Birth

For other uses, see Birth (disambiguation) and Childbirth.

Lambing: the mother licks the first lamb while giving birth to the second

Birth is the act or process of bearing or bringing forth offspring.[1] In mammals, the process is initiated by hormones which cause the muscular walls of the uterus to contract, expelling the fetus at a developmental stage when it is ready to feed and breathe. In some species the offspring is precocial and can move around almost immediately after birth but in others it is altricial and completely dependent on parenting. In marsupials, the fetus is born at a very immature stage after a short gestational period and develops further in its mother’s womb’s pouch.

It is not only mammals that give birth. Some reptiles, amphibians, fish and invertebrates carry their developing young inside them. Some of these are ovoviviparous, with the eggs being hatched inside the mother’s body, and others are viviparous, with the embryo developing inside her body, as in mammals.

Contents

  • 1 Mammals
    • 1.1 Human childbirth
    • 1.2 Cattle
    • 1.3 Dogs
    • 1.4 Marsupials
  • 2 Other animals
  • 3 See also
  • 4 References
  • 5 Cited texts

Mammals[edit]

Large mammals, such as primates, cattle, horses, some antelopes, giraffes, hippopotamuses, rhinoceroses, elephants, seals, whales, dolphins, and porpoises, generally are pregnant with one offspring at a time, although they may have twin or multiple births on occasion. In these large animals, the birth process is similar to that of a human, though in most the offspring is precocial. This means that it is born in a more advanced state than a human baby and is able to stand, walk and run (or swim in the case of an aquatic mammal) shortly after birth.[2] In the case of whales, dolphins and porpoises, the single calf is normally born tail first which minimises the risk of drowning.[3] The mother encourages the newborn calf to rise to the surface of the water to breathe.[4]

Most smaller mammals have multiple births, producing litters of young which may number twelve or more. In these animals, each fetus is surrounded by its own amniotic sac and has a separate placenta. This separates from the wall of the uterus during labor and the fetus works its way towards the birth canal.[citation needed]

Large mammals which give birth to twins is much more rare, but it does occur occasionally even for mammals as large as elephants. In April 2018, approximately 8-month old elephant twins were sighted joining their mother’s herd in the Tarangire National Park of Tanzania, estimated to have been born in August 2017.[5]

Human childbirth[edit]

Main article: Childbirth
Further information: Adaptation to extrauterine life

An illustration of normal head-first presentation by the obstetrician William Smellie from about 1792. The membranes have ruptured and the cervix is fully dilated.

Humans usually produce a single offspring at a time. The mother’s body is prepared for birth by hormones produced by the pituitary gland, the ovary and the placenta.[2] The total gestation period from fertilization to birth is normally about 38 weeks (birth usually occurring 40 weeks after the last menstrual period). The normal process of childbirth takes several hours and has three stages. The first stage starts with a series of involuntary contractions of the muscular walls of the uterus and gradual dilation of the cervix. The active phase of the first stage starts when the cervix is dilated more than about 4 cm in diameter and is when the contractions become stronger and regular. The head (or the buttocks in a breech birth) of the baby is pushed against the cervix, which gradually dilates until is fully dilated at 10 cm diameter. At some time, the amniotic sac bursts and the amniotic fluid escapes (also known as rupture of membranes or breaking the water).[6] In stage two, starting when the cervix is fully dilated, strong contractions of the uterus and active pushing by the mother expels the baby out through the vagina, which during this stage of labour is called a birth canal as this passage contains a baby, and the baby is born with umbilical cord attached.[7] In stage three, which begins after the birth of the baby, further contractions expel the placenta, amniotic sac, and the remaining portion of the umbilical cord usually within a few minutes.[8]

Enormous changes take place in the newborn’s circulation to enable breathing in air. In the uterus, the unborn baby is dependent on circulation of blood through the placenta for sustenance including gaseous exchange and the unborn baby’s blood bypasses the lungs by flowing through the foramen ovale, which is a hole in the septum dividing the right atrium and left atrium. After birth the umbilical cord is clamped and cut, the baby starts to breathe air, and blood from the right ventricle starts to flow to the lungs for gaseous exchange and oxygenated blood returns to the left atrium, which is pumped into the left ventricle, and then pumped into the main arterial system. As result of these changes, the blood pressure in the left atrium exceeds the pressure in the right atrium, and this pressure difference forces the foramen ovale to close separating the left and right sides of the heart. The umbilical vein, umbilical arteries, ductus venosus and ductus arteriosus are not needed for life in air and in time these vessels become ligaments (embryonic remnants).[9]

Cattle[edit]

A cow giving birth

Birthing in cattle is typical of a larger mammal. A cow goes through three stages of labor during normal delivery of a calf. During stage one, the animal seeks a quiet place away from the rest of the herd. Hormone changes cause soft tissues of the birth canal to relax as the mother’s body prepares for birth. The contractions of the uterus are not obvious externally, but the cow may be restless. She may appear agitated, alternating between standing and lying down, with her tail slightly raised and her back arched. The fetus is pushed toward the birth canal by each contraction and the cow’s cervix gradually begins to dilate. Stage one may last several hours, and ends when the cervix is fully dilated. Stage two can be seen to be underway when there is external protrusion of the amniotic sac through the vulva, closely followed by the appearance of the calf’s front hooves and head in a front presentation (or occasionally the calf’s tail and rear end in a posterior presentation).[10] During the second stage, the cow will usually lie down on her side to push and the calf progresses through the birth canal. The complete delivery of the calf (or calves in a multiple birth) signifies the end of stage two. The cow scrambles to her feet (if lying down at this stage), turns round and starts vigorously licking the calf. The calf takes its first few breaths and within minutes is struggling to rise to its feet. The third and final stage of labor is the delivery of the placenta, which is usually expelled within a few hours and is often eaten by the normally herbivorous cow.[10][11]

Dogs[edit]

