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vaginally born triplets | AIMS

To read or download this Journal in a magazine format on ISSUU, please click here

AIMS Journal, 2017, Vol 29, No 4

By Rowena Hazell

I had two children, and very much wanted a third child to complete my family. When I finally became pregnant, I started bleeding at about 6 weeks. The bleeding continued, and at 7 weeks I was sent for a scan. I was feeling very sick, which I thought might be a good sign, but the midwife said it might not be. She carefully prepared me that this might be a miscarriage. The sonographer told me that if I was 6 weeks pregnant, we might not see a heartbeat, but that if I was sure of my dates, we should do. I lay on the bed staring hard at the sonographer’s face, looking for clues. Why was the scan taking so long? Why was the assistant leaving the room? Then the sonographer turned to me and said, ‘I didn’t see just one heartbeat. I didn’t see two heartbeats. I saw three heartbeats.’

I was stunned. I thought so many things … There goes my home waterbirth … I can’t even breastfeed one myself, how am I going to breastfeed three? (I have a condition called insufficient glandular tissue, which limits the amount of milk I can produce) … How are triplets even born, is it one baby then one placenta, or all three babies and then the placentas?

The assistant who had left the scan room had gone to let everyone know the results. On my way out I saw the triage midwife and said to her, ‘I told you I felt REALLY sick!’

When I got home, very bizarrely, on the top of my Facebook newsfeed was a photo of an American mum, breastfeeding her triplets. I reposted the photo without comment, sat and stared at my scan photos, and tried to imagine how this might change things, compared to the single pregnancy I had been hoping for and expecting.

At my first appointment with the multiples specialist, it had sunk in a bit. There was so much information to take in. I was told about survival rates and percentages of babies born at different gestations who would have disabilities. The doctor discussed ‘selective reduction’ (abortion of one or two foetuses) with me, and pushed me to seriously consider this. Even though this was upsetting, I felt it was actually right for the doctor to push me to think about these things because carrying more than two babies makes premature labour – with all the risks for the babies – highly probable. So you do have to consider whether one baby on its own would have a better chance for a good outcome.

Maybe I might have felt differently if I had ‘done something’ to conceive triplets, if I’d had IVF for example. But in my head, my body had got pregnant with three babies naturally, so after consideration, it felt like the right choice was to let nature take its course, and continue the pregnancy with all three babies. However, I worried about whether I would be as pressured at all appointments, so I took a friend who was a student midwife with me to the next appointment to tell the specialist my decision. I was pleasantly surprised to find that the pressure had simply been to consider the issues, and that my decision was accepted and supported.

Planning three births

My birth plan caused more controversy though. The hospital had quite a lot of experience of caring for women who vaginally birthed their twins, which gave me some confidence. But conceiving triplets is rare, and birthing them vaginally is even rarer. I arranged a birth planning meeting with the Head of Midwifery, because the multiples specialist told me that although he would ‘support’ my choice to birth vaginally, he himself does not cover Labour Ward, and so could not be involved at all really with the delivery.

The Head of Midwifery arranged for a Labour Ward obstetrician to come to our meeting also. They began by discussing external holding – this is where the second baby in a twin birth is held in a head-down position by a midwife with her hands on the woman’s tummy after the birth of the first twin. They said that they were not sure whether this was a good idea with a triplet birth, so they had Googled it, and found some information from Australia, which said this was not helpful for the birth of the second baby in a triplet birth. The fact they had had to Google it amused me.

The Multiples Consultant had strongly advised me that I should have a ‘just-in-case’ epidural. A big concern with the birth of multiples is that once the first baby is out there is a lot of room for the others to get into different positions. This is why they do the external holding – but with a triplet birth this may be less safe, because you don’t know which baby is going to be born next, and it is less clear which limbs belong to which baby. If the next baby does get in the wrong position, for example a transverse position, then an internal version would be needed. This literally involves the obstetrician putting their hand inside the womb to turn the baby. It is very painful, hence the argument for the just-in-case epidural. That was quite a scary decision – ‘What happens if the next baby does get in the wrong position?’ I asked. They told me they would use a hand-held Doppler scanner to check the second and third babies’ positions, so it wouldn’t be undiagnosed, but an internal version would be needed immediately. I asked the obstetrician if she had ever performed an internal version (it sounded so strange). She said she had, most of them with epidurals in place, and once without, which was more difficult but still doable. That was reassuring. When I got home, I found someone online who had had an internal version without an epidural. She said it was very painful, but it was very fast. The internal bruising lasted much longer, and was more significant, and of course once the epidural wore off I would feel that anyway. I decided that I would not have a ‘just-in-case’ epidural, and would take my chances and deal with an internal version if it was needed.

From breastfeeding my previous two children, I know that I have a rare condition called insufficient glandular tissue (IGT), where my breasts literally cannot make enough milk for my baby. Three babies were definitely going to need more milk than I could produce, but I wanted that milk to be breastmilk. This was especially important to me as my babies were very likely to be premature, and breastmilk can save the lives of premature babies.

