Multiple Births (Encore)
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The following is an Encore presentation of Everything Everywhere Daily. There's an excellent chance that you know someone who has a twin sibling. In fact, there are some of you listening to this right now who have a twin brother or sister. Multiple births are something that isn't common, but it also isn't super rare. However, multiple births have become more common over time, despite the fact that there are some types of multiple births that are exceedingly rare.

Learn more about multiple births, twins, triplets, and more, and how they happen on this episode of Everything Everywhere Daily. This episode is sponsored by ButcherBox.

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Compared to most species, human births have always been an inherently dangerous thing. Historically, childbirth has been one of the highest causes of death for women. This has to do with the fact that humans have evolved to have large brains, which has resulted in large heads. About one birth in a thousand has a child with a head too large to actually fit through the birth canal.

Once a human child is born, they're totally helpless. Have you ever seen a video of a cattle or bison giving birth? The calf is often up and walking just an hour or two after being born. Human children usually won't start walking until a year after they're born. And once they start walking, it'll still be another year or two before they can reasonably function without the help of someone else.

Technically speaking, humans are born before they're done gestating. The reason they're born so early is that if gestation took any longer, their heads would be so large that birth would be impossible. On top of all of that, historically it was very common for children to die before they reached the age of five. Infant mortality was the big reason why early human life expectancies were so low. Assuming you could make it past infancy, then you had a good chance of living a long, decent life.

I bring all of this up to illustrate the point that birthing and raising humans is actually very difficult. It's more difficult than it is for any other species that we know of. Because it's so difficult, the default for humans is to only give birth to one child at a time. If you have more than one child, the risks of childbirth go up, the risks to the children go up, and the difficulty breastfeeding and raising the children goes up as well. That being said, multiple births obviously do occur.

With modern medicine, most multiple births today are no more dangerous than single births, both to the mother and the children. So as we get into the subject of multiple births, we should probably start with the most common form of multiple birth, by a wide margin, twins. Twins are uncommon, but not particularly rare. As I mentioned in the introduction, most of us probably know or are related to someone with a twin. The percentage of births that result in twins varies around the world and has varied over time.

The lowest rate of twin births can be found in South America and Southeast Asia, where 6 to 9 twins are born for every 1,000 live births. The highest rate of twins are found amongst the Yoruba people in West Africa, where 45 to 50 births out of 1,000 result in twins. The percentage of twins born over time has changed as well. In the United States, the number of births that resulted in twins was 9.4 per thousand in 1980.

But by 2009, it had risen 76% to 16.7 sets of twins born per 1,000 births. Recent data from the Centers for Disease Control in the United States reported that the rate of twins is now 3.4% of births. This is actually a dramatic increase, a more than doubling of the number of twin births in just 40 years. The increase is almost exclusively due to the use of fertility drugs.

The reasons why these result in increased multiple births and the reason why the Yoruba people have so many twins I will get to in a bit. You're probably also aware that there are different types of twins. The most common type of twins are fraternal or dizygotic twins. Fraternal twins result from two eggs, each of which is fertilized independently of the other. Each egg and each sperm is a unique mix of genes, which is why siblings can often look very different from each other.

Because separate eggs are fertilized by separate sperm, you can have twins that don't look the same or are even different sexes. Fraternal twins will develop in separate amniotic sacs as a result of separate fertilization. Statistically, women from families with high rates of fraternal twins are more likely to have fraternal twins themselves.

Normally, eggs resulting in fraternal twins will be fertilized at almost the same time. However, there is a rare condition known as superfecundation, where eggs can be fertilized by sperm from different men. In Greek mythology, the twins Castor and Pollux actually had two different fathers. Castor was the son of Tendarius and Pollux was the son of Zeus. In such cases, the children are actually genetically half-siblings, despite also being twins.

The other type of twins that you're probably familiar with are identical twins or monozygotic twins. Identical twins are produced in a totally different way. It results when a single fertilized egg forms a zygote, which splits into two to form two separate embryos. The percentage of identical twins to fraternal twins will vary depending on where in the world you are.

Fraternal twins are about twice as common in regions with low numbers of twins and as much as 8 to 10 times as common in rates with high numbers of twins. The rate of identical twins is approximately three sets of identical twins per 1,000 live births all over the world. Variance in the number of twins born across time and place is almost exclusively due to the increases in the number of fraternal twins, not identical twins.

Because identical twins come from the same fertilized egg, they have the same genetics. That's why they look the same and are always the same sex. But there is another type of twin which is extremely rare. It's so rare that there have only been two recorded examples of it. Although there almost certainly have been more, it's just that people didn't know it at the time. They're known as sesquiseotic twins.

Sesquiseotic twins have similarities to both fraternal and identical twins, but it requires multiple rare events to all take place. It occurs when a single egg is fertilized by two different sperm. Normally when this happens, the results in a set of three chromosomes and the fertilized egg will not survive. This is rare event number one. However, in some rare cases, the egg fertilized by two sperm can sort itself into three different cells.

