What determines the twins in the family. How twins are born: a review of an obstetrician-gynecologist. What is the difference between twins and twins

Today, many couples dream of twins or twins. There can be many reasons for such a desire. Someone wants to get a big family as soon as possible, and someone wants children of the same age to grow up in the family. Some women want to complete the program at least at a time and bear two children at once in one pregnancy, or simply dream of twins.

There are many myths around the conception and birth of twins, some of which are believed by a huge number of people. Let's see which of them are true and which are not.

Why are twins born?

Twins are different: monozygotic, dizygotic and monozygotic polar. Everyone has heard about the first two types of twins - these are identical twins and twins with different genotypes.

Identical (monozygotic) twins are formed from one egg fertilized by one sperm. If at the stage of crushing the cell divides into two or more parts, not one child is born, but two, less often three, etc. Such twins are strikingly similar and always of the same sex.

Very often there are mirror identical twins, when the children are a mirror image of each other. This is manifested in the location of internal organs, moles on the body. Mirror twins are born in 25 percent of cases of birth of monozygotic twins. The specularity of twins is associated with the late division of the cell into two.

Despite the striking external similarity, the twins still have a different pattern of the retina and different fingerprints.

Dizygotic (fraternal) twins— is a completely different matter. In Russian, such twins are usually called twins. In this case, there are two eggs and two sperm, and the eggs can not be fertilized at the same time, but even with a difference of three to four days.

Twins can be no more similar to each other than ordinary brothers and sisters, since their genotypes are different. Moreover, in rare cases, twins can be born from different fathers. Interestingly, when parents are of different races, twins can be born with different skin colors: black and white.

monozygotic polar twins- the third type of twins. They are also called semi-identical, and this is due precisely to their genotype. Such twins are born very, very rarely, and the process of their formation is extremely complicated, as it is associated with the formation of the so-called polar body, which can behave like a second egg. In such twins, half of the genes inherited from the mother are the same, and the paternal half is different. Monozygotic polar twins can be of different sexes. Here is such a natural phenomenon.

How to conceive twins

Why twins are born, we figured it out, now let's talk about what affects the birth in a family of twins.

The article is called "Twins are born in a generation" is not accidental, as this is the most established belief. You can't call it 100% correct. Indeed, the likelihood of giving birth to twins increases if there were similar cases in the family on the maternal side. That is, if your mother or grandmother gave birth to twins, then your chances of having twins increase. However, the increased chances of having twins do not give a one hundred percent guarantee of the birth of those. Strong heredity, both in the line of the woman and in the line of the man, gives a 50% chance of having twins, but no more.

But how do you conceive twins if you really dream about it? Fortunately, science has come a long way. There are ways to conceive twins both artificially and naturally.

Speaking of the artificial method, I mean the method of in vitro fertilization, which will cost spouses a lot. This method is very effective, it is thanks to him that the number of born twins and twins is increasing every year.

But what if you have no desire to take such a decisive step and resort to IVF? Increase the chances of having twins naturally.

Firstly, you can contact a specialist who will prescribe you a vitamin complex and draw up a nutrition program. Proper nutrition and vitamin intake greatly increases the likelihood of having twins.

There are also drugs and foods that cause hyperovulation. They are quite effective, but doctors recommend using them extremely rarely in order to avoid all sorts of complications during pregnancy.

Also, the likelihood of conceiving twins increases if the expectant mother ate supplements with a high content of folic acid during pregnancy planning.

Thus, the probability of being born in a family of twins increases if:

1. There is a genetic predisposition, that is, if twins or twins were born in the maternal lineage.

2. The woman was preparing for pregnancy, taking vitamin complexes and nutritional supplements.

3. Future parents do not have bad habits.

4. The older the woman, the higher the likelihood of multiple pregnancy.

The birth of a baby is happiness. And if there are several kids, it's even more fun! But multiple pregnancies require closer monitoring, because a pregnancy with a few crumbs is a rarity!

The twins themselves and their parents always attract increased attention: the birth of twins, and even more so triplets, is a rare phenomenon. Approximately 296 of all newborns are twins, and about 1% of all multiple pregnancies are triplets. We cannot plan or predict the birth of twins in natural conditions; in the process of fertilization, information about the number of fetuses and the development of pregnancy is immediately laid down. However, there are a number of factors that significantly increase the likelihood of becoming a mother of many children. More often, fraternal twins, or twins, are born that look alike, like ordinary brothers or sisters. They can be of different sexes, have different blood groups and a chromosome set. The birth of identical twins usually averages 0.3% of all births, they are always the same sex and look alike like two drops of water. They have the same chromosome set and blood groups, their development is influenced by environmental factors both during pregnancy and after it, and it is they that can form some not very significant differences.

Do you have twins?

More often, women over 35 years of age give birth to twins, since during this period the amount of the hormone responsible for stimulating the maturation of eggs increases in the woman's body. As a result, not one, but 2-3 eggs, which can be fertilized, come out of the ovary in time. The production of ovarian stimulating hormone is also strongly affected by stress and daylight hours, so it has been noted that twins are most often conceived in the spring, as well as during periods when women experience shocks or have problems in life. Several eggs may mature more often in women who have a short menstrual cycle - 21-24 days. In addition, twins are more often born in women with abnormalities in the structure of the uterus - bicornuate or having a septum in the cavity. Identical twins often appear in families with a hereditary predisposition. This ability is usually passed down through the mother's line. Dads can pass on this ability to their daughters, but they do not have twins, but they can become grandfathers of twins with a high probability.

Recently, there has been an increase in the number of twins. This is due to the active introduction of reproductive technologies into obstetrics - those couples who previously did not have the opportunity to have babies are given a chance: with the help of hormonal stimulation or a method, it becomes possible to become pregnant and give birth. A "side" effect of stimulation is the birth of not one, but two or even three children. With IVF, to increase the percentage of successful attempts, not one, but 2-3 embryos are implanted, and it happens that they all take root and develop.

When do parents find out about twins?

Previously, the birth of twins could be found out during childbirth or in the second half of pregnancy, after 22 weeks, when the obstetrician probed two babies in the tummy. Today, with the development of ultrasound technology, you can find out the good news from the 5-6th week of pregnancy - when the doctor detects 2 fetuses and two heartbeats during the study.

From about 14 weeks, you can already determine whether they are identical or fraternal. From 20-22 weeks, twins can be confirmed again by listening to the heart sounds of the twins in two different parts of the uterus.