I had managed to start collecting donor milk, together with antenatal blood tests, from the women who had donated their milk to me. I knew that, despite the antenatal screenings (as close as possible to UK Association of Milk Banks’ standards), it would be problematic to get the hospital to agree to using donor milk, and if I refused formula for my babies, it could result in a swiftly obtained court order giving the hospital shared Parental Responsibility, and then they would give them formula anyway. I discussed this with the Head of Midwifery. She got a Neonatal Intensive Care Unit (NICU) nurse to call me at around 20 weeks to discuss a plan. The NICU nurse was not helpful. She refused to make a plan with me, and disbelieved that I had IGT. She told me that I was upsetting myself over nothing, and that if I gave birth prematurely it would be my fault for upsetting myself about nothing. I did more research and found:

• Milk Banks in Norway have used and distributed unpasteurised milk for many years, without incidence of infection.
• Medical papers describing how premature babies who are given formula are at much higher risk from necrotising enterocolitis – a condition which is often fatal.
• A study published in the Lancet, for babies given pasteurised and unpasteurised human milk. In the group with mixed formula and pasteurised human milk, the infection rate was 33%. For the group given only pasteurised human milk, the infection rate was 14%. The group given mixed formula and unpasteurised human milk had an infection rate of only 16%. And for the group given unpasteurised milk, it was only 11%.
• In the Czech Republic, mothers with excess milk are encouraged to donate directly to mothers who need milk, and are talked through the benefits and risks. They sign a form to attest to this.

I emailed all this information (and more) to the Patient Advice and Liaison Service (PALS), who sent replies from the Trust Solicitor, refusing to allow me to use unpasteurised privately sourced donor milk. I offered to sign a disclaimer, and pointed out that the antenatal screening the women had had was in line with the UK Association of Milk Banks policy for donor milk. I also offered to pay for pasteurised donor milk from a Milk Bank. The reply was still no. Eventually the Head of Midwifery stepped in to help me make a plan. She was happy to use pasteurised donor milk from a Milk Bank, and told me that they had reserved some milk especially for my triplets, which I was delighted about.

There were also difficulties with my birth plan because I felt strongly about delayed cord clamping. Because my babies were likely to be premature and therefore low birth weight, I felt they needed every drop of their blood. However, when multiple babies share a common placenta, there is a risk of ‘twin-to-twin transfusion’ – where the baby (or babies) still inside the womb receive too much blood from the baby who has been born. This can be very damaging and even fatal to the baby who receives too much blood. The Multiples Specialist said that for this reason, current hospital policy was to ‘not allow’ delayed cord clamping, because they had had one case of twin-to-twin transfusion syndrome occur suddenly at birth. Scans showed that my triplets each had separate placentas (trichorionic), but the Multiples Specialist said that there was a 10% chance of the scans misdiagnosing the placentas as being separate. Therefore I could not have delayed cord clamping, because there was still a tiny chance it might harm the babies.

In the UK, all decisions are the mother’s until the baby is born because the baby is not considered a separate entity until the moment of birth. This means a hospital cannot overrule any decisions a woman makes about her body before a baby is born. However, as soon as a baby is born, a hospital has a duty of care to that baby. In a multiple birth, decisions about a baby who is born can affect a baby who is not, and vice versa.

The Trust Solicitor was contacted again, this time by the Multiples Specialist. He eventually confirmed that I had the right to insist on delayed cord clamping, but only because the potential harm is to the baby or babies still in the womb. Therefore I was legally allowed to make a decision about the baby who was born, that was potentially harmful to the unborn babies, because the Trust’s duty of care was only to the baby who was already born. It sounded slightly ridiculous to me that I was allowed to potentially cause harm to my unborn babies. But actually, sudden onset at birth twin-to-twin transfusion syndrome is quite rare even in twins who do share a placenta, and the Multiples Specialist calculated that even with the 10% chance of every scan being wrong, the actual risks were around .001%, and so I was quite confident this was a decision that was in my babies’ best interests, rather than one that would harm them. [AIMS note: TTTS in pregnancy is discussed in this article, but in this case, Rowena is referring to TTTS during birth. More information on this is available from TAMBA (link: https://www.tamba.org.uk/file/TTTS-Guide.pdf).]

At the meeting, both the Head of Midwifery and the Labour Ward Obstetrician supported my decision not to have continuous monitoring. With a triplet birth, I would have had bands around me for two babies, and one for my contractions, and then a scalp monitor for the third baby. In previous labours I had found any clothes really distracting and uncomfortable, so the thought of several bands round my tummy, and a scalp monitor, was not appealing. Cardiotocography (CTG) monitoring is also notorious for raising false alarms, leading to unnecessary interventions. The Head of Midwifery fully documented my birth choices, including no ‘just-in–case’ epidural, that I was not having CTG monitoring, and that I wanted to be in water for the first stage of labour, so I didn’t really need to write a birth plan. This then ensured that whichever midwives and obstetricians were on shift when I went into labour would know that my choices were informed choices, and would be less twitchy about them. My friend later told me that the Head of Midwifery had previously been an independent midwife with experience of twin homebirth. I felt lucky – she was the perfect person to be supporting me. It now felt like my plans were all in place, and I could enjoy the last few months of pregnancy.

