July 11, 2007
Tips for Having Multiples - Multiple Pregnancy - Multiple Birth - Raising MultiplesIt’s one thing for a couple to find out that they’re pregnant. If during that first ultrasound, more than one baby is discovered, a whole flood of emotions comes into play. These reactions may involve several of the following. How did this happen to us? How will multiple babies affect the pregnancy and what precautions need to be taken? How will we care for them? How will we afford it? Who can we call for help? Being informed that you are about to be a parent of multiples is enough to cause massive amounts of stress, what about when the babies actually get here? The good news is that parents have multiples all the time, they survive it, and it can actually be fun! The key to raising multiples successfully is to plan ahead so you can be prepared.
Causes of Multiple Births
So, how did this happen? Several factors can cause a multiple pregnancy and these pregnancies are becoming more and more common. This can be attributed in part to the fact that more women are having babies in their late 30’s and 40’s. Women over 35 are more likely to release more than one egg during ovulation. Further, infertility treatment has become more readily available, also adding to the increase in multiple births (Lindberg, 2005). Tinglof states, “Between 1980 and 1997, the number of twin births increased by 52% and the number of births involving three or more babies has quadrupled” (1998). Other factors that increase the likelihood of conceiving multiples include heredity (on the mother’s side) and race (Lindberg, 2005). Though the chances of having multiples are not likely, it can and does happen, much to our amazement. Though it’s a little bit like winning the lottery, the results and the planning needed are much, much different.
As for how being pregnant with multiple babies will affect the pregnancy, there are a few things to be aware of. A major concern in a multiple pregnancy is keeping the babies from being born too early. Babies born before thirty seven weeks are considered to be premature and often have low birth weights. Low birth weight babies weigh less than five and a half pounds. Because prematurity and low birth weight are “such strong predictors of health problems…every additional day is precious, as is every additional ounce of weight”. Since “inadequate nutrition is believed to be a leading cause of premature birth and low birth weight in multiples”, it is extremely important for a woman to eat well during her multiple pregnancy (Malmstrom, 1999). This is not the time for a woman to watch her weight, (or for anyone else to comment negatively on how much weight she is gaining). Malmstrom has found that recommendations for a woman carrying multiples are to gain anywhere from twenty five to sixty pounds, depending on her pre-pregnant weight. Also, Malmstrom points out that adequate weight gain needs to occur early in the pregnancy since it may not go to term. For more assistance on adequate weight gain information, a registered dietician may be contacted (1999).
Most importantly, a mother needs the best prenatal care available during a multiple pregnancy. At best, she should find a doctor who has experience delivering multiples. This way, he may anticipate the challenges a multiple pregnancy presents. He will also be able to provide competent information the couple will need. A multiple pregnancy requires more prenatal visits than a single pregnancy. After about 23 weeks, these visits may occur every week. During each visit, the doctor will take an ultrasound to ensure that the babies are all growing at the same rate and that they are all healthy. These visits will most likely increase along with the need for bed rest towards the term’s end.
Bed rest is often required for a good part of a multiple pregnancy to reduce the risk of pre-term labor. The term ‘bed rest’ can describe anything from just staying home or, ‘house arrest’ as Malmstrom puts it, to hospitalization (1999). To handle bed rest, just knowing that it is coming can help. Mom’s prenatal doctor can inform her early in the pregnancy as to when she will need to be on bed rest. Mom can then do everything that she can in advance to prepare for the birth of her multiples. Dad can be ready to take over household chores and care for other children. Additionally, help can be scheduled to help out when Dad is away or at work.
While Mom is on bed rest, there are a few things she can do to make the best of it. Malmstrom recommends doing mild exercises, with a doctor’s approval. This will help to keep her muscles in shape and toned to prepare her for labor. Also, she will better be able to regain her figure after the birth of her multiples. Mom can also meditate, visualizing her babies growing stronger every day (1999). Regular check-ups will help to confirm this. Other things Mom can do are needlework, quilting, or sewing for the babies. Writing in a journal, reading, writing letters and e-mailing someone else on bed rest can also help (Malmstrom, 1999).
Even though parents take precautions, get adequate nutrition, and stay on bed rest, many multiples are still born prematurely. According to Lindberg, “Nearly half of all twins are born prematurely [before 37 weeks, a typical pregnancy lasts 40 weeks] and the risk of having a premature delivery increases with higher-order multiples” (2005). This is because the uterus has limited space and stretching ability (Malmstrom, 1999). If a mother is having multiples, it is extremely important that her doctor(s)’ advice be followed while she is pregnant to reduce the risk of pre-term labor.
Malmstrom lists the warning signs of preterm labor as dull, low backache, menstrual-like cramps, pelvic pressure, abdominal cramping, possible contractions and “feeling bad”. If any of these warning signs present themselves, contact your doctor immediately. More serious signs include “water leaking or gushing from the vagina”, vaginal bleeding, and “contractions that come every ten minutes or less for one hour.” If these signs are experienced, “you should go to the hospital emergency or admitting room immediately” (1999).