Further information: Canine reproduction § Gestation and litters

Birth is termed whelping in dogs.[12] Among dogs, as whelping approaches, contractions become more frequent. Labour in the bitch can be divided into 3 stages. The first stage is when the cervix dilates, this causes discomfort and restlessness in the bitch. Common signs of this stage are panting, fasting, and/or vomiting. This may last up to 12hrs.[12] Stage two is the passage of the offspring.[12] The amniotic sac looking like a glistening grey balloon, with a puppy inside, is propelled through the vulva. After further contractions, the sac is expelled and the bitch breaks the membranes releasing clear fluid and exposing the puppy. The mother chews at the umbilical cord and licks the puppy vigorously, which stimulates it to breathe. If the puppy has not taken its first breath within about six minutes, it is likely to die. Further puppies follow in a similar way one by one usually with less straining than the first usually at 15-60min intervals. If a pup has not been passed in 2 hrs a veterinarian should be contacted.[12] Stage three is the passing of the placentas. This often occurs in conjunction with stage two with the passing of each offspring.[12] The mother will then usually eat the afterbirth.[13] This is an adaption to keep the den clean and prevent detection of predators.[12]

Marsupials[edit]

See also: Marsupial § Reproductive system, and Marsupial § Early development

A kangaroo joey firmly attached to a nipple inside the pouch

An infant marsupial is born in a very immature state. The gestation period is usually shorter than the intervals between oestrus periods. The first sign that a birth is imminent is the mother cleaning out her pouch. When it is born, the infant is pink, blind, furless and a few centimetres long. It has nostrils in order to breathe and forelegs to cling onto its mother’s hairs but its hind legs are undeveloped. It crawls through its mother’s fur and makes its way into the pouch. Here it fixes onto a teat which swells inside its mouth. It stays attached to the teat for several months until it is sufficiently developed to emerge.[14] Joeys are born with “oral shields”; in species without pouches or with rudimentary pouches these are more developed than in forms with well-developed pouches, implying a role in maintaining the young attached to the mother’s nipple.[15]

Other animals[edit]

Many reptiles and the vast majority of invertebrates, most fish, amphibians and all birds are oviparous, that is, they lay eggs with little or no embryonic development taking place within the mother. In aquatic organisms, fertilization is nearly always external with sperm and eggs being liberated into the water (an exception is sharks and rays, which have internal fertilization[16]). Millions of eggs may be produced with no further parental involvement, in the expectation that a small number may survive to become mature individuals. Terrestrial invertebrates may also produce large numbers of eggs, a few of which may avoid predation and carry on the species. Some fish, reptiles and amphibians have adopted a different strategy and invest their effort in producing a small number of young at a more advanced stage which are more likely to survive to adulthood. Birds care for their young in the nest and provide for their needs after hatching and it is perhaps unsurprising that internal development does not occur in birds, given their need to fly.[17]

Ovoviviparity is a mode of reproduction in which embryos develop inside eggs that remain in the mother’s body until they are ready to hatch. Ovoviviparous animals are similar to viviparous species in that there is internal fertilization and the young are born in an advanced state, but differ in that there is no placental connection and the unborn young are nourished by egg yolk. The mother’s body provides gas exchange (respiration), but that is largely necessary for oviparous animals as well.[17] In many sharks the eggs hatch in the oviduct within the mother’s body and the embryos are nourished by the egg’s yolk and fluids secreted by glands in the walls of the oviduct.[18] The Lamniforme sharks practice oophagy, where the first embryos to hatch consume the remaining eggs and sand tiger shark pups cannibalistically consume neighbouring embryos. The requiem sharks maintain a placental link to the developing young, this practice is known as viviparity. This is more analogous to mammalian gestation than to that of other fishes. In all these cases, the young are born alive and fully functional.[19] The majority of caecilians are ovoviviparous and give birth to already developed offspring. When the young have finished their yolk sacs they feed on nutrients secreted by cells lining the oviduct and even the cells themselves which they eat with specialist scraping teeth.[20] The Alpine salamander (Salamandra atra) and several species of Tanzanian toad in the genus Nectophrynoides are ovoviviparous, developing through the larval stage inside the mother’s oviduct and eventually emerging as fully formed juveniles.[21]

A more developed form of viviparity called placental viviparity is adopted by some species of scorpions[22] and cockroaches,[23] certain genera of sharks, snakes and velvet worms. In these, the developing embryo is nourished by some form of placental structure. The earliest known placenta was found recently in a group of extinct fishes called placoderms, which are ancestral to mammals. A fossil from Australia’s Gogo Formation, laid down in the Devonian period, 380 million years ago, was found with an embryo inside it connected by an umbilical cord to a yolk sac. The find confirmed the hypothesis that a sub-group of placoderms, called ptyctodontids, fertilized their eggs internally. Some fishes that fertilize their eggs internally also give birth to live young, as seen here. This discovery moved our knowledge of live birth back 200 million years.[24] The fossil of another genus was found with three embryos in the same position.[25] Placoderms are a sister group of the ancestor of all living jawed fishes (Gnathostomata), including both chondrichthyians, the sharks & rays, and Osteichthyes, the bony fishes.

Among lizards, the viviparous lizard Zootoca vivipara, slow worms and many species of skink are viviparous, giving birth to live young. Some are ovoviviparous but others such as members of the genera Tiliqua and Corucia, give birth to live young that develop internally, deriving their nourishment from a mammal-like placenta attached to the inside of the mother’s uterus. In a recently described example, an African species, Trachylepis ivensi, has developed a purely reptilian placenta directly comparable in structure and function to a mammalian placenta.[26] Vivipary is rare in snakes, but boas and vipers are viviparous, giving birth to live young.

