Category: Postnatal Education

Simultaneous Breastfeeding (Photos Included)

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Did you ever think you’d ever be considering nursing two babies at once? Probably not. I know I didn’t. Also known as tandem nursing or breastfeeding, simultaneous feeding can be an effective way to get both babies on the same schedule, and save you a significant amount of time in the long run!

Settle yourself in a comfortable spot and have both babies within reach. It isn’t unusual to have one baby who is a better sucker than the other. If this is you, latch Baby A, the “better sucker,” on first. When the Baby B is ready to be latched, take your free arm and place it over, around ultimately underneath Baby B with your palm supporting his head. Lift Baby B to your breast and you an focus on making sure he is properly latched. With practice, you will be able to hold your settled Baby A in place with your elbow to leave your lower same arm free to help latch Baby B. Make sure that you bring the babies to you and not you to the babies or you very soon get a sore back. Good posture is essential.

When nursing triplets, you might have Baby C in a chair on the floor in front with a propped bottle of breast milk simultaneously feeding. OR as an alternative and if that Baby C is not fussing, you may wait until Babies A and B have each nursed at least 10 minutes, then put Baby C to the each breast for 5 MINUTES each side. The demand will quickly increase your supply. Keeping a record of which baby fed where will be essential, and at the following feed, Baby C will be one of the ones to be tandem fed at the breast. In other words, rotate them each feed. The Jumelle Twin and Baby Tracking App will help you easily keep track of which baby fed when, where and for how long.

Ask anyone nursing multiples, and they will tell you that simultaneous breastfeeding is also a challenge, requires focus and patience and everyone practices getting latched and fed. It is worth the effort though and as the babies mature, things get easier. As a mother of multiples, you likely have questions about how to most effectively feed your babies. Sometimes the responsibility of feeding more than one baby can feel overwhelming, and you may worry that you won’t produce enough milk. Despite its many challenges, simultaneous breastfeeding is a great time saver! It will get your two babies on the same schedule, and can therefore be worth the effort. If you plan ahead and receive the support you need, you can certain successfully breastfeed two babies. If at any time you are feeling overwhelmed or worried about your babies’ weight gain, see a certified, registered lactation consultant who is familiar with simultaneous breastfeeding and she can properly assess what is going with you and your precious bundles.

Following are some drawings and photos which demonstrate a variety of positions for simultaneous breastfeeding of two babies/toddlers through a combination of holds: cradle holds, football holds, one lying down and then in a saddle hold while the little ones sit on Momma’s knees. Finding what works for you and your babies will make things run smoothly. Keep in mind that as the babies grow, by necessity, you may need to look trying other positions.

It may be that back-to-back feedings are what works best for your family, even from time to time.

If you find one or both babies are scratching you and pinching your breasts as they feed or maybe poking at each other, this is normal behaviour but it is also painful. A couple of hints to handle such a situation is to either put socks on their hands before each feed (they stay on better than mittens), or wear a nursing necklace for the babies to fiddle with. Some Moms wear two necklaces in case of competition. The idea is to provide some distraction to stop the painful behaviour.

 

Keeping Singleton Siblings, Entertained During Multiples’ Feeding Times

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It is only natural to wonder and worry about how to cope with or entertain young singletons while nursing or bottlefeeding newborn multiples.  It is difficult to imagine how that scenario might work and, in fact, you might tend to be leaning towards anticipating some chaos and upheaval as you try to figure out how to spread yourself around.  If this resonates with you, your feelings are normal.

Feeding times may run more smoothly depending upon the age(s) of your singleton(s).  The younger they are, the more likely they will require some type of attention from you, especially while you are least able to provide it.  Things may run more smoothly if there are at least two older siblings as they will have each other to connect with and play.  While an older child may take the opportunity to act up when you are tied up feeding the babies, there are some families who will have no issues at all during feeding times.

Simultaneous feeding of the babies, and depending upon how premature they were, may take anywhere from 20 to 30 minutes at each feeding session.  If you are feeding the multiples back to back (i.e. one after another), it may take closer to the 30 minutes per session. This is an approximation of how long a period an active, older sibling(s) may need some entertaining.

Here are some of those ideas for you to consider regarding entertaining your older child.  Mixing up the activity from time to time can help your singleton avoid getting bored with any set activity.

