The incidence of multifetal gestations has increased dramatically in the United States over the past several decades. In 2017, the twin birth rate was 33.3 per 1000 births compared with 18.9 per 1000 in 1980, representing an increase of 76%.[1],[2] This trend is most likely secondary to a shift towards older maternal age at conception and increased use of assisted reproductive technologies.[2] Multifetal gestations are associated with increased fetal, neonatal, infant, and maternal morbidity and mortality[3] and therefore are associated with substantially higher costs. The most significant complication of multifetal gestations is spontaneous preterm delivery. OB/GYN hospitalists should be able to diagnose multifetal gestations and manage common complications such as preterm labor, diabetes mellitus, and hypertensive disorders. OB/GYN hospitalists should also be skilled in the intrapartum management of multifetal gestations, including procedural skills necessary to effect safe vaginal deliveries, and should ensure systems are in place to deliver evidence-based, high-quality care to patients with multifetal gestations.