One labour …

The last few months turned out to be only the last few weeks of pregnancy. I had a few false starts of labour. At 29 weeks I went into pre-term labour and went into hospital. I was given a steroid injection to help my babies’ lungs mature. The UK policy for pre-term labour is that, if pre-term labour happens, it is taken as an indication that there must be a problem, and it is assumed that the babies would be better off in an incubator than in a womb. Therefore they usually only give 24 hours of the Atosiban drip (a drug that stops labour), to give the steroid injection time to work. After that, they will not try to prevent labour continuing. I understand this policy, but think that it is not necessarily appropriate for multiples pregnancies. I felt my pre-term labour might not have indicated a problem, but might have been just because there was so little room inside for the babies. In the USA, hospitals are willing to prescribe many drugs to try to stop pre-term labours in multiples pregnancies – I wish they would do that here too.

I asked the Multiples Consultant about this, and he did agree to give me a second 24 hours of Atosiban (because NICE guidelines say ‘up to 48 hours’), but after that nature would have to take its course. After this I was moved to a different ward. Because of the move, I missed a meal. In the new ward, the contractions started again. I quickly ate a sandwich, aware that I would need my energy, and labour stopped. I then woke up at 5am with a few contractions; I ate two biscuits, and labour stopped again! When I got home, I searched online for this and found that low blood sugar can precipitate labour. So from then on, every time I had contractions, I ate something. When I got up to go to the loo in the middle of the night, I made sure I ate a substantial snack – a banana, a biscuit and a glass of milk. I think this really helped to keep my babies in.

At 32 weeks I had a really horrendous scan. The sonographer tried to make me lie on my back, but by now my tummy was so huge that I couldn’t breathe if I lay on my back. The sonographer was truly awful, really prodding and poking me, and the scan was not just uncomfortable, it was very painful. I was very distressed during the scan and after. My friend who is a doula came with me, and she later described it as an assault. I wished one of us had spoken up during the appointment, not just talked about it afterwards. The scan had shown my babies were in the same position they had been throughout, lined up like three dominos, ready for birth.

I had a really uncomfortable night, and at an appointment with the Multiples Specialist the next day I discovered that my two boys were now transverse. I think the painful prodding was so rough that it had made them move, and with my babies in this position there was less room for them, which made my tummy much more uncomfortable.

That evening, I had more contractions, and they weren’t going away. At 10pm I realised this was definitely it, and went into hospital in early labour. I arrived at 11pm, at 32 weeks and 2 days pregnant. Everyone writing in my notes kept putting 32+2, though after I had been there an hour I kept saying ‘it’s 32+3 actually’, as it was now after midnight. The extra day felt important to me. Every day matters when your baby is premature.

I had been given pethidine in my first labour and had an awful time. I had also tried gas and air, and didn’t like that, so I just wanted to use water for pain relief (but understood actually giving birth in water would never be recommended because the babies would be premature). As the pool in the Labour Ward is rarely used, I hoped I would be able to use it. However, when I arrived, someone else was in it, much to my disappointment. Someone from NICU then appeared in the room, to give me a presentation about NICU care. This seemed very surreal to me, but it is what they do for all women arriving in premature labour. A few days later, I discovered a glossy brochure with pictures of shiny incubators in it, though I have no memory of having been given it. It must be very traumatic for women who were not expecting their babies to need NICU care and whose premature labour was unexpected. At least I had had time before labour to think about it and come to terms with it.

After I had been in hospital an hour, the Head of Midwifery came in. She must have asked to be called when I came in, and she cared for me during my labour. Otherwise I would just have been cared for by the duty obstetrician, who might or might not have had experience of multiple births before. I was glad to see the Head of Midwifery. She cared for me very respectfully.

I tried to find music I wanted, but I couldn’t. Vocalising had helped in my previous labour, but this time it felt like it used up too much energy. I spent most of my labour draped over a beanbag on the bed. The room was dimly lit, and the Head of Midwifery and the Obstetrician were very quiet. The Head of Midwifery would catch my eye when she thought I was having a contraction, and I would just nod slightly at her, so she didn’t have to ask me, which was wonderful.

… three babies, born

Finally, I was told the pool was vacant, cleaned, refilled and waiting for me. That was wonderful news, but as I was being wheeled along the corridor I knew that if I got in, I wouldn’t be getting out. I think I was probably in transition, and I didn’t want to tell them that because I wanted to get in the pool. In the corridor I told my doula ‘I think I need a poo’ and I was suddenly wheeled at high speed into the pool room, as everyone realised I was about to give birth. My daughter, Bee, was born just a few minutes later and was handed to me for just a precious few moments while they let her cord pulse.

If I had had a Caesarean birth, the theatre would have been so full of people – as well as the usual doctors, midwife and anaesthetist for me, there would have been a midwife and a neonatal doctor for each of my three babies, because they would all have been born within minutes of each other. However, because I was giving birth vaginally, only one baby was born at a time. The Head of Midwifery made sure only the midwife and neonatal doctor relevant to the baby currently being born were in the room – the rest waited elsewhere. This kept the number of people in the room to a minimum, and really protected my privacy.

