Planning and Care for a Multiple Pregnancy: What to Expect and How to Prepare

Highlights

If you are pregnant with triplets or more, your birth will need careful planning.
Your medical team will help you plan your babies’ birth.
If you are carrying multiple babies, there is a higher chance of them being born prematurely.
You will usually be offered a caesarean section if you are carrying triplets or more.
After giving birth to your babies, they may need a stay in a neonatal intensive care unit.

In This Article

• Preparing for a Multiple Birth
• Duration of a Multiple Pregnancy
• Deciding When to Give Birth
• Birth Method Considerations
• Signs and Management of Preterm Labour
• Specialised Care for Multiple Babies
• Tools And Assistance

Preparing for a Multiple Birth

When pregnant with triplets or more, it’s crucial to plan your birth carefully, ideally starting in the first trimester. Your medical team will:

• Consider the risks of premature birth and labor complications
• Monitor your health closely

In most cases, the longer your babies can stay in the uterus, the better. However, multiple pregnancies often come with complications that may necessitate an early delivery for the health and safety of both the mother and the babies.

Duration of a Multiple Pregnancy

The length of pregnancy varies depending on the number of babies:

• 40 weeks for a single pregnancy
• 36 weeks for twins
• 33 weeks for triplets (3 babies)
• Even fewer weeks for quadruplets (4 babies)

Pregnancy beyond 37 weeks can be risky for both the mother and the babies, so early delivery is typically recommended for multiple pregnancies.

Deciding When to Give Birth

The timing of birth will be decided based on several factors, such as:

• The position of each baby
• The weight of each baby
• The health of the mother
• The health of the babies

Since nearly all triplets or higher-order multiples are born prematurely, they will need special care, which may include a stay in the neonatal intensive care unit (NICU). It’s important to plan to give birth at a hospital equipped with the necessary facilities for both you and your babies.

Birth Method Considerations

A caesarean section is typically the safest option when carrying three or more babies, depending on factors like:

• The position of the babies
• The position of the placenta(s)
• The risk of the babies becoming entangled during a vaginal birth

If you’re carrying multiple babies, your medical team will likely recommend a planned caesarean section. For example, a caesarean section may be scheduled at:

• 32 to 33 weeks for a quadruplet pregnancy
• 34 to 35 weeks for an uncomplicated triplet pregnancy

If the babies are going to be born prematurely, your doctor may recommend steroid injections before the birth. These injections help the babies’ lungs develop, which can assist with breathing after birth.

You can discuss with your medical team the possibility of a vaginal birth, but delivering triplets or more vaginally is extremely rare.

Signs and Management of Preterm Labour

If you are pregnant with multiple babies and go into labor, contact your doctor or midwife immediately and go to your local hospital’s emergency department.

The signs of preterm labor are the same as those for normal labor and include:

• A “show”
• A sudden release of the waters
• Contractions

During pregnancy, a plug of mucus seals the cervix, and the “show” occurs when this plug comes away and exits the vagina. Pregnant women carrying multiples are more likely to go into labor naturally before 35 weeks, with around 3 out of 4 women experiencing this.

If you notice any signs of preterm labor, contact your medical team immediately. In some cases, it may be possible to slow or stop the labor. You will likely be admitted to the hospital for monitoring. If labor progresses, a caesarean section is often performed upon arrival at the hospital.

Specialised Care for Multiple Babies

Babies born before 34 weeks often require additional assistance with:

• Breathing
• Feeding
• Keeping warm

They are at a greater risk of complications than babies born full term. The neonatal intensive care unit (NICU) is specifically designed to care for premature or sick newborns, staffed with experienced medical professionals and specialized equipment.
Once your babies no longer need intensive care, they may be moved to a less intensive care area within the hospital, or in some cases, you may be able to take them home once they are stable and healthy enough. Your healthcare team will provide guidance on:

• Feeding: Premature babies may need assistance with feeding, either through a tube or bottle, as they may not have the strength to breastfeed immediately.
• Breathing: Some babies born prematurely may need help with breathing, which could involve the use of a ventilator or other respiratory support.
• Temperature regulation: Preterm babies are at a higher risk of becoming cold, so they are typically placed in incubators to maintain their body temperature.

Your babies will be monitored closely, and your healthcare team will assist you with any questions you may have regarding their care.

Tools And Assistance

For a successful multiple pregnancy and safe care for your newborns, there are numerous tools and resources that can assist you at every stage:

• Support from your medical team: Your doctor and obstetrician will regularly monitor both your health and the health of your babies. It is essential to discuss all aspects of birth planning, potential risks, and complications with them.
• Neonatal Intensive Care Unit (NICU): For premature or medically fragile newborns, NICU provides specialized care and monitoring until they are stable enough to go home. This unit is staffed with skilled professionals and equipped with the necessary tools for critical care.
• Steroid injections for preterm babies: If your babies are born prematurely, your doctor may recommend steroid injections before birth. These injections help the babies’ lungs mature, improving their ability to breathe after delivery.
• Preterm labor management tools: There are methods and medications that may be used to slow down or stop labor if it begins prematurely. You will be closely monitored in the hospital to manage contractions and other signs of early labor.
• Breastfeeding support: After delivery, you may need assistance with breastfeeding, particularly if your babies were born prematurely. Lactation consultants can provide expert guidance and techniques to ensure successful breastfeeding and proper nourishment for your babies.
• Mental and emotional support: Navigating a multiple pregnancy and caring for premature infants can be overwhelming. Support groups, therapy, and counseling are available to help you process the emotional aspects of the experience. Discuss your feelings with your healthcare provider for recommendations on available support services.