Upon my first ultrasound, the moment the wand touched my abdomen, two distinct black sacs appeared, each containing a small white dot. “No way!” was my immediate reaction. Twins? The sheer overwhelming nature of this realization hit me—far from the expected rush of maternal love, I was engulfed in anxiety: the challenges of carrying two babies, societal assumptions (let’s be honest, if you see a woman of a certain age pregnant with twins, thoughts of IVF likely cross your mind), and the pressure of becoming a mother to siblings while grappling with my own childhood as an only child.
I recognized my fortune compared to others struggling with infertility and cherished the life growing inside me (my daughters will celebrate their third birthday soon), but at just seven weeks along, adjusting to the reality of twins felt daunting. Would they both be healthy? Would they arrive prematurely? How would I care for them and myself?
In my youth, I only knew one set of twins, yet now, I encounter numerous multiples. My involvement in a parents’ group for twins has allowed me to connect with others, but even outside of that, it seems that every class my girls attend contains other twins. Playgrounds and bookstores are filled with them. The statistics reflect this trend: twin births have surged by 76 percent between 1980 and 2009, with 33 out of every 1,000 births now resulting in twins. The dramatic increase can be largely attributed to advancements in fertility treatments and assisted reproductive technologies. Fertility drugs like Clomid, often administered alongside intrauterine insemination (IUI) and in vitro fertilization (IVF), have led to a higher incidence of multiple pregnancies.
“Multiple gestations have flourished due to the success of fertility treatments,” states Dr. Emily Carter, a leading figure in maternal-fetal medicine. “The landscape has changed significantly; it’s not unusual to see several sets of triplets on the delivery floor.”
This rise in multiple births significantly impacts not only the mothers but also the infants and the healthcare professionals who care for them. Twin pregnancies carry increased health risks for mothers and their babies throughout gestation and during labor. Mothers expecting multiples are at a higher risk for conditions such as gestational diabetes and pre-eclampsia, along with complications like placenta previa and twin-to-twin transfusion syndrome. Consequently, these mothers require more frequent prenatal visits and ultrasounds than those expecting singletons.
Given that I was carrying twins and approaching 40, I was classified as high-risk and referred to a maternal-fetal medicine specialist instead of a general obstetrician. My appointments became monthly, escalating to weekly consultations as I neared 32 weeks. Regular checks on my cervix, blood pressure, and blood sugar became routine. My commute time extended dramatically; a simple walk to the subway turned into a 30-minute endeavor due to the physical demands of pregnancy. Thankfully, I transitioned to working from home around 7.5 months in, although I frequently relied on a walker just to navigate my apartment.
Mothers of twins are also more likely to undergo C-sections, either due to maternal or fetal health risks or if one or both babies are in a breech position. Currently, many obstetricians lack training in vaginal breech deliveries, opting for C-sections instead. “Healthcare providers are more adept at managing twin pregnancies, yet the skill set required for breech deliveries is not as prevalent,” Dr. Carter explains.
The financial implications are significant as well. A C-section delivery can cost around $50,000, compared to around $30,000 for a vaginal birth in singleton cases. In twin deliveries, each infant requires their own medical team, further driving up costs. Additionally, mothers of twins are 13 times more likely to deliver before 32 weeks and six times more likely before 37 weeks, with a substantial proportion of twins being born prematurely at low birth weights—defined as below 5 lbs., 8 oz.
“The average gestational age for twins is 35 weeks, which contributes to a higher incidence of preterm births,” Dr. Carter confirms. These premature infants often require extended stays in neonatal intensive care units (NICUs), significantly impacting both financial and emotional resources. “In Massachusetts, we now have far more NICU beds than two decades ago,” she adds.
Upon reaching 37 weeks, I was hospitalized due to pre-eclampsia. I chose to wait for my own OB to come in, as Baby B was breech (with Baby A in a vertex position), and my OB was trained in breech deliveries. Unfortunately, induction efforts failed and after 27 exhausting hours, I ended up in the operating room for a C-section. We were fortunate—one twin weighed nearly 7 lbs., and the other surpassed 6 lbs., with no complications. Despite my careful planning, the medical bills were still considerable.
The reality of twin pregnancies remains that they are inherently more costly than singleton pregnancies. “While we strive to manage costs, the nature of twins and triplets means we can only control so much,” Dr. Carter remarks. “Providing the best care possible is our priority.”
On a positive note, medical professionals are becoming increasingly skilled in managing multiple pregnancies. Residents gain more exposure to such cases, enhancing their training, while neonatologists are better equipped to care for premature infants. Ongoing research is exploring medical interventions, such as drugs that could prevent premature contractions. However, there are currently no definitive solutions for the health risks associated with multiple births. “We monitor and respond, but the best way to improve outcomes for mothers and infants is to have single births,” Dr. Carter asserts.
The American Society for Reproductive Medicine (ASRM) supports this approach. Their 2012 guidelines advocate for single embryo transfers for women under 35 undergoing their first or second IVF cycle, emphasizing that the optimal outcome is the birth of a healthy singleton. Remarkably, with advancements in fertility methods, the twin birth rate has stabilized, showing a 1 percent decrease in 2011 compared to the previous year.
“It’s crucial to reduce the rate of multiple gestations,” Dr. Carter insists. “Ultimately, our goal is to ensure the health of babies, which is best achieved through single births.” However, elective single-embryo transfer (eSET) adoption has been slow, particularly given the high costs of IVF. Many women facing infertility prefer to risk multiples rather than remain childless. Fertility treatments vary widely in their effects, particularly in older women who may prioritize a higher chance of pregnancy over the risks of multiples. The power of denial also plays a role; while I understood the risks, I never believed the outcome would apply to me.
As fertility science continues to advance, the landscape may shift. For now, the prevalence of twins persists. When I witness my daughters sharing a hug or comforting one another, I’m grateful for their bond—even if it’s sometimes accompanied by moments of hair-pulling. Their mutual affection is a precious addition to our lives.
For further insights on navigating pregnancy and home insemination, check out our detailed resources on home insemination or explore CCRM IVF’s blog for valuable information. Additionally, you can find expert advice on male fertility boosters at Make a Mom.
In summary, the increasing incidence of twin births significantly impacts the health of mothers and their infants, posing unique challenges in pregnancy and delivery. While advancements in fertility treatments have contributed to this trend, the associated health risks and costs necessitate careful management and consideration of medical practices.