Let's Talk About Twins (Triplets, Quads, etc.) Part 1: Getting Ready for Multiples

With multiple births on the rise, we thought we would share a short 2-part series on parenting twins, triplets, and higher order multiples. While multiple births represent only 3% of all deliveries in the United States, they account for 15% of preterm births (babies born before 37 weeks gestation), 20% of low-birth-weight births (less than 5.5 lbs.) and 19 to 24% of very-low-birth-weight births (less than 3.3 lbs.) (Goodnight 2009). Although each multiple birth experience is unique, one thing is universal: there is a lot of preparation needed to get ready for this wonderful yet challenging experience. Part one of this series will provide tips for families pregnant with multiples. Part 2 will provide insights into both the mother-infant bond and the twin-to-twin bond. Let’s start with some tips for getting ready for a multiple birth in your family.

Tip 1: Form your support group early

Having a support system in place is important for any pregnancy, but it’s essential for parents of multiples. Having two or more infants to care for will be overwhelming. Recruiting your family and friends to help you during this time will take some stress off of you and give you more time to focus on your new babies.

With this new experience it may also help to enlist the support of others who have parented multiples. Signing up for a local Mothers of Twins Club (http://www.nomotc.org/) or another similar organization could prove to be an invaluable resource for you. They offer support group meetings, newsletters and opportunities for education and networking.

Tip 2: Make nutrition a priority

Eating a well-balanced diet and getting enough calories can have an impact on the outcome of your pregnancy. Although there is a higher risk of preterm deliveries and low birth weights with multiples, the likelihood can be reduced by eating a well-balanced diet while you are pregnant. In one study, mothers eating a well-balanced diet with enough calories to support appropriate weight gain for a twin pregnancy were more likely to gain the proper amount of weight at 20 and 28 weeks gestation. They also experienced fewer complications with their pregnancies, including lower rates of low birth weight, very low birth weight, preterm births, and NICU (Neonatal Intensive Care Unit) admissions. (Goodnight 2009) Talk to your doctor or a registered dietitian to make sure you are eating what you and your growing babies need. Pregnancy weight gain goals vary depending on your pre-pregnancy weight and the number of fetuses you are carrying.

Tip 3: Prepare for your hospital experience early

Keep in mind that twins and multiples often deliver early (on average 35-36 weeks gestation for twins and a few weeks earlier for higher order multiples). (Goodnight 2009, Evans 1993) While you can’t entirely plan ahead for your birth experience, there are a few things you can do to prepare for the big day:

• Take a tour of the hospital where you are planning to deliver. Check out both the regular labor and delivery floor and the NICU for high risk babies.


• Talk to your doctor about what to expect when you go into labor. It is also possible that your babies will come home at different times as one baby may need to spend more time in the NICU.


• Talk to other parents of multiples to learn about their birth experiences. Even though every birth is a unique experience, you can ask them to share any tools that they found useful or helpful.


• Do your research: Reading books and articles (and this blog!) to learn more about what you can expect and how you can prepare for your babies will be valuable.

Tip 4: Prepare siblings & close family members too

Older siblings and other family members need to prepare for the new babies too! If you have other children, talk to them about what to expect when their new siblings arrive. Helping siblings feel connected to their new babies can make the transition easier for them. One idea is to let the older brother or sister pick out or make little gifts for the babies or make something for them. You can also give something to the older sibling from the new babies to foster a positive relationship between them (Bryan 2002). For more information about helping older children deal with your growing family, click here.

Tip 5: Give yourself time to adjust to the news

Finding out you are pregnant is big news, but hearing you are pregnant with twins or multiples can be quite an unexpected surprise and overwhelming. Take some time to mentally prepare for the new additions to your family. Talking to someone (whether it be your spouse/partner, your doctor, a friend or a counselor) can help you deal with the emotions you feel or concerns you have as they arise.

We hope this post was helpful for those of you out there who are parenting (or preparing to parent) multiples. Many of the topics we discuss in our posts, including this one, are based on comments from readers like you. Continue to let us know what you think and what questions you have! We also encourage you to share this post with any new parents of multiples in your life! Then, stay tuned next week for part 2 where we’ll discuss the art of bonding with multiples.

Next time: Multiple Births Part 2: The Art of Bonding

References:

Bryan E. Educating families, before, during and after a multiple birth. Semin Neonatol 2002; 7: 241–246.
Evans, M. I., et al. Efficacy of transabdominal multifetal pregnancy reduction: Collaborative experience among the world's largest centers. Obstetrics and Gynecology 1993; 82: 61-66.
Goodnight W, Newman R. Optimal Nutrition for Improved Twin Pregnancy Outcome. Obstetrics and Gynecology 2009; 114, 5: 1121-1134.
The American Congress of Obstetricians and Gynecologists: http://www.acog.org/publications/patient_education/bp092.cfm (accessed 8/31/10)
The National Organization of Mothers of Twins Club: http://www.nomotc.org/ (accessed 8/31/10)

*Special thanks to Kassandra Harding for her hard work on the research that allowed us to write this post!*

When Motherhood Doesn't Go According to Plan (Part 1 of 3)

Operation Baby Banuelos
I am a planner. I plan out the next day at night before I go to bed. I plan out the week's meals on Sundays. I even made a pregnancy plan. I sketched out exactly what becoming a mother would be like. Here is how "Operation Baby Banuelos" worked in my mind:

1. Decide to have a baby
2. After only 1 month of "trying," see 2 blue lines!
3. Look and feel great for 9 months
4. Have an easy, fast labor at 40 weeks
5. Bring beautiful, healthy baby home and live happily ever after!

