Delivering Multiples

If you're carrying more than one baby, chances are good you'll deliver early. Twins are usually born around 36 weeks -- four weeks early. Triplets arrive at about 33 weeks, and quads often make their debut at 31 weeks. Why? The more babies a woman is carrying, the more likely it is that her uterus will swell, triggering contractions, says Brian Brost, M.D., associate professor of maternal/fetal medicine at the Mayo Clinic, in Rochester, Minnesota. An early due date isn't the only challenge to having multiples. Here's everything you need to know about your special delivery.

Q: Will my labor be longer?

A: It could be -- or it could be slightly shorter. On the one hand, because your uterus will be stretched out, your contractions may be weaker, which means it may take you longer to reach a fully dilated ten centimeters, ultimately slowing things down.

On the other hand, you're likely to have more contractions prior to active labor, so your cervix may be quite dilated early on. What's more, since multiples often come weeks early, the pushing phase of a vaginal delivery may be quicker since the babies will be smaller.

Q: What extra precautions will my doctor take?

A: He'll probably use a monitor to track each baby's heart rate -- as well as one to follow your contractions. He may also give you intravenous antibiotics during labor. That's because you may not have been tested yet for Group B strep, a common vaginal bacterial infection that pregnant women are screened for at around 36 weeks. (Without prophylactic antibiotics, you can pass the infection on to your babies.) Finally, most moms of multiples are encouraged to get an epidural; if you need an emergency C-section, an IV and some pain medication will already be in place.

Q: Should I have a C-section?

A: It depends on your babies and on the comfort level of your obstetrician. If you're having twins and the first baby is head down, many doctors will suggest a vaginal delivery. Even if the second baby is feet first, your doctor may be able to externally turn her by manipulating your abdomen. If that fails, your doctor still may try a breech delivery. "If the first baby has dilated the cervix and vagina well, and the second is about the same size, a breech delivery is considered safe," says Ashi Daftary, M.D., assistant professor of ob-gyn at the University of Pittsburgh School of Medicine.

The majority of triplets and quads, however, are delivered by C-section. Monitoring more than two babies during labor can be logistically difficult. In addition, with more babies there's more risk of maternal or fetal problems -- things like high blood pressure for the mom or cord compression for the babies, says David Luthy, M.D., medical director of ob-gyn and perinatal medicine at Swedish Medical Center/First Hill Campus, in Seattle.

Q: About how far apart will my babies be born?

A: With vaginal deliveries, most babies are born within ten to 30 minutes of each other. With C-sections it's even quicker, with babies being pulled out moments apart.

Q: Will my babies be taken right to the NICU?

A: That depends on their gestational age and birth weight. Many twins born close to term can go to the regular newborn nursery. "Only about 20 percent of twin babies go to intensive care," Dr. Brost says. "That goes up to 80 percent with triplets, and even higher for quads." How long they stay in the hospital varies. For twins, the average stay is nine to 25 days. For triplets it's 11 days to up to three months. And for quads or more, it's longer.

Q: Will my babies be at greater risk for newborn complications?

A: If they were born prematurely, yes. Because the lungs and liver are some of the last organs to mature, preterm babies are at greater risk for respiratory distress syndrome and jaundice. "While just one out of 20 singleton babies will have jaundice, one out of five twins, one out of two triplets, and three out of four quads will have it," Dr. Brost says.

Q: Will my recovery be harder?

A: If you have a C-section, your recovery won't be any more difficult than if you'd had one baby. But recovering from a vaginal delivery may be tougher with multiples. "If the babies are very premature, they may not descend the birth canal in a controlled way," Dr. Brost explains. "They may come quickly and can cause large vaginal or cervical tears." Also, if you've had pregnancy complications like preeclampsia, or you've been on bed rest (both of which are more likely with multiples), it may take longer for you to get moving. "Muscles can atrophy, making it harder to regain your strength," Dr. Luthy says.

Reprinted with permission from Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.