Steven Rhue //
What is a triplet anyway?
Well . . . me.
I am one of three. A sibling to a brother and a sister. We were born in the same year, on the same day, at approximately the same time, and as it would imply, we are the same age.
A more technical explanation is that triplets occur when an individual becomes pregnant with three, as opposed to a single pregnancy, or twin pregnancy. A single fertilized egg may split into three, resulting in identical children, almost always of the same sex. Three separate eggs may become fertilized, producing fraternal triplets where children are of varying sex and more obviously differentiated in appearance. Alternatively, it’s possible to have two identical and one fraternal triplet should two eggs be fertilized and one split (Wazed et al; Cleveland Clinic). I am a result of the second possibility. Although the three of us vary substantially in appearance, we do share common facial characteristics that distinguish us as a family (e.g. our almond shaped eyes and a particular smile).
I would be surprised if you had met triplets prior to this reading, as triplet rates have declined substantially from their peak in the late 80’s and 90’s (Collins; Martin et al “Declines in Triplet”). In 2019, just over 3000 triplets were born in the United States (Martin et al. “National Vital Statistics”). Thus, its far more likely you have met a set of twins, as they account for over 90% of multiple births each year (Luke & Martin). In the United States during 2019, more than 120,000 twins were born. Through triplets do occur naturally, the majority of triplet pregnancies are the product of fertility enhancing therapies and assisted reproductive technology (ART) (Luke & Martin; Collins). However, changes in ethics surrounding the number of embryos used in ART and the advancement of fertility technology have also resulted in the decline of triplets and other higher-order pregnancies (Martin et al. “Declines in Triplet”).
Triplets are classified as high-risk pregnancies, as unfortunately, triplet and other higher order pregnancies are at increased risk of being born prematurely (Feldman & Eileman; Bieleninik et al) and face a higher probability of maternal and neonatal mortality (Luke & Martin; Blickstein & Keith). At one point, as triplet and other higher order births rates were on the rise, the medical community even referred to the upward trend as an “epidemic of multi-fetal pregnancies” (Blickstein & Keith; Bieleninik et al.). The medical community seems to forget that the “epidemic”, as it was referred to, was largely due to standards of practice at the time and advances in ART. However, even at its height, triplet birthrates were substantially outweighed by the number of singleton births.
Even so, it is not as if the concern is completely unwarranted. Some studies of triplet development have shown a higher rate of mild cognitive delay in comparison to twin and singleton births (Golombok et al.; Feldman & Eidelman). Additionally, triplets can be emotionally and finically taxing, as it can be difficult for parents devote time and attention to each baby, and the cost of three at the same time is high. Family, friend, and community support become critical assets to triplet parents, as the simultaneous needs of three children can be overwhelming (Åkerman et al.; Price).
However, in over 8 years of graduate course work on human variation and maternal-child wellbeing, across degrees in public health and anthropology, not once has any professor or study referenced/discussed multiple birth children or families. Being a triplet is a wonderful and unique thing, with its own considerations for families and research/services intended to support child wellbeing. For academic teachers I would encourage the inclusion of research and reading on multiple birth pregnancies and families. For others, I hope that this has been thought provoking about what it means to be a triplet.
Image Credit: Steven Rhue
Akerman et al. “The challenges of expecting, delivering and rearing triplets.” Acta Geneticae Medicae et Gemellologiae, vol. 46, no. 2,1997, doi:10.1017/s0001566000000623
Bieleninik et al. “A Mother’s Perception of Triplet Siblings. A Case Study. Acta Neuropsychologica. vol. 12, 2014, 10.5604/17307503.1124969
Blickstein, Issac & Keith, Louis. “The Decreased Rates of Triplet Births: Temporal Trends and Biologic Speculations.” American Journal of Obstetrics and Gynecology, vol. 193, no. 2, 2005, doi:10.1 016/j.ajog.2005.01.007
Cleveland Clinic. “Multiple Birth: Twins, Triplets, Complications and Symptoms.” https://my.clevelandclinic.org/health/articles/9710-expecting-twins-or-triplets
Collins, John. “Global epidemiology of multiple birth.” Reproductive Biomedicine Online, vol. 15, 2007, doi:10.1016/s1472-6483(10)62251-1
Feldman, Ruth, & Eidelman, Arthur “Does a triplet birth pose a special risk for infant development? Assessing cognitive development in relation to intrauterine growth and mother-infant interaction across the first 2 years.” Pediatrics, vol. 115, no. 2, 2005, doi:10.1542/peds.2004-1137
Golombok et al. “Parenting and the psychological development of a representative sample of triplets conceived by assisted reproduction.” Human reproduction, vol. 22, no. 11, 2007 doi:10.1093/humrep/dem260
Luke, Barbara & Martin, Joyce. “The Rise in Multiple Births in the United States: Who, What, When, Where, and Why” Clinical Obstetrics and Gynecology, vol. 47, 2004, https://journals.lww.com/clinicalobgyn/Citation/2004/03000/The_Rise_in_Multiple_Births_in _the_United_States_.16.aspx
Martin et al. “Declines in Triplets and Higher-order Multiple Births in the United States, 1998-2014.” Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db243.htm
Martin et al. “Births: Final Data for 2019” National Vital Statistics Report. https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf
Price, Frances. “Triplets: Who Cares?” Extending the Boundaries of Care: Medical Ethics and Caring Practices edited by Kohn, T., & McKechnie, R. Routledge. 1999
Wazed et al. “Spontaneous Triplet Pregnancy – A Case Study.” J Dhaka Med Coll, vol. 18, no. 1, 2009, https://doi.org/10.3329/jdmc.v18i1.6315
Image: Steven Rhue