I soon discovered that being a parent rarely goes according to plan. Here is what "Operation Baby Banuelos" taught me:

1. Deciding to get pregnant is the easiest part!
2. Getting pregnant right away isn't always as easy
3. Being pregnant isn't always fun
4. You can't plan when labor will start
5. Newborns don't always get to come home right away

Looking back, I realize I was more than a little idealistic. But for me, being a mother was something I had always dreamed about. Sure, I knew about morning sickness, premature labor, and the increasing prevalence of infertility. I was pursuing a Master's Degree in Maternal and Child Nutrition, so I knew more than most people about pregnancy and all of the possible risks. I just never considered that complications would be part of my story. They weren't part of my plan.

In this post, I will share my experience with early labor and the birth of my daughter. Next time I will describe what it was like leaving the hospital without my baby. Finally, in Part 3, I will share tips for coping and making the best of a difficult situation.

Briefly: Steps 1-4 of my story
For us, step 1, deciding to have a baby, was the easiest part. But it took 2 years to get to step 2. Once I finally got pregnant, I was determined to do everything right. I stopped moving heavy boxes; I left the house when my husband was painting; I bought more fruits and vegetables; I planned (there is that word again!) to go for walks in the evenings. Unfortunately, following a plan is hard when you can't even keep water down. I was so sick that I lost 10 pounds during the first 3 months of my pregnancy and I struggled to get to work each day. Just as I thought step 3 was a lost cause, I started to feel better. I had more energy, could eat real food, and I started to enjoy being pregnant. I began to feel my baby move and we found out we were having a girl!

Unfortunately, step 4 came much earlier than we expected. At 24 weeks, I noticed a little spotting and even though my doctor assured me that it was nothing to worry about, I made an appointment. What started out as a quick check-up over my lunch hour, turned into immediate admission into the hospital. At first, everything happened so quickly that there wasn't much explanation about what was going on. All we knew was that I was already dilated to 3 centimeters and we had to stop the labor. I was taken to a hospital equipped for high risk pregnancies and things improved. I wasn't having contractions, the labor didn't seem to be progressing, and I came to terms with the fact that the best thing for my baby was for me to stay in the hospital for as long as possible. But, on my 6th day in the hospital, my baby flipped over and started kicking downward. We couldn't wait any longer. Olivia was born 15 weeks early, at 25 weeks gestation. She weighed only 1 pound 15 ounces and was 13 inches long.

Step 5: Bring beautiful, healthy baby home and live happily ever after
Needless to say, with step 4 going so wrong, step 5 was thrown out the window. We knew that babies born so early faced an uphill battle and that our daughter would struggle just to survive. According to the March of Dimes, 1% of babies in the United States are born before 28 weeks and of those born at 26 weeks, 80% survive. Olivia was born at a time when research shows that things could go either way.

There are 2 things I remember clearly about those first few days. First, I remember how excited I was to take a shower! It had been 8 days since I was allowed to shower and it felt so good! The other thing, even better than the shower, was the first time I was able to take some of my breast milk to the NICU! I started pumping just a few hours after getting back from the recovery room because I knew how important my milk would be to Olivia. Since she was too small and weak to nurse, I needed to pump frequently to stimulate my the milk to come in. By day 3, the doctors had decided to start feeding her through an OG-tube, which is a tiny tube that went into her mouth and down to her stomach. I remember the first time I got any milk out, I had less than 1 milliliter of colostrum to take to her, but I was so excited. I carried it over to the NICU in a tiny syringe. It was the first time I felt like I could do something to care for my baby, and that was the best feeling I had had in days!

Just a few days after Olivia was born, it was time for me to be discharged from the hospital. I had mixed emotions about going home. On the one hand, I was glad to be leaving the hospital. I had been in bed for over a week, so the idea of being able to go outside (or even to the kitchen to get something for myself) was thrilling. On the other hand, I knew that I would be leaving my baby in the hospital and home was 30 miles away. Because I had a C-section, I was not allowed to drive for a few weeks after the surgery. My friends and family were very supportive and worked out a system to make sure I always had someone to take me back and forth. But, even though all of their support was appreciated, they couldn't make me feel any less helpless.

Next time I will continue the story about Olivia's time in the hospital and what it was like when we were finally able to bring her home.