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. Most families with multiple pregnancies find having several babies at once to be a very positive experience. Being pregnant with triplets or more does mean you will need extra medical support throughout your pregnancy.

How do 'higher order multiples' 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 usually the result of fertility treatments.

In 2020, 1.4% of all births in Australia were multiple births. Of these, almost all were twins. Just 1 in 100 of the multiple births were triplets or higher.

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

Extra care during a multiple pregnancy

When carrying triplets or more, you can expect the same early pregnancy symptoms that you would have with one baby. But they can start sooner and be more severe.

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

You will need tests such as a glucose tolerance test to check for gestational diabetes. Frequent ultrasounds may be recommended to see how your babies are growing. Ultrasound scans can also check whether there are any problems with the placentas or cords.

The most common pregnancy complication with triplets or more is premature birth. Your healthcare team will keep a close eye on your health. Carrying multiple babies puts you at higher risk of certain problems. These can include:

• pre-term labour (going into labour early)
• anaemia (not having enough red blood cells, usually caused by iron deficiency)
• gestational diabetes (diabetes during pregnancy)
• hypertension or pre-eclampsia (potentially dangerous forms of high blood pressure)
• hyperemesis gravidarum (severe morning sickness)
• polyhydramnios (having too much amniotic fluid around the baby)
• miscarriage or stillbirth (sometimes one of the babies may die in the womb)
• Postpartum depression (also known as postnatal depression, and perinatal anxiety and depression)
• postpartum haemorrhagep (heavy bleeding after the birth)

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

Looking after yourself during multiple pregnancy

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

Nutrition

If you are carrying triplets or more, 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 may need to take iron, calcium, Vitamin B12 and folic acid supplements. Your healthcare team will provide you with a nutrition plan.

Conditions associated with pregnancy

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

• reflux
• haemorrhoids
• varicose veins
• constipation

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

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

• continue gentle exercise as advised
• bend your knees when lifting
• tilt your pelvis forward when sitting, standing, or lying down
• consider stomach support

Activity and rest

Doing some gentle exercise during pregnancy can help ease tension and improve your muscle tone.

Towards the end of your pregnancy, you may need to make some changes, such as

• limiting physical activity
• limiting travel
• possible bed rest

You can feel very tired in the later stages of the pregnancy. You may have problems sleeping. Frequent rest and drinking plenty of water will help.

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

Preparing for multiple babies

Be as prepared as you can. The babies are likely to be born earlier so it's a good idea to get the nursery ready.

Attend antenatal classes earlier than you would for a single pregnancy. Some classes or information evenings are designed specifically for women expecting multiple babies. These sessions can provide support, and a chance to meet other families.

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 the 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 and the health of the babies. You may need to stay in hospital for a while before the birth.

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

Where to find more information

If you are expecting higher order multiples, 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.

You can also call Pregnancy, Birth and Baby on 1800 882 436 for advice or support 7 days a week