Bee stayed on my chest for a few moments before her cord was clamped and cut, and she was whisked away for checks. I had wanted a longer delay for clamping for my babies, but had agreed to 90 seconds, by which time most of the blood would be transferred. Shortly after this, Bee was taken by the midwife and neonatal doctor to NICU. It felt strange when they took her, even though I had been expecting it.

After Bee was born, labour just seemed to stop. Nothing happened for an hour and a half. I think this was because there was now more room in my uterus, and everything was comfortable again. The waters around my boys were intact, and had I been really in control of all the decisions, I might have liked to just carry on being pregnant with them, until labour restarted by itself. I have read that this has sometimes taken days or even weeks for other people. However, I didn’t feel strongly enough about this to want to debate it then. I was encouraged to move, but contractions didn’t restart. After an hour or so, everyone in the room was glancing at the clock. Eventually the Head of Midwifery suggested breaking my waters. I didn’t really want this, but I trusted her, so I agreed, and it worked. I wouldn’t have changed this decision. The Head of Midwifery then did some internal holding, and the Obstetrician did some external holding, as it was now clear that the second baby was in the right position. The Head of Midwifery then guided me in pushing, which I did need at this point (unlike with Bee, because this time I did not have any natural urge to push). So my son Alexis was born. Again I held him, though on my tummy not chest as his cord was so short. We waited before clamping and cutting the cord, and then he too was taken to NICU.

Thirty minutes later my third triplet, Lenny, was born, with similar holding and guided pushing. I found this helpful, as my body was a bit like ‘we’ve got the baby out, let’s go to sleep’, not seeming to realise there was still another baby to give birth to. Again, when he was born I held him for a few minutes. My doula managed to take some wonderful (and quite discreet) photos of my babies being born, which I love. The pictures surprise me a little, because everything is so brightly lit. My memory of the birth is that everything was quite dark and dim, but maybe that is because my eyes were mostly closed.

Although I had had physiological third stages for my previous births, I had agreed to Syntometrine to deliver the placenta to minimise bleeding, which seemed reasonable to me. Everyone else in the room was fascinated by this giant fused triple placenta! It weighed the same amount as one whole baby.

When all my babies had been taken away, and the placenta had been examined, they said I might as well get into the pool. It was lovely wallowing in such a huge bath after giving birth, and I felt euphoric … but strange, because my babies had disappeared.

NICU

As I tried to get back out of the pool, I had a weird sensation of not being able to breathe, as if all my body was suddenly too heavy. That was odd. On the postnatal ward I couldn’t sit up or stand for more than five minutes without finding breathing difficult. I was having to be wheeled across to NICU in a wheelchair because I couldn’t walk far. The midwives didn’t know why, didn’t take it seriously, and looked at me quite oddly when I said I needed to use a wheelchair. One of the other mums I met had brought a corset in, because she said that she had had severe diastasis recti before. This is when the stomach muscles have separated so much that for a while after birth they simply don’t hold your organs properly in the right place. The mum described it to me as your diaphragm not holding everything in, so it falls out of the bottom of your tummy. This was exactly what it felt like was happening to me! The midwives on the ward didn’t seem to have heard of this, but they did send a physio to see me. The physio made a corset out of a double layer of their largest Tubigrip, and immediately I could breathe, sit up, and walk again with ease.

My birth had been a great experience, but NICU was sadly not. The plan the Head of Midwifery had put in place to reserve donor milk for my triplets was overruled by the NICU paediatrician, on the grounds that my babies were not premature enough to qualify for it, and they had already used most of the Milk Bank milk that the Head of Midwifery had understood was reserved for my babies. I was trying to express colostrum, but apart from an initial few drops there was literally nothing at all for about five days. My babies needed milk. The paediatrician suggested pre-term formula, but I was very reluctant. I wanted to use donor milk from my friends, if the Milk Bank milk wasn’t available to them, but the paediatrician said the hospital would not allow this. Eventually they agreed to allow Milk Bank milk to be used for one week, while the issue was debated and resolved.

The Head of Midwifery and one of the neonatologists eventually came up with a plan. They would agree to my babies having one milk donor, as long as she was screened by the hospital, and came to express at the hospital under their controlled conditions. Her milk and my milk could be given to my babies whilst they were in NICU. When I took my babies home, I could feed them however I chose, so I could then use my donor milk for them without the hospital feeling liable. I was extremely lucky to know one good friend who had such oversupply that she was able to express an extra litre per day in addition to feeding her own baby, and she happened to live very close to the hospital.

And home

In the end, my babies had no formula. I found donors amongst friends and via Human Milk for Human Babies. They had only human milk for around eight months. I am so grateful to the women who donated their milk to my babies. By the time they were a few weeks old, they were needing an extra 1.5 litres of milk per day in addition to mine. I fed them myself as frequently as I could, sometimes almost constantly rotating them, tandem-feeding two at the same time as bottle-feeding the third.

