Labor Signs with Twins and Multiples: Recognizing Preterm Labor

According to the National Institutes of Health (NIH), more than half of twin births in the U.S occur preterm. It's important to know the signs of preterm labor in a multiple pregnancy so that you can get help in time.

There are some clues, but they might not be obvious until it's too late to stop a delivery: That's why it is so vitally important to know the signals, and to contact your medical provider as soon as you suspect something.

Dr. Chloe Zera of Brigham and Women's Hospital in Boston breaks down the signs of preterm labor.

Understanding Contractions

Sometimes preterm labor is silent. You won't feel your cervix dilating or effacing. You may not even feel contractions, especially if you've never been pregnant before.

The uterus contracts throughout pregnancy. These irregular, "practice" contractions are called Braxton-Hicks contractions and they can start as early as the second trimester. As the body readies for labor and delivery, however, the timing, regularity, and intensity of the contractions will increase.

It is the pattern and frequency of the contractions that can signal that labor is imminent. Occasional or irregular contractions are normal. Recurring contractions at a rate of more than four per hour are cause for concern and require further monitoring.

The following symptoms and situations should be reported to your caregiver:

• More than four or five contractions per hour
• Rhythmic or persistent pelvic pressure
• Cramps, similar to menstrual cramping
• Backache

Knowing Your Body

Women experience contractions in different ways; they may produce a sensation of pain, hardening, pressure, heaviness, tightening or cramping. They may be felt in the abdomen, pelvis, and lower back, or even the upper thighs.

You'll have to spend some time getting to know your body to understand how the contractions will be manifested in your multiple pregnancy.

The best way to tune into contractions is to lie quietly on your left side. Put your hands on your belly. You may feel protruding baby parts, such as a head, elbow or rear end. These will feel hard and bumpy; feel for a softer spot so that you can feel your uterus and not the movement of the babies.

At rest, your uterus will feel soft and fleshy, but when contracted, it will feel tight and hard, like a flexed muscle.

Learn about all of the signs of labor in this video.

Other Signs of Preterm Labor

While contractions are the main indicator of preterm labor, you can't count on them to let you know what's going on. There are some other signs that indicate that labor is already in progress.

If experience the following, notify your doctor immediately:

• Diarrhea
• Vaginal bleeding or discharge
• An uneasy sense that something is wrong

Some of these symptoms can be unrelated to preterm labor, but they should still be reported. Diarrhea and stomach upset can result from something you ate, but they can also be preliminaries to labor.

Vaginal discharge is not an uncommon occurrence during pregnancy, but a change in the amount or type of discharge can be a warning sign. Any vaginal discharge that is bloody or streaked with blood can indicate that the cervix is beginning to dilate.

If you experience a leaking or gushing of fluid from the vagina, it could be a sign of premature rupture of membranes (PROM). The fluid comes from the amniotic sac that contains one of the babies. If that sac breaks open, the fluid will escape through your vagina.

It might come out as a trickle or a gush, and it's usually clear with a distinct odor. A pH test can determine if it is indeed amniotic fluid, but you'll have to visit the doctor to confirm this. Even a small leak can present a danger of infection, so it's important to notify your caregiver as soon as possible.

Looking for more information on delivering multiple babies? Check out Multiple Pregnancy: When Will You Deliver?.