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BCM - Baylor College of Medicine

Giving life to possible

Obstetrics and Gynecology

Multiple Pregnancy

A multiple pregnancy is when a woman has two or more babies in her uterus. The babies can come from the same egg (identical) or different eggs (fraternal).

A multiple pregnancy takes special care and can pose risks to both the mother and babies. It is important to know what to expect during multiple pregnancy, labor and childbirth, complications that can arise, and how to prepare to take the best possible care of yourself and your babies.

Types of Multiples

Identical babies occur when one egg is fertilized by one sperm. The fertilized egg then splits into two or more embryos. Identical babies share a placenta, but each usually has a separate amniotic sac. Identical babies are the same sex and have the same blood type, skin, hair and eye color.

Fraternal babies come from different eggs fertilized by different sperm. Each has their own placenta and amniotic sac. Fraternal babies can be the same or different sexes, have different blood types and will look no more alike than any other siblings. Fraternal twins and multiples tend to run in families.

What causes a multiple pregnancy?

You are more likely to have a multiple pregnancy if you:

  • Take fertility drugs - which help you make several eggs at a time, increasing the odds that one will be fertilized
  • Use in vitro fertilization (IVF) or other assisted reproductive technology - where eggs are mixed with sperm in a lab and put back inside your uterus; several fertilized eggs are inserted to increase your chance of having a baby
  • Are age 35 or older
  • Are of African descent
  • Have had fraternal babies before
  • Have a family history of fraternal babies (on the mother's side)
  • Have just stopped using birth control pills

How is a multiple pregnancy diagnosed?

Your healthcare provider may suspect multiples if your uterus grows more quickly, is larger than normal, or if more than one fetal heartbeat is suspected. Certain blood tests may also suggest multiples.

A multiple pregnancy is confirmed through a fetal ultrasound, an imaging test that uses sound waves to create pictures of your uterus and the number of babies you are carrying.

What are the risks and complications of a multiple pregnancy?

Every pregnancy has risks but the chance of complications increases with each baby you are carrying. Healthy multiples are born every day; however, it's important to be aware of possible complications including:

  • High blood pressure (preeclampsia)
  • Anemia
  • Gestational diabetes (occurs while you are pregnant)
  • Preterm birth, before the babies' organs are fully formed
  • Low birth weight
  • Miscarriage
  • Genetic disorders or birth defects

What can I expect during multiple pregnancy?

Frequent checkups and testing. To closely monitor your health, track your babies' growth and development and watch for signs of preterm labor. In addition to regular physical exams, blood and urine tests, you may need frequent fetal ultrasounds or other tests. These checkups are vital to keeping you and your babies healthy - don't miss any appointments.

Proper nutrition. Through a healthy diet, a prenatal vitamin, and any supplements your doctor may prescribe.

More weight gain. Your doctor will determine the right weight gain for you and your babies' health.

Rest and limited activities. Proper rest is vital to staying healthy. As your delivery date approaches, your doctor may ask you to limit activities like work, travel and exercise.

How will multiples affect my labor and delivery?

How your babies are born depends on several factors, including the number of babies, their position, weight and health, and your health.

It's possible to deliver twins vaginally. In some cases the first twin may be delivered vaginally but the second twin may require a C-section.

For triplets or more, C-section deliveries are typically considered the safest option.

Depending on your condition, your doctor may recommend you deliver in a facility that specializes in high-risk pregnancies.

Caring for Multiple Babies

Ask your doctor about special childbirth classes for parents expecting multiples, to help you prepare.

If the babies are born early, they may need special medical care to breathe, eat and keep warm. Preterm and small multiples may be cared for in a neonatal intensive care unit.

Taking good care of yourself is the best way to take care of your babies. Get as much rest and support as you can. Ask for help when you need it. Join a support group for parents of multiples.

If you feel overwhelmed or sad, talk to your doctor immediately.

Can I breastfeed more than one baby?

Yes. When you breastfeed, your milk supply will likely increase to meet the amount needed by your babies. Eat a healthy diet and drink plenty of fluids. If your babies are premature, you can pump and store your milk until they are strong enough to nurse. Talk with a lactation specialist.