Twins, Triplets or More?

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If it seems you’re seeing double or triple more often these days, it’s not because you’re having vision problems; it’s because twins, triplets and even larger numbers of multiple births happen more and more often. Yet that doesn’t dampen our fascination with them.

Despite sensational news like the McCaughey’s septuplets, do we know what it’s really like to expect, give birth and care for multiples? With assisted reproductive technologies, such as ovulation induction and in vitro fertilization, the chance of having twins has gone from one in 89 pregnancies to one in 43. Triplets have gone from a rare one in 1,400 pregnancies to one in 800.

Not all couples who use assisted reproductive technologies will conceive multiples or even one child; the success rate for in vitro fertilization is less than half. Yet, if the process takes, couples will find out during the first trimester whether they are expecting one child or more.

Carrying Multiples

According to Dr. Frank H. Boehm, professor and director of Maternal and Fetal Medicine at Vanderbilt University Medical Center, expectant parents’ first reaction to hearing they are expecting multiples is elation. In the coming weeks, however, they may start to realize that expecting multiples can be a difficult, frustrating and even frightening prospect.

“When I heard I was expecting twins, I cried for two weeks,” says Kim Allen, past president of the local Parents of Twins and Triplets Organization (POTATO). Allen’s tears were a mixture of elation, disbelief, and terror – emotions many people feel when they hear the news.

While each pregnancy is different, and many factors come into play, parents expecting multiples in the Middle Tennessee area can anticipate a few things. First, the mother will meet more frequently with her OB/GYN. She may also be referred to a specialist in high-risk pregnancies. Women expecting multiple babies are at a greater risk for toxemia, premature labor and fetal loss, so frequent, regular monitoring is necessary to detect and prevent these risks.

At Vanderbilt, most women expecting multiples meet weekly with their doctor after 20 weeks of pregnancy. Besides the usual monitoring procedures, expectant women will have more frequent pelvic exams and ultrasounds every four to six weeks. During these procedures, the doctor checks for any cervical problems, excessive fluid or fetal growth problems.

Sometimes a doctor may have to put stitches around the cervix to prevent premature dilation. More often, doctors may suggest their patients make lifestyle changes. A woman may have to stop working early in her pregnancy, and most women will have to have bed rest at some point during their pregnancies.

Boehm likes to remind patients that a few weeks of boring, confining bed rest is very little in the greater scheme of things. He tells women expecting triplets that “they are carrying 225 years of human life in their womb,” basing that number on the average human life expectancy of 75 years and multiplying that by three.

Chris Manning, a local mother of five (three of whom are triplets) went on bed rest 22 weeks into her pregnancy, and went into the hospital at 29 weeks. She delivered her triplets at 35 weeks.

Couples expecting multiples should be prepared for the likelihood of a C-section, not to mention a delivery room full of people and monitoring equipment. Besides the OB/GYN and the nurses, as many as three surgeons, two anesthesiologists, a nurse and a pediatrician for each infant could be attending.

Premature multiples will go to the neonatal intensive care unit for supervision and care. Sometimes, as in Manning’s case, the children are able to breathe on their own and are at a high enough weight to go home within a few days.

But people who decide to carry three of more fetuses to term are taking a terrific gamble, says Boehm.

“They see the McCaughey septuplets and think, ‘if she can safely carry and deliver seven, I can do the same with four.’ But the McCaugheys did the equivalent of winning the largest state lottery in the history of the United States.” Boehm is concerned that people will forget risks involved in having multiples.

“What can, and does happen,” he explains, “is that a woman can lose all her babies and feel guilt over the loss. She’ll wonder why Mrs. McCaughey can do it and why she can’t.”

Still, every multiple pregnancy is different. Kim Allen, for example, carried her twin boys to term and had a typical delivery. Indeed, most OB/GYNs in the area are trained to handle twin pregnancies and treat them with the assumption that they will be carried to term and delivered vaginally. Of course, many twins are born prematurely and delivered by cesarean section, as are most triplets.