Female aphid giving birth

The majority of insects lay eggs but a very few give birth to offspring that are miniature versions of the adult.[17] The aphid has a complex life cycle and during the summer months is able to multiply with great rapidity. Its reproduction is typically parthenogenetic and viviparous and females produce unfertilized eggs which they retain within their bodies.[27] The embryos develop within their mothers’ ovarioles and the offspring are clones of their mothers. Female nymphs are born which grow rapidly and soon produce more female offspring themselves.[28] In some instances, the newborn nymphs already have developing embryos inside them.[17]

See also[edit]

  • Animal sexual behaviour
  • Breeding season
  • Dystocia
  • Foaling (horses)
  • Gestation
  • Kegel exercises
  • Lambing (sheep)
  • Mating system
  • Odon device
  • Reproduction
  • Reproductive system
  • Perineal massage
  • Episiotomy
  • Caesarean section
  • Forceps delivery
  • Ventouse

References[edit]

  • ^ “birth”. OED Online. June 2013. Oxford University Press. Entry 19395 (accessed 30 August 2013).
  • ^ a b Dorit, R. L.; Walker, W. F.; Barnes, R. D. (1991). Zoology. Saunders College Publishing. pp. 526–527. ISBN 978-0-03-030504-7. 
  • ^ Mark Simmonds, Whales and Dolphins of the World, New Holland Publishers (2007), Ch. 1, p. 32 ISBN 1845378202.
  • ^ Crockett, Gary (2011). “Humpback Whale Calves”. Humpback whales Australia. Retrieved 2013-08-28. 
  • ^ “Trunk Twins : Elephant Twins Born in Tarangire | Asilia Africa”. Asilia Africa. 2018-04-06. Retrieved 2018-04-06. 
  • ^ NICE (2007). Section 1.6, Normal labour: first stage
  • ^ NICE (2007). Section 1.7, Normal labour: second stage
  • ^ NICE (2007). Section 1.8, Normal labour: third stage
  • ^ Houston, Rob (editor); Lea, Maxine (art editor) (2007). The Human Body Book. Dorling Kindersley. p. 215. ISBN 978-1-8561-3007-3. CS1 maint: Extra text: authors list (link)
  • ^ a b “Calving”. Alberta: Agriculture and Rural Development. 2000-02-01. Retrieved 2013-08-28. 
  • ^ “Calving Management in Dairy Herds: Timing of Intervention and Stillbirth” (PDF). The Ohio State University College of Veterinary Medicine Extension. 2012. Retrieved 2013-12-17. 
  • ^ a b c d e f Kustritz, M. (2005). “Reproductive behaviour of small animals”. Theriogenology. 64 (3): 734–746. doi:10.1016/j.theriogenology.2005.05.022. 
  • ^ Dunn, T.J. “Whelping: New Puppies On The Way!”. Puppy Center. Pet MD. Retrieved 2013-08-28. 
  • ^ “Reproduction and development”. Thylacine Museum. Retrieved 2013-08-28. 
  • ^ Yvette Schneider Nanette (Aug 2011). “The development of the olfactory organs in newly hatched monotremes and neonate marsupials”. J. Anat. 219 (2): 229–242. doi:10.1111/j.1469-7580.2011.01393.x. PMC 3162242 . 
  • ^ Sea World, Sharks & Rays; accessed 2013.09.09.
  • ^ a b c d Attenborough, David (1990). The Trials of Life. pp. 26–30. ISBN 9780002199124. 
  • ^ Adams, Kye R.; Fetterplace, Lachlan C.; Davis, Andrew R.; Taylor, Matthew D.; Knott, Nathan A. (January 2018). “Sharks, rays and abortion: The prevalence of capture-induced parturition in elasmobranchs”. Biological Conservation. 217: 11–27. doi:10.1016/j.biocon.2017.10.010. 
  • ^ “Birth and care of young”. Animals: Sharks and rays. Busch Entertainment Corporation. Archived from the original on August 3, 2013. Retrieved 2013-08-28. 
  • ^ Stebbins, Robert C.; Cohen, Nathan W. (1995). A Natural History of Amphibians. Princeton University Press. pp. 172–173. ISBN 978-0-691-03281-8. 
  • ^ Stebbins, Robert C.; Cohen, Nathan W. (1995). A Natural History of Amphibians. Princeton University Press. p. 204. ISBN 978-0-691-03281-8. 
  • ^ Capinera, John L., Encyclopedia of entomology. Springer Reference, 2008, p. 3311.
  • ^ Costa, James T., The Other Insect Societies. Belknap Press, 2006, p. 151.
  • ^ Dennis, Carina (2008-05-28). “Nature News: The oldest pregnant mum: Devonian fossilized fish contains an embryo”. Nature. 453 (7195): 575. Bibcode:2008Natur.453..575D. doi:10.1038/453575a. 
  • ^ Long, John A.; Trinastic, Kate; Young, Gavin C.; Senden, Tim (2008-05-28). “Live birth in the Devonian period”. Nature. 453 (7195): 650–652. Bibcode:2008Natur.453..650L. doi:10.1038/nature06966. PMID 18509443. 
  • ^ Blackburn DG, Flemming AF (2012). “Invasive implantation and intimate placental associations in a placentotrophic African lizard, Trachylepis ivensi (scincidae)”. J. Morphol. 273 (2): 137–59. doi:10.1002/jmor.11011. PMID 21956253. 
  • ^ Blackman, Roger L (1979). “Stability and variation in aphid clonal lineages”. Biological Journal of the Linnean Society. 11 (3): 259–277. doi:10.1111/j.1095-8312.1979.tb00038.x. ISSN 1095-8312. 
  • ^ Conrad, Jim (2011-12-10). “The aphid life cycle”. The Backyard Nature Website. Retrieved 2013-08-31. 
  • Cited texts[edit]

    • “Intrapartum care: Care of healthy women and their babies during childbirth”. NICE. September 2007. Archived from the original on 2014-04-26. 


    Several birth

    “Triplets” redirects here. For other uses, see Triplet.

    Identical triplet brothers at graduation. Identical triplets are extremely rare.

    A multiple birth is the culmination of one multiple pregnancy, wherein the mother delivers two or more offspring. A term most applicable to placental species, multiple births occur in most kinds of mammals, with varying frequencies. Such births are often named according to the number of offspring, as in twins and triplets. In non-humans, the whole group may also be referred to as a litter, and multiple births may be more common than single births. Multiple births in humans are the exception, and can be exceptionally rare in the largest mammals.

