If you are pregnant with triplets or more, the birth will need careful planning.

The main risk with carrying multiples is that they will be born prematurely. Your medical team will help you plan your babies' birth. This may include deciding where and when your babies will be born.

Planning for your multiple birth

When you are pregnant with triplets or more, it is important to plan the birth. Your medical team will consider the risks of premature birth. They will weigh this against the risks of continuing the pregnancy for both you and your babies, based on your individual situation.

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.

A normal pregnancy lasts 40 weeks. The average length of a pregnancy for triplets is 32 weeks. For quadruplets, the average length is 30 weeks.

Continuing a multiple pregnancy past 36 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 doctor will consider different factors. Your medical team will think about:

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

A caesarean section is usually considered safest when there are 3 or more babies.

Giving birth to triplets or more vaginally is very rare. It is not recommended because of the higher risk of labour complications and infant mortality.

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 have the birth in a hospital with all 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. This may be because of:

• the position of the babies
• the position of the placenta (or placentas)
• the risk of one of the placentas or umbilical cords being compressed during a vaginal birth
• the risk of the babies becoming entangled during a vaginal birth

If you are carrying triplets or more, you will usually be offered a planned caesarean.

If your babies are going to be born early (preterm), your doctor may recommend giving you steroid injections. The injections are given to you before the birth.

Steroids can help develop your babies’ lungs. This can help them breathe more easily after birth. Steroids can also reduce the risk of other problems in babies born preterm.

Multiple babies and preterm labour

If you are expecting multiple babies and you go into labour, contact your doctor or midwife and go to your local hospital emergency department. The signs and symptoms of labour are the same as with normal labour. These include:

• contractions
• sudden breaking of the waters
• a ‘show’

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

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

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 after you arrive at hospital.

Extra care for multiple babies

Babies born before 34 weeks may need help with breathing, feeding and 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.

Resources and support

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 online education for those expecting a multiple birth.

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