A mom-to-be of triplets documented her growing belly on social media, sparking conversation about the differences between multiple and singelton births.

By Amanda MacMillan
September 25, 2018

When Maria Jorstad found out she was expecting triplets earlier this year, she decided to document her unusual pregnancy on Instagram so her friends and family could follow along. “But also because triplets are such a rare thing, I thought people would find it interesting,” the 36-year-old, who lives in Copenhagen, told HuffPost via email earlier this month.

“Find it interesting” turned out to be an understatement, as Jorstad’s triplets_of_copenhagen account gathered more than 200,000 followers. A video she posted during her 33rd week of pregnancy—showing from all sides just how large and heavy her baby bump had grown—received more than 300,000 views and 2,500 comments.

Jorstad’s social media posts have certainly generated lots of conversation about being pregnant with multiples—not only about what it means for the babies, but for the mother, as well. (Even after delivering the triplets earlier this month, at 35 weeks, Jorstad has continued posting updates about her babies and her body.)

To learn more about how pregnancy—as well as delivery and recovery—are different for moms of multiples, we looked at the research and spoke with several experts. Here’s what they want everyone to know about giving birth to twins, triplets, and more.

RELATED: 17 Things No One Tells You About Recovering From Childbirth

Multiple births are on the rise

The number of multiple births in the United States has increased steadily over the last several decades, growing from about 20 sets per 1,000 live births in the 1980s to almost 35 sets per 1,000 in the 2010s. That’s according to a recent Brown University study published in the journal Obstetrics & Gynecology.

In 2016, the Centers for Disease Control and Prevention (CDC) reports, there were 131,723 twin births in the United States—a rate of 33.4 per 1,000 live births. Multiples higher than two are much less common: The same year brought only 3,755 triplet births, 217 quadruplet births, and 31 quintuplet and higher-order births.

Older moms may be partially responsible

The jump in multiple births is often attributed to more women using in vitro fertilization to get pregnant. But Alan Copperman, MD, a clinical professor of obstetrics, gynecology, and reproductive services at Mt. Sinai Icahn School of Medicine, says that advances in reproductive technology mean that twins and triplets are no longer a common byproduct of the procedure.

“For many years, we would give women fertility meds and they would make a whole bunch of eggs, and we didn’t always know which would be the healthy one,” he says. “The feeling was that it was better to overdo it than to just pick one that wouldn’t be viable, and so sometimes women ended up with two or three or more fertilized eggs.”

That’s changed in the last few years, Dr. Copperman says. “Now we have entered this molecular age of medicine where we can sequence an embryo, and the IVF twins and triplets and octuplets of five or 10 years ago are almost now completely gone.”

What does seem to be a factor, say the authors of the Brown University study mentioned above, is that women are waiting longer to have kids. It’s well known in the medical community that older women are more likely to have twins naturally, but this study was the first to look at this phenomenon as it relates to the increase in multiple births over time.

In fact, the researchers found that by the time women in their study reached 35, they were three to four times more likely to have twins than younger moms—without the use of reproductive technology. They were also four and a half times more likely to have triplets, and six and a half times more likely to have quadruplets.

More babies means a greater physical burden

Even carrying one fetus during a singleton pregnancy can be physically stressful for a mom-to-be. And during a multiple pregnancy, that stress can be, well, multiplied. “Your body does take a hit, and the more babies you’re carrying the harder it can be,” says Christine Greves, MD, an obstetrician and gynecologist at Orlando Health System.

“As the belly gets bigger and bigger, that demonstrates a significant amount of asymmetry,” says Dr. Greves, “which can affect your balance and your ability to walk and carry yourself the way you normally do.” (Jorstad posted during her 35th week that her bump had grown to 20 kilograms, or about 44 pounds.) A woman’s muscles, particularly those in her back, legs, and glutes, can become strained from carrying multiple babies, she adds, while other muscles have to compensate.

On top of that, it can be extremely uncomfortable to move around with such a large baby bump. At 33 weeks, Jorstad wrote on Instagram that she was “reaching [her] limits” and trying to “move as little as possible” until her scheduled delivery date. “The babies are kicking hard and moving around all day and night, to great discomfort,” she wrote. “And my belly feels so full and stretched; I literally have to lift it with my hands to be able to turn over in bed.”