If the two sperm cells carry different sex chromosomes, one with an X and one with a Y, then you can wind up with cells having an XY coming from mother and father, an XX cell with chromosomes coming from mother and father, and an XY cell with both chromosomes coming from the father. The later cell with both sex chromosomes coming from the father can't develop, but the other two cells can exist in the same ball of cells. And that is rare event number two.

Finally, the ball of cells with both XX and XY cells would split, creating two different embryos. And that is rare event number three. The result is a set of twins, always one male and one female, similar to fraternal twins. However, they share the same amniotic sac, like identical twins. Sesquiseotic twins are also known as half-identical twins. They share more genetic material than fraternal twins, but not as much as identical twins.

There have only been two cases ever reported, one in the United States and one in Australia. However, if there were other cases, most people probably wouldn't have known it as it would have just appeared as a normal twin birth. Once you get beyond twins, then things start to become quite rare. While most of us probably know someone who is a twin, most of us probably don't know someone personally who is a triplet. That's because triplets are much more rare. Triplets can be identical, fraternal, or a combination of both.

Most commonly, they're the result of three separate fertilized eggs. However, it could happen when two eggs are fertilized and one of them identically splits. And in the rare case, one single egg can split into two, and then one of those two eggs can split again, resulting in identical triplets. Triplets generally only occur in about one in every thousand births. Identical triplets occur in only about one in every million births.

Identical triplets are so rare that if a set of them are ever born, it usually makes the local news. In 2015, there were only four sets of identical triplets born in the entire United States. Beyond triplets, multiple births start to become extremely rare. There are only 3,556 known sets of quadruplets in the entire world, of which only 70 are identical quadruplets.

The process of making quadruplets is the same as with triplets, with some combination of multiple eggs or zygote splitting. This many children being able to survive birth at the same time is an almost totally modern phenomenon. In ancient times, either the children and or the mother wouldn't have survived. The first recorded case of quadruplets that survived into adulthood were the Fisk quadruplets born in 1783 in Connecticut.

Once you get beyond quadruplets, the odds of it happening and the odds of all the children surviving are so low that anyone who has them will probably wind up with their own reality TV show. Quintuplets, five children, are believed to only occur naturally once in every 55 million births. The first surviving set of quintuplets in history were the Dionne quintuplets of Canada, who were born in 1934 and on whom which I've done a previous episode.

The world's first case of sextuplets, six children that were born alive, were the Thorns sextuplets born in Birmingham, England in 1968. However, three of the children died within two weeks of birth. The Rosenkowicz sextuplets, born in 1974 in Cape Town, South Africa, were the first sextuplets to ever survive into adulthood. The first surviving set of septuplets, seven children, were the McCoy septuplets, born in Iowa in 1997.

The first ever recorded birth of octuplets occurred in 1968 in Mexico City, but all eight children died within hours of birth. There have been, ironically, eight recorded instances of octuplets in history. In every case but one, at least one if not all of the children died soon after birth. The only case of surviving octuplets were the Suleiman octuplets born in 2009 in California. However, the most extreme case of multiple births have been non-uplets.

There have only been three cases of non-uplets, nine children, born in human history. In two cases, all of the children died after birth. In the most recent case, which were born to a couple from Mali while they were in Morocco in 2021, all nine children have so far survived and appear to be healthy. So what's responsible for such extreme multiple births?

The first and overwhelming reason for the rise in the number of twins over the last several decades and other extreme multiple births is the use of fertility drugs. Fertility drugs result in the release of multiple eggs, which can all be fertilized. Normally, it simply increases the odds that one of them might become fertilized and take hold.

However, it also increases the probability that all of them might become fertilized. Hence, while still rare, you see more of the extreme multiple births over time and more twins. In the case of the Yoruba people of West Africa, it's widely thought that the reason for the high number of twins may have to do with their diet. In particular, a type of yam that's consumed in the region which contains a natural phytoestrogen that stimulates the release of multiple eggs.

Another reason why more children from multiple births are able to survive is due to the improved care of babies born prematurely. Almost all multiple births run the risk of premature birth, and in the case of extreme multiple births, it almost always happens. It is pretty much impossible to have a full gestation period for that many children. That is why almost all of the cases of surviving extreme multiple births have taken place in just the last few decades.

Also, extreme multiple births almost always have to be delivered via cesarean section, which is a procedure that, until relatively recently, was only performed in extreme cases and often resulted in death. Today, it's a regularly done procedure at most hospitals. And on top of all that, developments in infant formula have made it possible for infants from multiple births to survive, whereas in the past, they might have starved to death.

Multiple births have always been a part of humanity, but recent developments in fertility treatments and medicine have made multiple births more common and have dramatically improved survival rates, which means that there are now more twins, triplets, quadruplets, and quintuplets than ever before. The executive producer of Everything Everywhere Daily is Charles Daniel. The associate producers are Benji Long and Cameron Kiefer.

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