Care for Premature Babies
The earlier babies are born, the higher their risk of having health challenges. Preemies may need to be cared for in a neonatal intensive care unit (NICU) after they are born, depending how early they are. How long they are required to stay in the NICU depends on their weight, how healthy they are, and how well they are developing. Lindberg describes the NICU as a section of the hospital used “to provide an atmosphere that limits stress to the infant and meets basic needs of warmth, nutrition, and protection to assure proper growth and development” (2005). Although professionals will provide most of the care for premature babies, both mom and dad will want to be involved. Any questions or concerns may be addressed with the doctors and nurses there. Also, they can educate you on what is going on with your babies and what you can do to help. The more you know about what is going on, the better prepared you will be to cope with the challenges and emotions that come with seeing your babies in the NICU.
There are several things for parents to prepare for who have babies that are in the NICU. One is whether Mom plans to breastfeed her multiples. According to Malmstrom, when babies are born early, the mother produces a particular kind of milk that’s made with certain nutrients to meet the needs of premature babies (1999). If a mother plans to nurse her babies, though the hospital may provide a breast pump while she is still there, she will need to invest in a breast pump to use at home to establish and maintain her milk supply while her babies are still in the NICU.
Though visiting rules may vary from hospital to hospital, it is important that the parents be involved with their babies’ care at this time. Fortunately, “more and more facilities welcome and encourage parental involvement” while babies are in the NICU. Parents may be allowed to visit their babies, talk to them, hold them, and help care for them to an extent. Hearing their mother’s voice and smelling her scent will help to sooth the babies while they are in the NICU (Malmstrom, 1999). Ask hospital staff who else may be allowed to visit the babies while in the NICU. It may be helpful to bring older siblings so they can get to know their new brother(s) and/or sister(s).
Though it will be a relief when your babies are healthy enough to be released from the NICU, this is when the real work begins. Babies born prematurely may have health problems ranging from apnea and increased susceptibility to infections to respiratory distress syndrome. These conditions will require special care and regular check-ups after the babies go home (Lindberg, D.A.B., 2005). They may also be required to have heart monitors for a time (Womack 1998). The need to plan for extra help, (e.g. volunteers to help feed and bathe babies, help with house work and meals) and sanitary conditions is essential to keeping your babies healthy at this time.
Keeping Multiples on a Schedule
Babies will most likely be kept on a schedule while in the hospital. It is wise to keep them on a schedule after they come home. Though getting and keeping multiples on a schedule can be challenging, the benefits are well worth the effort. Triplets mom, J.B. Kinnon, said that getting her babies, “on a schedule at first was key to maintaining our sanity"(2000). When multiples are on a predictable schedule, life is easier for the whole family and for those who help out.
A typical schedule for a baby involves several activities. They all eat, sleep, and as they get older, they are awake for longer periods of time. Eating and sleep time will be quite the same with gradual progress as they get older. Wake time should vary as there are several activities babies can do while they are awake to help them progress. At first they may just sit in their chairs and observe their new world. Later, they can lie in a playpen and play with various baby toys. Their options grow as they learn to roll over, sit up, crawl, and walk.
One of the most difficult things for a parent is getting a baby to sleep. With multiples, the challenge multiplies. So how is a sleep schedule accomplished? During the day, Womack suggests an eat/wake/sleep cycle, in that order. This consists of all babies waking up at the same time. Obviously, you would have to awaken them if they didn’t wake up on their own. They would then eat as soon as they woke up. After being fed, the babies would have some wake time. This would give them a chance to get the air bubbles out, or burp, before they go to sleep, helping them to sleep better. During the first few months, this would all take place within three hours, with their nap being at least one and a half hours long (Womack, 2005). So, during their synchronized sleep part of this routine, mom would be free to either nap, get some household chores done, or just have time for herself to spend however she wishes.
Another great challenge is how to feed multiple babies on a schedule. One big question any mom expecting multiples would want to ask is how do you feed more than one baby at the same time? This will take some work when the babies are first brought home, but should get easier as they settle into a routine and start eating faster. As Womack suggests, “a breastfeeding mom can feed two babies at the same time while someone gives a bottle to the third baby (1998). She can then pump to obtain anything that is left for the next bottle feeding. If Mom plans to bottle feed with formula, and has the luxury of one helper per baby, they can all be fed simultaneously with one-on-one assistance. With more than one baby, help will definitely be an asset, especially in the beginning. A good idea would be to schedule volunteers to help during feeding times whenever possible.
Whether you bottle feed or nurse your babies, or a combination of both, it is important to keep them on a two and a half to three hour schedule during the first few months. This will allow them to get adequate sleep; they will also be able to digest what they take in before they eat again, reducing the amount of spit-up (Womack, 1998).