Feature of multiple pregnancy

Until about 30 weeks, while there is still enough space in the uterus, the growth of babies corresponds to that of one crumb. In addition, it is important where the placenta is attached - it is good if it is located along the bottom, anterior or posterior wall of the uterus. Worse, if the placenta is located close to the neck, there are fewer arteries that feed the placenta, which means that the nutrition of babies is worse. After 30-32 weeks, the growth and weight gain of babies slows down, this is due to the ability of the mother's body to deliver nutrients and oxygen, as well as the limited space of the uterus. During the development of pregnancy, the uterus increases in size more strongly, its internal volume is greater than in a singleton pregnancy. Mechanisms for preparing for childbirth are launched earlier in order to prevent overstretching of the walls and problems in childbirth. So, when pregnant with two babies, the normal term of delivery is 36-38 weeks, and for triplets, the period is 34-36 weeks.

Even if your pregnancy is going perfectly, you still need to visit the doctor more often than with one baby.

What to pay attention to?

When carrying two crumbs, a double load falls on the mother, and with a triple, respectively, a triple load, special requirements are imposed on the body. The risk of various complications during pregnancy is higher, so you need to carefully monitor your health. With multiple pregnancies, a woman is more likely to get tired, because she has to carry more weight, her blood volume increases. From the second trimester, shortness of breath, increased heart rate may appear. This is due to the intensively growing uterus, the displacement of the diaphragm, and the increased load on the heart muscle. Pregnant twins are more likely to suffer from high blood pressure, more often varicose veins occur and the risk of thrombosis increases. Therefore, no weights, long standing or sitting! Light walking, swimming, gymnastics are acceptable. Rest more often with raised legs - this improves the outflow of blood from the limbs, is the prevention of varicose veins and improves heart function. Because of the rather large belly, it is recommended to wear a bandage and special tights. In addition, the rapid growth of the abdomen can lead to stretch marks - take care of your skin in advance with special creams or gels. The uterus presses on the bladder, which causes frequent urination. Often, due to a very large uterus, constipation and heartburn appear by the end of pregnancy, so you need to eat more often, but in small portions. Each baby requires an additional 300 calories to the diet and an increase in the level of calcium and iron in the diet. Iron deficiency and increased costs for several babies leads to the development of anemia, and this is the risk of oxygen starvation for babies and the mother herself. Therefore, mothers will be prescribed iron supplements, multivitamins and minerals without fail, it is very good if hemoglobin does not fall below 110 g / l.

Complications of multiple pregnancy

Such mothers are more likely to suffer from toxicosis, since their hormone levels are much higher than those of pregnant women with one fetus. In addition, they are more likely to experience severe complications such as gestosis (increased pressure, swelling and protein in the urine), preeclampsia (high blood pressure) and eclampsia (extremely high blood pressure that damages the brain and internal organs). You always need to control the pressure and weight. One of the serious complications is the threat of pregnancy, since a double or triple load on the uterus can lead to an earlier opening of the uterine os. Sometimes the doctor may suggest special devices or sutures to the cervix, allowing the pregnancy to be carried safely up to 36 weeks. So the doctor can offer hospitalization with relaxing the uterus and special medicinal procedures that allow you to bring the pregnancy to the desired time, you should not refuse the hospital - this will help to safely give birth to healthy babies. Sometimes there is a delay in the development of one of the fetuses due to the fact that the second baby receives nutrition from the common placenta and, as it were, “robs” the first one. You will be offered to regularly undergo an ultrasound examination in order to start the prevention of this problem in time.

Even if your pregnancy is going perfectly, you still need to visit the doctor more often than with one baby. This is the prevention of complications, and the control of weight and pressure, and preparation for childbirth. In the first trimester, you will visit the doctor every 3-4 weeks. And from the second trimester, your visits to the consultation will become frequent - once every 10 days, in the third - weekly. The doctor will carefully monitor your vital signs - pressure, pulse, respiratory rate. Weight will require special control - during a multiple pregnancy, its increase should be no more than 15 kg. Here you yourself will have to constantly monitor your diet. Analyzes will also become frequent, especially blood and urine tests, you will control the blood monthly, urine - at each visit to the doctor. The slightest deviation from the normal course of pregnancy will require hospitalization, since the risks for the mother of twins are much higher. Don't give up! Don't risk your children's health or your own.

You will be psychologically and physically prepared for childbirth, and hospitalization in the maternity hospital is carried out 2 weeks before the expected date of birth.

What will the birth be like?

Many mothers are worried about how they will give birth to their twins, whether it will be a natural birth or a caesarean section. The issue is resolved individually, in each case everything will depend on the weight of the children, their position in the uterus, the duration of pregnancy and your state of health. Most often they try to lead, but there will always be a help brigade at the ready if something goes wrong and is needed. The doctor will approach your case as carefully as possible and tell you about all the nuances - the decision will be joint: both yours and the doctor's.

The postpartum period during multiple pregnancy is not much different from that during childbirth with one fetus. Living together with babies will allow you to get in shape faster, restore psychological balance and establish natural feeding.

Of course, multiple pregnancy imposes increased obligations and requires a lot of strength, childbirth will be a little more difficult. However, soon the house will light up with the laughter of two or three kids, and you will get a lot of pleasant impressions and a lot of love!

In this article:

Pregnancy with two peanuts at once is a real happiness for every woman. Of course, there are certain problems with care and upbringing, but this happens only at the initial stage. But then the children will become real friends for each other and it will be interesting for them to spend time together. But unfortunately, not every woman can give birth to twins, and this is due not so much to childbirth as to problems of conception. According to statistics, there is only one multiple pregnancy for 80 pregnancies, and there are not so many chances that you will be lucky, but they are.

We increase the chances of success

What is the probability of having twins? There are several tips that increase this figure, as well as certain conditions under which a woman is capable of this. I propose to consider them in more detail.

