Rachel Franklin, M.D., mother of twins, is a board-certified family medicine specialist in private practice in Oklahoma City. Her practice includes obstetrics and gynecology services. Visit her Web site at
"You Knew You Were Having Twins, Right?"
Wot in hell have I done to deserve all these kittens?
--Don Marquis, Mehitabel and Her Kittens in Archy and Mehitabel
Thursday, November 9, 2000
Yesterday I found out I was pregnant with twins. My husband and I had gone for the routine ultrasound and had waited until I was eighteen weeks along so we could find out the sex of the baby.
I lay on the table and the tech put the goo on my belly. You know the stuff--not quite slime, not yet lotion. I'd always been convinced that some company decided that making conductive gel feel too much like a pleasant spa treatment would make it feel less like an actual diagnostic tool.
I already had the discomfort of a full bladder, and now this lady was pushing the probe right on top of it all. I felt like I was riding in a jeep over giant boulders wearing a too tight seat belt while trying not to pee on myself. But I was anxious to see the child we had made in England, and up until those first words out of the tech's mouth--"You knew you were having twins, right?"--I thought I could handle it.
Some strange picture popped up on the screen, and I quickly recognized it for what it was--the abdomen and the head of a baby, side by side. I knew one baby couldn't make this picture. I was convinced thatsomeone must have put the tech up to this. I had many friends in this hospital. Which one did this?
Then she moved the picture, and I saw two hearts, side by side. Twins!
I went completely numb. Ben, my husband, now says he felt all the blood leave his body. Then, partly recovered, he noticed that I was pale and hyperventilating. "Honey, are you okay?" he asked as he squeezed my hand. "Honey, you're not breathing. You've got to breathe."
"I am breathing," I insisted. I focused on the screen as the picture developed, fully switching into my "doctor mode," as my family calls my coping mechanism. Two sacs, two placentas (good, no twin transfusion--maybe), closed spinal cords (no spina bifida--maybe), intact hearts. The larger picture soon emerged in my mind: Side by side in separate sacs with the membrane between them running from the top of my uterus to the bottom, and ... they're perfect. A boy and a girl, we think, with two arms and two legs each, normal bones and hearts, and just the right size for their age.
I began laughing for fear I'd cry.
Whether multiple pregnancy is fortune's touch or the result of an arduous journey through the infertility clinics of the world, it is inevitably somewhat of a shock to most of us. While many who read this book may have known sooner than others that they would be carrying multiples, their uncertainty will likely be no less acute. You will undoubtedly have many of the fears and insecurities I had when first embarking on this adventure.
I want you to know that you've joined a sisterhood (and an amazingly strong fraternity for you dads) that is largely invisible to the world of "one kid at a time" families. You will be embraced (and accosted) with more stories than the average expectant mom. You will receive the stares and comments of those uneducated souls who think you're just plain fat. You will hear horror stories of terrible outcomes and predictions of the end of your social life from those who had only one at a time. I have been told, "Honey, you really need to watch whatyou're eating. Baby doesn't need all that," and "Just wait until they're six months old. You won't be able to go anywhere." Be kind in your thoughts toward these people; they haven't the slightest clue what you're going through. Ignore the ignorant. They mean well when they're not trying too hard to be clever. My response has typically been to ask them in feigned earnestness how old their twins are. It usually stops the intrusion.
Embrace the parents who have been where you are. They know the truth. Parents of multiples have had the fears you've had, and they've survived. From parents of multiples I have heard only reassurances. Strangers, friends, or patients, they remind me so often what a blessing their twins or triplets are and how they have weathered hardships and come out stronger. Ours, and now yours, is a survivors' club, forever changed by what we have endured and strengthened by new priorities, renewed patience, and a learned behavior of expecting the unexpected.
