Dr. Joseph Doyle, an OB-GYN who specializes in reproductive endocrinology and infertility at Shady Grove Fertility in Rockville, attributes the increase in multiple births to parental age, women delaying children to pursue their careers, and Maryland’s required insurance coverage for infertility treatments, including intrauterine insemination, IVF and frozen embryo transfers. In the last four years, the increase has stopped for triplets and slowed slightly for twins, he notes, as better freezing techniques and improved chromosomal testing have allowed doctors to implant fewer embryos.

“We spend an inordinate amount of time counseling our patients that singletons are the healthiest way to go,” Doyle says. “We see patients who say, ‘How does a celebrity have a baby at 47? How do so many of them have twins?’ But we’re trying to minimize birth risk. We don’t want patients to use financial considerations or age to have them be more aggressive than is medically recommended.

“For 40-year-olds, we generally transfer in two embryos,” Doyle explains, noting the lower success rate for older mothers. “For the majority of those mothers under 35, it’s just one embryo now. …It sounds good to have two and be done, but we want to get more healthy deliveries.”

 

Families buy and sell clothing, furniture and equipment for infants and children at the twice-a-year consignment sale. Photo by Liz Lynch.

 

Parents of older multiples talk of their joy and exhaustion, but their early emotions were often terror and fear. More than half of twins, triplets and quadruplets are born prematurely, according to the March of Dimes, which can mean complicated deliveries and stressful stays in the neonatal intensive care unit (NICU). “The actual birth was surreal,” says 68-year-old Jeffrey Jay of Bethesda, whose triplets were born on Halloween in 1991 at Georgetown University Hospital. “There were at least 30 people in the delivery room and, yes, some were in costumes.”

Kayton’s twins, born four weeks early, spent a month in the NICU at Holy Cross Hospital in Silver Spring, a fairly standard stay for premature twins. But the experience was anything but ordinary for their parents. The couple visited for hours each day, but since Kayton was recovering from a cesarean section, she wasn’t allowed to drive. “I had to get rides every day from friends and family,” she says. “My husband came from work at lunchtime, and we’d often come back again at night.” She remains grateful for all the help from the NICU staff. “They get your babies healthy for you to take home,” she says, “and then it’s a whole new set of things to learn.”

For moms of multiples, breastfeeding can be a challenge. Kathleen McCue, owner of Metropolitan Breastfeeding in Bethesda, has 20 lactation consultants who are experienced in teaching tandem nursing—feeding two babies at once—and even the “triple nipple,” a rotation of breast A, breast B and a bottle for triplets. Jay’s wife, Molly Peter, studied such a feeding plan for their triplets, “but I ended up just feeding the one that was crying,” she says. She tracked the feedings to make sure none of the babies was shortchanged.

To feed multiples, mothers who are breastfeeding sometimes supplement with formula or donor milk, or purchase pasteurized breast milk. Having multiples can mean an abundance of bottles, with continual washing, warming and storing. “You turn over your kitchen counters to bottles drying on racks,” Riley says. McCue even gives hormones to nonbiological lesbian mothers so they can pump their breast milk to supplement their partner’s supply. She provides mothers of multiples with stronger hospital-grade breast pumps to increase production. “Now that the Affordable Care Act covers lactation, we’re seeing a lot more moms of twins seeking us out,” she says.

Metropolitan Breastfeeding’s partner service in Bethesda, Metropolitan Doulas, is now thinking about duplicating the monthly meet-ups it holds in Northwest D.C. at the Bethesda location, across from Imagination Stage. “Parents need a place to connect with others and share experiences,” says Nikki Wray, owner of Metropolitan Doulas, which sends caregivers to homes to help parents and newborns. Many doulas report that new parents of multiples are nearing a breaking point when they arrive, overwhelmed by both a lack of sleep and worry over the fragility of their tiny babies.

Schools are also impacted by the rise in multiples. Most public and private schools in the area try to separate siblings of the same age in order to help them develop as individuals. There’s no requirement that schools do this, but educators cite studies that show gains in independence when multiples are placed in different classrooms.

“We separated our twins for this first year of pre-K, and it was a phenomenal decision,” Kayton says. “My son and daughter have grown so much. She was mothering him a lot, and she couldn’t do that as much being in separate classes.”

In recent years, a handful of states have passed a twins law to give parents the right to decide whether their children are placed in the same classroom or not. Maryland doesn’t have such a law, but Montgomery County Public Schools administrators say student populations are usually large enough to separate twins or keep them together, depending on what the school and parents think is best.

The costs associated with child-rearing, day care, school and college multiply with multiples. “We expected there might be volume discounts” for double car seats, changing tables and beds, recalls Deane-Bess, but “we still had to pay twice for everything.” Diaper costs, baby-sitting fees and planning for college educations are daunting, she says. “The bills in their early years are etched in my memory.”