    Each single fertilized egg (zygote) may produce a single embryo, or it may split into two or more embryos, each carrying the same genetic material. Fetuses resulting from different zygotes are called fraternal and share only 50% of their genetic material, as ordinary full siblings from separate births do. Fetuses resulting from the same zygote share 100% of their genetic material, and are hence called identical and are always of the same sex (except in cases of Turner syndrome).

    A multiple pregnancy may be the result of the fertilization of a single egg that then splits to create identical fetuses, or it may be the result of the fertilization of multiple eggs that create fraternal fetuses, or it may be a combination of these two. A multiple pregnancy from a single zygote is called monozygotic, from two zygotes is called dizygotic, or from two or more zygotes is called polyzygotic.

    Similarly, the siblings themselves from a multiple birth may be referred to as monozygotic if they are identical, or as polyzygotic if they are fraternal.

    Contents

    • 1 Terminology
    • 2 Human multiple births
      • 2.1 Twins
      • 2.2 Triplets
      • 2.3 Quadruplets
      • 2.4 Quintuplets
      • 2.5 Sextuplets
      • 2.6 Very high-order multiple births
    • 3 Causes and frequency
    • 4 Risks
      • 4.1 Premature birth and low birth weight
      • 4.2 Cerebral palsy
      • 4.3 Incomplete separation
      • 4.4 Mortality rate (stillbirth)
      • 4.5 Prevention in IVF
    • 5 Management
      • 5.1 Selective reduction
      • 5.2 Care in pregnancy
      • 5.3 Nutrition
      • 5.4 Cesarean section or vaginal delivery
      • 5.5 Neonatal intensive care
    • 6 Society and culture
      • 6.1 Insurance coverage
      • 6.2 Cultural aspects
    • 7 See also
    • 8 References
    • 9 External links

    Terminology[edit]

    Fraternal twins at two weeks old. The technical term for “fraternal” is “polyzygotic”.

    Fraternal twin sisters taking a nap. Nonidentical twins, the most common kind of multiple birth among humans, occur in about 1 out of every 80 pregnancies.

    Terms used for multiple births or the genetic relationships of their offspring:

    • Monozygotic – multiple (typically two) fetuses produced by the splitting of a single zygote
    • Dizygotic – multiple (typically two) fetuses produced by two zygotes
    • Trizygotic – three or more fetuses produced by three zygotes
    • Polyzygotic – multiple fetuses produced by two or more zygotes

    Terms used for the number of offspring in a multiple birth:

    • Two offspring – twins
    • Three offspring – triplets
    • Four offspring – quadruplets
    • Five offspring – quintuplets
    • Six offspring – sextuplets
    • Seven offspring – septuplets
    • Eight offspring – octuplets
    • Nine offspring – nonuplets
    • Ten offspring – decuplets

    See List of Multiple Births

    Human multiple births[edit]

    In humans, the average length of pregnancy (two weeks fewer than gestation) is 38 weeks with a single fetus. This average decreases for each additional fetus: to thirty-six weeks for twin births, thirty-two weeks for triplets, and thirty weeks for quadruplets. With the decreasing gestation time, the risks from immaturity at birth and subsequent viability increase with the size of the sibling group. Only as of the twentieth century have more than four all survived infancy.

    Recent history has also seen increasing numbers of multiple births. In the United States, it has been estimated that by 2011, 36% of twin births and 78% of triplet and higher-order births resulted from conception by assisted reproductive technology.[1]

    Twins[edit]

    Main article: Twin

    Twins are by far the most common form of multiple births in humans. The U.S. Centers for Disease Control and Prevention report more than 132,000 sets of twins out of 3.9 million births of all kinds each year, about 3.4%, or 1 in 30.[2]

    Triplets[edit]

    Identical triplets like these three sisters occur when a single fertilized egg splits in two and then one of the resulting two eggs splits again.

    Play media

    Monoamniotic triplets as seen on ultrasound[3]

    Identical triplets come from a monozygotic pregnancy, three fetuses from one egg. The most common set, strictly fraternal triplets, comes from a polyzygotic pregnancy of three eggs. Between these types, triplets that include an identical (monozygotic) pair of siblings plus a fraternal sibling are the result of a dizygotic pregnancy, where one zygote divides into two fetuses and the other doesn’t.

    Triplets are far less common than twins, according to the U.S. Centers for Disease Control and Prevention, accounting for only about 4300 sets in 3.9 million births, just a little more than 0.1%, or 1 in 1000.[2] According to the American Society of Reproductive Medicine, only about 10% of these are identical triplets: about 1 in ten thousand.[2] Nevertheless, only 4 sets of identical triplets were reported in the U.S. during 2015, about one in a million.[2] According to Victor Khouzami, Chairman of Obstetrics at Greater Baltimore Medical Center, “No one really knows the incidence”.[2]

    Identical triplets or quadruplets are very rare and result when the original fertilized egg splits and then one of the resultant cells splits again (for triplets) or, even more rarely, a further split occurs (for quadruplets). The odds of having identical triplets is unclear. News articles and other non-scientific organizations give odds from one in 60,000 to one in 200 million pregnancies.[2][4][5][6][7][8]

    Quadruplets[edit]

    Quadruplets are much rarer than twins or triplets. As of 2007, there were approximately 3500 sets recorded worldwide. Quadruplet births are becoming increasingly common due to fertility treatments. There are around 70 sets of all-identical quadruplets worldwide. Many sets of quadruplets contain a mixture of identical and fraternal siblings, such as three identical and one fraternal, two identical and two fraternal, or two pairs of identicals. One famous set of identical quadruplets was the Genain quadruplets, all of whom developed schizophrenia. Quadruplets are sometimes referred to as “quads” in Britain.[9]

    Quintuplets[edit]

    The Canadian Dionne sisters, seen in this 1947 photograph, were the first quintuplets known to survive infancy.

