Signs of Preterm Labor with Multiple Pregnancy

How will you know if preterm labor starts during your pregnancy with multiples? 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.


Sometimes preterm labor is silent. Many women don't realize that their body is undermining their pregnancy until it's too late—or rather, too early for their premature babies. You won't feel an incompetent 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.

Know 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.

E Alert

Don't ignore the signs. Your body may be trying to cue you that something is wrong. A prompt response may buy you extra time, crucial time for your babies to develop and grow.

Suspicious Signs

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

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. Should you experience the following, notify your doctor immediately:

  • Diarrhea
  • Vaginal bleeding or discharge
  • 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 a baby. If that sac breaks open, the fluid will escape through your vagina. It might come out as a trickle or a gush, and it is 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.

excerpted from:

From The Everything Twins, Triplets, and More Book Copyright © 2005, F+W Publications, Inc. Used by permission of Adams Media, an F+W Publications Company. All rights reserved.

To order this book go to Amazon.

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