Discovering you're pregnant with twins, triplets or higher-order multiples is exciting and overwhelming news that may come with many questions and concerns. Multiple-birth pregnancies may require more monitoring than single pregnancies since they are considered high-risk, but with the right team, most families experience healthy and uneventful pregnancies.
At The Ohio State Wexner Medical Center in Columbus, Ohio, our Maternal Fetal Medicine physicians specialize in high-risk pregnancies, including multiple births. They’ll walk you through every step – from finding out you’re having more than one baby, to recommending prenatal tests, to providing any additional support you may need during labor and delivery.
What are multiple-birth pregnancies?
Becoming pregnant with more than one baby at a time is called a multiple-birth pregnancy. This can include twins, triplets or higher-order multiples. Each year, 3.4% of births in Ohio are twins or multiples. Types of multiple births include:
- Non-identical twins: In most cases, multiple pregnancies are the result of more than one egg that becomes fertilized at the same time. Non-identical, or dizygotic twins, have their own placentas and amniotic sacs.
- Identical twins: When one fertilized egg splits, this is called monozygotic. Identical twins share the same chromosomes and may share a placenta or even an amniotic sac, depending on when the embryo divides. In extremely rare cases of only about one in every 8,000 pregnancies, identical twins share one sac. This is called monochorionic-monoamniotic twins, known as MoMo twins, which is a very high-risk pregnancy. This is because the umbilical cord could get tangled, limiting or cutting off blood flow to one or both babies.
Specialty maternity care for high-risk MoMo twin pregnancy
Madison Feinberg and her husband, Chad, had a rare high-risk pregnancy. Their twins shared the same amniotic sac and placenta, which could cause the babies to develop at different rates, among other dangers. At the Ohio State Wexner Medical Center, Feinberg and the identical twins were closely monitored by physicians who specialize in high-risk pregnancies.
What increases the odds of having twins?
Over the last 30 years, there's been an increase in the number of twins born. Learn what factors increase your chances of having twins.
How we monitor multiple-birth pregnancies
Monitoring your pregnancy helps to identify any possible problems early – often improving the outcome for you and your babies. This specialized care may include:
- More frequent ultrasounds, as frequently as every one to two weeks depending on the type of multiples you’re having
- Additional prenatal screenings for complications of multiple pregnancies (typically with ultrasound)
- Universal cervical-length screening at the time of anatomic ultrasound to assess your risk for preterm birth
- Fetal heart rate monitoring, typically with nonstress testing, at least weekly in the third trimester
- Collaborative care between obstetricians, Maternal-Fetal Medicine physicians and neonatologists, including identifying the best way to deliver and the best location at which to deliver
What may increase your chances of a multiple-birth pregnancy?
Most multiple pregnancies happen for natural reasons, meaning you have no control over their occurrence. Some factors that may increase the likelihood of a multiple pregnancy include:
- Fertility treatment: Reproductive and infertility treatment, like in vitro fertilization (IVF), can raise the possibility of having twins or another type of multiple-birth pregnancy.
- Maternal age: There’s an increased risk of having twins as you age because your body is more likely to release multiple eggs at the same time.
- Family history: Twins are more common in some families, which is linked to the parent whose body releases the egg. There may be an underlying genetic factor that predisposes someone to release more than one egg at a time.
Are multiple-birth pregnancies always considered high-risk?
Not every multiple pregnancy leads to complications, but they do require closer monitoring. Carrying more than one baby increases the physical demands on your body and the likelihood of early delivery. This is why you may be referred to one of our high-risk pregnancy doctors in our Maternal-Fetal Medicine department, to ensure that you and your babies remain safe throughout the pregnancy.
“High-risk” simply means you benefit from more frequent checkups and a team skilled in managing multiples. Across the state and even nationally, our experts are highly trusted to care for families expecting multiple babies and to achieve the best possible outcomes.
Does having a high-risk pregnancy mean I will have a C-section?
While a multiple-birth pregnancy does increase your chance of needing to deliver your babies by cesarean delivery, many women still give birth to twins vaginally.
You may need a C-section if your babies aren’t facing head-down, or if they show any other signs of complication. Your doctor will discuss your delivery with you to determine what’s best for you and your babies.
We prioritize your safety and your babies’ safety while also including parents’ choice in the overall care decision. We have a “team birth” approach to delivery that not only ensures you stay informed throughout the delivery and birth, but it also keeps you in charge of your own healthcare. At every check-in, your preferences are prioritized in the plan of care.
What complications could be associated with having twins or triplets?
If you’re pregnant with multiples, your provider will monitor you and your babies for these complications:
Maternal complications
- Gestational diabetes
- Gestational high blood pressure and preeclampsia
- Anemia
- Preterm labor
- Higher chance of postpartum hemorrhage
Fetal complications
- Preterm birth and low birth weight
- One baby grows slower than the other
- Complications from fetal blood-sharing between babies
- Cord entanglement in MoMo twins
- A stay in the neonatal intensive care unit (NICU)
When to call your provider
Contact your provider immediately if you experience:
- Persistent abdominal pain
- Vaginal bleeding
- Contractions before 37 weeks
Your doctor may recommend you visit our Obstetric Emergency Department, which is located in Labor and Delivery on the 23rd floor of University Hospital.
Why trust Ohio State with your multiple-birth pregnancy care?
As the only Level IV Maternity Center in central Ohio, we are highly sought for high-risk pregnancy care, and we’re equipped to handle any urgent situation or complex issue that may occur during your pregnancy, labor or postpartum stay. Our high-risk pregnancy physicians treat more high-risk pregnancies than any other hospital in central Ohio and are nationally renowned for achieving the best possible outcomes. Other reasons people choose us include:
- Collaborative approach – Our teams of high-risk obstetricians, certified nurse-midwives, generalists, anesthesiologists and nursing staff all collaborate to give you the best possible prenatal, delivery and postpartum experience. We also work closely with Nationwide Children’s Hospital, which we partner with to manage our NICU.
- State-of-the-art amenities – Our new Maternity Center is located in the stunning new tower that opened in early 2026. With private rooms, floor-to-ceiling windows and views of campus, parents who are expecting multiples give birth and recover in a comfortable, healing and luxurious space. The Labor and Delivery rooms are designed to be large enough to accommodate families delivering multiple babies.
- Expert newborn and NICU care – Following delivery, our unit is designed to keep you and your babies together, even if one of you needs more complex care. If your babies do require time in our Level III NICU, we welcome you to visit 24/7 and have rooms equipped to handle multiple babies. Our goal is to allow parents to be involved in their babies’ care from day one – doing skin-to-skin care and taking care of their needs.