Expecting Twins, Triplets or More?

The number of multiple pregnancies (twins, triplets or more) has risen at an extraordinary rate in recent years. Take a look at the latest press coverage of an unusual birth of octuplets in the US. According to the report, the mother, Nadya Suleman underwent in vitro fertilisation (IVF), an assisted reproductive technology (ART) that helps women who have fertility issues to conceive. This treatment has become increasingly common these days. In fact, most multiple pregnancies are becoming more frequent as a result of advances in these treatments. Here are some of the other common causes of multiple pregnancies:

  • Many women are delaying pregnancy well into their 30s and beyond. This delay may bring about age-related hormonal changes which can cause more than one egg to be released at a time.
  • The increased use of fertility medications such as menotropins and clomiphene have artificially increased the number of pregnancies with more than one baby.
  • The odds of having a multiple pregnancy also increases if the mother has had previous pregnancies or if the family has a history of fraternal twins or triplets.

In vitro fertilisation (IVF)

What is it? This fertility treatment helps increase the chances of conception by harvesting the eggs and having them fertilised in vitro – in a glass dish. One or more fertilised eggs are then transferred back into the mother’s uterus, where hopefully, she carries at least one of them to term.

The risk: Women who undergo this treatment need to be aware of its risk. Since these procedures involve implanting more than one fertilised egg in the uterus, they are more likely to result in twins or more. It is a known fact that 1 in 4 to 5 IVF pregnancies is a multiple one.

Challenges You May Face

Obstetrician and Gynaecologist, Associate Professor Dr Tan Ay Eeng explains that the experience of multiple moms are indeed more demanding than singleton moms. “They definitely require a higher level of care throughout pregnancy,” she says. Dr Tan also highlighted four unique challenges that you may face if you are carrying twins or more:

Emotion. You may feel worried and uncertain. You may also lack confidence in coping with more than one baby at a time. These mixed emotions will definitely require more emotional support from your spouse and other family members.

Symptoms of pregnancy. You may experience heightened symptoms such as substantial weight gain, excessive stretch of the abdominal wall, poor sleep, swollen legs and others.

Antenatal care. You need to pay more attention to your pregnancy care with more frequent visits to the doctor’s office. You should also be prepared to be admitted to hospital for rest or other care if complications arise.

Complications. You may be at a higher risk of experiencing complications such as anaemia, hypertension, diabetes mellitus, premature labour, congenital abnormality of foetus, growth retardation and increased chance of LSCS (lower segment Caesarean section).

Breastfeeding twins or more is possible with proper feeding techniques and support from your spouse and other family members.

Challenges Babies May Face

“I have nonetheless been perpetually amazed at the patience of parents and more than often the long term outcome has been gratifying”, says Consultant Paediatrician and Neonatologist Dato’ Dr Musa Mohd Nordin. Apart from the perseverance of parents, Dr Musa is often inspired by the fighting spirit and the will to live which these tiny babies demonstrate despite the odds.

Foetal complications. Multiple babies may experience more unique problems such as twin to twin transfusions, whereby one baby would be anaemic whilst the other would have problems of receiving too much blood from the shared placenta. They would also be more likely to experience growth restriction inside the womb.

Delivery. There is an increased likelihood of a preterm delivery, which for twins, is six times higher than single babies.

Infant Complications. If multiple babies are born with premature organs, their lungs may be immature which could lead to respiratory distress syndrome (RDS). Besides that, they may also be at a higher risk of having an immature liver which could lead to jaundice. These complications and more may require the baby to be nursed in NICU (neonatal intensive care unit).

Birth defects. The incidence of congenital abnormalities is about 20% higher in multiple pregnancies. Heart anomalies comprise the largest category of malformation. Some rare abnormalities such as conjoint twins (siamese twins) and acardia (absence of the heart) are unique to twins. Many common anomalies such as clubfoot and excess fingers or toes are less serious.

