Signs of Preterm Labor with Multiples: What to Watch For

Know the Warning Signs and When to Call Your Doctor

Expecting twins, triplets, or more? While every pregnancy is unique, carrying multiples comes with a higher risk of preterm labor. Knowing the signs early can help you act fast, get the care you need, and protect both your health and your babies.

In this guide, we’ll explain the most important signs of preterm labor in multiple pregnancies, how to tell what’s normal vs. concerning, and when it’s time to call your provider.

Why Preterm Labor Is More Common with Multiples

Preterm labor means going into labor before 37 weeks. If you're carrying twins or triplets, your body is under more pressure—so early labor is more common. According to the March of Dimes, more than 60% of twins and over 90% of triplets are born early.
👉 Source: March of Dimes

Common Signs of Preterm Labor in Twin or Multiple Pregnancies

1. Regular Contractions

• More than 4–6 per hour

• Don’t stop when you rest or hydrate

• May feel like period cramps or tightening

2. Low, Dull Backache

• Comes and goes or feels constant

• Not relieved by changing position

3. Pelvic or Abdominal Pressure

• A heavy feeling, like the babies are pushing downward

• Could signal early cervical changes

4. Changes in Vaginal Discharge

• Watery, mucus-like, or bloody

• Sudden increase in volume

5. Cramps

• Menstrual-like pain in the belly or thighs

• More persistent than usual pregnancy aches

6. Leaking Fluid

• A trickle or gush of clear fluid

• May indicate your water has broken

What’s Normal vs. What’s Not

It’s normal to feel occasional:

• Braxton Hicks (practice contractions)

• Mild pelvic aches

• Lower back strain

But call your provider if symptoms are regular, painful, or intensifying.

When to Call Your Doctor

📞 Contact your doctor right away if:

• You have frequent contractions (every 10 minutes or less)

• You feel constant pressure or pain

• You notice leaking fluid, unusual discharge, or spotting

• You just feel “off”—trust your instincts

How to Reduce Your Risk

While not all cases are preventable, you can lower the risk by:

• Resting often and staying hydrated

• Avoiding overexertion

• Keeping all prenatal appointments

• Following your provider’s recommendations closely

Final Thoughts: Know the Signs, Protect Your Peace

Preterm labor with multiples is more common—but with the right knowledge, you can be ready. Watch for warning signs, stay in touch with your provider, and take care of your body. You’ve got this, mama.