1.  Use one of the larger twin-nursing pillows which are wide enough to safely accommodate two babies so they can nurse or bottle feed while you have two arms free to engage with your singleton if you need to.

2.  Choose a location to feed the babies that will allow him/her access to you or be near you.  You might choose the couch, or the living room floor, with you leaning back against the couch for back support.  A child-size table and chair can be located near you for his/her special activity.  Some parents like their large bed. Keep in mind that beds tend to be soft and may not have enough back support for you to nurse the babies without your back going into spasm.

Mother nursing twins with older child nearby

3.  Set aside a special toy(s) or activity (colouring, crayons, building blocks, plasticine/play doh, [paints are potentially too messy], etc.) which only appears while you are feeding.  Having items already stored in plastic containers makes for easy accessibility as you get ready to nurse hungry babies.

4. Have an closed drink box or sippy cup handy so there is a drink available.   Consider some small snacks (cheese cubes, apple slices, crackers).

5.  If s/he is not toilet trained, have a pull-up diaper nearby in case you need to do a quick change.

6.  You can read together or put a story on a recorder that s/he could listen to beside you.  You might discuss the story after it is completed should the babies have not finished feeding.

7.  When you are done nursing, give him positive feedback, even if his behaviour is not quite perfect with helping you feed his babies.  Any negative behaviour should disappear as he learns the routine, notes the special attention focused on him even while you are feeding the babies, and the re-enforced positive feedback afterwards.

8.  For an older child with more advanced hand-eye coordination, consider offering them “sewing” cards, paint by numbers sets or working on a puzzle as a creative activity.  Maybe a child-focused iPad or tablet, which only comes out at feeding times.  You know your child best if these more advanced activities would be appropriate or of interest to them.

Does all this sound scary and seem over whelming?  No doubt, but give yourself and all your children a little time to get the routine in place.  Be patient, keep your child in the loop by explaining what is going to happen and make this time fun, upbeat, special and something to look forward to.  Things will generally move forward in no time at all as you all learn what to expect.  Making your older child(ren) part of the solution rather than part of the problem is helpful and letting him/her know that his/her co-operation is a huge help to the family can quickly bring him/her on board.

Reviewed by Bonnie Schultz

11 Breastfeeding Tips

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NOTE: The following suggestions on breastfeeding multiples are provided as information only. If you have any concerns about your particular situation, please check with a Lactation Consultant or your doctor.

Your breasts are going to make milk anyway, so why not give it a try and see where it leads? You may be pleasantly surprised!

  • If you run into any difficulties breastfeeding, get help right away. Don’t wait. Sometimes the answer(s) is very simple and a consultation with a Lactation Consultant may identify the problem and have everyone back on track very quickly.
  • Yes, enough milk can be produced for two or even three babies. Milk production is based on demand and supply. Frequent nursing stimulates breasts to meet nursing demands. Three things postively impact milk supply and production: a) frequent feedings of the babies; b) healthy eating, drinking and snacks; and c) keeping stress levels as low as possible.
  • Simultaneous feedings help get babies on the same schedule and saves an enormous amount of time. Most mothers of multiples feed simultaneously or one after another. Your babies will let you know which method works best for them.
  • Breastfeeding twinsAlternate breasts at each feed. It will be necessary to prepare a schedule so that you can remember who ate at which breast and when. By alternating breasts two important issues are addressed: a) one baby may be a better (stronger) sucker than the another thus stimulating the breast differently. Therefore, alternating breasts encourages both breasts to produce enough milk; b) when a baby only nurses at one breast, the lower eye doesn’t get equal opportunity to focus, look around and strengthen (an older nursing baby [i.e 6 months or so] will always look up, make eye contact and smile at you – it makes one’s heart turn over with love). Alternating breasts gives each of the baby’s eyes a chance to perform properly.
  • It isn’t unusual to have one baby who is a stronger sucker . When settling down for a simultaneous feeding, put the stronger sucker to the breast first then spend time settling and arranging the second baby. Keeps everyone happier.
  • For triplets or more , it may be necessary to introduce some formula before the milk supply is fully established. There are a couple of choices within this situation: a) top up each baby after a breast feed; b) feed two by breast and one by bottle, alternating who gets which at each feed (a schedule will need to be kept for equal opportunities). A helpful idea for increasing breast milk with triplets is to feed two babies, at each breast, followed by the third one on each breast. S uch a routine provides optimum opportunity to increase milk supply to meet the demand.
  • If you can, pump after each feed , collecting and freezing pumped breast milk for bottle feeding. Label and date the bottles. Following is a guide for storing breast milk:
    At room temperature – 10 hours
    In the fridge – 8 days
    In a fridge freezer – 2 weeks
    In a deep freeze – 6 months or longer