• Most often, twins are born by women who have undergone in vitro fertilization. This is due to the fact that several fertilized eggs are placed in the uterus at once. Therefore, if you really want to give birth to twins, then after consulting with a specialist, you can decide on this step.
• You can also conceive twins after stopping the use of contraceptives, which for a long time blocked the work of the ovaries. It is at this point that they begin to produce a lot of eggs, which greatly increases the likelihood of conceiving and giving birth to twins.
• Some claim that prolonged abstinence also helps, but this has not been scientifically proven. It is believed that after a long period of absence of ejaculation, spermatozoa become more active, which increases the likelihood of multiple pregnancy.
• Tall women are more likely to conceive twins. Perhaps this is due to the peculiarities of the structure of the body.
• The ability to get pregnant with twins increases with regular consumption of milk, as it increases the levels of insulin-producing hormones in the blood, which increases the production of eggs.
• There is also a high chance of getting pregnant with twins if the man is of Middle Eastern or African descent, as this is genetically inherent in them.
• Women have the opportunity to conceive twins if there have already been similar precedents in the family. Such a feature is transmitted through the generation and only through the maternal line.
• 40 years is the best age for the birth of twins, as the blood contains a large amount of the necessary hormone.
• The best time of the year to conceive twins is spring, as the sun contributes to the production of gonadotropin.
• In addition, the chances increase with each subsequent child. Most often, twins appear in women who already have at least two children.
• Do not get carried away with diets, as this significantly reduces the likelihood of getting pregnant with twins.
• And in extreme cases, you can try to visit places where many twins are born. They say that there the earth and water has some mysterious power.

How is the pregnancy

So you have learned that you will soon become a happy mother of twins. And besides joy, anxiety immediately crept into my heart. How will the pregnancy proceed? What to expect from childbirth? Who will help you take care of the children? Actually, you shouldn't worry too much. Already for a period of several weeks, if there is a predisposition to the birth of twins, you need to contact a gynecologist. Because the most important thing is to constantly be under the supervision of a specialist and follow all his recommendations.

Even if everything proceeds normally, a woman begins to get very tired for a period of 24-26 weeks. She has shortness of breath, her heartbeat quickens. This is due to the pressure of the fetus on the internal organs, the displacement of the diaphragm, and the increase in blood pressure. Therefore, when preparing to give birth to twins, one should not perform complex physical exercises or lift heavy things, especially during the last weeks. Instead, doctors recommend breathing more fresh air or swimming. Pay attention to special body care products that prevent stretch marks.

Toxicosis in a pregnant woman with twins is quite difficult. But besides it, the bearing of twins can be accompanied by such a complication as preeclampsia. This condition is very dangerous for both mother and fetus. It is manifested by edema, the presence of protein in the urine, increased pressure. This disease is typical for the last weeks of pregnancy and can cause premature birth. In addition, the process of bearing twins is often accompanied by heartburn and constipation.

But the biggest threat is such a complication as the risk of miscarriage. The fact is that under heavy load, the uterus begins to open ahead of time and sometimes, in order to wait at least until 36 weeks, the doctor even has to apply a temporary suture in order to delay the onset of labor as much as possible. Sometimes a mother can be put into storage so that she is constantly under supervision.

Despite everything, most multiple pregnancies up to 37-38 weeks proceed quite well, after which the expectant mother goes to the hospital, where she is examined, the final date is set and the appropriate method of delivery is chosen.

How long to expect childbirth

When carrying twins, childbirth is likely to begin earlier than with a normal pregnancy. Most often for a period of 36-38 weeks. At first, everything happens as usual: contractions begin, the bubble bursts, water pours out, the first baby is born. After that, the woman can rest a little (about 10-15 minutes) and the contractions resume with renewed vigor to push out the second baby, the second bubble bursts and another baby is born. Then 2 afterbirths come out.

Preterm delivery is considered to be at 32 weeks. At this time, doctors are trying very hard to keep the pregnancy, as the twins are not yet ready enough to get to know the world. But if this fails, they make every effort to make the children stronger, since modern opportunities allow this.

Natural birth or caesarean section

According to statistics, more than half of twins are born as a result of a caesarean section. Indications for it are usually weak contractions and insufficient labor activity. Other reasons may be the incorrect presentation of one of the fetuses or premature detachment of the placenta. In these cases, surgery is unavoidable. But what is the chance of giving birth to twins naturally?

Today, medicine has gone far ahead and the birth of twins in a natural way is quite possible. The main thing is that the woman should have good enough health and the pregnancy should proceed without complications until the very last weeks. You should get to know the doctor who will take delivery in advance. Since if any problems arise, he will be able to solve most of them at the stage of gestation. The gynecologist should familiarize himself with the history of the expectant mother in order to identify possible problems of the reproductive system, which will help to avoid a caesarean section. They can occur if the pregnancy occurred after infertility treatment, since certain hormonal drugs that stimulate the activity of the ovaries were used in this case.

But even in the absence of evidence, the woman is mentally prepared for the fact that at any time her consent to the operation may be required. Most often, the need for a caesarean section occurs urgently, during childbirth. This happens when there is a threat to the health and life of one of the twins or the mother. And you need to be aware that in order to save the life of yourself and your children, you should decide to take this step.

But it also happens that the expectant mother is offered to have an operation as planned. If it is necessary to give birth to twins, it is prescribed for a period of 38 weeks, and in case of pregnancy with triplets, it is carried out for a period of 35-36 weeks. But there must be good reasons for this. After a caesarean section, the mother and her children are under observation. This is due to the fact that with a decrease in the tone of the uterus, bleeding can open, and the twins very often need increased attention, and sometimes treatment. Therefore, they usually spend the first days of their lives in the intensive care unit.

The body weight of twins is usually significantly less than that of children born from a singleton pregnancy, but, as a rule, by the age of 3 they catch up with their peers in development. And the risk of pathologies is absolutely independent of how many fetuses a woman bears. Therefore, do not worry too much about the health of the kids.

• When pregnant with twins, it is very important to take care of your health. Remember that an additional load is placed on your body. Toxicosis usually lasts longer and a woman may face a problem such as varicose veins. Special underwear will help reduce the load on the muscles, facilitate breathing and relieve shortness of breath.
• Remember that although each baby will weigh less than during a normal pregnancy, their total mass will be large enough, which is fraught with premature birth. Therefore, if you are expecting twins, it is better to go to the hospital a little in advance. And even at a later date, physical activity should be abandoned, as they can serve as a pretext for the start of contractions.
• If in the middle of the term you lose your appetite, you should not completely refuse food. The fact is that the uterus is greatly enlarged and tightens the stomach. But both fruits must receive the required number of calories. Therefore, try to eat more often, but in small portions.
• Be sure to take folic acid, as it prevents congenital disorders and defects of the nervous system. This must be done not only up to 16 weeks, as in the general case, but also throughout pregnancy, since two babies need much more nutrients.