When you register the birth of multiple babies, they record their times of birth, not just the date, so that it is recorded who is the oldest. Here is my babies’ birth information for you:

From left to right: Beatrix, Valentin and Alexis at three months old:

With thanks to Mari Greenfield for her contribution to the writing of this article.

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.

The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: [email protected]

7 Amazing Stories of Naturally Conceived Triplets - Ukraine

Having triplets is actually not as easy as it might seem.

Video of the day

This phenomenon is quite rare and depends on many factors, for example:

1. The age of the mother - the older, the higher the probability.

2. The most frequent cases of the birth of triplets are found in African and Asian peoples.

3. Before "in vitro fertilization" was invented, triplets were very rare.

4. The chance of getting pregnant with triplets without IVF is 1:8000, and the chance of re-conceiving triplets is even less - one case in 64 million.

We present to your attention 7 amazing stories of the birth of triplets, which are conceived in a natural way.

"The daughter was confused when she saw many children"

Vladimir and Oksana Galaichuk from the city of Kostopol, Rivne region, are raising four children: a seven-year-old daughter Lisa and triplets Vladimir, Vladislav and Anna. The triplets are now three years old.

“I am very glad that I have so many children,” says 34-year-old Oksana Galaichuk. “But, I confess, throughout my second pregnancy, my husband and I got used to the idea that we would become parents of many children. We learned that I would have triplets at the 14th week of pregnancy. I remember when I was lying on an ultrasound, the doctor asked if there were twins in our family. I immediately realized that such curiosity was not without reason. My relatives on my father's and mother's lines really have several pairs of twins. That's why I was lying on the couch and was already mentally preparing for how I would inform my husband that we would have two babies at once.Suddenly, the doctor stunned me: “You have triplets! Exactly two boys, and it’s not yet clear who the third one is.” I don’t know how I didn’t lose consciousness after these words. When I left the ultrasound room and came to my senses a little, I started calling my husband. calmly told him that we would have three children. Volodya laughed: “Does this happen? each of us thought that the doctor was wrong. But when the second and third ultrasound confirmed the number of babies, they began to prepare psychologically. The triplets were born on the first day of spring 2012 by caesarean section. sister or brother. She constantly stroked my tummy and could not wait for the "toy". When we returned from the hospital, Lisa was confused - she could not understand where so many children came from at once! It was hard only at first, when the kids started screaming at the same time - then there were really not enough hands. Fortunately, my husband was next to me, took them in turn in his arms and calmed them down.0003

"There are never too many grandchildren"

25-year-old mother of triplets Olga Tymoshchuk from Zhytomyr recalls her pregnancy with delight.

“I couldn’t even think how wonderful it is to be pregnant!” says the girl. “My husband fulfilled all my whims, did not step aside and was constantly interested:“ Honey, do you want something else? and cooked food. And when my stomach grew noticeably, it didn’t allow me to dress myself, much less put on shoes. My husband and I walked every day in the park not far from home. At the sixth week of pregnancy, I was sent for an ultrasound. To be honest, I always dreamed of twins. Case the fact that my grandmother once gave birth to twins and often told me that it’s good to raise a couple of kids at once: they have fun together, they support each other, and when they grow up, they help their parents and do everything twice as fast. said he saw two peas in my stomach. I squealed with joy! But after a long pause, the man said that he was mistaken. I was already upset, but then I heard: "I see a third child!". I was in seventh heaven with happiness! But how will the husband react? t on what will become a father of many children? Mentally, I chose the right words to prepare him. When I left the doctor's hallway, my husband noticed that I was glowing with happiness. I took Lesha by the hand and blurted out that we would have triplets. He was suddenly thrown into a fever, then into a cold, and again into a fever. My husband did not calm down until he himself looked into my medical book, where it was written in black and white: "Triplets". For a while, he got used to the idea that he would immediately become a father of many children. And when it later turned out that all three were boys, he wept with happiness.

Our boys were born in 2013 with an interval of one minute. Since the children were born on July 27, and St. Vladimir's Day is celebrated on July 28, we decided to name the oldest one Volodya, and his brothers were given names starting with the letter "B" - Vladislav and Vitaly.

Most of all, our parents were delighted with such a number of children. "There are never too many grandchildren," they say. We are often asked how we cope with three at once, they say, to find a council for one. But we do not understand how it could be otherwise, we do not see the difference - to educate one or three. And we distinguish the boys easily, even though they are similar to each other.

There were difficulties: finding a triple stroller is not an easy task. We never got around to buying one. We got away with the "two plus one" option: one stroller for twins, and the second single. But I didn’t have to carry two strollers at once - I never walked alone with the kids. It is difficult to see behind them: the first one ran to the sand, the second one is already climbing the hill, and the third one is running to the neighbor's children. Therefore, our dad is always there. Or our parents help.

