Multiple Pregnancies Challenges


by Dr. Tan Ay Eeng

The number of multiple pregnancies (twins, triplets, or more) has risen significantly in recent years. The United States, for example, registered 100,750 twins and 5,939 triplets in 1996. In 2006, up to 137,085 pairs of twins and 6,118 triplets were born (source : US Centers for Disease Control). The sharp increase suggests that more couples will follow this trend of having a multiple pregnancy.



In-Vitro Fertilisation

Furthermore, advances in fertility treatments have not only enabled women with fertility issues to conceive, they make it possible to conceive more than one child at a time. One such treatment is in-vitro fertilisation, an assisted reproductive technology (ART) that increases the chances of conception by harvesting the eggs and fertilising them outside the body, before transferring them back to the mother's uterus.

This procedure involves implanting more than one fertilised egg in the uterus, resulting in the possibility of conceiving more than one child. Additionally, we have also observed the increased used of fertility medications, such as menotropins and clomiphene, which have increased the number of multiple pregnancies.



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Natural Occurrence

However, multiple pregnancies can also occur naturally. For instance, if your family has a history of fraternal twins or triplets, you have higher odds of having them, too. Research has shown that there is a gene for hyperovulation, where more than one egg is released during the ovulation cycle, that can be passed from mother to daughter.

Women who opt to delay their pregnancies into their 30s and beyond may also experience higher chances for multiple pregnancies due to age-related hormonal changes, which also causes more than one egg to be released at a time.

Challenges You May Face

Carrying and rearing one baby is challenging enough for most mothers, especially first-time mothers. Not only will she have to cope with the responsibility of caring for a new life, she will also have to cope with the physical and psychological changes that accompany the arrival of a newborn. The same goes for the family unit. Now, imagine multiplying all these challenges at once, and you might just get a small glimpse into what it is like to parent more than one baby at a time.

Needless to say, most of the difficulties of a multiple pregnancy will fall hardest and heaviest on the mother, as she will be the babies' main source of protection and nourishment. Heightened symptoms of pregnancy, such as substantial weight gain, excessive stretching of the abdominal wall, swollen legs, and others are to be expected.

Additionally, because the mother is sharing her body with more than one baby, she is prone to higher risk of complications such as anaemia, hypertension, diabetes mellitus, premature labour, and an increased chance of LSCS (lower segment Caeasarean section). Thus, a higher level of care throughout the pregnancy, which requires more frequent visits to the doctor's office, is necessary.

Emotionally, the new mothers may constantly feel uncertain, anxious, and lack self-confidence in coping with more than one baby. It is during this time that emotional support from her spouse and family members is most important.

Challenges Babies May Face

Babies from multiple pregnancies may find themselves fighting harder to survive compared to babies from single pregnancies. From the moment of conception, babies from a multiple pregnancy find themselves sharing almost every resource. Foetal complications such as twin-to-twin transfusions, where one baby would be anaemic and the other might receive too much blood from the shared placenta, and growth restriction inside the womb may occur.

The likelihood of preterm delivery also increases as twins are 6 times more likely than single babies to be born preterm. Preterm babies are likely to be born with premature organs, such as lungs and liver, and may need admission into a neonatal intensive care unit (NICU) to receive treatment for these complications.

Birth defects are also a probability for multiple pregnancies. For example, there is a 20% higher rate of congenital abnormalities in multiple pregnancies. Additionally, rare abnormalities such as conjoint twins (siamese twins) and acardia (absence of the heart) are unique to twins.

Challenges Families May Face

Besides the mother, the family as a whole may also find themselves coping with multiple challenges such as time management, financial, health, couple relationships, and more.

Juggling three crying babies is an incredible source of stress to a couple who only has two pairs of hands between them. Moreover, the need to purchase multiples of everything, including baby cribs, infant carriers, and much more, may be a financial burden to families with average incomes.

Thus, couples need to work even harder to share responsibility in raising their children, especially when there are other siblings that precede or follow the multiple pregnancy. Couples need to ensure that each and every child will receive equal love, care, acceptance, and nurturing to grow up happy and healthy.

Joy to Behold

Parents of multiples should never forget to look at the bright side of things amidst all the challenges - playmates will never be a source of worry for parents as their children will be each others' source of company and support. Their children's social skills may be enhanced as a result of constantly being in the company of others, and of course, for the families, there will never be a dull moment in the household.

Additionally, as the children grow older, mothers may even benefit from the extra 2 (or 3) pairs of hands to help around the house!

Multiple pregnancies may present multiple challenges, but remember, the joy and satisfaction derived from it is also multiplied. With the right precautions and steps, the journey of parenthood is just as amazing and fulfilling. Remember that the challenges you have now will be one of the sweetest memories in your life.


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