The thought of delivering one baby is daunting enough, but two? Or three? Or even four? Yikes! Twins and triplets have become increasingly common, thanks to assisted reproduction techniques and older mothers (age increases your chance of having multiples). Quadruplets and other higher-order multiples are still rare, however. Approximately 3 percent of the babies born in the United States are multiples.
Multiples tend to arrive early:
60 percent of twins, 90 percent of triplets, and virtually all higher-order multiples are born before their due dates. Many twin pregnancies last 36 weeks and triplets 32 weeks.
The type of delivery you have depends on your health, the babies' health, how many babies there are, how much they weigh, and how they are positioned in your uterus. Three or more babies are almost always delivered by cesarean. Twins generally can be born vaginally if they are both vertex, or in the head-down position. If both twins are head-up, or breech, most doctors go right to a cesarean delivery. If one twin is vertex and one is breech, a cesarean isn't always necessary provided twin A (the twin who will be born first because he is closest to the exit, so to speak) is head-down.
When you are admitted to the hospital to deliver your babies vaginally, an ultrasound will be performed to determine the babies' positions. Because of the risk of fetal intolerance to labor, bleeding from the placenta, and the possible need to switch quickly from vaginal delivery to cesarean delivery, you and your babies will be monitored closely throughout labor. An intravenous line may be inserted into your arm so that if you suddenly need a cesarean, time won't be wasted hooking you up to an IV for anesthesia.
When the first twin is delivered, the doctor will hand him over to a pediatric specialist for examination. (Several pediatricians or neonatologists--one for each baby--may attend the delivery, although this varies by hospital.) A trip to the NICU isn't necessary for all twins and triplets, but is more likely for preterm babies or those who need extra help breathing. The second twin may be born anywhere from a few minutes to a few hours later. In years past, doctors believed that the second baby would be in danger if he came out more than 15 minutes after the first baby, but now, with advanced medical equipment, your doctor can monitor the second baby during the time it takes for you to push him out.
If the umbilical cord becomes compressed or the placenta starts to separate too early, the baby or babies may be in danger, and your doctor will perform a prompt cesarean delivery.
If you are having triplets, your doctor will likely want to deliver them by cesarean, and if you're having quads or more, cesarean is the only option. With a cesarean delivery, the babies are delivered one after the other. If they are premature, very small, or have health problems, they'll be taken to the NICU.
Originally published in You & Your Baby: Pregnancy.
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