    Quintuplets occur naturally in 1 in 55,000,000 births.[10] The first quintuplets known to survive infancy were the all-female Canadian Dionne Quintuplets, born in 1934. Quintuplets are sometimes referred to as “quins” in the UK and “quints” in North America.[11]

    Sextuplets[edit]

    Born in Liverpool, England on 18 November 1983, the Walton sextuplets were the world’s first all-female surviving sextuplets, and the world’s fourth known set of surviving sextuplets. Another well-known set of sextuplets is the Gosselin sextuplets, born May 10, 2004 in Hershey, Pennsylvania.[12] Reality television shows called Jon & Kate Plus 8 and later Kate Plus 8 have chronicled the lives of these sextuplets.

    Very high-order multiple births[edit]

    In 1997, the McCaughey septuplets were born in Carlisle, Iowa. Multiple births of as many as eight babies have been born alive, the first set on record to the Chukwu family in Texas in 1998; one died and seven survived. In 2009, a second set, the Suleman octuplets, were born in Bellflower, California.[13][14] The most recent report that all were still alive shortly before their fifth birthday.[15]

    There have been a few sets of nonuplets (nine) in which a few babies were born alive, though none lived longer than a few days. There have been cases of human pregnancies that started out with ten, eleven, twelve or fifteen fetuses, but no instances of live births. The pregnancies of the 10, 11 and 15 fetuses have all resulted from fertility medications and assisted reproductive technology (ART). However, there has been one documented case when 12 fetuses were conceived naturally.[16][not in citation given]

    Causes and frequency[edit]

    The frequency of N multiple births from natural pregnancies has been given as approximately 1:89N-1 (Hellin’s law) and as about 1:80N-1.[17] This gives:

    • 1:89 (= 1.1%) or 1:80 (= 1.25%) for twins
    • 1:892 (= 1:7921, about 0.013%) or 1:802 (= 1:6400) for triplets
    • 1:893 (= approx. 0.000142%, less than 1:700,000) or 1:803 for quadruplets

    North American dizygotic twinning occurs about once in 83 conceptions, and triplets about once in 8000 conceptions. US figures for 2010 were:[18][19]

    • Twins, 132,562, 3.31%
    • Triplets, 5,503, 0.14%
    • Quadruplets, 313, 0.0078%
    • Quintuplets and more, 37, 0.00092%

    Human multiple births can occur either naturally (the woman ovulates multiple eggs or the fertilized egg splits into two) or as the result of infertility treatments such as IVF (several embryos are often transferred to compensate for lower quality) or fertility drugs (which can cause multiple eggs to mature in one ovulatory cycle).

    For reasons that are not yet known, the older a woman is, the more likely she is to have a multiple birth naturally. It is theorized that this is due to the higher level of follicle-stimulating hormone that older women sometimes have as their ovaries respond more slowly to FSH stimulation.[20]

    The number of multiple births has increased over the last decade. For example, in Canada between 1979 and 1999, the number of multiple birth babies increased 35%. Before the advent of ovulation-stimulating drugs, triplets were quite rare (approximately 1 in 8000 births) and higher-order births much rarer still.[citation needed] Much of the increase can probably be attributed to the impact of fertility treatments, such as in-vitro fertilization. Younger patients who undergo treatment with fertility medication containing artificial FSH, followed by intrauterine insemination, are particularly at risk for multiple births of higher order.

    The Gosselin sextuplets with their parents and sisters, cover of KoreAm, May 2008

    Certain factors appear to increase the likelihood that a woman will naturally conceive multiples. These include:

    • mother’s age: women over 35 are more likely to have multiples than younger women[21]
    • mother’s use of fertility drugs: approximately 35% of pregnancies arising through the use of fertility treatments such as IVF involve more than one child

    The increasing use of fertility drugs and consequent increased rate of multiple births has made the phenomenon of multiples more frequent and hence more visible. In 2004 the birth of sextuplets, six children, to Pennsylvania couple Kate and Jon Gosselin helped them to launch their television series, originally Jon & Kate Plus 8 and (following their divorce) Kate Plus 8, which became the highest-rated show on the TLC network.

    Risks[edit]

    Premature birth and low birth weight[edit]

    Babies born from multiple-birth pregnancies are much more likely to result in premature birth than those from single pregnancies. 51% of twins and 91% of triplets are born preterm, compared to 9.4% in singletons.[22] 14% of twins and 41% of triplets are even born very preterm, compared to 1.7% in singletons.[22]

    At present, there is no way to stop twins being born early.[23] In women with single pregnancies drugs called betamimetics can relax the muscles of the uterus and delay birth.[24] Giving betamimetics can give more time to give steroids, for the baby’s lung development, or to transfer the mother to a hospital with a special care unit.[24]

    However, there is not enough evidence to say whether or not women with twin pregnancies should be given oral betamimetics to reduce the risk of preterm birth.[23] In some studies betamimetics have reduced the rate of preterm labour in twin pregnancies however the studies are too small to draw any solid conclusions.[23] Likewise, putting a stitch in the neck of the womb (a cervical suture) to prevent premature birth has not been shown to work in women carrying more than one baby due to the small sample sizes in the studies.[25]

    The preterm births also result in multiples tending to have a lower birth weight compared to singletons.

    Some evidence[who?] indicates that only 1.10% of singletons are born with a very low birth weight and 10.12% twins and 31.88% triplets were found to be born with very low birth weight. This study[who?] was conducted by looking at the statistics from the U.S. Natality Files (5).

    Among the exceptions are the Kupresak triplets of Mississauga, Ontario, Canada; their combined weight at birth in 2008, of 17 lbs, 2.7 ounces, set a world record.[26]

    Cerebral palsy[edit]

    Cerebral palsy is more common among multiple births than single births, being 2.3 per 1,000 survivors in singletons, 13 in twins, and 45 in triplets in North West England.[27] This is likely a side effect of premature birth and low birth weight.

    Incomplete separation[edit]

    Further information: Twin § Degree of separation

    Multiples may be monochorionic, sharing the same chorion, with resultant risk of twin-to-twin transfusion syndrome. Monochorionic multiples may even be monoamniotic, sharing the same amniotic sac, resulting in risk of umbilical cord compression and nuchal cord. In very rare cases, there may be conjoined twins, possibly impairing function of internal organs.