What Parents Endure

The reality of living with a newborn doubles or triples when there are multiples. Unless you have had them, it is impossible to understand the unique situation of having one, two or more newborns to feed, change and comfort. It can be all-consuming.

“You’re so busy you have no time to think,” says Allen. She staggered feeding times for her twins, but some parents try to keep their multiples on the same feeding and napping schedule. When expecting multiples, parents should try to line up as much help as possible for the first few months following delivery. This is why groups such as POTATO and the Middle Tennessee Parents of Multiples exist. They offer friendship, understanding and support.

POTATO, founded in 1975, has about 100 active families as members. The group holds monthly meetings and social events throughout the year for parents and children. The group also publishes a directory listing people who can help advice with different circumstances. For instance, a mother wanting to breastfeed her twins can contact another mother who has done it.

Then there’s everyday life. Taking multiples on errands is an exercise in organization and coordination. Allen remembers how she would tote two infant carriers into the grocery store, and either put each carrier in a shopping cart or put both in one cart and drag another around for groceries. Well-meaning strangers stare, ask questions and even want to touch and hold the babies.

Boehm says multiples can cause a lot of stress to a family. Hobbies and other interests may go by the wayside as parents care for their babies. Older siblings may have a hard time adjusting to the loss of their parents’ attention and other adults’ fixation on their younger siblings. Multiples, especially during their infancy and preschool years, can be exhausting and frustrating.

And yet parents of multiples take great delight in their children. “They’re fun,” Manning says. She and her husband feel blessed to have such healthy, active children. Allen says, “You have two little smiles, two pairs of little feet coming at you when you come home.” And that can make all the diapers worth it.

The Face in the Mirror

With School-Aged Multiples, Identity and Independence Come Front and Center

You’ve gotten through the initial years with your multiples – now it’s time for school. What’s your decision? Will you place them together in kindergarten or will you seek out separate classrooms? The issue of identity is an important one, especially for parents of identical twins: where does one end and the other begin? Current research places importance on emphasizing each child’s individuality. Most multiples retain a closeness throughout their lives, so it’s up to parents to help them sort out their individual selves.

Debbie DeJean, mother of 6-year-old identical twins Cameron and Conner, says her children started preK in separate classes. “School officials recommended we separate them so they could get out and make their own friends,” she says. “I was a little nervous about it but they loved it.”

DeJean says she has always emphasized her boys’ individuality. “I haven’t dressed them alike since they were tiny babies, when it was fun and easy to just buy two of everything,” she says. “I began to dress them separately so they could develop their own identity and also so people could tell them apart.”

Although even extended family members still do get the boys confused, it doesn’t upset them, says DeJean. “They correct people immediately, in a very nice way. They accept that people are going to get them confused.” The confusion, she says, doesn’t seem to affect their sense of individuality.

Colline Roney, Nashville mom of grown fraternal twins Jay and Emily Schibig, says her children’s individuality was also something she wanted to encourage when they entered school.

“I separated them in kindergarten so they could be two separate people,” she says. “I started when they were little because it can be traumatic to separate them later if they’ve never been apart before.”

The early years were the hardest for Roney. When multiples are babies and until they are able to manage for themselves, she says “each day is a struggle.” For support and understanding, she turned to the local chapter of POTATO (Parents of Twins and Triplets), a connection she says was invaluable.

“I don’t know what I would have done without it,” Roney says. “You can have two or more children close in age, but unless you have two children of the same age you just don’t understand.”

Elaine Phillips is a mother, writer, teacher and researcher.


Making Connections

Local Support for Parents of Multiples

• Middle Tennessee Parents of Multiples, 595-1313
• Parents of Twins and Triplets (POTATO), 746-3531

Online Support for Parents of Multiples
www.marvelousmultiples.com – Online group dedicated to providing education and information for parents expecting twins, triplets or more.
www.mostonline.org – Mothers of Supertwins, a support network of families with triplets or more providing information, resources, empathy and more.
www.tripletconnection.org – The Triplet Connection, a support network for caring and sharing for multiple-birth families providing information for families expecting triplets or more.

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