Care and Management of Multiple Pregnancy

When You Have a Multiple Pregnancy

How is a multiple pregnancy managed?

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.

How are multiple pregnancies delivered?

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.


Illustration of a twin birth, head down/head down


Illustration of a twin birth, head down/head up


Illustration of a twin birth, head up/head down

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)