    Mortality rate (stillbirth)[edit]

    Multiples are also known to have a higher mortality rate. It is more common for multiple births to be stillborn, while for singletons the risk is not as high. A literary review on multiple pregnancies shows a study done on one set each of septuplets and octuplets, two sets of sextuplets, 8 sets of quintuplets, 17 sets of quadruplets, and 228 sets of triplets. By doing this study, Hammond found that the mean gestational age (how many weeks when birthed) at birth was 33.4 weeks for triplets and 31 weeks for quadruplets. This shows that stillbirth happens usually 3–5 weeks before the woman reaches full term and also that for sextuplets or higher it almost always ends in death of the fetuses.[28] Though multiples are at a greater risk of being stillborn, there is inconclusive evidence whether the actual mortality rate is higher in multiples than in singletons.

    Prevention in IVF[edit]

    Today many multiple pregnancies are the result of in vitro fertilisation (IVF). In a study in 1997 of 2,173 embryo transfers performed as part of in vitro fertilisation (IVF), 34% were successfully delivered pregnancies.[29] The overall multiple pregnancy rate was 31.3% (24.7% twins, 5.8% triplets, and .08% quadruplets).[29] Because IVFs are producing more multiples, a number of efforts are being made to reduce the risk of multiple births- specifically triplets or more. Medical practitioners are doing this by limiting the number of embryos per embryo transfer to one or two. That way, the risks for the mother and fetuses are decreased.

    The appropriate number of embryos to be transferred depends on the age of the woman, whether it is the first, second or third full IVF cycle attempt and whether there are top-quality embryos available. According to a guideline from The National Institute for Health and Care Excellence (NICE) in 2013, the number of embryos transferred in a cycle should be chosen as in following table:[30]

    Also, it is recommended to use single embryo transfer in all situations if a top-quality blastocyst is available.[30]

    Management[edit]

    Bed rest has not been found to change outcomes and therefore is not generally recommended outside of a research study.[31]

    Selective reduction[edit]

    Main article: Selective reduction

    Selective reduction is the termination of one or more, but not all, of the fetuses in a multiple pregnancy. This is often done in pregnancies with multiple gestations to increase the likelihood that one child may live a healthy life. Armour[32] reported a loss rate of 5.4% in a review of 1,000 cases of selective reduction. Fifteen percent of the losses occurred within 4 weeks of the procedures and more than 50% occurred after 8 weeks. This suggests that the reduction was successful at reducing the embryos from multiple gestations to single.

    Though selective reduction seems to be effective, mothers of multiples who undergo this procedure are at a higher risk of miscarrying compared to that of an unreduced multiple pregnancy. A study done by looking at 158 pregnant women who underwent selective reduction from higher order multiples to twins showed that the mother had a 10.6% chance of miscarriage. Mothers of twin pregnancies without reduction only had a 9.5% chance of miscarriage. A study by Antsaklis[33] showed a small increase in mortality for reduced twin pregnancies versus unreduced twin pregnancies.

    However, there is a lack of good quality research on the risks and benefits of selective reduction procedures.[34] Many parents often find the suggestion of selective termination upsetting particularly if the pregnancy is a result of IVF or they have had difficulty getting pregnant in the past. Background, religious or personal beliefs can all play a part in effecting whether parents want to go through with the procedure and could be the reason why research in this area is scarce.[34]

    Competition among fertility clinics does not appear to increase rates of multiple births from fertility treatment by promoting more aggressive embryo transfer decisions.[35]

    Care in pregnancy[edit]

    Women with a multiple pregnancy are usually seen more regularly by midwives or doctors than those with singleton pregnancies because of the higher risks of complications.[36] However, there is currently no evidence to suggest that specialised antenatal services produce better outcomes for mother or babies than ‘normal’ antenatal care. [37]

    Nutrition[edit]

    As preterm birth is such a risk for women with multiple pregnancies, it has been suggested that these women should be encouraged to follow a high-calorie diet to increase the birth weights of the babies. Evidence around this subject is not yet good enough to advise women to do this because the long term effects of the high-calorie diets on the mother are not known.[38]

    Cesarean section or vaginal delivery[edit]

    A study in 2013 involving 106 participating centers in 25 countries came to the conclusion that, in a twin pregnancy of a gestational age between 32 weeks 0 days and 38 weeks 6 days, and the first twin is in cephalic presentation, planned Cesarean section does not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal disability, as compared with planned vaginal delivery.[39] In this study, 44% of the women planned for vaginal delivery still ended up having Cesarean section for unplanned reasons such as pregnancy complications. In comparison, it has been estimated that 75% of twin pregnancies in the United States were delivered by Cesarean section in 2008.[40] Also in comparison, the rate of Cesarean section for all pregnancies in the general population varies between 40% and 14%.[41]

    Fetal position (the way the babies are lying in the womb) usually determines if they are delivered by caesarean section or vaginally. A review of good quality research on this subject found that if the twin that will be born first (i.e. is lowest in the womb) is head down there is no good evidence that caesarean section will be safer than a vaginal birth for the mother or babies.[42]

    Monoamniotic twins (twins that form after the splitting of a fertilised egg and share the same amniotic fluid sac) are at more risk of complications than twins that have their own sacs. There is also insufficient evidence around whether to deliver the babies early by caesarean section or to wait for labour to start naturally while running checks on the babies’ wellbeing.[43] The birth of this type of twins should therefore be decided with the mother and her family and should take into account the need for good neonatal care services.[44]

    Cesarean delivery is needed when first twin is in non cephalic presentation or when it is a monoamniotic twin pregnancy.

    Neonatal intensive care[edit]

    Multiple-birth infants are usually admitted to neonatal intensive care immediately after being born. The records for all the triplet pregnancies managed and delivered from 1992-1996 were looked over to see what the neonatal statistics were. Kaufman[45] found from reviewing these files that during a five-year period, 55 triplet pregnancies, which is 165 babies, were delivered. Of the 165 babies 149 were admitted to neonatal intensive care after the delivery.

