How Many?? Multiple Births

The recent birth of octuplets has made the news. Eight babies, all small but all “healthy.”


This blog is not going to be about the societal and ethical issues of eight babies conceived by in vitro fertilization and borne by a mother who has six living children. This blog is going to be, briefly, very briefly, about the medical and health issues in multiple births.


Multiple births include all births of more than one baby – twins, triplets, quadruplets, etc. Multiple births can occur naturally, that is, not as the result of fertility treatment or they can occur as a result of fertility treatments. That’s why there are more multiple births today than there were 25 years ago. More women are delaying pregnancy and then finding that conception does not come easily. Conception is assisted by various means, drugs, artificial insemination, and in vitro fertilization.


The challenges to the body of the woman carrying more than one baby are greater than those for a woman carrying a singleton (one baby). These challenges include:

  • More pregnancy “side effects” such as morning sickness and insomnia.
  • A greater need for important nutrients in the diet, such as folic acid (to prevent neural tube defects, that is, abnormalities of the nervous system), iron and protein.
  • The need to gain more healthy weight to support the babies’ growth – and the need to lose the excess later.
  • More precautions such as limiting activity or travel.


Every pregnancy, singleton or multiple, carries with it certain risk of complications. For women carrying more than one baby, the risks of having complications increase. These risks include:

  • Preterm labor – sometimes preterm labor can be stopped or postponed by drugs, sometimes not.
  • Preterm birth results in having a premature baby or babies. Premature babies have their own set of challenges and complications.
  • High blood pressure.
  • Gestational diabetes.
  • Twin-twin transfusion – one baby gets too much blood and the other gets too little.
  • Caesarean section (C-section, surgical delivery).


Premature babies have challenges, too. They include:

  • Respiratory distress syndrome – a potentially fatal problem.
  • Bleeding in the brain – this has potential for long term effects.
  • Patent ductus arteriosus – the ductus arteriosus normally closes before birth or shortly thereafter in a baby that is born at term (on time). In a premature baby the ductus has not had time to close. This can lead to heart failure.
  • Necrotizing enterocolitis – a very big word for gangrene of the bowel. A potentially fatal problem.
  • Retinopathy of prematurity – an eye problem that, if untreated, can lead to blindness.


What is important about the above information is that the challenges and complication increase with the number of babies that have to share the mother’s womb. All babies are beautiful. However, multiple births are just more complicated.


I won’t even begin to talk about the challenges when these tiny babies finally come home!


Mary Lou Bernardo, PhD, MSN


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