If you are about to give birth to twins in the near future, this is not at all a cause for alarm. Today's medicine completely allows a woman to endure and give birth to healthy babies, no matter, naturally or by caesarean section. The most important thing is to carefully monitor your health and visit the gynecologist's office on time. And in caring for children, close relatives will readily help you, and if your financial situation allows, you can simply hire a nanny. But this is a great opportunity to become a mother of two children at once, which many women simply dream of. In addition, parents of twins will be able to receive payments from the state before those who have a difference in age of several years.

Useful video about multiple pregnancy

Today we will discuss all the issues of the development of twin pregnancy, the features of the course of pregnancy itself and childbirth. As a pediatrician, I will even say a few words about my observations of the development of twins and pairs of twins after birth in my area.

So, it is customary to call a pregnancy multiple, when two or more fetuses develop. But, since triplets and even more multiple pregnancies are not so common, today we will only talk about twins. If for some of you the problem of triplets is relevant, then I will say that everything is developing in approximately the same way.

Twins vs Twins: What's the difference?

Twins develop when not one egg, but two, matures in a woman's body. These sex cells can develop both in one ovary and in different ones at the same time. Of course, a prerequisite is that both of them will be fertilized by two spermatozoa (of course, different ones).

So it turns out two organisms with different genetic material. They may be of the same or different gender. There is no particular resemblance in their appearance, they are just like brothers and sisters.

Since children develop from different eggs, they may be called fraternal twins. Regarding medical details, I will explain, each of the babies has its own fetal sac, its own placenta.

Twins are called babies developing from one egg fertilized by one sperm, which at a certain time was divided into two parts, and from each part the development of a separate organism began. One egg, one sperm, same genetic material. Thus, twins are always the same sex, have an identical set of genes and the same appearance.

Twins can also have two of their own amniotic sacs and two placentas. Doctors call such twins bichorionic and biamnionic. The earlier the separation of the egg occurs, the greater the likelihood of the formation of a separate placenta and a separate amnion (fetal bladder). So, for example, the above-described variant of twins will turn out if the separation of the egg occurred on the 3rd day from the moment of fertilization.

But more common are twins with one placenta and two separate amniotic sacs (biamnic monochorionic twins). This scenario is possible if the fertilized egg decides to give two lives 3-8 days after meeting with the sperm.

The third version of the development of twins is also common. This is when one amnion and a single placenta are formed (monochorional monoamnionic twins). Usually this option is possible with a fairly late division of the egg - 9-10 days after conception.

Why does multiple pregnancy develop?

Double happiness is not given to everyone to experience. The frequency of twin births in the human population is approximately 1.5%.

The main reasons for the development of twins and, in general, multiple pregnancy are:

• ovarian hyperstimulation by hormones. It is used in medicine as an auxiliary technique for the early conception of a child. Hyperstimulation is indicated for a woman in whom the cause of infertility has been identified, and it consists in a violation of the maturation of female germ cells in the ovary;
• twins are often born after in vitro fertilization. To increase the likelihood of pregnancy during IVF, several embryos are simultaneously fertilized and implanted into the uterus of the expectant mother (in Russia, up to three embryos are possible at once). In the early stages, the death of the embryo may occur, so doctors are counting on the successful fixation of at least one of the implanted embryos.
• Of course, at the request of the parents, the reduction of the embryo is possible if two have taken root. But this is a rather risky step, not to mention a sin. Reduction of the engrafted embryo at the request of the parents after unsuccessful attempts to conceive is infrequent;
• recent withdrawal of oral contraceptives after prolonged ovarian rest also increases the likelihood of multiple oocytes maturing at the same time;
• hereditary factor. Heredity occupies not the last place in this phenomenon. Moreover, this feature is transmitted more along the female line, and more often through a generation. That is, for a woman who has given birth to twins, her granddaughter, and not her daughter, is more likely to give birth to twins. Although not a fact. For example, my mother never had twins in her family. But in the family of the father, having delved into the pedigree, they nevertheless found a case of twins. Few people remembered this case, since only one of the two children survived after giving birth. And the fact that the possibility of multiple pregnancy was passed down the paternal line does not contradict genetic patterns.

Are there early signs of multiple pregnancy?

It is practically impossible for a woman to find out about her multiple pregnancy on her own. More often, pregnant twins note the appearance of early toxicosis. Moreover, a pregnancy test can be with the usual color intensity of the indicator strip. Only at the appointment, the doctor can note the too large size of the uterus and their discrepancy with the calculated gestational age.

It is not always possible to recognize two embryos on the first ultrasound confirming the fact of pregnancy. But at a gestational age of 8-10 weeks, when it is possible to determine the heartbeat using doplerometry, it is already possible to say with accuracy about the beating of two hearts. And at the obligatory first screening ultrasound, which is carried out up to 12 weeks, the specialist will always notice the development of two babies, since their sizes at this time are no longer tiny.

At a later date, women with twins report more pronounced heartburn, shortness of breath, and swelling of the lower extremities. A pregnant woman gains weight more rapidly. Normally, during a multiple pregnancy, a woman can gain 20-22 kg.

After 18-20 weeks, a woman may feel tremors simultaneously in different parts of the abdomen. And the doctor can feel several large parts, for example, two heads and two butts of babies.

Features of the course of multiple pregnancy

About the earlier appearance and more pronounced toxicosis, I already wrote above. It is understandable that pregnancy with one child puts an enormous burden on all systems and organs of a woman, and with twins, it is even more difficult for the body to withstand the load.

Women with twin pregnancies are more likely to suffer from iron deficiency anemia, since it is incredibly difficult to provide oxygen and iron for the synthesis of red blood cells in the blood of two babies.

During pregnancy with twins, the volume of circulating blood increases. Since the mother's blood has the function of providing nutrients to the fetuses, the blood in the mother's body must circulate more intensively than during a normal pregnancy in order to provide nutrition for two babies.

Fetoplacental insufficiency is a fairly common occurrence during pregnancy with two babies, since two embryos require a more intensive metabolism in the placenta. Because of this, changes in the structure of the placenta inevitably appear, leading to disruption of the blood supply and nutrition of babies.

More often, this malnutrition occurs in one of the babies, which can lead to fetal fading in the early stages. There is another option that is often found - one baby develops more intensively and is born with noticeably more weight than the second.

As a rule, during pregnancy with twins, the size of the placenta is more impressive than during pregnancy with one fetus. That is, it is often partially or completely attached to the baby's path at the time of birth. This phenomenon is called placenta previa. With this development of events, childbirth through the birth canal is contraindicated. Placenta previa is one of the absolute indications for operative delivery.