It also means a riskier pregnancy

With the right care and guidance, women who are pregnant with multiples can and do deliver healthy infants, says Dr. Copperman. (Jorstad, fortunately, is a great example of that.) But it’s also important to understand that pregnancies with multiples are riskier than singleton pregnancies, both for the babies and for the mom-to-be.

“Women who are pregnant with multiples get bigger sooner, and they are often cared for by a high-risk specialist who will monitor them with increased surveillance,” says Dr. Copperman. Moms of multiples are at increased risk of delivering prematurely, before their babies are fully developed, so a doctor may conduct regular cervical-length screenings to check for early warning signs. It’s also common for them to be put on bed rest, which can reduce the chances of going into labor too early.

Pregnancies with multiples also carry higher odds of the mother developing complications such as severe morning sickness, gestational diabetes, and preeclampsia, a dangerous form of high blood pressure that can occur during or after pregnancy. Blood loss during delivery can also be higher, regardless of whether it’s a C-section or a vaginal birth.

RELATED: 8 Unexpected Ways Your Body Might Change After You Have a Baby

Multiples are almost always delivered early

Even when a multiple pregnancy goes smoothly, delivery is usually scheduled before the 40th week. Experts say the best time to deliver twins, for example, is at 37 weeks gestation (or at 36 weeks if the babies share a placenta) to reduce the risk of stillbirth and complications. Triplets and higher-order multiples are usually delivered even earlier.

That often means that multiples tend to be smaller when they’re delivered, and they may need extra care in the hospital. That was the case with Jorstad’s triplets, despite her generally healthy pregnancy: The babies spent nine days in the neonatal intensive care unit before going home earlier this week.

C-sections are much more common

Vaginal births can be safe, and do happen, for some twin deliveries. (“If both heads are down and the babies are cooperating and the placenta’s in the right position, we love to try for vaginal delivery,” Dr. Greves said in a previous interview.) But the more babies a woman is birthing at once, the more likely it is that she’ll have a C-section.

That being said, it’s not unheard of for mothers of triplets to deliver vaginally. A 1998 Scandinavian study compared the outcomes of 16 triplet births at a hospital in Sweden—nine women who delivered vaginally and seven with C-section. Based on adjusted mortality rates, the authors determined that C-section was “not superior,” and that vaginal delivery “may be suggested” for triplet births when there are no obvious additional complications.

RELATED: What Really Happens During a C-Section

Recovery can be harder

Physically, a woman who’s just carried and given birth to multiple babies may have a harder time recovering after she gets home from the hospital—whether she had a C-section or not. Some moms of multiples have to go on bed rest or cut back on exercise toward the end of their pregnancy, which can make getting back in shape take longer and feel more daunting.

Plus, these women’s bodies have gone through extreme changes over the past few months. “Their skin may certainly stretch more, and it can take longer for their body to get back to the way it was before,” says Dr. Greves. A woman’s uterus also takes time to shrink back to normal, especially after carrying multiple babies.

Jorstad has already posted a few photos of her post-babies belly, which she says is “really weird looking” and “still quite heavy.” She commented that she’d like to get a belly band to support the sagging tissue, which also makes her C-section scar hurt.

Breastfeeding can be more difficult, too

When it comes to breastfeeding multiples, “it can be difficult, but I have moms who do it,” says Dr. Greves. Staying hydrated is important for producing enough milk for two or more babies, she says, and “pumping is helpful as well, if you’re trying to tag team.” (Former Health contributing editor and mom of twins Kristin McGee agrees; here’s her take on how she nursed her two sons at once.)

Breastfeeding can also have a rewarding side effect for moms of multiples, adds Dr. Greves. “You gain more weight when you’re pregnant with more babies,” she says, “and breastfeeding can help you burn 500 calories a day.”

Moms (and moms-to-be) of multiples need extra support

Finding out that you’re pregnant with multiples can be quite a shock—and it’s easy to feel overwhelmed, both during your pregnancy and after you give birth, says Dr. Greves. “It’s important to validate the joy that comes with having twins or triplets, and recognize that, yes, this is really cool,” she says. “But also recognize this is also more risky to the patient and to her babies, and it’s also going to be harder.”

“I think more than anything, these women need emotional support and to be surrounded by people they love,” she adds. “And they need more especially after they give birth and they’ve got two or three—or more—babies to take care of.”

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