Why pregnancy should be prolonged
If you are at risk of giving birth early, your midwife or doctor may offer you treatment to try and stop this from happening. This will give your baby more time to develop in the womb and get ready for the outside world.
You may be offered treatment to prevent early labour if:
- you've given birth at less than 34 weeks pregnant before
- you've had a miscarriage after 14 weeks pregnant before
- your waters have broken before 37 weeks (PPROM), in this pregnancy or in previous pregnancies
- your cervix has been injured in the past, for example through surgery
- your cervix is shorter than expected (measured with an internal vagina scan).
If you are having more than 1 baby
The National Institute for Health and Care Excellence (NICE) recommends that all women carrying multiple babies should plan to give birth earlier than women carrying 1 baby. This helps to reduce the risk of complications.
This means that even if you don’t go into premature labour naturally, you will be advised to give birth before your due date.
You may be offered an induction (starting labour artificially) or a caesarean section. Exactly when this will be will depend on your circumstances. But if your pregnancy has been uncomplicated, this may be at:
- 37–38 weeks if you are carrying twins with their own placentas (dichorionic)
- 36–37 weeks if you are carrying twin babies that share a placenta (monochorionic)
- between 32 and 33+6 weeks if you are carrying twin babies that share a placenta and amniotic sac (monochorionic monoamniotic)
- 35 weeks if you are carrying triplets with their own placentas and amniotic sacs (trichorionic triamniotic), or 1 baby that has a separate placenta and 2 babies that share a placenta and all 3 babies have separate amniotic sacs (dichorionic triamniotic).
You’ll have an individual assessment to decide when to give birth if you:
- have had a complicated twin or triplet pregnancy
- are expecting triplets where all 3 babies share 1 placenta but each has its own amniotic sac (monochorionic triamniotic)
- a triplet pregnancy where any babies share an amniotic sac (dichorionic diamniotic monochorionic diamniotic or monochorionic monoamniotic).
Unless labour starts on its own, when you give birth is ultimately up to you. Your doctors will talk to you about the risks of continuing with the pregnancy beyond the recommended time. If you still don’t want to give birth at the recommended time, you’ll be offered weekly appointments with your specialist doctor. They will monitor your babies closely.
If you are at higher risk of premature labour starting on its own, you may still be offered treatments to prevent your babies from being born too early. These include progesterone, a cervical stitch or an arabin pessary. But these treatments may be less effective than in women carrying more than 1 baby, so they are not routinely offered to women carrying multiple babies. Bed rest is also not routinely advised.
You may be offered a medication called corticosteroids during your pregnancy to help your baby’s lungs develop more quickly. This can reduce the risk of complications associated with giving birth prematurely.
You will also be monitored with frequent scans for signs of twin-to-twin transfusion syndrome (TTTS), which can cause premature birth.
Find out more about giving birth to multiple babies.
Will I have a choice about what treatment I have?
It is really important that you are involved in every decision about your care and treatment. How you are treated is ultimately up to you, so your healthcare team should talk to you about what options are available and what the advantages and disadvantages are for each. Don’t be afraid to ask any questions that will help you help make an informed decision.
If you decide to go ahead with treatment, you will likely be asked to sign a consent form that states that you agree to have the treatment and you understand what it involves.
Monitoring – also known as the ‘wait and see’ approach
Your healthcare team may arrange for you to have transvaginal ultrasound scans to measure your cervix. If your cervix is found to be short (less than 25 mm long), you may be offered:
- a cervical stitch
- a hormonal treatment with progesterone
- a combination of the two treatments above
- close monitoring by your healthcare team.
Progesterone is a hormone that can help prevent contractions and help a pregnancy continue to full term. If your healthcare professional thinks you should take it, NICE recommends that women should be offered this from between 16 and 24 weeks of pregnancy and until you are at least 34 weeks pregnant. This will be given to you as a small tablet that you put into your vagina or bottom.
The Arabin Pessary is a soft silicon ring that is inserted into the vagina by your doctor and moved into place so that the cervix sits inside it.
It is not used in all hospitals because there isn’t enough evidence that they work. Tommy’s Edinburgh Research Centre is looking at whether it can stop premature birth in women who are pregnant with more than 1 baby. Tommy’s London Research Centre is looking to see whether it works as well as a stitch or progesterone in women with single pregnancies.
You can ask your doctor or midwife for more information about the Arabin Pessary.