    Previously frozen breast milk can be kept in the fridge for 24 hours. Do not refreeze previously frozen breast milk.*

  • Never microwave breast milk . The high temperature affects its nutritional value. Breast milk defrosts very quickly in a bowl of hot water in the kitchen sink. The milk itself need not be hot, room temperature will do.
  • Using a twin nursing pillow is a real advantage. This larger pillow can comfortably cradle two babies at a time and allows burping/changing one while the other continues to feed.
  • Breast feeding is a learned art , for both mother and babies. Be patient, give it time and, if necessary, get some help.
  • Babies hit a growth spurt at about 6 weeks. As a result, they may feed more often. Many Moms interpret shorter times between feeds as they don’t have enough milk. Consequently, they become discouraged and quit nursing. Continuing to nurse will soon rebuild the milk supply to meet the demand. Don’t give up too soon.

* Mothering Multiples: Breastfeeding & Caring for Twins & More, by Karen Kerkhoff Gromada, La Leche League International, 1999

Other Resources

Breastfeeding Premature Multiples

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A singleton gestation is based on 40 weeks, twins on 38, triplets on 36 and quads on 34. Many multiples are born prematurely, from days to weeks early.

For parents of multiples wishing to breast feed their babies, the extent of the babies prematurity can impact breast feeding success. Mother’s milk provides superior nutrition, protects against disease and enhances infant development. In short, it is perfectly made for babies, especially when they are premature. While premature birth complicates the breast feeding of these infants, with knowledge, patience, perseverance, and good support systems in place, breastfeeding can be successful and any amounts of breast milk they can receive is beneficial. Following are some ideas and suggestions to help you, your partner and premature infants successfully breast feed.

  • Whether or not you have decided to breast feed your infants, your breasts will produce milk. This early milk is called colostrum and it contains high levels of antibodies and other substances that protect babies against infection. Therefore, pumping this colostrum and feeding it to the babies makes a lot of sense, and will ensure that they benefit from its important life-supporting properties.
  • One of the last things to develop in the few weeks before birth is the sucking reflex. Thankfully babies can learn how to suck and swallow and that is one of the reasons you will sometimes see some babies in the nursery with a soother. They are practising sucking and swallowing. If the babies are a few days or even weeks premature, you may be able to put them to the breast right away and with a little coaxing, trials and patience, they will learn to latch on and suckle. If the babies are very premature (4 or more weeks), you will have to pump as they will be too tiny and weak to take the breast.
  • At the beginning of each feed a baby gets the foremilk. This stimulates and releases the hindmilk, which is higher in fat (for growth) than the foremilk. It is important that either nursing or pumping lasts long enough to stimulate the let-down of the fat rich hindmilk.
  • When expressing breast milk, expect to pump 8 to 10 times in a 24-hour period. It is helpful to also pump during the nights, as if you were getting up to breast feed term babies. This round the clock pumping will help you establish your milk supply.
  • Once nursing or pumping has been established, supply and demand keeps breast milk forming and flowing. The more the babies feed, or you pump, the more milk your breasts will produce to meet the demands of your growing babies. Remember: make sure you pump frequently, drink lots of fluids and keep your stress levels low. All of these affect the quantity of milk available for your babies.
  • Your doctor, healthcare provider, lactation consultant, doula or midwife can help you decide when to transition from expressed breast milk to putting your babies to the breast. Factors that can help decide when the time is right, will depend on each babies’ ability to suck, breathe and swallow. Each baby will reach this goal at his or her own rate.
  • Premature infants are notorious for falling asleep before their wee tummies are full. While it is wonderful to hold and cuddle each baby, it is important that their tummies be full. You may need to encourage them to continue feeding by undressing them, holding one outstretched in front of you to encourage burping in case that is giving him the feeling of being full or moving them around in your arms to discourage sleep.
  • Initially breast feeding may be a challenge with your premature infants. Don’t give up! Take your time, choose a relaxing place to feed, stop and begin again if need be, and don’t be afraid to ask for help. Talk to the nurses in the NICU unit, check in with a lactation consultant. Babies aren’t born knowing how to breast feed and sometimes with a small adjustment from a knowledgeable source you can all be back on track very quickly.
  • You may wish to begin feeding your babies one at a time until you feel comfortable. If you take this route, the milk stimulation in one breast may also cause a let down in your other breast. Having a sterile container nearby to catch any let-down will make sure that not one drop of your milk is wasted.
  • This double let-down can have a silver lining when feeding two babies simultaneously. It isn’t unusual to have one baby be a stronger sucker than another. Put your best sucker to the breast first then you can spend a little more time adjusting your second baby, plus s/he gets the benefit of the simultaneous let-down without even working hard for it.

