetal problem that requires delivery. Multiples higher than twins often arrive earlier.

Risks of Carrying Multiples

• Preterm labor
  
• Pre-eclampsia (high blood pressure)
  
• Gestational diabetes
  
• Miscarriage
  
• Placenta complications
  
• Fetal growth concerns, especially for monochorionic (identical) twins
  
• Increased risk for postpartum depression or anxiety due to complications
  

Prenatal Visits Are Even More Important If You’re Expecting Multiples

When you’re expecting twins or multiples, your doctor will likely want you to have more prenatal visits than for a singleton pregnancy due to a higher chance for complications. You’ll also likely need additional ultrasounds and fetal monitoring during pregnancy to check for any complications. That’s why it’s important to not skip prenatal appointments.

When to See a Maternal Fetal Medicine Specialist

If your doctor is not comfortable with managing or delivering twins, or if you have additional complications, you’ll probably be invited to see a maternal fetal medicine (MFM) specialist. This is especially true if your babies are monochorionic (identical). MFM specialists are trained in obstetrics and gynecology like general obstetricians, but then they do an additional three years of training specific to high risk pregnancies and deliveries. If you’re expecting three or more babies, it’s highly recommended you see an MFM specialist.

If there is not an MFM specialist in your area, ask your doctor about consulting with one through telehealth. We try to keep patients close to their home.

Things to Do at Home If You’re Expecting Multiples

• Take prenatal vitamins as you would for a single pregnancy.
  
• Drink plenty of water to stay hydrated
  
• Eat well. Don’t focus on the number of pounds to gain. Your provider will watch the weight of your babies with growth ultrasounds.
  
• Get enough exercise
  
• Bed rest is not recommended just because you’re expecting multiples.
  

Be Aware of the Signs of Preterm Labor

If you feel more pressure or have cramping, bleeding, or are leaking fluid, or have decreased fetal movement, call your doctor.

Prepare for the Postpartum Period

Set up social support for after the babies arrive. Your chances of having premature babies or a Caesarean delivery are higher when you are carrying multiples. If your babies are born prematurely, one or more of your babies may need to stay in a neonatal intensive care unit. You may want to think about how close you live to a hospital with a NICU or ask your provider if they have access to telehealth consultations for your baby.

You may be at higher risk for postpartum depression or anxiety due to increased stress or complications.

Breastfeeding

Breastfeeding is best for babies, especially premature babies. It is possible to nurse multiples successfully. If breastfeeding is not working, there’s no shame in needing to supplement with formula.

For more information, here are some helpful links:

https://intermountainhealthcare.org/

https://intermountainhealthcare.org/services/womens-health/intermountain-moms/

https://intermountainhealthcare.org/locations/intermountain-medical-center/medical-services/women-and-newborn-care/women-and-newborn-services/high-risk-pregnancy/

https://intermountainhealthcare.org/primary-childrens/programs-specialties/fetal-program

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.