Vovchik, Vladik and Vitalya are very fond of playing with the ball: my husband and I are glad that future football players are growing up. Children do everything together: we feed them at the same time, we buy the same toys and clothes. True, it is not always possible to find three clothes of the same color and size. Therefore, it happens that one person is a little different. The boys are also mischievous together. " Young parents rejoice at their children and think about another pregnancy. "It's just as dishonest: dad has three assistants at once," the young mother laughs. “But what about my assistants?” When the boys go to first grade, my husband and I will definitely return to the maternity hospital for the girl! Friends joke about this that there will also be three daughters. "

"I had 15 minutes to sleep"

“I got married and gave birth to triplets when I was 22,” says 35-year-old Alla Gorobets from the Zhytomyr region. “During the ultrasound, the doctor said that I would have twins. He expected a violent reaction, but I was completely calm. From of my three sisters, two of them had twins, my husband's relatives also had twins. At one time, my older sister gave birth to a girl, she was taken away from the delivery room, and after half an hour they returned back: the second baby asked to be born.It turned out that the doctors did not know about the upcoming twins My husband told me at the initial stages: “It’s good if you give birth to two at once. Wouldn't stop at one anyway."

I had another ultrasound at 6 months. I remember the doctor studied the monitor for a long time, then called a colleague, he called another one. I did not understand what was happening, I thought that something was wrong with the children. And then the doctors stunned me: "Young lady, you have three guys growing in your tummy!" Of course, I was confused by such news, and my husband had to be soldered with valerian. When journalists found out about the triplets, local authorities allocated money for a three-room apartment.

When my boys were small and started crying as if on cue, I understood that I needed to feed everyone at once. How? One had one breast, the other the other, and the third was laid on its side and slipped a bottle. Be sure to write down who eats from the bottle. At the next feeding, the next one received the bottle. The children were restless and required constant attention. I, like Stirlitz, had time to sleep in fifteen minutes. "

The children were so similar in everything that up to a year, mother Alla attached name tags to everyone's handles.

“But as soon as the boys were one year old, each of them began to show character,” she says. “Finally, I began to distinguish them by voice, laughter, call, behavior. Only when Dima, Maxim and Sasha went to school, they asked why there are three of them. Like, everyone goes to school one at a time, no one else goes to the same class with such a company. I explained that someone had a brother or sister born earlier or later, and in our family sons were born all together. Then they asked another question: “If we are not different, then why does the teacher address the students by name, but calls us Gorobetsy?” I said, they say, maybe the teacher has not yet learned to distinguish them like a mother. And then the children demanded dress them differently.Since then we have been buying different clothes on the same day.The brothers will never go out in the same way!Even if both of them immediately like one thing, they will never buy it together.Despite the fact that they are friends between they share themselves and everyone, according to the nature of the boy, they are absolutely o different. Dima always needs to be reminded that it's time to do homework. Maxim is fond of playing the button accordion and piano, draws amazing pictures. Dima and Sasha are left-handed, they have calligraphic handwriting. Maxim is right-handed. Even the friends of the brothers are different."

"The house where Faith, Hope and Love live"

“In the 90s, when I was under 30, there were thoughts of leaving for a monastery,” says 49-year-old Nadezhda Mrichko from Lviv. “But I understood that this is the place where you need to go only at the call of the soul, and I felt that I’m not ready yet. I went to work in Poland. Then I got tired of wandering back and forth and returned, I was already 36. At a party with friends, I met a man, I remember how nicely we talked with him all evening. Then there was an engagement, we dreamed of getting married Soon I found out that I was pregnant. The future husband seemed to be delighted, said: "It's great that we will have a baby." But I was not at all ready for the fact that I was carrying triplets. When I was informed about this after the ultrasound, I immediately exclaimed: "What am I going to do with them?!". When I showed the ultrasound certificate to my man, he turned pale. He tried to hide his fear under a bitter smile, and a few weeks later, exactly on March 8, he ... disappeared. Even the parents didn't know where their son had gone.0003

Later I found out that I would have three daughters. I had no idea how to live on: no housing, no work, no money, no husband. I could only count on faith, hope and love - that's how I later decided to name my daughters. When I was still pregnant, I thought more than once how I would distinguish between girls. I was so worried about this that I began to pray every day: I stroked my stomach and asked God for the children to be different. And imagine, I had a blonde, a brown-haired woman and a brunette! By the nature of the girls are also completely different. Verunya is very active, athletic, she always liked to climb trees and run. Nadyushka is more restrained, while Lyubochka is very calm. When the girls ran in different directions and I had to catch them, I always held Nadya and Lyuba with my left hand, and the restless Vera with my right. "

After the birth of children, the newly-made family had nowhere to go: there was no own housing, and it was difficult to live in the home where the old mother and brother lived. “All this scared me very much,” says my mother. “I could only live in the maternity hospital. I spent six months there with the children. Thanks to the journalists who wrote about my problem, kind people began to help me and the children. we were given a 4-room apartment. It was a miracle! I asked everyone for his name in order to know for whom to pray to God, but they only told me where he worked.

The first time after the move, I did not even have money for a stroller. Up to ten months, I just carried the babies out into the street from the seventh floor one at a time - I put an “envelope” on the bench at the entrance and followed the next one. Then one charitable foundation gave us a stroller - it became easier.

