Risks to the mother

You may have heard of, or know personally, mothers who have successfully carried and given birth to twins or more babies. Newspapers and magazines often carry articles on such families, and the story is usually one of joy, rather than heartache.

Unfortunately, this rosy picture hides the reality for the women who suffer a miscarriage or life-threatening conditions during pregnancy, or who, in extreme cases, die during pregnancy or labour.

Am I at risk?

At present, about 1 in 4 in vitro fertilisation (IVF) / intra-cytoplasmic sperm injection (ICSI) pregnancies leads to the birth of twins. This means that after IVF/ICSI, you are around 20 times more likely to have a multiple pregnancy than you would be if you'd conceived naturally.

Other fertility treatments, such as drugs and intrauterine insemination (IUI) can also increase the risk.

Multiple pregnancy and birth carry significant risks to the children and they also carry considerable risks for mothers. See Risks to the child for more information.

What are the main risks to mothers?

The risks to mothers from multiple pregnancy and birth range from the mild to the potentially life-threatening.

Risks during pregnancy
During pregnancy, mothers of twins are at greater risk of various serious health problems, as well as the risk of losing their babies.

• The risk of early and late miscarriage is higher for mothers of twins than for mothers of singleton pregnancies.
• 20% of mothers carrying twins suffer from induced hypertension (high arterial blood pressure), compared to only 1–5% of mothers of singletons.
• The risk of pre-eclampsia is up to 30% for twin pregnancies compared to 2–10% in singleton pregnancies.
• The likelihood of women who are pregnant with twins developing gestational diabetes is up to 12% compared to only 4% for mothers with singleton pregnancies. Although the risks to the mother are fairly mild, gestational diabetes can increase the risk of the death to the unborn child or newborn baby.
• If a multiple pregnancy is thought to be a serious health threat to mother or babies, the clinician may suggest a fetal reduction. This involves aborting one or more of the fetuses.

Risks during or after birth
During birth, mothers of twins are more likely to require intervention, more likely to experience serious problems and more likely to die than mothers of singletons.

• Caesarean section (C-section) is very common among twin births because complications with the birth are more likely with twins – for example, one or both babies are in a breech position.
• The risks of a range of other problems such as haemorrhage and anaemia are also higher in twin births.
• The risk of the mother dying is twice as high during twin pregnancy or birth.
• Multiple births also carry the risk that, after the baby is born, the new mother will be at greater risk of stress and depression. See Bringing up twins for more information. 
• If you have a history of infertility, you are more likely to find being a parent stressful and it´s more likely to affect your health, even if you are a singleton first-time mother compared to naturally conceiving first-time mothers or mothers with a history of infertility who already have children.

Even the less serious problems may result in the mother spending longer periods in hospital than would normally be necessary. You may have to spend the last weeks of your pregnancy in hospital, and the birth may have to be induced early.

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