Written By: Judy Slome Cohain, CNM

Can triplets be born naturally at full term? Yes, Easily!

Triplets are typically delivered by cesarean section due to concerns about the babies' ability to withstand the stress of vaginal birth because nearly all triplets are born premature.1 However, it is possible to have full-term triplets by eating enough.2 Except for the rare example described below in which the triplets were 3 kg each at full term, triplets are typically between  2 and 2.5 kg at term and therefore easy to deliver vaginally. Vaginal births of term babies under 3 kg have better outcomes than cesarean if managed by an experienced practitioner. The key to a successful vaginal triplet birth lies in speed at the time of birth. All three babies must be delivered within 5 minutes to ensure they deliver before the placentas separate and stop sending them oxygen. This rapid delivery is best achieved by the mother pushing in a squatting position, which harnesses gravity and allows for more effective use of abdominal muscles and the diaphragm.

Achieving healthy, full-term triplets, is accomplished the same way as achieving healthy full term singleton or twin births: by excellent nutrition and appropriate physical activity during pregnancy. But for triplets, it means three times as much protein and calories. Essential elements are:

1. Daily intake of greens, such as parsley
2. At least 50 grams of complete protein per day per fetus after 12 weeks of pregnancy, so 100 gms per day for twins, 150 grams of complete protein per day for triplets.
3. Adequate calorie intake- triplets- gaining 1.5 lbs per week after 11 weeks.

A case study2 of successful full-term, 3 kg each triplets provides valuable insights:

• Mother: 35 years old, fifth pregnancy, delivered triplets at 39+4 weeks
• Height: 170 cm
• Pre-pregnancy weight: 74 kg (163 lb)
• Starting BMI: 25.6
• Weight gain: 24 kg (53 lb) during pregnancy or 8 kg (17 lb) per fetus
• Final weight: 98 kg (216 lb)
• Two fetuses shared one 600 gm placenta & the third had its own placenta that weighed 500 gm.

This case challenges the common belief that if twins or triplets share a placenta, then twin to twin transfusion syndrome is inevitable. With proper maternal nutrition, all three babies can develop normally, even when two share a smaller placenta. Typically, triplet birth weights fall behind singleton weights after 32 weeks, reaching the 10th percentile by 38 weeks.3 However, this case study suggests that with adequate nutrition, triplets can achieve the same birth weights as singletons.

For women considering a triplet pregnancy, aim for:

• Weight gain: 1.5 lbs/week starting at 11 weeks gestation
• Total weight gain: 19 kg (42 lb) by 39 weeks i.e. 6 kg weight gain per fetus   
• Protein intake: 150 grams of complete protein daily4

While nutritional counseling can be time-consuming and changing dietary habits challenging, it's crucial for successful multiple pregnancies.5

As a midwife with experience in home vaginal triplet birth, I welcome inquiries from women interested in exploring this option. Please contact me at [email protected] for more information.

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