If you expect two or more babies – it is called multiple births. The management of multiple births has its own characteristics. The competence of doctors (an obstetrician-gynecologist, a specialist in monitoring the condition of the mother and fetus, an anesthesiologist, a neonatologist) and equipment of the maternity hospital are very important for the successful outcome of childbirth.
Multiple births require highly skilled and professional staff. Birth of twins is one of the most difficult tasks in obstetrics. Each of the babies can behave individually during childbirth. While one of the babies is absolutely healthy, another one can have complications.
Multiple births are one of the most common causes of child mortality during home births. Even worse is the case if the second child was not noticed in time (poor examination or the mother refused to make ultrasound) and a surprise was found only during childbirth. Often one of the babies cannot be saved.
Multiple Births Statistics
Multiple births are the births of more than one child in one pregnancy. It was found that twins appear in approximately one of 89 pregnancies. Much less often one pregnancy ends with the birth of three, four or five babies. However, since the 1960s, when gonadotropic hormones (hormones that stimulate ovulation) began to be given to infertile women, the frequency of multiple pregnancies increased and, in some cases, six twins were born. Unfortunately, such children due to their prematurity do not always survive. But the improvement of the methods of taking care of newborns reduces this danger.
The simultaneous birth of five children who survived the infancy was first recorded in 1934 in Canada (the Dionne family). The survival of six twins was first observed in South Africa in 1974 (the Rosenkowitz family). Subsequently, several more such cases were reported.
Pregnancy with twins can be the result of fertilization of two eggs, simultaneously formed in an ovary, or one egg which during the subsequent crushing for some reason completely divided into two separate cells. In the first case, the so-called fraternal (dizygotic) twins are born, whereas in the second – identical (monozygotic, or enzygotic) twins. Fraternal twins can have the same or different sex. They don’t look alike. Monozygotic twins in all respects, including the gender, are identical. At the same time, sometimes they are a mirror image of each other (the right side of one exactly repeats the left side of the other). During the period of intrauterine development, one- and two-egg twins can be distinguished by the fact that, in the first case, only one placenta is formed, in the second – there are two. Unlike fraternal twins, identical twins have the same fingerprints.
There is no hereditary tendency for the birth of identical twins. At the same time, a clear hereditary predisposition is revealed with respect to the fraternal twins. Some racial differences have also been noted. Fraternal twins are most often born in representatives of the black race, less often white, and even less often in yellow. The frequency of the appearance of twins is also affected by the age of the mother. Women of the older age group more often give birth to twins.
Other Cases of Multiple Births
A larger number of twins may be the result of the fertilization of either one or several ovules. For example, a triplet can develop from one, two or three fertilized eggs. So, one-, two-, and three-egg twins are found. In the study of one of the births of five children at once, it turned out that three of them developed from one egg, and two from another egg. All five twins born in the Dionne family developed from one egg.
The available statistics show that triplets appear in 1 of 7700 pregnancies; four twins – only in one of 680 000 cases, and five – in approximately one of 85 000 000 cases.
The term “multiple births” means the presence in the uterus of more than one fetus.
The number of twins, triplets, and more children born is increasing nowadays. Approximately in 1 of 70-80 deliveries, more than one fetus is born. The following factors most likely lead to multiple births:
- Infertility medication
- Use of assisted reproductive techniques
- Previous multiple pregnancy
- Senior age
During and After Multiple Births
Bearing more than one fetus leads to overstretching of the uterus. This, in turn, often leads to dilating pains until the full term of pregnancy. As a result, babies are usually born prematurely and of small size. In some cases, the overstretched uterus does not contract well enough after delivery, which causes postpartum bleeding. Since the fetuses can be in different positions and presentations, vaginal delivery can be complicated. In addition, contraction of the uterus after the birth of the first baby can tear the placenta of an unborn child or children. As a result, the birth of a child or children after the first baby can be more problematic.
Multiple pregnancies also increase the risk of problems for a woman. These include increased blood pressure and protein in the urine (preeclampsia), pregnancy diabetes, heavy bleeding after labor (postpartum blood loss), the need for Cesarean section, small newborns, and premature birth.
During pregnancy, ultrasound is used to confirm the number of fetuses.
Since there are certain problems associated with multiple births, doctors can decide in advance whether a woman will give birth naturally or with the help of Cesarean section. If the first infant of the twins is in a pathological position, doctors most likely decide on Cesarean section. Sometimes the first twin is born naturally, while for the second twin, a Cesarean section is considered safer. For triplets and other multiple births, a Cesarean section is usually used.
When Does the Birth Begin?
During multiple pregnancy, labor often occurs prematurely. The volume of the uterus grows significantly faster than in the case of a singleton pregnancy. It reaches its maximum size much earlier, begins to actively contract and prepare for childbirth.
In the case of twins, this occurs approximately in the 36-37th week of pregnancy; of triplets – in the 34-35th week. At the same time, the adaptive capabilities of twins are significantly higher. They feel much better after birth than premature babies of the same age in a singleton pregnancy.
The percentage of Cesarean sections in multiple pregnancies is much higher than in singleton ones. But this does not mean that it is always used. There are strict indications for Cesarean section, and, in many respects, they echo with indications for C-section during the delivery of one child:
- clinically narrow pelvis;
- the transverse position of the first fetus of twins or both;
- pelvic presentation of the first fetus;
- hypoxia of one or both of the babies;
- conjoined twins and other anomalies.
When the number of babies is three or more, Cesarean sections are almost always done. The aim is not just to spare the mother’s body. In this case, there is a very high risk of entanglement of the umbilical cord, premature detachment of the placenta, and other complications. Practically, the risk for each child has multiplied. Thus, one of the children can suffer if not to do a C-section.
An emergency Cesarean section is carried out if at the beginning of labor there are complications. For example, the first twin has been born normally, and the second one has placental abruption and hypoxia. This is a strict indication for an emergency Cesarean section.
Complications During Multiple Births
Perfectly proceeding multiple births are possible, but there are also various kinds of complications.
If the labor is weak, it can be due to the fact that the muscles of the uterus are overstretched and cannot contract well enough. The period of the cervical dilatation can become protracted and exhaust the woman. Moreover, labor activity will be even more oppressed in this case. Delay in the rupture of the fetal bladder of the second child is also an unpleasant circumstance. The doctor, in this case, makes a rupture of the bladder themselves.
Premature detachment of the placenta is a serious complication leading to a severe bleeding and hypoxia of the second fetus.
The danger for the woman is represented both by the period after the birth of the second child and the release of the afterbirth. The matter is that the uterus cannot normally contract, as it has been greatly stretched for a long time. As a result, the release of the afterbirth takes time. A woman can lose a lot of blood. It is not uncommon in this situation to prompt blood transfusion and the injection of drugs stimulating the uterus. Sometimes the afterbirth is removed under anesthesia. The period after childbirth can also bring unpleasant surprises – bleeding and endometritis. A new mom needs to pay great attention to her own health during the first days after childbirth.
Undoubtedly, multiple births have a lot of peculiarities, including complications. But do not set yourself up for a “mandatory program” of problems and difficulties. Complications can accompany any pregnancy, but it doesn’t mean such a pregnancy will be yours. But, above all, being pregnant with more than one baby is an incredible joy for the future mother because not every woman has the opportunity to give birth to two or more children.