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Everything you Need to Know about Higher Order Multiples


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On this episode of the podcast, we discuss Higher Order Multiples (HOM).

We hear from Chair in Obstetrics and Gynaecology and Professor Fetal Medicine, Head of Discipline Obstetrics and Gynaecology at the University of Newcastle and John Hunter Hospital Professor Craig Pennell who explains the different types of Higher Order Multiples and what to expect from your pregnancy.

Triplet mum Laura Sarubin talks about her experience of finding out she was having triplets and how she tried to normalise the pregnancy as much as possible.

And, Jannelle Snaddon shares her story of infertility, her journey with IVF, and how she was hoping for one baby and ended up with four – Quadruplets.

Types of HOMs

Professor Pennell explains the three patterns of combinations with triplets.

  1. Three eggs that are fertilised by three different sperm known as a Trichorionic Triamniotic pregnancy.
  2. Monochorionic twins and a singleton, known as a Dichorionic Triamniotic pregnancy.
  3. Monochorionic triplets, known as a Monochorionic Triamniotic.

For quadruplet pregnancies, most are where four eggs are fertilised by four different sperm, known as a Quadrachorionic Quadramniotic pregnancy, however, you can also have twins and two singletons. It’s also theoretically possible to have two sets of identical twins but it’s extremely rare, according to Professor Craig Pennell.

Enjoy Your Pregnancy and Ask For Help

The trick with HOMs is that you want to do as much as you can early on. You’ll want to sort out the type of HOM you’ve got, make sure you’ve got great care and great imaging, and that you’re optimising the situation in terms of your haemoglobin, so ensuring you have enough iron, calcium, and vitamins.

Enjoy your second trimester and during that time take as much help from your friends as possible.

“My advice is to buy a second or third freezer and whenever someone offers to help you say it would be great if you could make me a few frozen casseroles, and you just fill those freezers up such that you’ve got all these resources for later,”

“If you’re in a good situation physically and metabolically by the time you get to 22-24 weeks, and you’re being cared for by a great team then you can feel confident that you will get through the situation,” says Professor Pennell.

Professor Pennell insists that if you’re one of the unlucky people who starts contracting early, bleeding, or has some complications, seek medical help quickly. In this situation, you will be transferred to a tertiary centre, if you’re not already there, and you’ll be given steroids which optimises the outcomes for each of the babies.

“The benefit of being administered corticosteroid at 23-weeks reduces the mortality by 50 percent,”

It’s important to be realistic and understand that there will be tough times. You are going to have good days and bad days.

“If you are showing signs of post-natal depression, get onto it, get it treated, seek help, see a psychologist, start taking medication if you need it,” urges Professor Pennell.

Key Points

  • Monochorionic Triamniotic, or identical triplets, are delivered around 32-34 weeks.
  • In terms of quads and quins, the aim is to get as close to 30-weeks’ gestation as possible.
  • The benefit of being administered corticosteroid at 23-weeks’ gestation is that it reduces the mortality by 50 percent.
  • Between 8-and-12 weeks’ gestation is the best time to formally classify Higher Order Multiples.
  • There is a greater chance of miscarrying one or all of the babies in a HOM pregnancy than a twin pregnancy, simply because there are more embryos to lose.

Remember, there are some great FREE downloads on the Double Happiness Multiplied website with diagrams that explain the types of Higher Order Multiples we’ve learned about in this episode.

I hope you’ll join me on Episode Two where we hear from Professor Craig Pennell again who gives us some tips on what you should be asking your specialist, Sonographer Sam Ward walks us through what to expect during your ultrasounds, and twin mum Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson shines a light on your right to choose your care providers.

Until next time…

I wish you Double Happiness … Multiplied.


Australian Multiple Birth Association

Perth & Districts Multiple Birth Association

Multiples of America

Twins & Multiple Births Association

The Multiple Births Foundation

Irish Multiple Births Association

Multiple Births Canada

About the author, Sally

Sally Barker is a Hypnotherapist, Meditation Mentor, Pregnancy & Birth Trauma Coach, Podcaster, Author, and Educator on the topic of Multiple Births.

First and foremost, though, she is the proud Mamma of identical twin girls.

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