As soon as the ultrasound probe made contact with my stomach, two dark sacs, each containing a small white dot, appeared vividly on the screen. “Nooooo!” was my immediate reaction. Twins. Oh my goodness.
Instead of feeling a rush of maternal warmth as many describe, I was overwhelmed with fear: fear of carrying two babies, fear of judgment from others (let’s be honest, when you see a woman of a certain age expecting twins, don’t you think “IVF”?), and fear of navigating the complexities of raising siblings as an only child. I recognized how fortunate we were compared to couples facing infertility challenges, and I adore my two little ones (who will be turning three in a couple of months). However, at just seven weeks pregnant, still processing the reality of successful fertility treatments, the thought of delivering twins felt daunting.
Would both babies thrive? Would they arrive prematurely? How would I care for them, not to mention myself?
In my childhood, I knew only one pair of twins, but today, I encounter many. I’m part of a community for parents of multiples, and it seems that every class my girls join has at least one other set of twins. At the playground, in bookstores—twins are everywhere. Statistics support this observation: the rate of twin births surged by an astonishing 76 percent from 1980 to 2009, with twins now accounting for 33 out of every 1,000 births. While triplet births increased by over 400 percent until 1998, they have since declined by 29 percent. The primary driver of this trend is the success of fertility treatments and assisted reproductive technologies. Medications like Clomid, which stimulate egg production, are often used alongside IUI (intrauterine insemination) and IVF (in vitro fertilization), resulting in a higher incidence of multiple pregnancies.
“Multiple gestations have increased due to the advancements in fertility treatments,” explained Dr. Emily Jordan, president of the Society for Maternal-Fetal Medicine and medical director of Labor and Delivery at a leading hospital. “It’s common to see one or two sets of triplets on the delivery floor.”
This sharp increase in multiple births has significant implications for mothers, their children, and the healthcare providers involved. Twin pregnancies pose heightened risks to both maternal and fetal health throughout gestation and delivery. Mothers expecting multiples face a greater likelihood of developing gestational diabetes, pre-eclampsia, and various complications, including placenta previa and twin-to-twin transfusion syndrome. Consequently, they require more frequent prenatal visits and ultrasounds compared to those carrying singletons.
Because I was pregnant with twins and nearing 40, I was classified as high-risk and was referred to a maternal-fetal medicine practice rather than a typical OB-GYN. My appointments became monthly, then weekly after 32 weeks, where my cervix, blood pressure, and blood sugar were closely monitored. My daily routine changed drastically; a 10-minute walk to the subway took 30 minutes, and climbing subway stairs felt like a monumental task. Fortunately, I transitioned to working from home around 7.5 months into the pregnancy, avoiding bed rest, though I found myself needing a walker just to cross my apartment.
Mothers of twins are also more prone to C-sections, often due to the position of the babies or other risks. Many obstetricians today lack training in performing vaginal breech deliveries, leading to a preference for C-sections. “Practitioners are now more skilled at managing twin pregnancies, but breech deliveries require specific expertise,” noted Dr. Jordan.
The costs associated with twin births can be significant. A C-section typically costs around $50,000, while a vaginal delivery is about $30,000 for a singleton. In the case of twins, each baby requires its own medical team. Furthermore, mothers of twins are 13 times more likely to deliver before 32 weeks and six times more likely before 37 weeks, resulting in more than half of twins being born prematurely and at low birth weights, defined as under 5 lbs., 8 oz. “The average gestational age for twins is 35 weeks, and we see a marked increase in premature births,” emphasized Dr. Jordan. These preterm infants often require time in a neonatal intensive care unit (NICU), adding to the emotional and financial burden of raising twins. “Here in Massachusetts, there are significantly more NICU beds than two decades ago,” added Dr. Jordan.
At 37 weeks, I was hospitalized with pre-eclampsia, but I chose to wait for my own OB to be on call as one twin was breech (the other was head down), and he was the only one comfortable with breech deliveries. After a failed induction and two unsuccessful epidurals, I ended up with a C-section after 27 grueling hours.
We were fortunate; one twin weighed nearly 7 lbs., and the other was over 6 lbs., without complications. Despite my meticulous efforts to ensure all medical personnel were in-network and our insurance covered most of the costs, the bills still added up.
Twin pregnancies will always be more costly than singleton ones. “There is pressure to manage expenses, but with twins and triplets, we can only do so much,” remarked Dr. Jordan. “We must provide the best care possible.”
On the positive side, healthcare providers today are more experienced in managing mothers of multiples and their babies. Training has improved, and research continues into medications that may help prevent complications. However, many health risks associated with twin pregnancies remain unaddressed. “Currently, we don’t have treatments—we simply monitor and respond,” stated Dr. Jordan. “To enhance the lives of pregnant women and infants, having one baby at a time is preferable.”
The American Society for Reproductive Medicine (ASRM) supports this view, advocating for single embryo transfers for women under 35 during their initial rounds of IVF to optimize outcomes. Despite this guidance, the implementation of elective single-embryo transfer (eSET) has been slow, as the high costs of IVF lead many women grappling with infertility to opt for multiple embryo transfers.
As advancements in fertility science progress, this trend may shift. For now, the reality of twin births is significant and likely to persist. Watching my daughters embrace each other or comfort one another during tough moments brings me joy, even if they occasionally bicker. Their bond is a beautiful reminder that more love in the world is always welcome.
Next in this series: Twins in educational settings and the unique challenges faced by multiple births.
For more insights on home insemination, check out our article on at-home insemination kits. For more information on fertility and pregnancy, visit UCSF’s fertility insurance FAQ, an excellent resource. Additionally, explore bridal beauty tips for those embarking on their parenthood journey.
Summary: The rise in twin births, largely attributed to advancements in fertility treatments, presents unique challenges and risks for mothers and their babies. Twin pregnancies require more medical supervision, often lead to higher delivery costs, and increase the likelihood of complications. As healthcare providers become more skilled in managing multiple births, the emphasis remains on ensuring healthy outcomes for both mothers and their children.