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Twin Pregnancy: Recognizing Preterm Labor

There are so many things we worry about when carrying multiples. It seems we multiple mamas are at increased risk for everything, right? But that’s why, though it’s scary to talk about (probably the #1 scariest topic for a mom carrying multiples), we’re going to give you a run-down of the signs and symptoms of preterm labor.

Because knowledge is power. 

For the ultra-worried types, this info might be too much. I understand, so please — know yourself. Take in as much info as you think you can handle.

For those who want to proceed, read on….

Preterm Labor with Multiples

In the US, roughly 60% of twins and 90% of triplets are born prematurely (which means before 37 weeks). With multiples, your chances of preterm labor are 6 times higher than with a singleton pregnancy.


This is just the way it is because multiple babies share such a small space; try not to dwell on it or worry too much (easier said than done, right?).

For mamas carrying multiples, it’s just extra important to educate yourselves on the symptoms of preterm labor, and to prepare for the various outcomes (both physically and emotionally).

The Stats
  • The average twin pregnancy lasts 35-36 weeks; not too shabby for multiples.
  • Triplet pregnancies average 33 weeks and quad pregnancies average 29 weeks.
  • Most OBs in the US won’t let twin pregnancies go past 38 weeks, but a lot of this depends on the type of pregnancy you have (sharing a sac, placenta, both, neither?) and other risk factors.
  • Of these babies, the majority of them are born between 34 and 36 weeks. These are called late-preterm births. Many late-term preemies leave the hospital on time with no complications – yay!
  • If your multiples are born between 32 and 34 weeks, they are considered moderately preterm, less than 32 weeks is very preterm, and at or before 25 weeks they are extremely preterm.

Who Goes to the NICU (neonatal intensive care unit)?

Babies born close to term can usually go to the regular newborn nursery — sweet! About 20% of twin babies go to the NICU. That number goes up to 80% with triplets and nearly all quads end up in the NICU. How long they stay depends on their condition.

For twins, the average stay is 9 to 25 days, but again, this varies greatly. For triplets it can range anywhere from 11 days to up to three months. And for quads or more, it can be months.

* Scary Stuff Warning *

Preterm babies can face an increased risk of lifetime disabilities such as: intellectual disabilities, learning and behavioral problems, vision and hearing loss, cerebral palsy, and chronic lung problems. With so much out of your control with multiples, it is important to do whatever you can to keep those babies cookin’!

With all of the miscellaneous aches and pains associated with pregnancy, it’s really hard to tell what’s what!

So, what to look for? Here’s the cheat sheet (courtesy of KeepEmCookin.com):

If you are less than 37 weeks along, call your doctor immediately if you are experiencing any of the following symptoms:

  • 4+ contractions in 1 hour — either with or without pain; menstrual cramp-like pains (this one is tricky for people with lots of Braxton Hicks, but you’ll get to know your body over time to know what feels “normal” and what doesn’t).
  • Intense vaginal pressure or pressure on your bottom; a sensation that the baby is going to “fall right out”. I had a friend on bedrest with twins who felt like she had to poop in the worst way. The minute she sat on the potty, she knew something was terribly wrong, as Baby A started descending. One of the big problems in deciphering preterm labor with multiples (early on) is that they are so small, you might not even feel the contractions and progression of labor.
  • Increased discharge; loss of the mucus plug (aka “bloody show”)
  • Persistent lower back ache, or one that comes and goes (this could also be kidney stones, which are not uncommon in pregnancy ~ these are fun, lemme tell ya!)
  • Bleeding (of any sort)
  • Steadily leaking fluid — or, a sudden gush of fluid
  • Increased bowel movements or diarrhea
  • A decrease in the baby’s activity; fewer kicks
  • A sense that something just isn’t right

Talking to Your Doctor

Some women worry about bothering their doctor, but don’t! This is why they get paid the big bucks, sister. And believe me, they would much rather prevent a catastrophe than be bothered. So if something feels wrong to you, CALL them.

Seriously. Just call.

On a regular Tuesday morning at work, my belly felt weird: I could feel it tightening. I was 29 weeks and didn’t want to overreact if it was nothing. I almost wrote it off as gas (I mean, isn’t everything gas nowadays?), but luckily I called just to be safe. The nurse told me to come in to see the doctor, who then confirmed my cervix had begun to dilate. I was then sent to the hospital for preterm labor. A two-day hospital stay later, complete with steroid shots for lung development and meds to stop the contractions, my five-week bedrest journey began. This is so common with multiples, you guys.

At least you’ll know. You know?

Most OB’s offices have an advice line you can call 24/7. Keep this number with you throughout your pregnancy. I’d be surprised if you don’t have to call a handful of times along the way.

When Things Get Confusing

(a la: is that an earthquake or are my neighbors having sex again?)

Braxton Hicks Contractions Vs. “Real” Contractions

By 22 weeks, you may already be experiencing Braxton Hicks. BH is a tightening of the uterus. You can put your hands on your belly and feel as it becomes hard as a rock, then softens again. Some women get them regularly — and some never get them at all. They can be brought on by sex, physical activity, dehydration…or for no particular reason whatsoever.

The difference: BH are irregular and won’t intensify over time. They may go away after you relax and have a few glasses of water (this was always my litmus test). “Real” labor contractions will become more regular and more painful over time and will cause your cervix to soften and dilate (which you won’t feel). The only real way to tell is to be examined.

Round Ligament Pain Vs. Preterm Labor

Ask yourself: WHERE is the pain (predominantly)? Round ligament pain is the result of stretching of the uterus and is completely normal. RLP may come on very suddenly and may be sharp, or (just to confuse you)… it can persist and feel dull and achy. The pain will be along the bikini line, commonly on the right side, and can cause discomfort from the groin to the hips.

With preterm labor cramps, the pain will be in the area above the pubic bone and below the belly button, like a menstrual cramp. You may also be having pain in your lower back.

Leaking Urine Vs. Leaking Amniotic Fluid

How does it smell? Leaking a little pee every now and then is oh-so-common during pregnancy, but you need to be sure. Smell your underwear. Does it smell like pee/ammonia/old popcorn? If yes, it’s pee. Amniotic fluid, on the other hand, is usually odorless or sweet smelling.

If you aren’t sure, consider the quantity and frequency. A small trickle that doesn’t stop is likely to be amniotic fluid — and so is a big, sudden gush. The only way to know is for your doc to test the fluid in his/her office. They will test the pH and look for the fluid to “fern” under a microscope, which is indicative of amniotic fluid and hence, ruptured membranes.

The pH test is super easy and quick (I had one) and can be done in your doctor’s office in about 10 minutes. Painless.

Not to be cliché, but the bottom line is better safe than sorry, gals!

~~ For Addison Lewis, sweet butterfly – Always in our Hearts



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