Resources

Breastfeeding Your Premature Baby, La Leche League International

Web Sites

Multiple Births Canada, Breastfeeding Support Network
Breastfeeding Online
Dr. Jack Newman, The Newman Breastfeeding Clinic
La Leche League International

Breastfeeding Multiples: Pumping Tips

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There are a variety of reasons why a mother might want or need to pump: for preemie or sick infants; to increase her milk supply; to maintain her supply; for when she goes back to work, to name some.

The purpose of this article is to address some of the situations when Mom may need to pump for her babies, and to offer pumping tips.

  1. Begin regular pumping as soon as is possible after their births. Short, frequent sessions are better than long, infrequent sessions.
  2. Choose a quiet, private spot with comfortable seating.
  3. Moms of multiples will usually double pump for efficiency and because they are typically set for simultaneous letdown. Using a double pump will allow you to take advantage of the simultaneous letdown. In addition, double pumping saves a lot of time rather than pumping one breast at a time.
  4. When nursing one baby, pumping the other side takes advantage of the simultaneous letdown. This may help with better milk production so that one multiple, who may be having difficulty breastfeeding, also has enough milk available. Getting organized for such a scenario may take a little practice.
  5. It may be helpful to establish the proper ‘mood’ for expressing, have photos of your babies around you, perhaps listen to a tape of soft music.
  6. Dad/Partner can massage Mom’s back, shoulders and neck to help with relaxation. Bring her a drink, keep Mom company, wash, sterilize pumping bottles/tubing so they are ready for the next pumping session.
  7. It is important to surround Mom with proper support to ensure a successful pumping session.
  8. Eat nutritiously, rest, minimize stress levels and drink plenty of fluids.
  9. Typically newborns breastfeed 8 times or up to 12 to 14 times in 24 hours. Simulating a newborn’s feeding routine helps produce more milk. While each pumping session may take 10-20 minutes, the length of time will vary with each woman. Continue to pump as long as you have a good flow.*
  10. The opposite will also help with milk supply: pumping when there is low or no flow, helps stimulate the breasts for the next day.*
  11. Keep a record of the date and time of pumping and how much is collected. This will clarify if pumping is occurring often enough to keep the breasts stimulated to produce.
  12. To keep on a newborn’s nursing schedule, set a timer during the night to ensure that you wake up and pump at appropriate intervals.

Storing and Handling Expressed Breast Milk

Most Neonational Intensive Care Unit’s (NICU) have procedures in place for storing and handling expressed breast milk. If your babies are in the NICU, you will need to acquaint yourselves with their regulations. Ask the staff if the hospital provides sterile containers for expressed milk. Your hands will need to be thoroughly clean as will all parts of the pump that come in contact with your milk. Sterile containers will need to be clearly labeled with each baby’s name, date of expression, and perhaps a hospital identifying code prior to being placed in the refrigerator. If you are on any medications at all, you may need to also note what they are on the container label.

Breast Milk can be stored in clean, sterile containers:

  • At room temperature (25C or 77F) for 4 hours
  • In a refrigerator (not the door) for 48 hours [fresh]
  • In a refrigerator (not the door) for 24 hours [frozen]
  • In a refrigerator freezer compartment for 2 weeks
  • In a freezer compartment with a separate door for 3-4 months
  • In a deep freeze for 6 months

Frozen breast milk takes no time at all to thaw in a saucepan filled with warm water. Do not heat breast milk on a stove or in a microwave. Do not refreeze breast milk.

