You want me to what? Six things you should know about having multiples

Are epidurals mandatory, can I have a home birth and other burning questions you'll have when you're pregnant with twins.

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Since in vitro fertilization became mainstream in the 1990s, the rate of multiple births has grown steadily in Canada and around the world. Multiples now account for 3.2 percent of births, compared to two percent in 1991. While that isn’t a huge spike, because multiples are considered high risk, it carries an outsized impact on health services.

But just because we’re making more multiples doesn’t mean that our bodies are any better at bearing or birthing twins and triplets—multiples are still a high-stakes process. To get a handle on what twin-parents-to-be can expect, Today’s Parent spoke with Jon Barrett, a senior scientist at Sunnybrook Health Sciences Centre in Toronto and co-director of the Sunnybrook Research Institute’s Centre for Mother, Infant and Child Research, and asked him to answer some of the most common questions.  Mom and dad creating a heart with their hands
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1. Are epidurals mandatory?
No, but they are highly recommended. And doctors don’t just recommend an epidural because it helps alleviate the mother’s pain; the babies are actually the main beneficiaries. “Once the first child is delivered, the second gets itself into all kinds of funny positions,” says Barrett. “If you have an epidural in place and you’re in an operating room, it allows for immediate intervention.” If you choose to not have an epidural and complications lead to a Caesarean section, you will likely be put under general anaesthetic and not be conscious for the birth.

2. Will I have a C-section?
Not necessarily. The rate of Caesarean birth is higher for multiples, but that’s because there is a higher risk of complications. (Rates of pre-eclampsia are two times higher in multiples, and gestational hypertension is two to five times higher.) If all is going well, Barrett says there is no evidence to support choosing a C-section over a vaginal birth. That doesn’t hold for triplets, though: You will be scheduled for a Caesarean.

3. Can I still choose a home birth or have a midwife?
No. Both home births and midwife deliveries are ruled out, due to the higher risk of complications. In twin pregnancies, the risk of adverse outcomes is much higher than in singleton pregnancies. “Not many people realize this, but having multiples is one of the highest risks you can have in pregnancy, equivalent to gestational hypertension and diabetes,” says Barrett. You will likely deliver in an operating room or in a hospital with access to operating equipment.

4. Will the babies come early?
About 60 percent of twins are born before 37 weeks—the point at which multiples are considered full term. Late-preterm babies (those born after 32 weeks) face a number of dangers, but the highest risk is for those born before 32 weeks, and twins are 10 times more likely than singletons to be early preemies, born before 30 weeks.

5. Will my twins have developmental delays?
The odds are definitely in your favour, but there are things to be aware of. Multiple Births Canada says twins develop in a similar way to singletons, unless there are specific issues due to prematurity or birth defects. Premature babies have two “birth dates”: when they were born and when they were due. Their development will be monitored according to their due date, so while they look like they are behind their birth peers, they are probably doing just fine for how old they would be if they’d gone full term. If your babies are behind, don’t fret: Studies show that most twins catch up to their singleton peers before they start school, if not earlier.

6. What else should I keep in mind?
When it comes to his own misconceptions, Barrett says that his biggest surprise in 20-plus years of specializing in multiple births wasn’t a clinical result; it was the impact that having twins (or more) has on families. “I don’t think I was aware of the stress of looking after those babies,” he says. “Rates of divorce and family violence are higher. Society has trouble realizing that the ‘minor’ difficulties of singletons are much higher for twins.”

Still, knowing that things will be stressful doesn’t necessarily help reduce the stress itself. Even the strongest couples will hit hurdles. But at least knowing that the stress is real and that feeling overwhelmed isn’t failure might help families reach out and ask for help.

Read more:
Twin tricks: advice from a paediatrician and mom of twin girls
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