Since a double burden also falls on the kidneys of pregnant twins, very often edema in such women appears earlier and manifests itself to a greater extent than during pregnancy with one baby.

An excessively enlarged uterus causes a change in the location of the internal organs - the stomach, intestines, ureters. In this regard, such women have more pronounced heartburn, constipation, and a greater risk of urinary tract diseases during pregnancy.

The expectant mother can hear the movements of the babies already at the 15th - 16th week. The intrauterine development of children in both singleton and multiple pregnancies is the same. However, during pregnancy with twins, due to the proximity of the enlarged uterus to the surface of the skin, the woman notices the first movements earlier.

The intensity of fetal movements also differs from their intensity in a more familiar singleton pregnancy. In the later stages, babies push very hard, trying to compete for a more comfortable position in the cramped space of the uterus.

A woman with multiple pregnancy is observed in the antenatal clinic more carefully and examined more often. Until the 30th week, an attendance is prescribed every 10 days, and after the 30th week of pregnancy - once a week.

The condition of the cervix is ​​carefully monitored, since isthmic-cervical insufficiency (prenatal opening of the cervix) due to overdistension of the uterus is a fairly common occurrence in multiple pregnancies.

A woman with twins can receive maternity leave and a disability certificate two weeks earlier than with a singleton pregnancy. That is, at 28 weeks, and not at the prescribed 30 weeks of pregnancy. Payments of benefits after the birth of babies do not differ in terms. But they are charged for each of the kids.

twin pregnancy calendar

Obstetrician-gynecologists count the first week of pregnancy from the first day of the last menstruation, when, in fact, menstruation is still going on and the egg is not fertilized. That is why, with the arrival of a delay in regular menstruation, a woman learns about the existence of pregnancy with a fairly decent period of 3-4 weeks.

We will analyze by week what happens to babies and mothers at different stages of pregnancy.

First trimester

• 1-4 weeks

As a rule, a woman does not even suspect that she is pregnant.

After the fusion of the egg and sperm in the fallopian tube, a zygote is formed. This is a single cell, from which a multicellular organism will be formed in the future. If initially there were two eggs, and they are fertilized by two different sperm, then two zygotes are formed, and fraternal twins will develop.

In the process of crushing, the zygote turns into a morula. This is at first 2 cells (one cell split in half), then 4, then successively 8, 16 and 32 cells, arranged in a dense cluster in the form of a raspberry. It is at the morula stage of 32 cells that the proembryo enters the uterine cavity. It can be implanted into the wall of the uterus not immediately, but after 2-3 days.

I will dwell in more detail on the moment when one fertilized egg gives two lives. This happens if, during crushing, the morula at some point suddenly “falls apart” into two parts, and each part begins to develop further independently, forming a separate organism.

If the division of a single fertilized egg occurs in the first three days after meeting with the sperm, twins develop with separate amniotic sacs and separate placentas (second column in the figure).

If this egg division occurs between days 3 and 8 after conception, the twins will have separate amniotic membranes and a shared placenta (third column in the figure).

If the egg decides to separate later than 8 days, but before the 13th day from the moment of fertilization, twins with a single fetal membrane and a single placenta will develop (fourth column in the figure).

Late division of the egg (after 13 days of life) threatens the development of undivided twins (Siamese).

Before implantation, a cavity forms between the cells of the morula, and it turns into a blastocyst - a hollow vesicle filled with liquid contents.

Implantation occurs approximately on the 7th day after conception. At this stage, the process of cell division only progresses. The process of introducing the embryo into the uterine wall can take a couple of days. This is considered the first critical period in the development of pregnancy.

In the second week, the formation of primary and secondary chorionic villi (the future placenta) and the differentiation of the germ layers, which subsequently give all the organs and systems of the baby, take place. This is considered the second critical period in obstetrics.

Up to 14 days, the embryo looks like a vesicle, consisting of three germ layers. From the third week, blood vessels form and grow into the chorionic villi. Due to this, with direct contact of the chorionic villi with the mother's blood, the fetus receives nutrients. Thus, the type of nutrition of the embryo changes to hematotrophic (through the blood).

With the beginning of the third week, all organs are laid down (organogenesis). First, the neural tube, heart and gonads are laid, then the liver, lungs, primary intestine and primary kidney. Starting from the 3rd week, it is possible to determine the fetal heartbeat on ultrasound, if the permission of the apparatus and the qualifications of the doctor allow this.

At the 4th week, the nervous system continues to develop, the rudiment of the brain and spinal cord is formed. At this time, the rudiments of the upper and lower extremities are already visible in the embryo.

Until the end of the 4th week, the embryos will be no larger than 2 cm.

• 5-8 weeks

During this period, organogenesis continues, that is, the formation of organs and body systems of developing children. The structure of all previously laid down organs and systems becomes more complicated. Nerve fibers are formed that connect organs with the central nervous system, that is, with the brain and spinal cord. The head of the embryos at this time is disproportionately large.

At the sixth week of pregnancy, the embryos can already bend and straighten the neck, changing the position of the head. Facial features are gradually emerging, eyes, auricles, mouth are formed. A clear difference between the upper and lower extremities emerges, the fingers differ.

At this stage, gender has already been formed, but it is not yet possible to determine the sex. The sexual organs visible on ultrasound have yet to form.

The blood flow in the uterus and placental bed becomes more intense to ensure such intensive growth and development of the embryos.

The eighth week ends the embryonic period of development of babies. At this time, the length of the embryos is usually 4.5-6 cm, weight is about 15-20 g.

• 9-12 weeks

By the ninth week, the babies have everything formed to be called no longer embryos, but fruits. There is a blood type and Rh factor. With the end of the embryonic period, complete differentiation of the brain and spinal cord, central and peripheral nervous system is observed.

The fetuses swallow amniotic fluid. They have a functioning bladder and kidneys. The movements of the fetuses become more diverse - they can cover their faces with their hands, suck their thumbs, move to the sides. The external genitalia are formed. The structure of the placenta becomes more complicated. It begins to perform more and more functions (respiratory, protective, metabolic, hormonal).

At 12 weeks, the length of the babies is approximately 85-90 mm, the babies weigh up to 30 g each.

So the first trimester of pregnancy has come to an end.

What changes await the expectant mother of twins in the first trimester?