Keeping Multiples Healthy
So, how will you know if your babies are getting adequate nutrition? Tinglof suggests keeping a notebook to keep track of when each baby eats and for how long, bowel movements, and wet diapers (1998). In the first few months, babies should eat from eight to twelve times a day for at least ten minutes each time. They should have from six to eight wet diapers a day and several bowel movements (Tinglof, 1998). Writing these things down each time they happen will help to keep track of whether each baby is getting adequate nutrition. A chart can be used to organize this information. This will provide assurance that babies are healthy, alert, and strong.
So now, where exactly will all the much needed ‘volunteer help’ come from? Some parents of multiples are lucky enough to have friends and relatives who have time to spare and would love to spend it with them and their babies. They may not even have to ask, as many may volunteer as soon as they hear the news that the couple is expecting multiples. For those who are not so lucky, Womack suggests, “some high schools, colleges, seminaries, and yeshivas near your home may offer classes in childhood development. Your home could become a learning lab for a kind-hearted student.” Also, many churches have members who would love to lend a helping hand and all you need to do is ask. Also, if your babies are on monitors after they come home, the state may pay for in-home nursing care (Womack, 1998).
Dad can be a great help in caring for multiples as well. Womack states, “it’s even more essential with multiples that dad help out” (1998). Dad can take night time shifts bottle feeding babies and give mom her much needed sleep. He can do things like household chores and grocery shopping. Moral support is a great way to help mom at a time when she may question her ability to provide adequate care for her children. Just the fact that dad supports her and helps out will help boost her morale greatly. To be able to do this, dad needs to plan ahead and bring any stresses in his work and social life to a minimum so he will be able to provide this much needed assistance. Another option would be to hire a nanny, but few couples can afford this after delivery expenses are paid for. Regardless of where your help comes from, when your babies’ schedule is predictable, it is much easier to get people to help. It is convenient for both of you because a schedule allows you to have a set time for them to come over, and they will know exactly what they will be doing.
Having one baby can put a strain on any budget. Paying for more than one baby at a time can be a financial nightmare. Tinglof suggests re-evaluating your budget (1998). Cut costs as soon as possible wherever you can and determine how much everything will cost. It is important to plan to get set up for multiples way in advance, as all your time after the babies are born will be focused on the babies themselves. This will minimize the stress of finances when your babies arrive with all the other stresses involved.
There are several items you will need to think about getting. Some things you will need are quilts, diapers, crib sets, receiving blankets, and baby food. When purchasing some of these items, keep in mind that store brands are usually less expensive than name brands and work just fine. Some companies also offer samples and discounts to parents with multiples. One option, Tinglof suggests, is doing it yourself (1998). Lots of money can be put away just by making some of these things yourself. You can make your own wet wipes using paper towels, baby oil and water (Tinglof, 1998). You can also check your library or take a class during your pregnancy to learn how to sew. Making blankets and quilts yourself will be well worth the effort financially. Another way to save money is to buy things second hand or borrow from friends who are in between babies. Chances are you will never have multiples again and buying extra items at full price just doesn’t make sense.
All this planning and preparing ahead of time will be a great asset and save you much stress for when your babies arrive. The stress of all these things combined with exhaustion from lack of sleep and hormonal changes can certainly take its toll on any mom and /or dad. To cope with postpartum depression, which is perfectly normal, Tinglof suggests getting out of the house (1998). Even a quick shopping trip can provide a breather and allow a mother or father to come back refreshed and ready to resume their responsibilities again. This will take planning ahead to arrange for a babysitter (or two or three) and to provide them with any special instructions.
You’re On Your Way!
So from getting help for everyday tasks to financing these little miracles, everything goes more smoothly when you plan ahead. Just know that you’re not the first and you won’t be the last to face this great challenge and adventure. According to Malmstrom, “52,000 families…give birth to multiples each year in the United States” (1999). It will definitely be more challenging than raising one child, but the joy in your successes will also be multiplied.
Kinnon, J.B. (2000). Corporate Attorney Raises Triplets. Ebony, 56(2). Retrieved October 19, 2005, from Academic Search Elite.
Lindberg, D.A.B. (2005). Twins, Triplets, Multiple Births. Retrieved November 11, 2005 from Medline Plus.
Malmstrom, P., Poland, J. (1999). The Art of Parenting Twins: The Unique Joys and Challenges of Raising Twins and Other Multiples.
New York: Skylight Press.Tinglof, C. B. (1998). Double duty: The parent’s guide to raising twins from pregnancy through the school years. Lincolnwood, IL: NTC Contemporary.Womack, E. (1998).
Multiples: the endless party. G. & A.M. Ezzo (6th), Preparation for parenting pp. 155-166. Simi Valley, CA: Micah 6:8.