Expecting twins, triplets, or higher-order multiples? You’ve probably got a lot of questions (and likely everyone who knows you does, too). Let’s take a look at some of the most frequently asked questions by and for those experiencing a multiple pregnancy.

How did this happen?

This is the first question many parents ask upon learning that they’re expecting more than one baby. Multiple pregnancies can arise through natural processes in two distinct ways, according to the American College of Obstetricians and Gynecologists. Firstly, when multiple eggs are released during the menstrual cycle and each is fertilized by a sperm, the result is the implantation and growth of multiple embryos in the uterus. This type of pregnancy gives rise to fraternal, or dizygotic, twins (or even more multiples). Conversely, when a single fertilized egg undergoes spontaneous division, it leads to the development of multiple identical embryos, resulting in identical, or monozygotic, twins (or potentially more). Notably, fraternal twins are more prevalent than identical twins.

The use of fertility medications, such as Clomid (clomiphene), to stimulate ovulation often prompts the release of multiple eggs from the ovaries, increasing the likelihood of twins, triplets, or more. In vitro fertilization (IVF) can also lead to a multiple pregnancy if multiple embryos are transferred to the uterus. Identical multiples can also occur if the fertilized egg splits after transfer. Additionally, women aged 35 and older have a higher likelihood of releasing two or more eggs during a single menstrual cycle compared to younger women, which increases their chances of conceiving multiples.

What are the symptoms of multiple pregnancy?

Multiple pregnancy symptoms are similar to those of expecting only one baby, but they can be more intense and occur much earlier than in a singleton pregnancy. Early signs of pregnancy with multiples may include more extreme breast tenderness and severe morning sickness. You may feel very hungry or gain weight quickly in the first trimester. Your womb also grows faster and develops beyond the size it would typically reach with just one baby.

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How is a multiple pregnancy diagnosed?

Determining the presence of multiple pregnancies typically involves the use of ultrasound. Whether as part of routine screening or due to the administration of fertility treatments or pregnancy-related complications, most cases of multiple pregnancies are identified well before childbirth.

In some instances, the suspicion of multiples may arise when the pregnancy hormone hCG (human chorionic gonadotropin) levels are significantly elevated or when the growth of the uterus exceeds the anticipated rate. Additionally, the presence of multiples might be considered if the pregnant individual experiences excessive fetal movement or if the healthcare provider detects more than one heartbeat during an examination.

How is a multiple pregnancy different?

Generally speaking, the more babies you’re expecting at one time, the shorter the pregnancy will be. A typical single-baby pregnancy lasts around 40 weeks. By comparison, the average gestational period for twins is 37 weeks, around 33 weeks for triplets, and about 28 weeks for quadruplets. 

It can be really difficult to get comfortable during a multiple pregnancy. Your dietary preferences and appetite may change, which leaves some people feeling less hungry or feeling full faster. Consuming smaller, more frequent meals can alleviate this issue. You might have a more difficult time finding maternity wear that fits. You’ll likely also experience more fetal activity. Your doctor may ask you todo fetal kick counts.

Will I have to have a C-section?

While a vaginal birth is still a possibility in some cases, the presence of more than one baby often means that at least one will be in a position other than a cephalic vertex presentation (head down, facing mom’s spine). For this reason, twins and other higher-order multiples tend to have a higher rate of C-section delivery.

What happens after multiples are born?

After the birth of your little ones, it’s possible they may require a stay in the neonatal intensive care (NICU) if they arrived far ahead of schedule or if they had medical issues. After you head home, you may feel overwhelmed and exhausted (as most new parents do). Don’t be hesitant to reach out for help! Enlist the assistance of friends and family. There are even local volunteer and support groups online for parents of multiples. The risk for postpartum depression is higher among parents of multiples, so make sure you understand what to look out for and know who you can turn to for help if you need it. 

Can I breastfeed multiples?

You can! In fact, breastfeeding is especially helpful for multiples, who are often very small at birth. That said, it might take more effort and practice, and you’ll need a lot of support. You’ll need to eat a healthy diet and stay well hydrated. Your milk supply will increase to meet demand. Even if you can’t begin nursing right away, you can express milk for your little ones. Consult with a lactation specialist at your hospital or within your community for assistance. The most important thing you can do to ensure a successful breastfeeding experience is to educate yourself about what to expect. Visit La Leche League to learn more.

Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. Please contact your health provider if you have any medical questions or concerns about your child or yourself.

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