Surprisingly, the first word spoken by Lyubochka and Verunya was "dad". "Where did you see this dad?" I wondered. But Nadyusha said the word "mother" the next day, so jokingly I called her my mother's daughter. And, ironically, it is Nadia who looks like her dad the most - the same eyes and nose. "0003

The father of the children is not interested in their life. Nadezhda knows from relatives that he left for the ATO zone.

“Of course, it’s difficult to raise three babies alone,” says the mother of many children. “Sometimes nuns helped me, and my sister came to bathe babies from time to time. When someone alone was sick, she went to the hospital with three. Girls prefer the same clothes - they I like to be alike.In June they will be 11 years old.The sisters attend music, dance, swimming and church classes together.We secretly and go out together.We often reminisce about our adventures.One of our favorites was when we first went to the sea and got sick chickenpox: then three green "toads" walked around the sanatorium. When they went to the sea, cars honked and waved to us. We were constantly surrounded by attention - you don't often see triplets on the street. "

As the Observer reported, in Ukraine, a girl gave birth to triplets in three months.

Giving Double: Natural or Caesarean section

Previous

Content:

1. Why do multiple pregnancies and twin births happen?
   • Fraternal twins
   • Identical twins
   • Features of pregnancy by identical twins depending on the time of separation of the zygote.
2. Can a woman have twins in her first birth?
3. How often do twin births occur?
4. How long does a twin birth take?
5. When is the due date for multiple pregnancies?
6. Which is better for twins - caesarean section or natural childbirth?

The human reproductive system is very economical, and usually a woman becomes the mother of one baby. However, occasionally we come across parents walking with a double stroller or trying to fit two identical toddlers into a car. Why is this happening? What is the probability of becoming a mother of twins? What awaits a woman when the time comes for twins to be born - caesarean section or natural childbirth? We answer your questions.

Why do multiple pregnancies and twin births happen?

Sometimes two or even more babies begin to grow in the womb of a future mother at once. If you do not consider unique and very rare cases, then twins can be homozygous (identical, emerging from the same egg) and heterozygous (fraternal, grown from different eggs).

Fraternal twins

Heterozygous twins appear when several eggs mature in a woman at the same time. Babies are always isolated - each of them has an individual placenta and fetal (amniotic) bladder. They may have different sexes, and, in general, they usually resemble each other no more than the children of this couple, born several years apart from different pregnancies. At the same time, eggs can be fertilized both as a result of one sexual intercourse, and different - with an interval of several hours or days.

If a woman has a very active sex life, it is even possible that one egg is fertilized by the sperm of one partner, and the second by the other. Then, during the birth of twins, babies are born, each of which has its own father, which in scientific language is called the term "superfecundation". The exact frequency of this phenomenon is unknown, but in cases where DNA examinations were performed when paternity was disputed (in other words, when potential dads suspected in advance that the matter was unclean), superfecundation was confirmed in 2.4% of twin pairs ¹ .

Identical twins

Monozygotic twins are a different story. At first, everything happens as usual: one egg comes out of the follicle during ovulation, it is fertilized by one sperm, it becomes one zygote (a cell with the combined genetic material of the parents), from which one embryo should develop. But after a while, it suddenly splits into two identical copies. One of them can divide again, and then instead of giving birth to twins, the mother will give birth to triplets, if both zygotes do this, there will be four twins.

Features of pregnancy by identical twins depending on the time of separation of the zygote.

If fraternal twins always have separate "apartments" - each has its own placenta and amniotic bladder, in identical twins it depends on the time of separation ² .

Can a woman have twins in her first birth?

Everything is possible. Do you remember that multiple pregnancies can be identical and heterozygous? The likelihood of developing identical twins is the same for all women. In both first and subsequent births, twins of identical babies are born in about 4 out of 1000 pregnancies ³ .

Fraternal twins appear for a different reason - due to hyperovulation, i.e. maturation of two or more eggs in one cycle. This is influenced by the following factors ⁴ :

• Use of fertility drugs.

• Recent withdrawal of hormonal contraceptives or irregular use of contraceptives.

• Obesity, i.e. body mass index above 305.

• Genetic predisposition. If you yourself have a twin, if your mother or your sister gave birth to twins, your chances are higher than the average natural probability of giving birth to twins ⁶ .

• Rost. Tall women are more likely to become mothers of fraternal twins.

• Woman's age. The likelihood of multiple pregnancy increases after age 35 ⁷ .

How often do twins occur?

In obstetrics, there is the so-called Hellin's law ⁸ , which states that the probability of having twins, triplets, etc. obeys the following formula: 1/89N-1, where N is the number of twins.

Hellin's law is just a curious observation made by a late 19th century physician, and modern science offers much more complex formulas. However, sometimes it works amazingly. For example, in 2016 in Russia there were 1,876,646 births, in which 22,144 twins and 408 triplets were born ⁹ , which in percentage terms is 1.18% and 0.021%. Not bad accuracy!

In general, the statistics of twin births in our country looks like this:

Percentage of twin births among all births in Russia from 1996 to 2016 ⁹ .

