There are several reasons why twins are born prematurely. In this article, I will discuss each one individually.

My twins were born early due to premature rupture of membranes. The fetus is normally enclosed in the amniotic sac, and in my case, the amniotic sac broke, commonly referred to as the ‘water breaking.’ I gave birth to my twins at 34 weeks, which is six weeks earlier than a typical full-term gestation delivery time.

Quick Summary
There are several reasons why twins are born early, such as limited space in the womb, premature rupture of the amniotic sac (water breaking), placental complications, growth issues, and severe hormonal imbalances. However, premature babies can survive with the assistance of medication and NICU incubators.

Why Are Twins Born Early During Pregnancy

The gestation period of a normal or singleton pregnancy is typically 40 weeks, which is approximately 9 months. However, typical gestation times for a twin pregnancy lie between 32 and 38 weeks. Sometimes, this happens naturally, but often medical experts intentionally intervene to reduce the risk factors. There are various factors used to predict these risks.

The onset of labor pain and contractions usually determines the delivery. However, in certain cases with twins, if labor doesn’t start naturally and there’s a risk of complications, medical experts may use methods like gels or other interventions to induce labor and ensure the safety of both the mother and babies. These may be some reasons why twins are born early during pregnancy.

• Preterm Labor: Preterm labor, occurring before 37 weeks of gestation, is termed as such due to its onset before the expected time and this is what we call preterm twin pregnancies. Preterm labor can be categorized into two types: early preterm and late preterm.
  Early preterm labor can happen anytime between 20 to 32 weeks of gestation, while late preterm labor occurs between 32 to 37 weeks. Early preterm labor poses higher risks for both the mother and the baby. This is because there is a high risk of infection for the mother, and for the babies, it’s because they are premature.
  
• Preeclampsia: High blood pressure during pregnancy is a symptom of preeclampsia, which can also occur postpartum. In preeclampsia, there is an increase in the level of protein in the urine, indicating a urinary infection, which can lead to premature delivery. I experienced a urinary infection in the 32nd week of my pregnancy, which resulted in the birth of my twins in the 34th week. Preeclampsia can involve other complications such as fluid accumulation in the lungs, decreased blood platelets, and problems in the kidneys, and brain.
  
• Placental Abruption and Placenta Previa: Placental abruption refers to the premature separation of the placenta from the uterus, which can lead to fresh internal or external bleeding, known as hemorrhage. This condition typically occurs after the 20th week of pregnancy and affects approximately 1% of pregnancies worldwide. In placenta previa, the placenta covers the opening part of the uterus, known as the cervix, completely. This can result in severe bleeding either before or after pregnancy. In such cases, early delivery is often necessary, especially in twin pregnancies where these complications are more common, necessitating premature delivery.
  
• Premature Water Breaking – The fetus resides inside a covering called the amniotic sac. In twin pregnancies, due to the increased pressure on the uterus and amniotic sac, this sac can rupture. Generally, delivery is conducted within 24 hours of the sac breaking because now the baby is exposed to the dirt from the sac, which can lead to infection in the mother’s womb. This is why twins are often born prematurely.
  
• Limited Space in the Womb: As babies grow inside the uterus, the space inside becomes increasingly limited. Due to this crowding, they exert pressure on the cervix and uterus. As a result, the uterus struggles to handle this pressure, leading to the cervix opening and initiating physical contractions, which signal the onset of labor. This scenario often results in the premature birth of twins.
  
• Hormonal factors: In twin pregnancies, higher levels of estrogen and progesterone hormones can lead to the onset of contractions in the uterus, resulting in preterm labor.
  
• Placental Insufficiency: Sometimes, in twin pregnancies, the placenta doesn’t function properly, leading to inadequate delivery of oxygen and nutrients to the babies. This can prompt the body to initiate labor prematurely for the well-being of the babies. The children’s growth is also hindered, which necessitates taking immediate action and delivering accordingly.
  
• Complications: Twin pregnancies often come with complications during the gestation period, some of which may be emergencies. This is why twin pregnancies are considered high-risk, as complications such as placental issues or others may arise.
  

Is it normal for twins to be born early?

Twins are typically delivered before the full gestation period of 40 weeks, usually occurring before 37 weeks. On average, twins are born between 32 to 36 weeks of pregnancy. However, this timeframe can vary depending on the type of twin pregnancy and the overall health condition of both the mother and the babies.

It is considered normal for twins to be born just after completing 36 weeks, as by this time, the baby has fully developed and may not require NICU (Neonatal Intensive Care Unit) services. Therefore, it is important to consult with a doctor if contractions commence before 36 weeks of gestation, it is crucial to seek immediate medical attention.

Babies born before 36 weeks may have immature lungs, so medical experts will administer treatments to help them develop properly and ensure their overall health.

Twin’s pregnancy signs week by week

Twin Pregnancy Labor Sign

If pregnant women experience four to five contractions per hour or regular contractions occurring more frequently, continuous pelvic pain resembling cramps typical of pregnancy, stomach pain radiating to the lower back, experiencing jelly-like vaginal discharge or frequent leakage, vaginal bleeding, or a feeling of impending discomfort, these could indicate potential signs of preterm labor.

Premature Twin Birth Complications

Premature birth can lead to various complications, such as:

• Breathing problems due to immature lungs: Babies born before 36 weeks may not have fully developed lungs, resulting in difficulty breathing. In such cases, doctors may recommend lung development medication before birth and NICU (Neonatal Intensive Care Unit) beds after birth for newborn twins. Breathing problems can also increase the risk of pneumonia in twins.
  
• Digestive problems: The growth of the digestive system occurs later in the fetus’s development. If a newborn is premature, digestive issues may arise as a complication.
  
• Infection: Premature babies have immature skin and a weaker immune system, making them more susceptible to infections, which can affect any part of the body.
  
• Jaundice (bilirubin): Jaundice is common in newborn twins because their skin and liver are not fully developed. It is caused by undeveloped skin and an immature liver. This condition can be treated with blue light therapy and breastfeeding. Bilirubin is broken down in the skin and excreted from the body through urine and stool.
  
• Other Complications: there is a risk of various diseases due to immaturity, such as brain problems, heart problems, apnea, patent ductus arteriosus, dysplasia, and many more.

Premature Twins Survival Rate

If twins are between 32 to 36 weeks and there are no other complications, the survival rate is generally good. Doctors may utilize NICU beds (incubators) and medications to promote organ maturity to help the babies’ development before their expected due date.

However, if babies are born prematurely before 32 weeks then a higher risk is involved. In such cases, babies may need to spend an extended time in the incubator to support their growth. Doctors strive to create a similar environment to the womb inside the incubator for twins newborns who are born early.

Overall, premature twins have a lower survival rate compared to singleton pregnancies. Kimyah and DJ Jackson are the youngest premature twins in the world who survived. They were born at 22 weeks and spent four months in the NICU incubator.

What Causes Twins To Be Born Early? – Final Conclusion

The early onset of twins can be due to complications or limited space in the womb. Complications can include preterm labor, placental insufficiency, placental abruption, placenta previa, and the rupture of the amniotic sac. I just discussed why are twins born early.

However, an accurate diagnosis can only be made through medical processes and investigations. Therefore, after 28 weeks, it is important to stay in contact with your doctor or medical advisor and undergo regular weekly check-ups. Other than this, if you ever experience any pain or feel that something is wrong, it is crucial to promptly schedule an appointment with your doctor.

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