The expectant mother of twins in the first trimester may experience an earlier and more pronounced toxicosis, which may also be felt in the second trimester.

The uterus is rapidly increasing in size. By the end of the first trimester, it more often already goes beyond the small pelvis, therefore it puts pressure on adjacent organs and can disrupt their usual work. So, pregnant twins feel frequent urge to urinate already in the first trimester. Constipation is also a frequent (but not mandatory) companion of multiple pregnancy.

In women during this period, the mammary gland actively increases, becomes moderately painful and sensitive. But this sign is typical not only for twin pregnancy, but for any pregnancy.

A woman should visit her doctor once a month. The gynecologist, at his own discretion, can set an individual schedule of visits for you. Up to 12 weeks, women must undergo an ultrasound scan, during which all violations and malformations of babies are excluded.

Second trimester

• 13-16 weeks

The skeletal system of babies is actively developing. The rudiments of the ribs are formed. The bones of the skull become smooth and more dense. You can already observe superficial respiratory movements. It's more like exercising the chest muscles. The digestive system begins to function. There are peristaltic waves of the intestine. The production of bile in the liver of babies begins. Interestingly, it is at this time that taste sensations are formed in babies.

The movements of developing children in the uterus become more and more active. They already have a fairly rich facial expression, but so far it remains involuntary (children frown, smile, open their mouths, perform sucking movements).

The skin of babies is quite thin, blood vessels are clearly visible through it. There is practically no subcutaneous fat. The scalp is gradually covered with the first vellus hair.

The approximate size of 16-week-old babies from the sacrum to the crown is about 12 cm, they weigh about 90 g each.

• 17-20 weeks

Children are actively growing. The growth of the trunk of children at this time prevails over the growth rate of the head.

At the seventeenth week of pregnancy, the size of the babies from the sacrum to the crown is about 14-15 cm, each already weighs about 130-140 g.

Children at this stage of prenatal development already hear and distinguish sounds, react to them with certain movements. With loud sharp sounds, babies move more intensively. Their eyes are still closed, but they already distinguish between light and darkness. On ultrasound, you can observe that the baby, reacting to some external influences, tries to cover his face with his hands, bring his chin to his chest, that is, bend his head.

Twins have been proven to sense each other's presence.

As a rule, women bearing twins hear the first movements of the fetus earlier than usual (16 weeks for nulliparous, 18 weeks for pregnant women again). Since the babies are cramped in the uterus, they are more actively repelled from its walls. At this time, a woman can feel up to ten movements of babies per day. At this time, the blink reflex is formed in babies.

The heartbeat of the fetus can already be clearly heard with a phonendoscope or an obstetric stethoscope. The rudiments of teeth, including permanent ones, are intensively formed. During this period, a cheese-like protective lubricant is also formed on the body of the fetus. Subcutaneous fat is formed.

In the body of babies, immune cells are already being produced. Fetal hemoglobin is gradually replaced by adult hemoglobin.

By the end of the fifth month, the coccygeal-parietal size of babies reaches 21-24 cm, and the weight is already quite decent - 320-340 g.

• 21-24 weeks

During this period, all pregnant women already felt the first movements of their babies. The sleep time of babies gradually decreases, and the time of wakefulness and active movements increases.

There is an active strengthening of bones. The skin is still wrinkled and has many folds, in large folds especially a lot of cheese-like lubricant of the fetus accumulates.

The child actively swallows amniotic fluid containing particles of lubricant, desquamated epithelium, and dark green fetal feces are already accumulating in his intestines. In a normal pregnancy, the emptying of the intestines of babies can occur only after birth.

At this time, the amount of subcutaneous adipose tissue increases, including brown adipose tissue, which will protect babies from hypothermia after birth.

Toddlers are already very good at distinguishing sounds. It is noticeable that for themselves they distinguish sharp, loud, pleasant or unpleasant sounds, react to them in a certain way (by excitement or fading).

By the end of this period, babies reach a height of 26-28 cm, their weight increases to 450-550 g.

• 25-28 weeks

The facial features of the children are becoming more and more clear, they already have eyelashes and eyebrows. The curves of the auricles are gradually formed.

The lungs are actively developing, the so-called air sacs (alveoli) are formed. While they are not yet filled with air, but at the 25th week, a substance such as a surfactant begins to be produced, which will not allow these sacs to subside after birth, when they are filled with air.

Babies actively gain weight by increasing the amount of adipose tissue, muscle growth, growth and strengthening of bones.

During this period, in boys, the testicles begin to descend into the scrotum, and in girls, the genitals continue to form.

By the 28th week, as a rule, the final presentation of the fetus is established, since they are already cramped in the uterus, they cannot roll over from head presentation to pelvic presentation or vice versa.

By this period, the babies are practically formed. In the case of premature birth, with proper nursing, they are already quite capable of surviving.

By the end of this period, the mass of babies is approximately 800-900 g, growth is up to 35 cm.

Changes in the body of the expectant mother of twins in the second trimester of pregnancy

The uterus has already grown enough, the tummy is noticeably rounded. It is already more difficult for a pregnant woman to lead a habitual active lifestyle at this time. But the correct alternation of periods of rest and activity will help to avoid problems with constipation, varicose veins, and swelling.

During this period, the expectant mother should pay special attention to the diet, namely, the sufficient content of protein and calcium in it. It is worth enriching the diet as much as possible with products containing calcium and phosphorus, vitamin D 3 (fish, canned fish, eggs, nuts, hard cheeses, dairy products), since the skeletal system in babies is actively formed. At this time, the future mother may be disturbed by heartburn.

It's time to use a support bandage, since during this period most often a woman still has to work, and back pain and heaviness in her legs are already bothering her. Already the physiologically changing gait (swinging) itself contributes to less back tension and pressure of the uterus on the pelvic bones. But in the case of multiple pregnancy, it is difficult to do without additional support of the bandage.

Often pregnant women complain that it is difficult for them to find a comfortable position during sleep. Experts recommend sleeping on the left side, bending the upper leg at the knee and straightening the lower one. Specially designed pillows for pregnant women are designed to relieve the bones of the pelvis and lower back, to support the already enlarged tummy of a woman.

Actively in the mammary gland, adipose tissue is replaced by glandular tissue. To the touch, the mammary gland has a fine-mesh structure.

The pigmentation of the peripapillary region on the chest, the median line on the abdomen is becoming more and more pronounced. Age spots and freckles may appear on the body. This is due to an increase in melanin content in the skin of a pregnant woman.

