Your healthcare provider or midwife
will discuss your care with you 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 babies, you will need
  more calories, protein, and other nutrients, including iron. You should also gain
  more weight. The Institute of Medicine advises 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). They may do special testing or ultrasound
  evaluations and coordinate the care of complications.

• Maternal and fetal testing. You may need testing to watch the babies’
  health, especially if there are pregnancy complications.

• Tocolytic medicines. You may be given these medicines if preterm labor
  happens. They help slow or stop contractions of the uterus. You may take the
  medicines by mouth (orally), as a shot, or through an IV (intravenous) line into a
  vein. 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.

Delivery of multiples depends on many factors, such as:

• How the babies are
  positioned

• Gestational age

• Your health and the health of
  your babies

Generally, in twins, if both babies
are in the head-down (vertex) position and there are no other complications, a vaginal
delivery is possible. If the first baby is vertex but the second isn’t, the first
baby
may be delivered vaginally. The second is either turned to the vertex position or
delivered with buttocks presented first (breech). 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 baby 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:

• Babies that are in abnormal
  positions

• Certain health conditions of the mother

• One or both babies not
  getting enough oxygen (fetal distress)