Challenges Families May Face

“Multiple pregnancies come with multiple joys, multiple choices as well as multiple challenges on a combination of things such as time management, financial matters, health, couple relationship and so on,” noted Dr Anjli Doshi-Gandhi, Deputy Director-General (Policy), National Population and Family Development Board Malaysia.

It is a tough call for today’s parents of twins or more, especially for young couples struggling to juggle career, parenthood and most especially if they are living on their own. Couples need to work even harder to share responsibilities in raising their children, as every child deserves equal love, care, acceptance and nurturing to grow up happy and healthy.

Families of Twins Share Their Experiences

Positive Parenting is inspired by the resilience of these families with multiple babies. Here, we listen to their heartwarming experiences.

“As we have two sets of twins, we face a big financial burden. We normally plan a budget every month as we need to be really careful in our spending. Also, we do not just buy from any shop. We will hunt around for the cheapest possible products. Apart from being thrifty in our spending, we believe it’s important to invest in health insurance for the children as early as possible. We will never know when an emergency would arise,” shares Megat Syahrul Rizal Megat Ismail.


Megat Syahrul Rizal Megat Ismail & Radin Diana R Ahmad


Megat Amer Hakim & Putri Amera Syahirah (3 1/2 years); and Megat Ahmad Haikal & Putri Aqeela Hana (6 months)

“My wife’s family is very supportive and helpful. During the first few months, my wife faced some challenges, especially during her confinement. Thankfully, we have families who live near us. I used to play tennis a lot, but I know that there’s a greater need to be with my family. I always believe that as a family and most importantly, as husband and wife, we should work together to support each other by taking turns in caring for our twins as well as our eldest son. As they grow up, I think it gets easier for the both of us,” shares Mohd Azmir Ramli.


Mohd Azmir Ramli & Azeleen Binti Mohd Razali


Firash Hameez & Farish Hadeef (9 months)

“We never dreamed of having twins. It was a pleasant surprise as we already had four children before the arrival of the twins. Apart from the excitement of seeing double, we always appreciate them as individuals. One carries the books wherever she goes (even to sleep) and the other enjoys colouring and drawing. Both of them have different interests and you can’t compare them. One thing about having twins is that everything tends to be wonderful. When we see them after coming back from a hard day’s work, all the stress and tiredness seem to fade away,” shares Farehana.


Mohd Naim b. Mohammad & Farehana Hanapiah


Azra Sofiyah & Ayra Sofiyah (5 years)

“People assumed that as twins, we must be the same. We must go out together, have the same hobby, hang out with the same friends and see eye to eye on everything! They simply assumed that we don’t have our own individual life. As we grew older, our personalities seem to become more different. I’m the studious type while my brother is the total opposite. We are now heading towards different career paths, with me in the creative field and him in engineering. We both have our own identities as we excel in different areas,” shares Timothy.


Timothy Khor & Jed Khor (19 years)

One or More

“Families who are expecting twins, triplets or more are often expected to face more challenges when it comes to experiencing pregnancy and the journey through birth and beyond,” says Datuk Dr Zulkifli Ismail, Consultant Paediatrician.

While you do not have the choice of control in determining a single or multiple pregnancy, you can prepare yourself for what is to come. Note that it is normal to feel puzzled and worried when you find out that you are expecting multiple babies. It is not surprising that you may wonder how you can handle the medical, physical and psychological challenges of having twins or more. Firstly, knowledge is power. As parents, you are responsible to learn everything you can to better equip yourself for a good pregnancy, birth and care of your babies. It is part and parcel of preparing yourself for parenthood.

Couples who plan to have babies should consider trying to have children at a younger age, preferably before the age of 35. This is to minimise the possible risk of pregnancy complications that comes with a late pregnancy. “If you do opt for IVF, do understand that the chances of conceiving multiple babies are higher. However, I am sure that it will still be an amazing journey to parenthood for you and your spouse!” he concludes.

Subscribe to our parenting newsletter.