“Ms. Celine Dion has been admitted … for observation at the recommendation of her doctors. …She has been admitted to prevent the early delivery of her babies, which is the standard of care for any patient with twin pregnancy in this clinical setting.”

The twin boys are due in November and the result of in-vitro fertilization.

In the previous article about the baby “boomlet” amongst middle aged celebrity moms, we talked about the risks of pregnancy after age 40. Today will will talk a little about risks of multiple births, and what can be done to prevent premature delivery.

Preterm labor (also called premature labor) is labor that begins before 37 weeks of pregnancy. Because the fetus is not fully grown at this time, it may not be able to survive outside the womb. Health care providers will often take steps to try to stop labor if it occurs before this time. A baby born before 37 weeks of pregnancy is considered a preterm birth (or premature birth). Preterm births occur in about 12 percent of all pregnancies in the U.S. It is one of the top causes of infant death in this country. For more information about very premature infants, see our story about Josie Duggar.

Women are at greatest risk for premature labor if:

• They are pregnant with multiples
• They have had a previous premature birth
• They have certain uterine or cervical abnormalities (sometimes called an “incompetent cervix”) where the cervix is more likely to open early

What are possible treatments to prevent premature labor from starting or continuing?

• Bedrest: Bed rest decreases pressure on the cervix and increases blood flow to the placenta. Although there is no evidence that long-term bed rest lowers the risk of preterm delivery, a doctor may advise a patient to take it easy and try to rest as much as possible. Studies have shown that strict bed rest for 3 days or more may increase the risk of getting a blood clot in the legs or lungs.
• Tocolytics: Tocolytics are anti-contraction medications, which relax the muscles of the uterus. They include drugs such as magnesium sulfate, Ritodrine, and Nifedipine. These medication do not completely eliminate contractions, and are frequently used to delay delivery by a few days in order so that corticosteroids can be given to help mature the baby quickly.
• Corticosteroid is a medication given 24-48 hours before birth to help accelerate the baby’s lung and brain maturity.
• Cervical cerclage: Cerclage is the placement of stitches in the cervix to hold it closed. It is rarely done. Cerclage is meant to stop the cervix from opening early, which could lead to miscarriage or preterm birth. It has helped some high-risk pregnancies last longer, but cerclage also has risks including infection or miscarriage. For a woman who has had a preterm birth in the past because her cervix did not stay closed, cervical cerclage may prevent another preterm birth.
• Progesterone: Researchers have had success using a treatment of a specific type of progesterone—called 17P. Progesterone is a hormone that the body makes to support pregnancy. An NICHD Maternal-Fetal Medicine Units (MFMU) Network study, which began in 2003, set out to determine whether injections of 17P could reduce the number of preterm births among women who had already had one preterm birth. The results were remarkable: for women carrying one baby and with a history of preterm delivery, injections of 17P reduced preterm birth by one-third. A similar study was done in women carrying twins and unfortunately the results showed that 17P is not effective at reducing preterm delivery among these women.

While the great majority of multiple pregnancies result in healthy babies, any pregnancy with twins or more is considered high risk. And the more babies, the higher the risk of complications. The greatest risk is that the babies will be delivered prematurely, which increases their chances of health problems. According to the March of Dimes, close to 60 percent of all twins and more than 90 percent of triplets are born prematurely (before 37 weeks). The average twin pregnancy lasts 35 weeks. Triplet pregnancies average 33 weeks, and quad pregnancies average 29 weeks.

Twins and triplets often don’t have a chance to reach a healthy weight before they’re born. While the average single baby weighs 7 pounds at birth, the average twin weighs 5.5 pounds. Triplets typically weigh 4 pounds each, and quads weigh 3 pounds each. Babies with low birth weights are likely to have health problems even if they weren’t born prematurely including difficulty breathing on their own, decreased ability to fight infections, control their body temperature, or put on weight.

Mothers of multiples are more likely to develop high blood pressure (as well as a condition called preeclampsia) during pregnancy.

Although it is possible to deliver multiples vaginally, C-section deliveries are common for twin pregnancies, especially if the babies aren’t in a head-down position. In some cases, complications after the vaginal delivery of the first twin may require a C-section delivery for the second twin. C-section is the preferred method of delivery for multiples of three or more.