Giving birth to triplets or more

When you are pregnant with triplets or more, it's important to plan your birth. This should ideally begin in your first trimester. Your medical team will:

• consider the risks of premature birth, labour complications
• monitor your health carefully

Generally, the longer your babies can stay in your uterus, the better.

But when you are pregnant with triplets or more, complications can often develop. This can often mean that it's better for you and your babies if they are born early.

The average length of a pregnancy is:

• 40 weeks for a normal pregnancy
• 36 weeks for twins
• 33 weeks for triplets (3 babies)
• even less for quadruplets (4 babies)

Continuing a multiple pregnancy past 37 weeks can be risky for you and your babies. So, it's usually considered best to deliver them early.

When deciding when and how the babies should be born, your health care team will consider different factors, such as:

• the position of each baby
• the weight of each baby
• your health
• the babies' health

Since almost all triplets or more will be born prematurely, they will need special care. This may include a stay in a neonatal intensive care unit (NICU).

It's important to plan to give birth in a hospital with the facilities that you and your babies will need.

Caesarean section

A caesarean section is usually the safest option when you are carrying 3 or more babies, depending on:

• the position of the babies
• the position of the placenta (or placentas)
• the risk of the babies becoming entangled during a vaginal birth

If you are carrying 3 or more babies, you will usually be offered a planned caesarean section.

Your medical team may recommend a caesarean section after:

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

If your babies are going to be born early (preterm), your doctor may recommend giving you steroid injections. These injections are given to you before the birth. Steroids can help your babies' lungs develop. This can help them breathe more easily after birth.

You can speak to your medical team about giving birth vaginally. Giving birth to triplets or more vaginally is very rare.

Preterm labour

If you are expecting multiple babies and you go into labour:

• contact your doctor or midwife
• go to your local hospital emergency department

The signs and symptoms of preterm labour are the same as with normal labour. These include:

• a 'show'
• sudden release of the waters
• contractions

During pregnancy, a plug of mucus seals the cervix. A 'show' is when the plug comes away and out of your vagina.

Women who are pregnant with multiple babies may go into labour naturally before 35 weeks. This happens in around 3 out of 4 people.

Contact your medical team immediately if you have any signs of preterm labour. It may be possible to slow down or stop the labour. You will most likely be admitted to hospital.

If you go into labour spontaneously, you will likely be given a caesarean section after you arrive at hospital.

Babies born before 34 weeks may need help with:

• breathing
• feeding
• keeping warm

They are at greater risk of complications than babies born at full term.

The neonatal intensive care unit (NICU) is specialised to care for premature and sick newborn babies. This unit has experienced medical staff and equipment.

When your babies no longer need this high level of care, they may be transferred. They may then spend time in the special care nursery or special care baby unit.

If you are preparing for a multiple birth, there are different organisations you can turn to for information.

The Australian Multiple Birth Association can provide support and resources for families expecting multiple babies.

The Royal Women's Hospital Melbourne offers pregnancy fact sheets in other languages.

The Australian Breastfeeding Association can provide information on breastfeeding multiple babies, and link you to services such as lactation consultants.