Pregnancy: Carrying and delivering multiples

If you're expecting twins or triplets, you may be riding a wave of emotions. On one hand, it’s exciting: More than one baby to love and nurture, with a built-in playmate (or two), all at once. On the other hand: More than one baby to love and nurture — and feed and diaper and dress and soothe, all day, every day. Gulp.

The number of multiple births has skyrocketed across Canada over the past 10 years because of women using assisted reproductive technologies, according to Jon Barrett, obstetrician and chief of maternal fetal medicine at Toronto’s Sunnybrook Health Sciences Centre. “The rate of twin births has increased probably 30 to 40 percent,” he explains. “And triplets have increased about 300 percent.”

While it’s becoming more common to know a family with twins, the different experience of carrying and delivering multiples (versus one baby) doesn’t get as much attention as it should, says Barrett.

There’s much more to a multiple pregnancy than deciding on extra names.

During your pregnancy First off, ditch the idea that you’re eating for three. Barrett explains that it’s key to eat healthfully, but that caloric intake doesn’t differ much from a singleton pregnancy (your babies’ growth is more related to the blood flow in your uterus than your food intake).

The pregnancy symptoms you’ll experience aren’t so different, either — except that you may feel them sooner and more severely. Breathlessness, discomfort walking and extra pressure will start midway through your pregnancy, which is about six to eight weeks earlier than if you were carrying one, and these symptoms could impact your ability to stay on the job. “Once they get past 32 weeks, many moms carrying multiples find it very difficult to do a normal day’s work,” Barrett explains. In addition, complications such as high blood pressure, gestational diabetes and anemia are much more common.

The physical strain on your body, coupled with the potential risks, can lead to added emotional stress. It’s important that you establish a reliable support network for rough days during pregnancy — and for after the babies arrive. (The website multiplebirthscanada.org is a good place to start.)

Delivering multiples The biggest risk in any pregnancy is preterm birth (when a baby is born before 37 weeks gestation) — and in a multiple pregnancy, that risk rises to 50 percent, compared with eight to 10 percent for singleton pregnancies. The more serious risk is for babies born before 30 weeks, which happens with 10 percent of multiples.

The good news? About half of women carrying twins go into labour naturally and deliver vaginally. “Most will go into labour themselves before their due date,” says Barrett. “For those who don’t, even if everything’s going well, we tend to induce at around 38 weeks because twins have a much higher risk of stillbirth.” At Sunnybrook, about half of twins are born by Caesarean section.

Barrett admits it’s a balancing act to help parents-to-be understand the real-life demands. “People come to me very excited because twins are great and many do well, but the reality is that there is a significant increased risk for the mother and the babies, compared to a singleton pregnancy. I don’t think people realize it’s a high-risk pregnancy.”

A version of this article appeared in our October 2012 issue with the headline "Babies on board" (p. 73).