It is easy to see that in the late 90s and early 2000s, the statistics were almost constant, and then unexpectedly, but surely, they crept up. The answer is simple: medicinal and other assisted reproductive technologies have been actively developed lately, and they often lead to multiple pregnancies ¹⁰ . So the last numbers are naturally occurring twins plus the contribution of infertility treatments.

How long does it take to give birth to twins?

Doctors distinguish three stages in childbirth - the period of disclosure, the period of exile and the subsequent period. The first period begins with contractions and ends with the full opening of the cervix, the third starts after the birth of the baby and ends with the appearance of the afterbirth - the placenta and the remains of the membranes. The duration of these periods depends more on the individual characteristics of the body than on how many babies the woman bore.

Of greatest interest is the period of exile - the very one when babies from a cozy mother's womb are "expelled" into our difficult world. They come out sequentially, which means that we can assume that the birth of twins is longer for this particular interval between the appearance of the first and second child. So how much does he make?

Thanks to doctors from the Hesse region in Germany, this question has a very precise answer. For 15 years, they carefully researched information about natural births of twins in local hospitals. As a result, an impressive amount of data was collected - more than 4,000 cases of multiple pregnancies, as a result of which more than 8,000 babies were born. The analysis of this array made it possible to calculate the most probable interval that passes between the birth of babies in twin births in a natural way. For 3 out of 4 mothers, this takes no more than 15 minutes, and on average, one twin is only 13.5 minutes older than the other ¹¹ .

Rarely in obstetric practice, surprising cases are noted when a much longer time passes between the birth of twins. Apparently, the first position among the record holders for the duration of the birth of twins is occupied by a resident of the German city of Cologne named Oksana (we will not say, but the name suggests that she may be our former compatriot).

On November 17, 2018, at the 26th week of pregnancy, a woman went into premature labor. She gave birth to a live premature baby girl weighing 900 grams, after which the cervix closed and the contractions stopped. The doctors decided to give the second child the opportunity to stay in the mother's womb as long as possible. As a result, another girl was born four days after the planned date - 97 days later than her sister and already in 2019 ¹² . By the way, don't worry about the older baby: the doctors took her out, and after a three-month separation, the twins met again.

When is the due date for multiple pregnancies?

Pregnancy in a woman expecting several babies at once is usually shorter. Twins can be expected as early as week 35, triplets at week 33, and four twins starting at week 29 ¹³ . After the birth of twins, doctors surround newborns with special care. And the birth of three or more babies requires the closest attention, because such twins in the vast majority of cases are born prematurely.

A woman who has several children has a significantly higher chance of becoming a mother ahead of schedule. Doctors will try to do everything to prolong the pregnancy as much as possible, but the woman herself should not risk the future of her babies either. At the very least, she needs to monitor her diet and health, breathe fresh air, avoid psychological stress and excessive physical exertion.

Which is better for twins - caesarean section or vaginal delivery?

The final decision on the tactics of childbirth is made by the specialists of the maternity hospital, guided by all the information available to them about the pregnancy. However, practice shows that if everything goes on the whole normally (the gestational age at the time of delivery exceeds 32 weeks, and the first twin is settled in head presentation, that is, it is going to go head first), there is no significant difference between the natural birth of twins and caesarean section ¹⁴ . A large study involving 106 medical centers in 25 countries showed that the risk to babies remains the same with both modes of delivery.

Cesarean section is indicated for breech presentation of the first twin in twin birth. However, in this situation, the operation is recommended even during pregnancy with one baby. If the twins are growing up in a common amniotic sac, doctors also usually opt for a caesarean section. In other cases, you should not be afraid of giving birth to twins in a natural way - they are no more dangerous than surgery ¹⁴ .

Sources:

1. Wenk, R. E.; Houtz, T; Brooks, M; Chiafari, F. A. (1992). How frequent is heteropaternal superfecundation? Acta geneticae medicae et gemellologiae. 41(1):43–7.

2. Curran, Mark (2005-11-02). twinning. Focus Information Technology.

3. Professor Hanan Hamamy. GFMER. Monozygotic twinning.

4. Joel Forman, MD. Causes of Identical and Fraternal Twins.

5. WebMD. Moms' Obesity Makes Twins More Likely.

6. U.S. National Library of Medicine. Is the probability of having twins determined by genetics?

7. ACOG. Multiple Pregnancy.

8. Johan Fellman (November 5th 2018). Historical Studies of Hellin's Law, Multiple Pregnancy - New Challenges, Julio Elito Jr., IntechOpen.

9. Federal State Statistics Service (Rosstat). Demographic Yearbook of Russia. 2017: Stat. Sat / Rosstat. - M., 2017. - 263 p. ISBN 978-5-89476-447-4.

10. Kulkarni AD, Jamieson DJ, Jones HW, Kissin DM, Gallo MF, Macaluso M, Adashi EY (2013). Fertility Treatments and Multiple Births in the United States. New England Journal of Medicine. 369(23): 2218–2225.

11. Stein W, Misselwitz B, Schmidt S (2008).

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