    Society and culture[edit]

    A women bearing 9 or 11 children, Prodigiorum ac ostentorum chronicon, 1557, by Conrad Lycosthenes

    Insurance coverage[edit]

    A study by the U.S. Agency for Healthcare Research and Quality found that, in 2011, pregnant women covered by private insurance in the United States were older and more likely to have multiple gestation than women covered by Medicaid.[46]

    Cultural aspects[edit]

    Certain cultures consider multiple births a portent of either good or evil.[47]

    Mayan culture saw twins as a blessing, and was fascinated by the idea of two bodies looking alike. The Mayans used to believe that twins were one soul that had fragmented.[citation needed]

    In Ancient Rome, the legend of the twin brothers who founded the city (Romulus and Remus) made the birth of twin boys a blessing, while twin girls were seen as an unlucky burden, since both would have to be provided with an expensive dowry at about the same time.

    Beatrix with her seven swan-children, in the Knight of the Swan romance (Talbot Shrewsbury Book)

    In Greek mythology, fraternal twins Castor and Polydeuces, and Heracles and Iphicles, are sons of two different fathers. One of the twins (Polydeuces, Heracles) is the illegitimate son of the god Zeus; his brother is the son of their mother’s mortal husband. A similar pair of twin sisters are Helen (of Troy) and Clytemnestra (who are also sisters of Castor and Polydeuces). The theme occurs in other mythologies as well, and is called superfecundation.

    In certain medieval European chivalric romances, such as Marie de France’s Le Fresne, a woman cites a multiple birth (often to a lower-class woman) as proof of adultery on her part; while this may reflect a widespread belief, it is invariably treated as malicious slander, to be justly punished by the accuser having a multiple birth of her own, and the events of the romance are triggered by her attempt to hide one or more of the children.[48] A similar effect occurs in the Knight of the Swan romance, in the Beatrix variants of the Swan-Children; her taunt is punished by giving birth to seven children at once, and her wicked mother-in-law returns her taunt before exposing the children.[49]

    See also[edit]

    • Biological reproduction
    • Conjoined twins
    • The Loud House a 2016 animated series, the character Rita Loud was the mother of eleven children.
    • Half a Dozen Babies a 1999 drama film, about the 1993 born Dilley sextuplets.
    • List of multiple births
    • List of twins
    • Only child
    • Superfecundation (multiple pregnancy resulting from separate sexual intercourses)
    • Twin
    • Feodor Vassilyev

    References[edit]

