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So, I know that 出生 means to birth or "To give birth" - but what if I want to casually say that my friend (who is a male) recently had two kids.

Could I say 他最近生了两个小孩 。 Or does that imply that he physically gave birth to them?

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That implies he physically gave birth. On the other hand the meaning is readily discernable, and in a casual environment people could understood it to be a small joke.

In any case, I've usually heard it phrased as something along the lines of 他的孩子剛出生 or 他老婆最近幫他生了兩個小孩.

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Interesting. I'm not sure whether there's difference between different area. In my part of work, "他最近生了两个小孩" makes perfect sense since listener knows he's a man and cannot give birth, so will understand that "his just became father of two babies". Also you can say "他家(his family)最近生了两个小孩", so no one will know who gave the birth -- he or his wife :) – Caff Huang Aug 9 '14 at 5:15
Could you just say "他最近有了两个小孩?” I feel like the second second you gave semaphore is a bit long - is there a way to have the directness of the first while still saying "two children" Like "他的两个孩子刚出生?“ – Stephen Aug 10 '14 at 2:38
@Stephen From where I'm from (Northern China), 他最近生了两个小孩 does sound like he physically gave birth, and 他最近有了两个小孩 is understood but not the first expression come to mind (because it leads the listener to wonder where did the kids come from). The most natural thing to say, as this answer suggested, is 他老婆最近生了两个小孩. – NS.X. Aug 10 '14 at 3:02
他最近生了两个小孩 is acceptable though. – Ma Ming Aug 11 '14 at 21:29

他最近生了两个小孩 does imply that he physically gave birth to them.

You can say 他最近有了两个小孩.

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