So, what is a multiple pregnancy, how rare is it really, and how does a couple survive it with their sanity and relationship intact? First, you need to arm yourself with some facts. Then, you need to assemble the team of experts you can trust to guide you the rest of the way through. With luck, patience, and learned skills you can soon begin to deal with stress and with the unexpected conditions of an experience completely out of control.
Get ready for the two most common questions you will hear at home, at work, at the grocery store, at church, or at the mall: "Ooh, are they twins?" (in the first two years of life I think the answer should be "duh") soon to be followed by "Are they identical?" You may also hear my favorite query: "Are they natural twins [triplets, and so on], or did you go through fertility treatment?" For some reason the intrusion on one's privacy when one has multiples doesn't end with pregnancy, as it blessedly does for those with a singleton pregnancy.Whether you like it or not, you will be fodder for the public's perceived "right to know" for some time. Whether you answer them or not (especially about the fertility treatments), you should be familiar with the terms used when referring to your pregnancy and babies.
Ladies, if your husband is anything like mine, he will undoubtedly take this opportunity to pride himself on his skill at having impregnated you twice or more at one go. Ben was said to have returned to work after the first ultrasound bragging that he had been "shooting from both barrels" the night I conceived. I think it's compensation for their suppressed desire to turn tail and run in the opposite direction from the diagnosis.
By definition, a multiple pregnancy is one in which either more than one egg was fertilized or the fertilized egg split early in its development. The babies produced in a multiple pregnancy are defined in such a way as to clarify the source of multiplication and to help doctors identify potential problems as early as possible. Many of the following definitions are those pertaining to twins. Your doctor can help you with definitions for your pregnancy if you are having more than two babies.
Those babies produced from more than one egg are called fraternal twins, triplets, and so on. The medical term for them is dizygotic (two eggs) if they are twins. These babies by definition are as similar as any other siblings and will each have her own sac of amniotic fluid and her own placenta. Dizygotic twins will have their own potential complications but will be spared others (discussed in other sections and in the Rapid Reference Guides in chapters 14 and 15). By luck of the draw, these multiples can be any combination of boys and girls.
Babies who are the result of a single fertilized egg splitting are called monozygotic (one egg). They share an identical set of genetic material and are of the same sex. They have the potential to look exactly alike, although not all do because of the different ways in which our genetic material can express itself. These eggs split at different stages of development, during which time the parts essential to support life inside the uterus (placenta, fluid, protective sac [chorion], and umbilical cord) are forming. Because of this difference, these babies can live life inside their moms in a variety of conditions. If the egg splits within the first three days, each child will have his own amniotic sac and placenta and live a completely separate life in the womb. They are known as diamnionic/ dichorionic if they are twins, and frequently have the same promise and potential problems as fraternal (dizygotic) multiples. If the egg splits after certain components of fetal life have formed, the babies can share the placenta or sac or both (known as monoamniotic /monochorionic). Those eggs that wait too late to split (around days thirteen to fifteen) give rise to conjoined, or Siamese, twins. Very rarely do eggs splitting at this stage result in more than two babies.
Twins do tend to run in families. The likelihood of having twins resulting from one egg (monozygotic) can be inherited from our mothers, and the likelihood of having twins from two eggs (dizygotic) can be inherited from either parent. The odds of having twins is 1.7 times normal for those whose sisters have had twins, and 2.5 times normal for those who are the children of a twin mother.
In 2002, the last year for which statistics are available, there were more than 4 million live births to women of all ages. Just over 125,000 of these births, or 3.1 percent, were to moms of twins, and almost two in a thousand pregnancies resulted in the birth of triplets, quadruplets, or more babies. This represents a continued increase in the number of women having twins and a slight decrease in those having more than two babies per pregnancy. Overall, the chance of having twins has increased from one in eighty (according to a 1993 textbook I have) to one in thirty-two pregnancies!
The chance of having multiple births increases with older mothers, those who used assistive technologies (Clomid, in vitro fertilization, and so on; see the discussion below), and with mothers of African...