Abstract
The twin birth rate has declined by 4% over the years, with the research on multiple pregnancies growing smaller. The lack of resources and information makes it difficult for expecting mothers of multiples to properly prepare during and after their pregnancy. This chapter aims to address the various challenges, risks, and care requirements that may come with multiple pregnancies, as well as maternal well-being, the adjustment period of bringing the children back home, and maintaining a positive quality of life for the family. This chapter not only identifies a number of these challenges, but also offers best practices to mothers of twins and multiples via a brief study, wherein mothers report on demographics, pregnancy and delivery histories, self-reported levels of anxiety and depression, and the most shocking, positive, and negative features of being the mother of a twin or multiple. Finally, the study offers helpful recommendations for parents of how to best raise twins and multiples and how to ensure they maintain their own, unique identities.
TopIntroduction
Prevalence Rates of Multiples in the US
In the United States, a total of 3,664,292 births were registered in 2021. Of those registered, 114,161 were twin births (31.2 per 1,000 births), 2,785 were triplet births (80.0 per 100,000 births), 133 quadruplet births, and 15 quintuplet higher-order multiple births (Osterman, Hamilton, Martin, Driscoll & Valenzuela, 2023). These numbers reflect an increase of 2% of twins, triplets, and multiples since 2020. However, these percentages in no way compare to the 76% rise of twins from 1980-2009 (18.9 to 33.2 per 1,000 births) (Osterman et al., 2023). Interestingly, the birth rate of twins and multiples then declined by 3% in 2022 (Horon & Martin, 2022).
How One Conceives Multiples
Multiple pregnancies typically occur when more than one egg is fertilized as compared to a singleton pregnancy, also known as one baby, when only one egg is fertilized (March of Dimes, 2021). Factors linked to having multiple pregnancies include conceiving naturally or undergoing the process of assisted reproductive technology.
Natural Reproduction
It is estimated that naturally conceived twins occur in 1 out of 250 pregnancies (Cleveland Clinic, 2022). Naturally occurring factors in conceiving multiples include one’s heredity, one’s family history of having multiples, older age as women older than 30 release more than one egg during a menstrual cycle, and having had one or more previous pregnancies (University of Rochester, n.d.). These factors can potentially increase the chance of naturally having twins, but there is no way for an individual to accurately predict if they will have twins or not.
Assisted Reproductive Technology
Assisted reproductive technology increases the chance of having multiples. In Vitro Fertilization (IVF) is a method that often uses ovulation-stimulating medicines to produce multiple eggs that are fertilized in a lab and returned to the uterus to grow (University of Rochester, n.d.). IVF is most effective for those with fertilization or unexplained infertility issues, poor egg quality, issues with sperm, or genetic disorders (Mayo Clinic, 2023). The odds of having a multiple pregnancy through IVF is roughly 30% with the majority resulting in twins (Shastri, 2021). The process is cycle-based, with most individuals and couples undergoing two to three IVF cycles before conception has taken place (Elite IVF, 2023). Undergoing the technology, IVF can bring about unexpected stress while progressing through and waiting for the results of cycles (SART, n.d.). The vast majority of patients adjust well emotionally, but the use of coping mechanisms greatly aids the process. Gathering information, preparing decisions, garnering support, anticipating problem areas, and identifying already known stressors are some of the few steps to take before and after undergoing IVF (SART, n.d.). This may ensure a less stressful process when trying to conceive.
Key Terms in this Chapter
Dizygotic: Twins : Dizygotic twins or Fraternal Twins result when two separate eggs (ova) are fertilized by two separate sperm. These babies are as genetically similar as siblings. They can be the same sex or different sexes.
Pre-Partum: Prepartum or prenatal refers to before one gives birth.
Intrauterine Growth Restriction (IuGR): Intrauterine Growth Restriction is when a baby doesn’t grow to a normal weight during pregnancy. IuGR can result from placenta abnormalities, high blood pressure in the mother, infections, smoking, alcohol abuse, etc.
In Vitro Fertilization (IVF): A medical procedure wherein an egg is fertilized by sperm in a test tube or elsewhere outside of the body.
Cord Entanglement: Umbilical cord entanglement is when one or more loops of the umbilical cord encircling any part of the fetal body or two umbilical cords become entangled with one another.
Postpartum Depression: Postpartum Depression is depression that occurs after childbirth. Individuals who experience Postpartum Depression may be more at risk of developing Major Depression later on in life.
Monozygotic Twins: Monozygotic Twins or Identical Twins result from the fertilization of a single egg by a single sperm, with the fertilized egg then splitting into two. Identical twins share the same genomes and are always the same sex.
NICU: The Neonatal Intensive Care Unit is an intensive care unit that focuses on the care of premature newborn infants.
Post-Partum: The postpartum period begins after childbirth and is usually considered to last for six weeks. There are three distinct, but continuous phases of the postnatal period: the acute phase (lasting six to twelve hours), the subacute phase (lasting six weeks) and the delayed phase (which lasts up to six months).
Twin-to-Twin Transfusion Syndrome (TTTS): TTTS is a condition that occurs during pregnancy wherein one twin gives blood and nutrients to the other twin. The donor twin (or the one who gives blood) tends to give away more blood than it receives and therefore runs the risk of malnourishment and organ failure. The recipient twin (the twin who receives the blood) receives too much blood and is at risk of overworking the heart and having other cardiac complications.
MFMs: A maternal fetal medicine specialist is a doctor who helps take care of women who are experiencing complex or high-risk pregnancies.
Vanishing Twin Syndrome: Vanishing Twin Syndrome is when one of a dyad of twins or multiple embryos dies in utero, disappears, or gets partially or fully reabsorbed, which causes a spontaneous reduction of a multi-fetus pregnancy to a singleton pregnancy.