The Allure of Multiples

I don't get it. Right now in the NICU we have 18 babies. Of these, only 4 are singleton births. And one probably shouldn't count as a singleton because she started off as a twin but her sister died at 23 weeks gestation.

We have two sets of triplets, and all the rest are twins. I can't tell you the number of times I've heard women express the desire for twins. I'm not sure where the romanticized idea originated from, but I guess the idea of getting two children with one pregnancy or the attention that moms get when they walk down the street with a double stroller plays a part. Honestly, though... I just don't get it.

A normal pregnancy is one baby. That's what the human body was built for. A multiple pregnancy is a complication. Call it what you want... a miracle, a double blessing, whatever. I just feel that people don't understand the risks of what they're wishing for.

For starters, the most immediate risk involved with multiple births is pre-term labour. A typical, single pregnancy lasts about 40 weeks, but a twin pregnancy often lasts between 35 to 37 weeks-- and that's if they're lucky and stay put. Nearly half of all twins are born prematurely (before 37 weeks), and the risk of having a premature delivery increases with higher-order multiples. Prematurity carries an enormous amount of risks unto itself, the most common complications being feeding difficulties, sepsis and apnea (episodes where the amount of oxygen in the baby's blood falls to dangerous levels, usually due to immature respiratory drive). Then there is the risk of various twin-to-twin transfusion syndromes, where one baby essentially 'steals' blood and nutrients from the other, putting the smaller twin in danger of intrauterine demise. Now I'm no neonatologist (clearly) but why would anyone wish for a condition that would put their baby's health at risk?

And the risks aren't just to the babies. Women are not built to breed large numbers of offspring at once. Imagine all of the ways that pregnancy is hard on a woman's body. Now imagine them doubled. Preeclampsia, gestational diabetes, and placental problems are all more likely to happen in the case of a multiple pregnancy, and can be much more serious as well. The labour is also riskier, as regardless of the initial presentation of the multiples (even if they're vertex-vertex as opposed to one or more babies being breech) as soon as one baby is born the other frequently changes position. This often requires an emergency c-section, which is significantly riskier for both mother and baby than vaginal delivery.

I know... not my most lighthearted post. But it drives me crazy to hear another misguided mom express how much she's always wanted a multiple birth. Particularly when I've spent the last month caring for the complications of just this kind of 'miracle'.

An interesting article was published in the journal 'Fertility and Sterility' in 2004, examining the desire of infertile couples for multiple births.* They reported that 20% of infertile couples expressed a strong desire for a multiple pregnancy. In one way, it makes sense-- if these couples have had significant difficulties in conceiving, they probably figure that having more than one baby with a single pregnancy gives them more 'bang for their buck' so to speak. They end up with more children without having to go through the stress and financial strain of additional fertility treatments. Also not surprisingly, this desire was correlated with a lack of knowledge regarding the risks of twin gestations. The study concluded that patients need to be educated about these risks before attempting fertility treatments that put them at higher risk of conceiving multiple fetuses. No kidding.

I need to get out of the NICU. I have babies on the brain. Thank God I start full-time family medicine next week.

And before you ask, yes... all of the babies but one set of triplets and one set of twins were conceived on Clomid. So these are man-made multiples, not naturally occurring multiples. But I'm not getting into fertility treatments and their repercussions. That's a post for another day.

* Ryan, G.L., Zhang, S.H., Dokras, A., Syrop, C.H., Van Voorhis, B.J. The Desire of Infertile Patients for Multiple Births. Fertility and Sterility: 81(3), 500-504.