When you’re having multiples
If you’re seeing twins wherever you go, you’re not seeing double: there really are more twins now than ever before, writes Melany Bendix
WORLDWIDE THERE’S BEEN a dramatic increase in the number of multiple births (two or more babies). In the United States alone the number of twin births has increased by 70 percent since 1980, and that’s thought to be the pattern in many developed countries. The most obvious cause is the rise of the fertility treatment in-vitro fertilisation (IVF) – the fertilisation of eggs by sperm outside the body. Dr Nomathamsanqa Matebese, a specialist in reproductive medicine at the Cape Fertility Clinic, says multiples are conceived during IVF when more than one fertilised egg is transferred into the uterine cavity. She says that scientific advancements in methods of embryo selection have reduced the chances of a multiple pregnancy in IVF. “Most IVF specialists are now doing single embryo transfers, with a good pregnancy rate and a reduction in multiple pregnancy rates resulting from IVF treatment,” she explains. But the chances of getting more than one baby through IVF is still much higher: “In our clinic, if two embryos are transferred into the uterine cavity, the likelihood of a twin pregnancy is 20 percent.” Another reason the multiple birth rate has, well, multiplied, over the past three decades is that women are choosing to have babies later in life. Women older than 35 are more likely to have twins because multiple ovulation (when two or more eggs are released in a single ovulation cycle) is more common from this age. And multiple ovulation is the most common cause of naturally conceived fraternal twins – two babies that come from two different eggs. You’re also more likely to conceive multiples naturally if you’ve had fraternal twins before, anyone on your mother’s side of the family has had fraternal twins, you’ve very recently stopped using birth control pills or you’re of African descent.
MORE BABIES, MORE RISKS
Regardless of how you conceived your twins, triplets, quads (or more!), the fact is all multiple pregnancies are automatically considered high risk, according to Dr Henk Burger, a Gautengbased gynaecologist and obstetrician specialising in high-risk pregnancies. That doesn’t necessarily mean that anything will go wrong – many multiple pregnancies are absolutely trouble-free. It just means that you run a higher risk of developing complications. These include miscarriage – both babies or only one (called “vanishing twin syndrome”) – and uterine growth retardation. “The incidence of anaemia in the mother is also five times higher, the incidence of pre-eclampsia (a pregnancy condition characterised by high blood pressure) five times higher and the incidence of polyhydramnios (increase in amniotic fluid) six times higher,” says Dr Burger. What all this means for you is more frequent check-ups throughout your
THERE’S A HIGHER INCIDENCE OF FOETAL DISTRESS, ESPECIALLY FOR THE SECOND BABY
pregnancy, especially if your babies are among the very few that share a placenta (monochorionic twins), as their risk is significantly higher.
BIRTHING OPTIONS
Birthing multiples can also be a risky business. “There’s a higher incidence of foetal distress, especially for the second baby, and a higher incidence of cord prolapse, haemorrhaging and other birth complications,” says Dr Burger. Twins are also more likely to have abnormal presentation, where they lie in the wrong direction for natural birth (either sideways or head up). For all of these reasons, doctors are far more likely to recommend a caesarean, says Marion Smith, chairperson of the South African Multiple Birthing Association (SAMBA) and a mother of twin boys. “The doctors usually advise C-sections because they feel they’re far less risky,” she says. “I can comfortably say that around 90 percent of multiple births in private hospitals in South Africa are C-sections.” However, natural birth with multiples is still an option in South Africa, in private care but even more so in public health care. Still, Dr Burger stresses that obstetricians will usually only consider trying for a natural birth if the pregnancy is at least 36 weeks, both babies are in a head-down presentation and there are no other complications. Whereas secondtime moms may be more inclined to try for natural birth, Marion says first-time moms tend go for a C-section. “If you’re feeling confident and you’d like to try for natural, don’t be put off – speak to your doctor about the possibilities.”