In 2014, September was dedicated as Neonatal Intensive Care Unit Awareness Month to raise awareness of the unique needs and challenges that NICU families face and to highlight resources available to families during and after their NICU experience. While each pregnancy is different, the most frequent complication of a multiples pregnancy is preterm delivery (prior to 37 weeks) which often means a NICU stay for one or more of the babies. This does not mean that every multiples pregnancy involves a NICU stay, however it can be helpful to learn a bit about the NICU experience prior to delivery to allow your family to be prepared and informed if the need for a NICU hospitalization arises. 

Take a peek into the NICU

While it’s not typically a standard part of a hospital tour for expecting families, a peek into the NICU before your babies arrive can be extremely beneficial. The unit can be an overwhelming place, so having an opportunity to hear the sounds, learn about the monitors, meet some of the staff, and learn a bit about the supports available prior to your babies’ entrance into the world can allow you to focus your energy on your little ones instead of learning the ropes of this new environment. Even something as simple as knowing the sign-in procedure or learning about visitor policies on the unit can make it feel less like you’ve been thrust into a completely alien world and all you to feel more comfortable navigating this difficult time. 

What level of care is available?

Another important piece of information to find out before you deliver is the level of care available at your hospital. Ranging from a Level I nursery providing routine care to a Level IV NICU with pediatric subspecialists and neonatal surgical capabilities, different hospitals are equipped to serve different populations of infants. Learning about your particular hospital’s capabilities can help determine the best course of action for you and your babies, from delivering at an alternate location if prior to a certain gestational age, to transferring hospitals if the necessary post-delivery. It can also be reassuring to have discussed and agreed upon all potential plans with your care team well in advance to delivery to ensure that you have time to have all questions answered and you are eliminating as many potential surprises as possible. 

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Hospital Policies

In addition to different levels of care, each hospital has different policies around visitors in the NICU. Families of multiples, even if you do not already have older children at home, should inquire about their NICU’s sibling policy. At some hospitals, particularly during cold, flu, and RSV season, visitors under 18 years of age are not allowed on the unit to help maintain a healthy environment. This can be challenging for families of multiples however, if only one baby requires a NICU stay or if one or more are discharged earlier than their siblings. Talking to your hospital about their sibling policies, including if they have separate rules for twin or higher order multiples families, can help determine the type of supports you might need to have on call during the postpartum period. 

Address parental leave

Parental leave and the NICU is also an area that families can begin to address prior to delivery. In the United States, there are no federal laws dictating how much paid leave every new parent should receive although there are general guidelines for unpaid leave with qualifying companies. Families expecting multiples can find it beneficial to talk to their employers as early as they are comfortable around leave expectations and options. Depending on how long your child(ren) remain in the NICU, some families and employers find it helpful to split leave, allowing for the parent to have time at home with the babies once they’ve been discharged. Workplace policies and your legal rights can be complicated to navigate even under the best of circumstances, so it can be extremely useful to have at least begun the discussion in the event one or more babies need NICU time. 

No set time frame

One final thing that can be helpful for expectant parents of multiples to know about the NICU is that there is no set equation to determine how long a baby will be in the NICU. Some people will make guesses based on gestational age at birth, others may try to estimate based on birth weight, but each baby is going to have their own unique needs and own unique timeline. Regardless of the amount of time a child spends in the NICU, it can be a challenging and emotional experience for all family members. Short of finding a crystal ball, the best thing to do is to gather information and resources before delivery and surround yourself with support to help your family navigate parenting in the NICU. 

NICU Resources:

Hand to Hold

Graham’s Foundation

Project Sweet Peas

Support 4 NICU Parents by the National Perinatal Association

About the author

Emily Lindblad is Twin Love Concierge’s and Three Birds Family Education & Postpartum Care’s Postpartum Doula and Certified Newborn Care Specialist – providing perinatal support and education to Massachusetts families of multiples and Triplet parents worldwide. Emily is also the mother of triplets and knows first-hand that welcoming multiple newborns can be a daunting task. By providing practical tools and assistance, Emily provides families with the skills and confidence needed to successfully transition to life with twins, triplets, or more. For more information on our Triplet and Boston classes /services or to contact Emily, please email