Celebrities and regular folks alike idealize having twins—especially boy/girl sets—but we need to address the very real health, financial, and ethical implications that are tied up in this glamorization.

By Zara Hanawalt
February 11, 2021
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Credit: Getty Images (1). Art: Jillian Sellers.

When I told people I was expecting two babies, they'd say things like, "Two for the price of one!" And when I found out I was having a boy and a girl, the reactions were even more over-the-top excited. I heard "What a perfect situation!" more times than I could count. Many people have even asked me if I "planned" to have twins—and if I could share the "method" I used to get pregnant with a boy and a girl at the same time.

That's why I wasn't surprised when I heard recent comments from Paris Hilton, who shared that she's undergoing in vitro fertilization (IVF) in hopes of conceiving boy/girl twins. While I believe in reproductive autonomy and know Hilton is entitled to do what she wants with her body and money, her decision brings up so many issues—both maternal and fetal health, privilege, access to fertility treatments, and ethical boundaries.

There's a lot to unpack here, but one thing is clear: There's a glamorization around boy/girl twin pregnancies, and it has a greater impact than you might think.

Why Are Twin Pregnancies Glamorized?

Beyoncé, Jennifer Lopez, Amal Clooney, and Mariah Carey are all moms of boy/girl twins. With that kind of A-list affiliation, it's no wonder twin pregnancies seem glamorous. But does a cultural desire to emulate these celebrities have people who don't otherwise need it opting for the grueling IVF process so they can join the twin parent club?

Barry Witt, M.D., reproductive endocrinologist and medical director of WINFertility, says he hasn't seen evidence of this practice—but he does see patients who request IVF with genetically tested embryos so they can guarantee they'll have a baby of a certain sex, even in the absence of fertility issues.

He frequently caution patients who are already undergoing IVF for infertility against transferring two embryos (like Hilton is alluding to) due to the risks of carrying multiples. "We very, very, very, very strongly recommend single embryo transfers because of the risk of twin pregnancies," says Dr. Witt. "I wouldn't say I've never [transferred two] but it requires major twisting of my arm."

To be fair, we don't know the real root of Hilton's decision to undergo IVF (she could have legitimate fertility issues that require this procedure), but Dr. Witt says IVF for the sole purpose of conceiving twins may be more common in Hollywood circles.

Of course, no amount of celebrity privilege can fully remove the physical demands of the IVF process or the uncertainty of Hilton's request. "The implantation rate of a tested embryo is still like 60-something percent," says Dr. Witt. "You can say, 'I'm putting a girl and a boy embryo in,' but that doesn't mean you're getting a boy and a girl baby out. Not every embryo you put in implants. There's certainly a pretty high chance, but there's also a chance only one would implant."

The Risks of Twin Pregnancies

As a parenting writer, I knew immediately that my twin pregnancy would be high risk—but I never imagined how hard or scary things would get. I couldn't envision breaking out into a viciously itchy full-body rash (the condition is known as PUPPP, but might as well be renamed "pregnancy hell"). I didn't foresee a diagnosis of cholestasis, which could have been life-threatening for my babies, or preeclampsia, which could have been life-threatening for me. I didn't expect my first few days as a mother to be spent on strict bed rest after my blood pressure skyrocketed and my hemoglobin levels dipped dangerously low.

But that's how it went, and it's not even an exhaustive list of all the issues I faced during and after my pregnancy. And in the grand scheme of things, I got extremely lucky.

Dr. Witts points out twin pregnancies have a higher risk of stillbirth and neonatal death, while almost 60 percent of twin babies are born preterm and can stay in the NICU for months. Twins are at a higher risk of lifelong issues, including cerebral palsy, pulmonary immaturity, and neurological issues.

As an OB-GYN and a mom of 19-year-old twins, Tara Scott, M.D., understands the risks both personally and professionally. "Preterm labor is a huge cost for the country: Preemie babies are in the NICU; it's very expensive care, and obviously babies born very prematurely can be there for months," says Dr. Scott, who went into labor when she was five months pregnant and had to have a surgery to sew her cervix shut during her pregnancy.

Twin pregnancies also increase a mom's odds of developing pregnancy complications, including gestational diabetes, preeclampsia, and postpartum hemorrhage. The odds of needing a C-section are much higher in twin pregnancies as well.

The risks don't disappear after delivery either. "You've got twice the load. You're just so exhausted, which definitely increases the incidence of anxiety and depression," says Dr. Scott. "Part of the reason for postpartum depression is that crash in your hormones ... you've got two babies, and that's a deeper crash. The science would follow that being a greater risk for postpartum depression."

We Need to Change the Conversation

It's important to stress the reality of having twins, especially as we have a maternal mortality crisis in the United States. While no amount of privilege can totally remove this tragic risk, maternal death disproportionality affects mothers in marginalized communities—which makes it frustrating to hear a wealthy white woman speak so casually about opting in for a high-risk pregnancy.

Again, we don't know if Hilton requires IVF in order to get pregnant or if she's been trying to conceive for over a year, which is the threshold for an infertility diagnosis. Still, I imagine her comments struck a major nerve with many couples who are desperately trying to conceive and can't afford IVF treatments, which are often not covered by insurance.

Dr. Witt points out that trends celebrities embrace when it comes to fertility treatments don't always reflect what the rest of the world is doing, and he's right. While Hilton may have been advised by her friend, Kim Kardashian West, to use IVF to "pick" twins, that doesn't necessarily mean everyday people will do the same.

But here's the thing: Celebrities may make up a small slice of the population, but they comprise a massive space in the dialogue around parenting issues; comments like Hilton's have the power to influence public perception. For celebrities, it can be a glamorous experience. But for the rest of us? Well ... it's not all matching outfits and adorable photo ops. And let's not leave out the financial toll of having twins and how much more difficult it is raising two newborns without access to round-the-clock help.

"I don't think pop culture really says anything about twins being a risk," says Caroline Hershey, who gave birth to twins at just 26 weeks. "[People say], 'You're so lucky, you have a boy and girl.' Even when they hear how premature they were and that we were in the hospital for four months, they don't really understand [and say things like], 'Oh, but you have everything now.' It's a weird thing to respond to because I didn't choose to have it that way."

The Bottom Line

If you're pregnant with twins, don't let this information alarm you: You will likely come out of this with your health and your children's intact. And having a front row seat to that magical twin bond? It's amazing. But doctors—and many people who have experienced pregnancy with multiples—caution against "trying for twins" for good reason. "It's certainly safer to have the babies one at a time," says Dr. Witt. "So that's what we try to talk people into."

Comments (1)

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