Before the 22nd week of pregnancy, women undergo a second mandatory (screening) ultrasound. In this study, they may already be told the sex of the babies, if, of course, the position of the twins allows them to consider their gender.

third trimester

• 29-32 weeks

In babies, the brain, the cerebral cortex are actively developing, the number of its convolutions is increasing. The mass of the brain of babies is 25% of the mass of an adult.

Now one of the cerebral hemispheres is already beginning to function more actively, which determines whether the child will be left-handed or right-handed, whether left-hemispheric or right-hemispheric activity will prevail.

The endocrine glands that produce hormones (thyroid and parathyroid glands, pancreas, pituitary gland) are actively working.

Surfactant accumulates in large quantities in the lungs, and they begin a test mode of operation.

By the end of this period, the weight of the babies is 1500-1600 g, the length is about 40 cm.

• 33-37 weeks

The skin of babies becomes lighter, as subcutaneous fatty tissue accumulates (about 10-15 g per day). Vellus hair is gradually wiped off. By birth, they can remain on the shoulders and back. There is more and more cheese-like lubricant on the body.

During sleep, the eyes of babies are closed, and during periods of wakefulness, the eyelids are open. The color of the iris of the eyes of all children is the same (deep dark blue) and only after birth can it change. The pupil already reflexively reacts by constriction or expansion to the intensity of the penetrating light.

The pulmonary and digestive systems are fully formed. The kidneys are fully functional, excrete up to 500 ml of urine per day. Amniotic fluid is updated about eight times a day (every three hours). The bones of the skull are denser, but mobile and pliable, which is so important for the normal passage of the head through the birth canal.

The babies are fully formed and ready to meet their mother. By the end of this period, the weight of babies can vary significantly - from 2200 to 3000 g, height - about 43-46 cm.

Pregnancy at 37 weeks is already considered full-term, and a woman pregnant with twins is being prepared for planned delivery.

Changes in the condition of the mother of twins in the third trimester

Future mothers of twins have the right to finish work early and go on a well-deserved rest. For them, maternity leave starts at 28 weeks. In the third trimester, until the 30th week, gynecologists prescribe a visit to a pregnant woman every 10 days, and after the 30th week of pregnancy - once a week.

During this period, the intensity of the movements of the babies decreases (they are cramped), but the strength of the shocks increases. A greatly enlarged uterus can compress the inferior vena cava in the position of a woman lying on her back. Therefore, in this position, pregnant women often experience weakness, dizziness, and a pre-fainting state appears.

Constipation, incessant heartburn, hemorrhoids are frequent (but again I repeat - not at all necessary!) Companions of the third trimester of multiple pregnancy. During this period, women may notice the first droplets of colostrum from the breast. This is fine. The mother's body is preparing for the birth of babies. The genital tract, the mammary gland are prepared for childbirth and functioning after childbirth, the hormonal background changes.

At 32 weeks, women undergo a third screening ultrasound. Here you can finally see the position of the babies, their presentation, which fetus is closer to the womb. It is possible to assess the state of the placenta, since with the development of twins, it often prematurely shows signs of aging (fast and intense metabolism through the placenta quickly wears it out). This is another reason for earlier delivery of multiple pregnancies.

The future mother of twins is hospitalized in advance in an obstetric hospital. This happens about 3-4 weeks before the expected due date. This is done to finalize the method and term of delivery.

In just the third trimester, a mother of twins can gain up to 6-7 kg. In the last weeks of pregnancy before childbirth, a woman can lose from 500 to 1.5 kg. The body gets rid of excess fluid, the mother's blood thickens, swelling decreases.

Features of childbirth when carrying twins

A woman with twins should be prepared for early hospitalization before delivery. This situation requires more careful monitoring of the pregnant woman in the later stages.

Preterm birth in these women is very common. The reason for this is the overstretching of the muscles of the uterus, which can serve as one of the triggers for the onset of labor. As a rule, if operative delivery of a multiple pregnancy is required, then it is planned for 36-37 weeks.

If there are problems with bearing twins and it is difficult to safely bring intrauterine development to 36-37 weeks, doctors try to maintain and bring the pregnancy to at least the 32nd - 34th week.

During this period of development, children already have surfactant in their lungs. This is a substance that prevents the air sacs of the lungs (alveoli) from collapsing, and the lungs become more or less prepared to perform their function after the birth of babies.

But more often there is a different picture - when one child is in the head, and the other - in the breech presentation. It happens less often when one child is located in the head or pelvic, and the other in a transverse presentation.

Natural childbirth with a single placenta of twins is dangerous because at the birth of one of the babies, placental abruption may occur and, accordingly, the nutrition of the other child will be disturbed. In this regard, you still have to resort to an emergency caesarean section in order to save the second baby.

Thus, preliminary hospitalization of a woman with twins 3-4 weeks before the expected date of birth is necessary to clarify the obstetric status and additional examination of the future woman in labor, as well as to resolve the issue of the method of delivery. More often, the issue is resolved in favor of a planned caesarean section, since the natural birth of twins much more often ends in complications for both the fetus and the mother.

My observations on the development of twins and twins after birth

As a pediatrician, observing the development of twins and twins after natural childbirth, I always note that the first born child of twins is larger and stronger for health reasons. It is he who tolerates the period of adaptation after birth more easily.

Children born first are less likely to experience transient (borderline) conditions after birth (toxic erythema, physiological jaundice, transient neurological disorders: depression or arousal syndrome).

And development in the first year of life, as a rule, shows that the first child of twins develops faster than the second born.

These observations are confirmed by my twins in the family. The twin sister was born larger and earlier than the twin brother by 5 minutes. So, let's say, the brother, like a true gentleman, let the lady go first.

And in life, the sister quickly acquired new skills. She quickly sat down, crawled. She learned to walk much earlier than her brother.

Now I am a mother of two children, the youngest of whom has just learned to walk. It so happened that at different times I had to lead both by the hands for a long time before the children themselves went. The little man wants to walk, but his strength is still not enough. So he demands: “Take me, mother, by the hand!” Although there is still a question of who drives whom)) J Rather, the baby drives his mother. He also demands with his hand: “Take me there!”

I asked my mother how she coped with the twins in such a difficult time. It's necessary to drive, keep two. But then nature itself, probably, took care that the twins did not simultaneously enter a new period of development. One is still crawling, the other is learning to walk.

