How Long Do Twins Stay in Hospital

There is no standard number

Nobody publishes an average length of stay for twins, because the range is enormous. Two babies born at 37 weeks who feed well may go home in a day or two, like any other newborns. Two babies born at 30 weeks will be in hospital for weeks. The gestation at birth does most of the work in that calculation.

Start with the gestation you have been offered

NICE NG137 offers planned birth at 37 weeks for uncomplicated dichorionic diamniotic twins, at 36 weeks for uncomplicated monochorionic diamniotic twins, between 32+0 and 33+6 weeks for uncomplicated monochorionic monoamniotic twins, and at 35 weeks for uncomplicated trichorionic or dichorionic triamniotic triplets.

NG137 also says teams should explain that spontaneous and planned preterm birth are both associated with an increased risk of admission to a neonatal unit, and that about 60 in 100 twin pregnancies result in spontaneous birth before 37 weeks. For monoamniotic twins it goes further, stating that these babies will usually need to be admitted to the neonatal unit and have an increased risk of respiratory problems.

So the answer to how long your twins will stay begins with which of those lines describes your pregnancy.

How likely neonatal care actually is

Twins Trust says around 40% of twins and triplets need extra support in hospital after birth. On its cervical length page it gives a slightly different cut of the same reality: in just under half of twin births and almost all triplet births, at least one baby will need to go to the neonatal intensive care unit.

Both figures are Twins Trust's, describing UK multiple births. Neither means your babies will need it. They mean it is common enough to plan for.

Transitional care: not the same as the neonatal unit

Twins Trust describes an option many parents have not heard of. Some babies can stay with you on the postnatal ward with transitional care, meaning staff monitor and support your babies at your bedside rather than admitting them elsewhere. If they need more help, they are admitted to the neonatal unit.

Worth asking about if your babies are borderline. Staying together is the outcome most parents want, and transitional care is how it happens.

The levels of unit, and who goes where

Twins Trust sets out the three levels. A special care baby unit, sometimes called special care, looks after babies who need extra monitoring but not full intensive care, and it says 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 provides a higher level of medical and nursing support, and Twins Trust says babies born between 28 and 32 weeks often start here, with care that can include ventilation, short periods of intensive care and feeding through a drip.

A neonatal intensive care unit is for the smallest or sickest babies, and Twins Trust says many babies there are born before 28 weeks or become very unwell soon after birth, usually cared for in incubators until they can control their own temperature and move to a heated cot and then a normal cot.

Babies move between levels as they get stronger, so the unit your babies start in is not where they will finish.

What has to happen before they come home

Twins Trust says that before your babies go home the team will check they are feeding well and can keep a normal temperature in a cot. It also mentions a step that catches people out: 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.

Buy or borrow the seats before the birth rather than after. With twins that is two seats, and a discharge can be delayed by their absence.

Things that commonly extend a stay

Twins Trust notes that being born early or unwell can lead to conditions including neonatal jaundice, treated with phototherapy, infections treated with antibiotics through a drip, and oral thrush treated with antifungal medicine. The NHS lists prematurity, low birthweight, infection, jaundice, a very difficult birth, and recovery from surgery as reasons for admission to neonatal care.

Feeding is the most common reason a stay stretches out. A baby who needs tube feeds has to learn to take milk by mouth and gain weight before discharge, and that is a matter of days rather than hours.

Steroids before birth, and what they change

NG137 says planned birth for monochorionic diamniotic twins, monoamniotic twins and triplets should be offered after a course of antenatal corticosteroids has been considered. Twins Trust explains the purpose: steroids cross the placenta and help the lungs mature, which may lower the chance of breathing difficulties after birth and reduce how much breathing support a baby needs in a neonatal unit.

It also says the evidence in twins is less complete than in singletons, and that RCOG advises discussing benefits and drawbacks after 34 weeks so you can make an informed choice. Fewer breathing problems can mean a shorter stay, which is why the conversation is worth having properly rather than in passing.

Your own discharge is a separate question

You may be medically ready to leave before your babies are. That is one of the hardest moments in a twin admission and it is common. Twins Trust says it is quite common for one baby to be discharged before their sibling, that this can feel very unsettling, and that your neonatal team will help you plan how to manage it. The NHS notes that not all hospitals provide specialist neonatal services, so babies may be transferred to another hospital.

Ask early where your babies would be transferred to if cots were needed, whether both could go to the same unit, and what accommodation the unit has for parents. RCOG says that wherever possible babies are kept together, but that depending on their individual needs they may need to be cared for separately.