Double Trouble

Cathy Gruetzke-Blais knew her identical twins were a flight risk. At two years old, neither would sit in a shopping cart for more than a few minutes before trying to climb over the side and make a break for it. So on a trip to her local Target one spring day, the desperate Framingham mother strapped a tiny blue harness around each girl's shoulders, then clipped a leash to their backs, convinced the contraption would thwart any escape attempts.

Wrong: As they approached the checkout aisle, Isabelle wriggled free of her mother's grasp and sprinted away, leash and all. Knowing that she'd never catch her while also wrangling Allison and the shopping cart, Gruetzke-Blais tied Allison to the cart and gave chase. But when she returned with her fugitive in tow, Allison was gone.

Gruetzke-Blais soon discovered that her daughter had wandered down the aisle, dragging the cart behind her, and fallen down. She was lying on the floor—still attached to the leash—surrounded by gawking shoppers. "Here was this baby tied to a shopping cart like a sled dog," recalls Gruetzke-Blais, who quickly scooped up her child, apologized, and paid for her purchases. The kids were fine, but when she finally had them safely in the car, she burst into tears, realizing (not for the first time) that with twins, nothing comes easy.

It's an awareness no doubt shared by the 30,000 mothers around Massachusetts who have given birth to twins in the past decade. These are the women who have helped make ours the state with the highest rate of twins in the nation: more than 40 per 1,000 births—a whopping 34 percent above the U.S. average. The trend seems particularly concentrated in and around Boston, which will come as no surprise to those of you who have been run off the sidewalk by one of those SUV-size double-wide strollers now so ubiquitous on Newbury Street; or tried to enroll your child in a preschool class only to find many of the slots already claimed by twins; or heard tales about overcrowded neonatal units at area hospitals, where underweight twin newborns are tended to for weeks, sometimes months.

Indeed, twins have become so commonplace that one can easily overlook how hard it is to raise two babies at the same time. But for me—well, suffice it to say this reality has been impossible to ignore. In February 2006, I gave birth to fraternal twin boys. And two years into my own towheaded family invasion, I have to wonder if this deluge of doubles is a good thing for their parents—or for our area as a whole. I adore my boys and wouldn't trade them for the world. But I would no more wish multiples on a couple than I would bubonic plague.

So what accounts for Boston's status as the new Twin City? Is it that our residents are especially fertile? Not exactly. The truth is, we're just especially well insured. In 1987, Massachusetts became one of the first states to require carriers to cover the cost of infertility treatments for otherwise healthy couples. While a dozen states now offer some kind of fertility coverage, the laws here remain among the most comprehensive in the nation.

One of the best-known treatments for infertility is in vitro fertilization (IVF), in which a woman's eggs are extracted, fertilized with sperm, and then transferred back to her uterus. The more embryos transferred, the more likely a woman will become pregnant—and pregnant with multiples: The odds of conceiving twins through IVF are 29 percent, compared with just 2 percent for naturally occurring twins. It stands to reason if insurance companies cover this costly procedure, which can run $12,000 or more per cycle, more women will take advantage of it. And they do. Among all states, Massachusetts has the highest rate of use of assisted reproductive technology.

Another significant factor: Massachusetts has the highest average age of first-time mothers (28), and since 1996, the majority of babies here have been born to women age 30 and older. Such women are more likely to release multiple eggs during ovulation, resulting in twins. I fall into this category, although apparently there are twins way back in my family history (information that would have been helpful to know before my first ultrasound, Grandma!). I was 33 years old when Emmett and Phineas were born at 35 weeks, just two weeks shy of what doctors consider full term.

Their early arrival was not unusual. More than half of twins are born prematurely and at a low birth weight, which puts them at risk for everything from breathing difficulties to underdeveloped organs. Consequently, many local neonatal intensive care units (NICUs) are overburdened. When our twins were born at Beth Israel, the NICU had room for only one of the boys—talk about Sophie's choice. Since Emmett was deemed the healthier of the two, Finn was whisked upstairs to the NICU; three days later, they swapped places when Emmett physically shut down, refusing to eat because he was overwhelmed by all the activity.