  • ^ 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. doi:10.1056/NEJMoa1301467. PMID 24304051. 
  • ^ a b c d e f Cohn, Meredith (October 23, 2015). “Rare identical triplets born to Baltimore couple”. Baltim. Sun. Retrieved October 23, 2015. 
  • ^ “UOTW #19 – Ultrasound of the Week”. Ultrasound of the Week. 23 September 2014. Retrieved 27 May 2017. 
  • ^ Keating, Caitlin (January 10, 2015). “1 in a Million Chance: Minnesota Mom Welcomes Identical Triplets”. People. Retrieved January 15, 2015. 
  • ^ “Rare identical triplets born in Austria”. Vienna. Reuters. August 8, 2007. Retrieved January 15, 2015. 
  • ^ Mohney, Gillian (December 5, 2013). “Identical Triplets, Conceived without Fertility Drugs, are ‘One in a Million'”. ABC News. Retrieved January 15, 2015. 
  • ^ Fierro, Pamela Prindle (December 15, 2014). “Identical Triplets”. About.com. Retrieved 15 January 2015. 
  • ^ “Mothers of Supertwins: Supertwins Statistics”. Archived from the original on January 18, 2015. Retrieved January 15, 2015. 
  • ^ Oxford English Dictionary, 2nd ed.: “quads” used for “quadruplets”
  • ^ Multiples in pregnancy – twins triplets quads identical and fraternal development information. Baby2see.com. Retrieved on 2015-04-15.
  • ^ Oxford English Dictionary, 2nd ed.: “quads” used for “quadruplets” and “quins” for “quintuplets” in various senses
  • ^ http://news.psu.edu/story/215904/2004/05/10/day-after-mothers-day-gosselin-sextuplets-arrive
  • ^ US woman gives birth to octuplets, BBC
  • ^ Octuplets born in Bellflower, LA Times
  • ^ 8 facts about ‘Octomom’ Nadya Suleman
  • ^ Facts About Multiples
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  • ^ National Center for Health Statistics – Multiple Births
  • ^ National Vital Statistics Reports, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Volume 61, Number 1, August 28, 2012, Births: Final Data for 2010
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  • ^ “Multiple Pregnancy – ACOG”. www.acog.org. Retrieved 2016-01-13. 
  • ^ a b Alexander G., Kogan M., Martin J., Papiernik E. (1998). “What are the fetal growth patterns of singletons, twins, and triplets in the United States?”. Clinical Obstetrics and Gynecology. 41 (1): 114–125. CS1 maint: Multiple names: authors list (link) Note: This study was done by looking at the 1991–1995 U.S. Natality Files, which were received from the National Center for Health Statistics
  • ^ a b c Yamasmit, W; Chaithongwongwatthana, S; Tolosa, JE; Limpongsanurak, S; Pereira, L; Lumbiganon, P (8 December 2015). “Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy”. The Cochrane Database of Systematic Reviews. 12: CD004733. doi:10.1002/14651858.CD004733.pub4. PMID 26645888. 
  • ^ a b Neilson, JP; West, HM; Dowswell, T (5 February 2014). “Betamimetics for inhibiting preterm labour”. The Cochrane Database of Systematic Reviews. 2: CD004352. doi:10.1002/14651858.CD004352.pub3. PMID 24500892. 
  • ^ Rafael, TJ; Berghella, V; Alfirevic, Z (10 September 2014). “Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy”. The Cochrane Database of Systematic Reviews. 9: CD009166. doi:10.1002/14651858.CD009166.pub2. PMID 25208049. 
  • ^ Le, Julia (26 July 2011). “Scale-tipping triplets set world record”. Mississauga News. Mississauga ON. Retrieved 26 July 2011. ; note that the record wasn’t confirmed until July 2011.
  • ^ Pharoah PO, Cooke T (1996). “Cerebral palsy and multiple births”. Arch. Dis. Child. Fetal Neonatal Ed. 75 (3): F174–7. doi:10.1136/fn.75.3.f174. PMC 1061194 . PMID 8976682. Note: They conducted a study by looking at the registered births of babies born with cerebral palsy during the periods of 1982-1989 in the counties of Merseyside and Cheshire. 
  • ^ Hammond KR (1998). “Multifetal pregnancy reduction”. J Obstet Gynecol Neonatal Nurs. 27 (3): 338–43. doi:10.1111/j.1552-6909.1998.tb02657.x. PMID 9620827. 
  • ^ a b Elsner CW, Tucker MJ, Sweitzer CL, Brockman WD, Morton PC, Wright G, Toledo AA (1997). “Multiple pregnancy rate and embryo number transferred during in vitro fertilization”. Am. J. Obstet. Gynecol. 177 (2): 350–5; discussion 355–7. PMID 9290450. 
  • ^ a b Fertility: assessment and treatment for people with fertility problems. NICE clinical guideline CG156 – Issued: February 2013
  • ^ McCall, CA; Grimes, DA; Lyerly, AD (June 2013). “”Therapeutic” bed rest in pregnancy: unethical and unsupported by data”. Obstetrics and gynecology. 121 (6): 1305–8. doi:10.1097/aog.0b013e318293f12f. PMID 23812466. 
  • ^ Armour KL, Callister LC (2005). “Prevention of triplets and higher order multiples: trends in reproductive medicine”. J Perinat Neonatal Nurs. 19 (2): 103–11. doi:10.1097/00005237-200504000-00006. PMID 15923959. 
  • ^ Antsaklis A, Drakakis P, Vlazakis G, Michalas S (1998). “Reduction of multifetal pregnancies to twins does not increase obstetrics or perinatal risks”. Human Reproduction. 14 (5): 1338–1340. doi:10.1093/humrep/14.5.1338. 
  • ^ a b Dodd, JM; Dowswell, T; Crowther, CA (4 November 2015). “Reduction of the number of fetuses for women with a multiple pregnancy”. The Cochrane Database of Systematic Reviews. 11: CD003932. doi:10.1002/14651858.CD003932.pub3. PMID 26544079. 
  • ^ Henne MB, Bundorf MK (April 2010). “The effects of competition on assisted reproductive technology outcomes”. Fertil. Steril. 93 (6): 1820–30. doi:10.1016/j.fertnstert.2008.02.159. PMID 18442821. 
  • ^ Dodd, JM; Dowswell, T; Crowther, CA (6 November 2015). “Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes”. The Cochrane Database of Systematic Reviews. 11: CD005300. doi:10.1002/14651858.CD005300.pub4. PMID 26545291. 
  • ^ Dodd JM, Dowswell T, Crowther CA (2015). “Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes”. Cochrane Database Syst Rev (11): CD005300. doi:10.1002/14651858.CD005300.pub4. PMID 26545291. 
  • ^ Bricker, L; Reed, K; Wood, L; Neilson, JP (24 November 2015). “Nutritional advice for improving outcomes in multiple pregnancies”. The Cochrane Database of Systematic Reviews. 11: CD008867. doi:10.1002/14651858.CD008867.pub3. PMID 26599328. 
  • ^ Barrett JF, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA, Gafni A, Joseph KS, Mason D, Ohlsson A, Ross S, Sanchez JJ, Asztalos EV (2013). “A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy”. New England Journal of Medicine. 369 (14): 1295–1305. doi:10.1056/NEJMoa1214939. PMC 3954096 . PMID 24088091. 
  • ^ Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ (2011). “Trends in Cesarean Delivery for Twin Births in the United States”. Obstetrics & Gynecology. 118 (5): 1095–101. doi:10.1097/AOG.0b013e3182318651. PMC 3202294 . PMID 22015878. 
  • ^ Women can choose Caesarean birth – BBC article by James Gallagher. 2011.
  • ^ Hofmeyr, GJ; Barrett, JF; Crowther, CA (19 December 2015). “Planned caesarean section for women with a twin pregnancy”. The Cochrane Database of Systematic Reviews. 12: CD006553. doi:10.1002/14651858.CD006553.pub3. PMC 4110647 . PMID 26684389. 
  • ^ Shub, A; Walker, SP (23 April 2015). “Planned early delivery versus expectant management for monoamniotic twins”. The Cochrane Database of Systematic Reviews. 4: CD008820. doi:10.1002/14651858.CD008820.pub2. PMID 25906204. 
  • ^ Shub, A; Walker, SP (23 April 2015). “Planned early delivery versus expectant management for monoamniotic twins”. The Cochrane Database of Systematic Reviews. 4: CD008820. doi:10.1002/14651858.CD008820.pub2. PMID 25906204. 
  • ^ Kaufman GE, Malone FD, Harvey-Wilkes KB, Chelmow D, Penzias AS, D’Alton ME (1998). “Neonatal morbidity and mortality associated with triplet pregnancy”. Obstet Gynecol. 91 (3): 342–8. doi:10.1016/s0029-7844(97)00686-8. PMID 9491857. 
  • ^ Moore JE, Witt WP, Elixhauser A (April 2014). “Complicating Conditions Associate With Childbirth, by Delivery Method and Payer, 2011”. HCUP Statistical Brief #173. Rockville, MD: Agency for Healthcare Research and Quality. 
  • ^ “Korea’s ‘lucky’ triplets seized”. Herald Sun. Fairfax. 2003-03-30. 
  • ^ Laura A. Hibbard, Medieval Romance in England p295, 244 New York Burt Franklin,1963
  • ^ Laura A. Hibbard, Medieval Romance in England p239, 243 New York Burt Franklin,1963
  • External links[edit]

    • Facts About Multiples
    • HFEA consultation on multiple births after IVF
    • D. L. Ashliman, Multiple Births in Legend and Folklore
    • Twins and Multiple Births Association

    Childbirth

    Postpartum

    Obstetric history

    • Gravidity
    • Parity
    • TPAL


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