Sore Nipples

If nipples become sore during pumping, make sure that your nipples are properly centered within the suction cup. It is easy to become distracted during pumping and inadvertently shift the equipment. Some mothers report that applying a small amount of modified lanolin cream is helpful. If problems continue, contact a Lactation Consultant or La Leche League member. Don’t wait for the pain to become severe.

Types of Pumps

  1. Electric: efficient, thorough, expensive, can be rented by day, week or month
  2. Battery: good for occasional pumping or not near electrical outlets, not as efficient as electric
  3. Manual: takes a long time to pump, not practical for women who pump often, inexpensive
  4. Hand Expression: difficult for some to master, inefficient, helpful for emergency such as engorgement.

Available Pumps

Medela double pump, lactina, the Avent is is a good manual pump for double pumping.

Some considerations: Find out about the level of suction of the pump. Some can be very strong and some inefficient. Are the instructions for using it clear? Does the company have a 1-800 number if you need to ask questions? Some drugstores and hospitals rent pumps, which can be quite expensive. Some Lactation Consultants offer rentals. Check out the Yellow Pages. Do your homework to find out what works for you.

With input from: Erin Shaheen, Child Birth Educator and Mom of 4 breastfed babies, including twins; and Valerie Lavigne, Chiropractor and Mom of 3 breastfed babies, including twins.

Bibliography

*Mothering Multiples: Breastfeeding & Caring for Twins or More!!! by Karen Kerkhoff Gromada, La Leche League International

Resources

Multiple Births Canada, Breastfeeding Support Network

Multiple Births Canada’s Breastfeeding Multiples Fact Sheet Series
–Guidelines for Transporting Breast Milk to NICU
-Breastfeeding Multiples: Fathers/Partners
-Breastfeeding Multiples: Nipple Pain & Vasospasm
-Are My Babies Getting Enough Breast Milk?
-Breastfeeding Multiples: Resources
-10 Tips to Successful Breastfeeding

La Leche League International

Additional Reading

Multiple Blessings, Betty Rothbart, Hearst Books, 1994
Your Premature Baby, Nikki Bradford, Firefly, 2003
The Joy of Twins and Other Multiple Births, Pamela Patrick Novotny, Crown Trade Paperbacks, 1991
Feeding Your Baby the Healthiest Foods: from breast milk to table foods, Louise Lambert-Lagacé, Stoddart, 2000

Guidelines for NICU

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It isn’t unusual for twins, triplets or more to be born preterm (i.e. before their due date) and having to spend days, weeks or even months in the Neonatal Intensive Care Unit (NICU) as a result. For those families wishing to breastfeed, it is possible to do so by pumping and bringing in breast milk to the NICU to be fed to their babies.

To ensure the best quality milk for your babies, here are some recommended collecting and storage guidelines of breast milk. Remember that every drop counts and whatever is collected is the best thing for your infants. If you have any questions regarding your milk supply or how to conserve it, be sure to ask the NICU staff.

Storage and Sterilization

  1. Purchase some bottles and labels to store the milk. The bottles need to be boiled and sterilized before each use. Bags are not appropriate for storing milk in the NICU.
  2. Clearly label each bottle, including the babies’ names, date and time that the breast milk was collected.
  3. Ideally prepare bottles of 1 ounce, 2 ounces or 4 ounces, if you can, for storage.
  4. Do not overfill the bottles as breast milk expends when it is frozen.
  5. Make sure all pump material is properly cleaned and sterilized between uses.

Storage Times of Breast Milk for Preterm Infants

Storage time
Freshly expressed milk Room temperature 25C or 77F 4 hours
Refrigerated milk (store in back not on door)4C or 39F a)Refrigerator (fresh milk)

b)Refrigerator (thawed milk)

 a) 48 hours

b) 24 hours
Frozen Milk (Store at back, not in door. DO NOT REFREEZE) a) Freezer compartment inside refrigerator door

b) Freezer compartment with separate door

c) Deep freezer not attached to refrigerator

 a) NOT RECOMMENDED

b) 3 Months

c) 6 months
Transporting Milk
(fresh, refrigerated or frozen)15C or 60F		 Packed in insulated cooler with ice or “ blue ice” 24 hours

 Transporting Breast Milk to NICU

Fresh breast milk can be refrigerated and transported to the NICU on ice or “blue ice” packs in a little insulated cooler. Once at the NICU, give your labelled breast milk to the nurse in charge of your babies to be placed in the refrigerator or freezer.

