Key takeaways
Neonatal care supports babies who are premature, unwell or need help to grow
Twins, triplets or more are more likely to need neonatal care after birth
Babies may move between different neonatal units as they get stronger
One baby may go home before the other which can feel very emotional
Neonatal care for twins, triplets or more
Around 40% of twins and triplets need extra support in hospital after birth. This is called ‘neonatal care’.
Many twins are born before 37 weeks. Being early or unwell can mean your babies need help with breathing, feeding or keeping warm. Neonatal care gives them time and specialist support to grow, recover and get ready to come home.
It is completely normal to feel shocked, worried or sad if your babies go to the neonatal unit. Understanding what happens there can help you feel more confident and more involved in their care.
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Levels of neonatal care your babies may need
Right after birth, a team from the neonatal unit is usually present. They will check each baby and decide what support is needed. If one or more of your babies is struggling with breathing or seems unwell, they may be taken straight to the neonatal unit. You will be able to visit them once they are settled and the team will explain what is happening.
Some babies can stay with you on the postnatal ward with ‘transitional care’. This means staff monitor and support your babies at your bedside. If they need more help, they will be admitted to the neonatal unit, which has different levels of care.
A Special Care Baby Unit (SCBU), sometimes called ‘special care’, looks after babies who need extra monitoring but not full intensive care. Babies born after 32 weeks may come here if they need help keeping warm, a little more oxygen or close observation of their breathing and heart rate.
A Local Neonatal Unit (LNU), sometimes called a high dependency unit, provides a higher level of medical and nursing support. Babies born between 28 and 32 weeks often start here. Care can include breathing support called ventilation, short periods of intensive care, feeding through a drip in a vein, known as parenteral nutrition, and cooling treatment after a difficult birth or if a baby is unwell.
A Neonatal Intensive Care Unit (NICU) is for the smallest or sickest babies who need the highest level of support. Many babies in NICU are born before 28 weeks or become very unwell soon after birth. They are usually cared for in incubators, which keep them warm and help protect them from infection. As they grow and can control their own temperature, they are moved to a heated cot then to a normal cot.
Being born early or unwell can sometimes lead to other conditions. These include neonatal jaundice, which causes yellow skin and is treated with a blue phototherapy light, infections that are treated with antibiotics through a drip, and thrush in the mouth, which is a common fungal infection treated with antifungal medicine.
Before your babies go home, the team will check they are feeding well and can keep a normal temperature in a cot. You will usually be asked to bring in your car seats so staff can check your babies sit safely in them, as they may still be smaller than many newborns.
It is quite common for one baby to be discharged before their sibling. This can feel very unsettling and you may feel pulled between home and hospital. Your neonatal team will help you plan how to manage this and you can usually bring the baby who is at home in with you when you visit.
How to prepare and stay involved in NICU
During pregnancy, your doctor or midwife should talk with you about where you will give birth and the chance that your babies may need neonatal care. This is a good time to ask what would happen if your babies needed extra support or transfer to another hospital.
Some hospitals offer antenatal classes for parents expecting twins, triplets or more, or run dedicated multiples clinics or groups. These can help you meet other parents, hear real experiences of neonatal care and feel less alone if your babies need to spend time in a unit.
If possible, ask for a tour of the neonatal unit before you give birth. Seeing the incubators, monitors and cots in advance and meeting some of the team can make things feel less frightening later. You can ask practical questions about visiting, expressing milk, staying overnight and how the team will involve you.
Once your babies are in neonatal care, you are still central to their care. You can ask staff to explain any equipment or terms you do not understand, take part in cares such as nappy changes and cuddles when it is safe, ask about skin to skin contact, and talk to staff about feeding plans, whether you are breastfeeding, expressing or using formula.
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Support and next steps with Twins Trust
You do not have to face neonatal care on your own. Support is available from your hospital team and from Twins Trust.
- Download our neonatal care booklet (LINK) - for Premium Members
- Sign up to our pregnancy courses (LINK) to learn more about pregnancy and birth with twins and triplets
- Join our online community (LINK) to meet other expectant twin or triplet parents
- Reach out to our helpline (LINK) for support and advice
If you are finding things hard at any stage, asking for help is a strength. The hospital team and Twins Trust community understand the unique journey of having twins, triplets or more and are here to stand alongside you.
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