When You Have a Multiple Pregnancy
How is a multiple pregnancy managed?
Your healthcare provider or midwife will decide on care based on your pregnancy, overall
health, and health history. Care will also be based on the number of fetuses.
Care of a multiple pregnancy may involve:
Increased nutrition. If you are carrying 2 or more fetuses, you will need more calories, protein, and other
nutrients, including iron. You should also gain more weight. The Institute of Medicine
recommends that women carrying twins who have a normal body mass index should gain
between 37 and 54 pounds. Those who are overweight should gain 31 to 50 pounds; and
obese women should gain 25 to 42 pounds.
More frequent prenatal visits. Multiple pregnancy raises the risk for complications. More frequent visits may help
find problems early enough to better treat and manage them. Your nutritional status
and weight should also be watched more closely.
Referrals. You may need a referral to a maternal-fetal medicine specialist (perinatologist).
He or she may do special testing or ultrasound evaluations and to coordinate the care
Maternal and fetal testing. You may need testing to monitor the health of the fetuses, especially if there are
Tocolytic medicines. You may be given tocolytic medicines if preterm labor happens. These medicines help
slow or stop contractions of the uterus. You may take the medicines by mouth (orally),
as a shot, or through an IV. Magnesium sulfate is one such medicine often used.
Corticosteroid medicines. Corticosteroid medicines may be given to help mature the lungs of the fetuses. Lung
immaturity is a major problem of premature babies.
How are multiple pregnancies delivered?
Delivery of multiples depends on many factors, such as:
Generally, in twins, if both fetuses are in the head-down (vertex) position and there
are no other complications, a vaginal delivery is possible. If the first fetus is
vertex, but the second is not, the first fetus may be delivered vaginally. The second
is either turned to the vertex position or delivered breech (buttocks are presented
first). These procedures can increase the risk for problems such as prolapsed cord.
This is when the cord slips down through the cervical opening. Emergency cesarean
(C-section) birth of the second fetus may be needed. Most triplets and other higher-order
multiples are born by C-section.
Vaginal delivery may take place in an operating room because of the greater risks
for complications during birth and the potential need for a C-section. A C-section
is often needed for: