As the ultrasound wand glided over my belly, it didn’t take long for two distinct black sacs to appear on the screen, each cradling a tiny white dot. I gasped, “No way!”
Twins. Oh my goodness.
In that moment, instead of feeling the rush of maternal bliss that many expect, I was overwhelmed with anxiety: the daunting reality of carrying two babies, concerns about others speculating on our conception journey (let’s be honest, if you see a woman pregnant with twins, your mind might jump to IVF), and the shock of transitioning from an only child to a mother of multiples. I knew how fortunate I was compared to those who struggle with infertility, and yes, I adore my little ones (who will be celebrating their third birthday soon), but at just seven weeks along, the prospect of delivering twins felt monumental.
Would both babies make it? Would they arrive too soon? How could I care for them—and for myself?
Growing up, I only knew one pair of twins, but now it seems that everywhere I go, I encounter them. Whether it’s at the playground or during storytime at the bookstore, twins are everywhere! In fact, the statistics reflect this growing trend. From 1980 to 2009, the rate of twin births skyrocketed by 76 percent, with twins now accounting for 33 out of every 1,000 births. While triplet births surged over 400 percent until 1998, they have since seen a decline of 29 percent. The primary catalyst for this growth? Advances in fertility treatments and assisted reproductive technologies. Fertility medications like Clomid, which stimulate egg production, combined with procedures such as intrauterine insemination (IUI) and in vitro fertilization (IVF), have led to a higher number of multiple pregnancies.
“Multiple gestations have flourished due to the success of fertility treatments,” explained Dr. Sarah Mitchell, president of the Society for Maternal-Fetal Medicine and medical director of Labor and Delivery at a prominent hospital. “It’s now common to see one or two sets of triplets on the labor floor.”
This significant increase in multiple pregnancies has profound implications for expectant mothers, the children they bear, and the healthcare professionals who support them. Carrying twins heightens the risks for both mothers and their babies throughout the pregnancy as well as during labor and delivery. Mothers expecting multiples face a greater likelihood of complications such as gestational diabetes and pre-eclampsia, and they require more frequent monitoring, with additional prenatal visits and ultrasounds compared to those with singletons.
As a soon-to-be mom of twins nearing 40, I was classified as high risk and transferred to a specialized maternal-fetal medicine group. My routine included monthly check-ups and ultrasounds, which escalated to weekly visits after 32 weeks. My daily life changed drastically; a short walk to the subway transformed into a 30-minute trek, and navigating the subway stairs felt like an Olympic event. I did manage to work from home after about seven and a half months, but I essentially ended up on bed rest, using a walker just to make it to the door.
The likelihood of cesarean delivery is also higher for mothers of twins, driven by potential risks for the babies or the mother, or when one or both babies are positioned incorrectly. Many obstetricians today are less trained in performing vaginal breech deliveries, opting instead for C-sections.
According to The New York Times, a C-section costs around $50,000, while a vaginal delivery is around $30,000—including singletons. In twin deliveries, each baby typically requires a dedicated team of doctors. Furthermore, mothers of twins are 13 times more likely to deliver before 32 weeks and six times more likely to give birth before 37 weeks, leading to over half of all twins being born premature and at low birth weight (under 5 lbs., 8 oz.).
“The average gestational age for twins is 35 weeks. We certainly see more premature births,” Dr. Mitchell noted. These preemies often need to spend time in a neonatal intensive care unit (NICU), significantly increasing the overall costs of childbirth, both financially and emotionally. “In Massachusetts, the availability of NICU beds has grown substantially over the last 20 years,” she added.
At 37 weeks, I was hospitalized due to pre-eclampsia but insisted on waiting for my own doctor, as one twin was breech and only he could perform that delivery. After 27 exhausting hours, my induction failed, and I underwent a C-section.
We were incredibly fortunate—one twin weighed nearly 7 lbs. and the other was over 6 lbs., with no health complications. Despite my efforts to ensure all medical providers were in-network and our insurance covered most costs, the bills were still significant.
It’s important to recognize that multiple pregnancies are inherently more expensive than singleton ones. “While we strive to manage costs, the complexity of twins and triplets makes it challenging,” Dr. Mitchell explained. “We need to provide the highest level of care.”
On a positive note, healthcare providers have become more adept at managing multiple pregnancies. Residents gain valuable experience in caring for such patients, and neonatologists are better equipped to treat preemies. Research continues into preventative measures, such as medications that might delay uterine contractions. But the reality remains that there are limited medical solutions for the health challenges that accompany multiple births. “We lack effective treatments—we just monitor and respond,” said Dr. Mitchell. “For the health of both mothers and babies, it’s generally best to have one at a time.”
The American Society for Reproductive Medicine (ASRM) supports this view, advocating for a single embryo transfer for women under 35 undergoing their first or second IVF cycle, a practice known as elective single-embryo transfer (eSET). Their guidelines state, “The optimal outcome of an IVF cycle is the birth of a healthy singleton.” With advancements in fertility science, the rate of twin births has stabilized, showing a slight decrease in 2011.
“It’s crucial to reduce the rate of multiple gestations,” Dr. Mitchell emphasized. “Ultimately, having healthy babies should be our priority, and it’s safer to have them one at a time.”
However, eSET implementation has been gradual, particularly since IVF treatments are costly, and many women facing infertility prefer to increase their chances of conception—even if it means risking multiples. Fertility medications can affect each woman differently, and as age increases, so does the willingness to accept the risks associated with multiples. Denial also plays a role; while I understood the possibility of twins, I never truly believed it would happen to me.
As the field of fertility treatment evolves, we hope to see changes in this landscape. For now, the reality of twins is here, and I treasure watching my daughters embrace each other in the hallway or console one another during tough moments—even if they occasionally end up pulling each other’s hair! Their bond is a reminder that more love in the world is always welcome.
For more insights into pregnancy and home insemination, check out this excellent resource and learn about ways to enhance fertility at this authority on the topic.
Summary
The rise of twin births, significantly influenced by advances in fertility treatments, has transformed pregnancy experiences and healthcare practices. Mothers of multiples face unique challenges, including higher risks of complications and increased healthcare costs. While managing these pregnancies is becoming more streamlined, the emphasis remains on the health and well-being of both mothers and babies.