So it is possible to cope with twins, although it is not easy. If, having learned about your double joy, you doubt and are full of fear about the upcoming birth and the future in general, then do not hesitate.

Double happiness is not given to everyone to experience, which means that you are a special person. The time of pregnancy will fly by. The good news is that instead of 18 months pregnant, you will only have 9 months. The result will be two crumbs, your two wonderful little bloods. Double positive emotions and double your difficult happiness await you.

Health and happiness to you and your children!

A practicing pediatrician, twice mother Elena Borisova-Tsarenok told you about the pregnancy with twins.

The news of pregnancy is always good news. Pregnancy with twins is both exciting and scary at the same time. How will it proceed? Will the expectant mother be able to carry out the birth of twins on her own? A million questions pop into your head as soon as future parents find out that there will be two children.

Most often, a pregnant woman does not know that she is expecting twins until the first ultrasound. Although often a blood test for hCG already for a period of 4 weeks can tell about multiple pregnancy.

Despite the fact that such a pregnancy in many cases is quite easy, doctors tend to classify it as a pathology. The risks can be very different: premature birth of twins, miscarriage, fetal pathology.

As a rule, the possibility of conceiving twins is inherited, often through several generations. However, modern medical facilities and various folk remedies can help make such a bold dream come true.

To begin with, it is worth determining that twins are fraternal babies, often of different sexes. Twins, on the other hand, develop in the same egg and are called, respectively, identical. Twins are almost always the same sex.

Conceiving twins with the help of medical procedures and drugs:

• After stimulating ovulation with potent hormonal drugs, multiple pregnancy may develop due to the maturation of a large number of follicles.
• Stopping birth control can also give rise to a surge in follicle-stimulating hormone activity.
• Artificial insemination, or. The most common cause of twins. In recent years, more and more women have resorted to the help of reproductive specialists in order to conceive a child. Doctors stimulate the growth of a large number of follicles. Then, after ovulation, an operation is performed to remove the follicles with eggs, which are subsequently crossed with sperm. Based on how many embryos turned out, the issue of replanting is being decided. As a rule, it is recommended to plant no more than two. Thus, twins and triplets are born.

1. Folic acid intake. It has a beneficial effect on the woman's body and contributes to the appearance of twins.
2. Long-term breastfeeding of the first child may also help in the issue of conceiving subsequent twins.
3. Proper nutrition and the inclusion in the diet of foods that stimulate the activity of the ovaries will have a beneficial effect. Chicken eggs, dairy products, walnuts, whole grains contain various vitamins and amino acids, they have a beneficial effect on the functioning of the pelvic organs.
4. It has been proven that the age of a woman is also able to "help" in planning a multiple pregnancy. Women over 30 are more likely to have twins.

How does a multiple pregnancy proceed?

Often, pregnancy with twins or triplets proceeds quite favorably and is not much different from the usual. However, it still has some features.

Tracking the course of multiple pregnancy, doctors pay special attention to the uniform development of the fetus in the womb. A pronounced difference in weight and size may indicate a developmental pathology.

In addition, due to the different blood supply to the fetuses, one child can "eat" another. Because of this, the second baby receives less nutrition and may die or lag behind in development.

The first trimester of multiple pregnancy in 20% of cases brings unpleasant surprises. Under unfavorable circumstances, the death of one fetus is possible.

If the second baby feels good and continues to develop, then doctors prefer to simply monitor such a pregnancy. If the second fetal egg does not harm a living baby, then it is left in the womb until delivery.

Pregnant twins often suffer from iron deficiency. There is a condition called anemia. To prevent this from happening, doctors prescribe additional vitamin complexes.

The second and third trimesters are the hardest for multiple pregnancies. The walls of the uterus stretch too much, the internal organs suffer due to increased blood circulation, a large load on the heart and kidneys. Because of such loads, miscarriages and premature births often occur.

How long to expect childbirth?

A multiple pregnancy differs from a normal one even in the timing of the birth of babies. Twins and triplets mature a few weeks earlier. Of course, the later the birth date of the fetuses, the less problems may arise with their health.

If we are talking about delivery through a caesarean section, then only the doctor determines the date of birth. However, in most cases, multiple pregnancy ends.

For a period of 32-33 weeks, childbirth is complex and unpredictable. Babies can be quite viable. However, they often go through a long course of rehabilitation. At this time, children are not always able to breathe on their own, they lack many reflexes.

34-36 weeks give a much better chance of survival for babies. If the woman still has not given birth, she is offered to go under observation, since childbirth can begin at any time. At 36 weeks, a woman can already give birth to children naturally, without resorting to surgical intervention.

Childbirth at 37-38 weeks is considered normal. The babies are already full-term and ready for independent life. At this time, you can no longer worry about the onset of premature contractions.

At any stage of pregnancy, the question of how to give birth to twins is decided only by a doctor. Even if the pregnancy proceeded without complications, various unforeseen situations may arise during childbirth, which only an obstetrician can resolve.

Natural birth or caesarean section

Favorable multiple pregnancy may well end in natural childbirth. In this case, the expectant mother needs to know how they proceed.

Harbingers of labor can be frequent urination. Also, a woman notices a pronounced one, after which it becomes easier to breathe. Pain in the lower abdomen will prompt the thought of an early delivery.

Contractions in a pregnant woman can begin from 25 weeks. They are called training, do not cause pain and pass quickly. In this case, the pregnant woman has nothing to worry about.

However, if the gestational age is already more than 30 weeks, and the contractions are strongly given to the perineum, then it is necessary to visit a doctor to confirm the onset of labor. Contractions may also be accompanied by the discharge of water and plugs. Real contractions have a clear frequency, which is reduced over time.

During the onset of contractions, the woman's cervix begins to prepare for the birth of babies. Its opening should be within 9-10 cm.

After the onset of contractions and the opening of the cervix, attempts begin. This is the most critical part of natural childbirth for the mother. It is on how correctly she knows how to push that the favorable outcome of childbearing depends.

The difference in time for the appearance of babies from twins is from 5 to 20 minutes. In order to speed up the process of having a second child, doctors manually open the fetal bladder.

After the birth of babies, they are washed, weighed and evaluated by. With a favorable outcome, the children are laid out on the mother's stomach.

Some time after the birth of children, the woman has another important task: the birth of the placenta. She also comes out with an effort. The state of the mother's pelvic organs depends on how whole the placenta came out.

Natural childbirth of twins proceeds quite favorably. Much depends on how competent the obstetrician-gynecologist is.