Version July 2025
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What are multiples? —
This is when a person is pregnant with more than 1 baby. Doctors also use the terms "multiple gestation" or "multiple birth."
Twins are the most common type of multiples. Triplets, quadruplets, or more are called "higher-order multiples." These are much less common. This article is about higher-order multiples.
Being pregnant with triplets or more increases the risk of certain problems. Your doctor will want to see you often during pregnancy.
How do multiples happen? —
First, it can help to understand how pregnancy happens. Usually, the body releases 1 egg from an ovary. The egg is "fertilized" by a sperm and becomes an embryo, which can grow into a baby.
In most cases, triplets (or more) happen when a person used treatments to help get pregnant. For example:
●Some people take medicine to help their ovaries produce eggs. This can cause multiple eggs to be released, increasing the risk of multiple embryos.
●In a treatment called "IVF," eggs are fertilized with sperm in a lab. Then, 1 or more embryos are placed in the uterus to grow into a pregnancy. When multiple embryos are placed into the uterus, this can lead to twins, triplets, or more. This is no longer commonly done. It is also possible for 1 embryo to be placed in the uterus and then split into 2 or more embryos.
Triplets can also happen naturally or "spontaneously." But this is rare.
How will I know if I'm having multiples? —
Most of the time, this is first seen during an ultrasound early in pregnancy. An ultrasound uses sound waves to create pictures of the inside of your body. Early on, this can show how many embryos are in your uterus.
When your doctor examines you, they will also feel the size of your uterus. People who are having multiples usually have a uterus that is bigger than expected for how far along they are in pregnancy.
Will I need special care during pregnancy? —
Yes. If you are pregnant with multiples, you need special prenatal care. As you get farther along in pregnancy, you will see your doctor more often.
You will also have frequent ultrasounds to check how the babies are growing. Your doctor will check the position of each baby, as well as things like:
●Whether they have separate or shared amniotic sacs – The sac surrounds a developing baby and holds amniotic fluid. With multiples, the babies can have separate sacs, or 1 or more can share a sac.
●The placentas and umbilical cords – The placenta is the organ inside the uterus that brings a baby nutrients and oxygen and carries away waste. The umbilical cord connects the baby to the placenta. The babies might all share 1 placenta, or they might each have a separate placenta, or 2 might share a placenta.
This information will help your doctor decide how often you should have ultrasounds. When babies share a sac or placenta, this can increase the risk of certain problems.
As you get further along in pregnancy, you will have other tests to check both your and your babies' health. These might include special ultrasounds, blood tests, and other tests.
What problems can happen? —
Being pregnant with multiples increases the risk of certain problems, including:
●Nausea and vomiting during pregnancy – This is often called "morning sickness," but it can happen at any time.
●Gestational diabetes – This is diabetes that starts during pregnancy. It causes high blood sugar.
●1 of the embryos does not develop – Sometimes, early in pregnancy, 1 or more of the embryos stops developing. This is called a "vanishing twin."
●Preterm birth – People who are pregnant with multiples are more likely to give birth early. Preterm babies are more likely to be smaller and need to stay in the hospital for longer after birth. They are also more likely to have medical problems, such as breathing problems.
●Preeclampsia – This is a serious problem that can happen during pregnancy. It causes high blood pressure and other problems. Your doctor will probably recommend taking daily low-dose aspirin to help prevent this.
●Problems with growth – Sometimes, 1 or more of the babies does not grow at the expected rate.
●Problems with the placentas or umbilical cords
●Heavy bleeding after birth
What can I do on my own? —
Your doctor will tell you if there is anything specific you should do or avoid. Many of the recommendations are the same as those for people who are pregnant with 1 baby.
Being pregnant with multiples is physically tiring. By halfway through pregnancy, you will probably need to slow down and rest more. You will also need to make sure you are eating plenty of healthy foods.
When and how will I give birth? —
If you are pregnant with triplets or more, your doctor will probably schedule a cesarean birth ("c-section"). In some cases, it might be possible to have a vaginal birth. But this comes with increased risks.
The timing of birth will depend on your health and whether the babies have separate or shared amniotic sacs. But most people with multiples give birth before 36 weeks of pregnancy.
What else should I know? —
As you prepare for birth, you might want to think about:
●Breastfeeding – It is possible to breastfeed triplets or multiples, if this is your choice. Your body can adapt to the babies' needs and make more milk. But this can be a lot of work. It can help to have the support of a partner, family, or friends. You can also talk to a breastfeeding expert, called a "lactation consultant."
●Support – After giving birth, it's important to have help and support when possible. Caring for multiple newborns can be exhausting and stressful. It might help to connect with other parents and caregivers of multiples. You might be able to find a group in your community or online.
If you are very worried, stressed, or struggling to cope, talk to your doctor or nurse. They can help you.
Patient education: Having twins (The Basics)
Patient education: Prenatal care (The Basics)
Patient education: Prenatal ultrasound (The Basics)
Patient education: When your baby is measuring small during pregnancy (The Basics)
Patient education: Preterm labor (The Basics)
Patient education: Preeclampsia (The Basics)
Patient education: Cesarean birth (The Basics)
Patient education: What to expect in the NICU (The Basics)
Patient education: Breastfeeding (The Basics)
Patient education: Preterm labor (Beyond the Basics)
Patient education: Preeclampsia (Beyond the Basics)
Patient education: C-section (cesarean birth) (Beyond the Basics)
Patient education: Breastfeeding guide (Beyond the Basics)
