Pregnant with twins? Triplets?

“During my pregnancy I was always very large for my due date,” recalls Gail Ractliffe, who already had a son, Justin, but desperately wanted a daughter too. “I followed a ‘recipe’ to conceive a girl.

This involved a couple of low-dose pills prescribed by my gynaecologist to regulate ovulation, and the right timing. I didn’t know then that the pill I was taking (Clomid) was a fertility drug!” says Gail. 

“This was in 1978, when pregnancy scans were still new. It was a huge shock to discover at about 12 weeks that I could be having twins,” says Gail.

“I spent six weeks in hospital after going into early labour at around 31 weeks. The doctor, who was about to discharge me, did an exam and thought that he felt a third head. He sent me for an X-ray at 33 weeks and then for another scan, but they wouldn’t tell me what they had seen. Finally they told me that there were four babies. Never in my wildest dreams would I have thought it possible – I had just grown used to the idea that there might be three!

“Well, I got such a fright that I went into labour immediately,” she says. But Gail’s doctor was able to delay labour again and the babies were born four weeks later, at 37 weeks. “I was huge and so uncomfortable – it was as if there was a Labrador in bed with me,” she says.

Why are there more multiples?

There has been a dramatic rise in the number of multiple births worldwide over the past 30 years. Since 1980, the number of twin births has increased by 70 percent in the US alone and the number of births involving three or more babies has quadrupled. This is mainly because more women are having fertility treatments such as in vitro fertilisation (IVF).

Women are also having babies later in life. “Multiple ovulation, the most common cause of multiple pregnancy, is more common in women over 35. A generally less sensitive ovary needs to be pushed harder to ovulate (by the pituitary gland hormone FSH) and sometimes this results in more than one egg-containing follicle reaching the point of ovulation,” explains Dr Philip Zinn, an obstetrician and gynaecologist in private practice in Cape Town.

Gail’s two boys and two girls were delivered via Caesarean, within two minutes of each other, weighing a combined 9.1kgs. Simon, Dominic, Antonia and Claudia Bothner will turn 35 in December this year.

“I called Susan Rosenkowitz (who gave birth to the first known surviving sextuplets in 1974) because I didn’t know anyone who’d had more than two babies at a time. She said: ‘You will be inundated with tips, mostly from people who’ve only had one child. Ignore it and do what works for you,’ ” says Gail.

How to prepare for multiples

1. Read up about multiple births and attend a support group.

The South African Multiple Birth Association (SAMBA) holds an Expectant Parents Seminar three times a year in the major centres. 

2. Expect to have more frequent checkups than if you were carrying a single baby.

“The risks and demands of a multiple pregnancy on the mother and the fetoplacental unit is greater than for a singleton and more frequent visits allow for closer surveillance to pick up any negative trends. The pregnancy risk is significantly higher when the placenta is shared (monochorionic twins) and successful management depends on early diagnosis and accurate dating,” says Dr Zinn.

3. Prepare yourself emotionally for the possibility of complications.

The most immediate risk in multiple pregnancy is pre-term labour. A normal gestation is about 40 weeks, while nearly half of all twins are born before 37 weeks and triplets commonly arrive at 32 to 34 weeks, and quads at 30 weeks.

4. Pack your hospital bag by 28 weeks and plan maternity leave from 30-32 weeks.

So suggests Lousanne Terblanche, seminar co-ordinator at SAMBA. “Since the chances of premature birth are good, aim to take five to six months’ maternity leave, if possible,” she advises.

5. Get into a routine.

“The babies had set feeding times and I had lists of who drank what and when and who’d had a poo. This made it that much easier for us and the babies. A routine enables you to plan and have a bit of a life,” explains Gail.

6. Set boundaries.

As children get older, they need rules and structure to give them a sense of security.

7. “Get whatever help you can afford,” says Gail.

“I was lucky to have a night nurse for a month after the babies were born, and we had domestic help during the day. I had a roster so there was always an extra set of hands, and we would all put a baby on our backs,” she says. “When people said they wanted to visit, I would say: Sure, come at feeding time and be prepared to change nappies!”

8. Treat them as individuals.

Bonnie Bester, mother of fraternal twins Abigail and Kiara (6 years) and Jessica (4 years), says when her twins were three they were in the same class at playschool. “None of the kids or teachers could tell them apart and so they became known as ‘The Twins’. They began to resent each other because they felt as if they had no identity at all. 

One morning, Abigail was sick and couldn’t go to school. Kiara was so excited to go on her own. We separated them the following year and it was the best decision – it brought them closer.”

Julie Lunn, mother of twins Will and Seth (9 months) agrees. “We see our boys as two brothers who were born on the same day. They are experiencing so much of life together but still with individual differences in how they approach it.”

On the other hand, says Jessica Jones (32), who is one of identical twins, “Forced differences can cause the biggest conflict! You are born with a wingman, so why try break it up? It’s the biggest gift on earth being a twin, so embrace that.” 

9. Avoid comparisons.

“The fact that children are twins doesn’t mean they can cope with the same situation in the same way. It’s bad enough that they are competing for emotional resources from their parents, and I think they can start to find comparison almost claustrophobic,” says Sophia Mortakis-Lasker, mother of fraternal twins Luke and Allie Metcalfe (16).

10. Don’t forget the other children in the family.

“Our first son, Justin, was nearly four when the quads were born. This was a very difficult time for him, because so much of the attention was focused on his siblings,” says Gail.