During your pregnancy, you may find out that you're expecting 3 or more babies. This can sometimes be a surprise or even a shock. It's normal to feel a range of both positive and negative emotions.

If you are pregnant with triplets or more, you will need extra medical support throughout your pregnancy.

How do pregnancies with 3 or more babies occur?

If you are having 3 or more babies, they are known as 'higher order multiples'. This sort of multiple pregnancy can occur when:

• a single fertilised egg splits
• more than one egg is fertilised

Both of these things can also happen at the same time. This means that multiple babies could be fraternal (non-identical) or identical.

Higher order multiples rarely happen naturally and are often the result of fertility treatments.

In 2020, less than 2 in 100 births in Australia were multiple births. Of these, almost all were twins. Just 1 in 100 births were 3 babies or more.

You can find out if you are having a multiple birth when you have an ultrasound.

What extra care will I need during a multiple pregnancy?

When carrying 3 or more babies, you can expect the same early pregnancy symptoms that you would have with one baby. But these symptoms can start sooner and be more severe. These may include:

• tiredness
• morning sickness
• hyperemesis gravidarum (severe morning sickness)

You will need extra medical care throughout your pregnancy. Choose an experienced doctor and medical support team that is right for you.

You may see a team of health care professionals who are experienced in higher order multiple pregnancies. These may include:

• obstetricians (specialist doctors who give medical care during pregnancy and birth)
• midwives (specialist nurses who give medical care during pregnancy and birth)
• sonographers (specialist in imaging with ultrasound)
• physiotherapists
• dietitians

Your healthcare team will keep a close eye on your health, through:

• glucose tolerance tests to check for gestational diabetes
• frequent ultrasounds to see how your babies are growing

Ultrasound scans can also check whether there are any problems with the placentas or cords.

Talk to your healthcare team if you have any concerns while you are pregnant.

Looking after yourself during a multiple pregnancy

Having a multiple pregnancy can be physically and mentally overwhelming. It's important to take care of yourself. Make sure to surround yourself with a positive support network.

Food and nutrition

If you are carrying 3 or more babies, you may grow bigger than with a normal pregnancy. You may also grow more quickly.

You will need to eat more to meet the babies' nutritional needs, and your own.

You will need to ensure you have enough:

• iron
• calcium
• vitamin B12
• folic acid

Your healthcare team can provide you with a nutrition plan and advise you on taking supplements during pregnancy.

Conditions associated with pregnancy

You may experience backache, so correct posture is very important. To manage backache while pregnant, you should:

• continue gentle exercise as advised
• avoid lifting heavy objects or standing for long periods of time
• apply heat to painful areas
• avoid standing on one leg
• avoid activities that involve squatting

With a multiple pregnancy, you may be more likely to experience:

• indigestion
• haemorrhoids
• varicose veins
• constipation

See your doctor for information and advice about how to manage these symptoms.

Activity and rest

Doing some stretching and gentle exercise during pregnancy can help ease tension and improve your muscle tone if approved by your medical care team.

In the later stages of the pregnancy, you may:

• feel more tired
• have problems sleeping

You may need to:

• limiting strenuous physical activity
• limiting long periods of travel
• resting frequently
• drink plenty of water

You may have to stop work earlier than with a single pregnancy. Your healthcare team can advise you on the right time for this.

How do I prepare for multiple babies?

If you are having multiple babies, there are things you can do to help you prepare for their arrival.

At home

The babies are likely to be born earlier so it's a good idea to get a nursery ready earlier.

Attending classes

Attend antenatal classes earlier than you would for a single pregnancy.

Some classes or information evenings are specifically about preparing for multiple babies. These sessions can provide support, and a chance to meet other families.

Feeding multiple babies

Before your babies are born, you can speak with your midwife or lactation consultant about feeding. They can provide advice and support on:

• what to expect when feeding multiple babies
• positions for breastfeeding
• different baby formula options
• how to bottle feed
• what equipment you may need

When are multiple babies born?

While a normal pregnancy usually lasts 40 weeks, triplets are often born earlier.

Usually, the longer your babies can stay in your uterus, the better. But when you are pregnant with triplets or more, complications can often develop. With some complications, it may be better for you and your babies if they are delivered early.

Most multiple births take place by caesarean section. Your medical team will decide when to deliver. This will be based on:

• your health
• the health of your babies
• the number of babies you are having

You may need to stay in hospital for a while before the birth.

What complications can occur during a multiple pregnancy?

The most common pregnancy complication with 3 or more babies is premature birth. Carrying multiple babies puts you at higher risk of certain problems. These can include:

• anaemia (not having enough red blood cells, usually caused by iron deficiency)
• gestational diabetes (diabetes during pregnancy)
• hypertension (high blood pressure) or pre-eclampsia (a serious medical condition)
• miscarriage or stillbirth (sometimes one of the babies may die in the womb)
• pre-term labour (going into labour early)
• postpartum haemorrhage (heavy bleeding after the birth)

If you experience any signs of preterm labour, call your hospital immediately.

Resources and support

If you are expecting 3 or more babies, it's common to worry about things such as:

• possible pregnancy complications
• changes to your body
• how your other children will cope
• what help you will need

For support and resources, contact the Australian Multiple Birth Association.