If you have any questions regarding these procedures or about breast feeding in general, be sure and talk to the nurse in charge of your babies. Hospital staff will be most happy to answer your questions and help you at any point.

If you have any questions regarding pumping or storing your breast milk, do not hesitate to discuss them with the nurse or lactation consultant.

Your breast milk is important to your babies. Save ALL the milk that you pump.

References

  1. Lots and lots of great, supportive, every-topic-you-could-think-of information and resources on breastfeeding, www.themilkmeg.com
  2. Hamosh M, Ellis LA, Pollock Dr., Henderson TR and Hamosh P. Breastfeeding and the working mother: effect of time and temperature of short-term storage on proteolysis, lipolysis, and bacterial growth in milk.Pediatrics Vol. 97, issue 4 pp. 492-498
  3. Lauwers J, Shinskie D., Counseling the Nursing Mother: A Lactation Consultant’s Guide, 3rd edition p.351
  4. Riordan Jan, Breastfeeding and Human Lactation, 3rd edition. p.378-382

From Valerie Lavigne, Mom of three breastfed babies, including twins.
Adapted by Lynda P. Haddon, Multiple Birth Educator,www.jumelle.ca 
Reviewed by Erin Shaheen, Child Birth Educator, Mom of 4 breast fed babies, including twins.

Other Resources:

Multiple Births Canada Fact Sheet: Breastfeeding Multiples: Pumping Tips

Vanishing Twin Syndrome (VTS), Part 2

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This article is for information and overview purposes only and does not represent every possibility or situation.  If you are concerned about any aspect of your pregnancy, please consult your doctor as affects your particular situation.

The use of diagnostic ultrasound imaging has made it possible to determine as early as five or six weeks that Mom is pregnant. Ultrasound (US) picks up the fetal heartbeat(s) allowing the medical team to also determine how many fetuses are present. In some cases, two or more fetal heartbeats can be found leading to excitement and some trepidation for the expecting parents. The use of US to determine pregnancy at such an early stage, however, has also identified another issue which might occur known as Vanishing Twin Syndrome (VTS).1  For women experiencing VTS, during a subsequent US (up to about 12 weeks gestation), one or more fetal heartbeats may no longer be found. The empty sac may, or may not, be visible on the screen.

In years past, women had their first US after the 12th week of gestation therefore eliminating the possibility of knowing that they were initially carrying more than one fetus. The availability of US as early as the 5th week of pregnancy has allowed researchers to conclude that the rate of multiple-birth conception is much higher than previously thought. It is estimated that one in eight people may have started as a twin, but only one in seventy pregnancies actually resulted in a twin birth.2  VTS usually has no symptoms, but sometimes a pregnant woman might have unexplained bleeding, cramping or passage of tissue in the week(s) in her first 12 weeks of pregnancy. Such symptoms could indicate the loss of a multiple pregnancy, a blighted ovum, or in some cases nothing at all. Not all cases of VTS are associated with any outward signs and many women continue with an uncomplicated pregnancy and the birth of a healthy child(ren).

VTS does not just occur with twin pregnancies, but can occur within higher order multiple sets as well. The loss of one, or more, embryo in the first trimester can be emotionally devastating for expecting parents. For example a couple was 8-1/2 weeks pregnant with triplets when they registered for a multiple-birth prenatal class.  When they arrived for the class at just over 13 weeks pregnant, they advised that a subsequent ultrasound had shown that they were now carrying two babies, and an empty sac had been visible on their latest ultrasound.  The couple had a difficult time because two other couples in the group were carrying triplets and they realized they were no longer part of that special group.  In such cases, referral to counseling may assist expecting parents in dealing with their early fetal loss and allowing them to celebrate in their continuing pregnancy.

Risk factors for experiencing VTS are generally unknown but seem to include a maternal age over 30. If the vanishing fetus occurs in the first trimester, as it does in most cases, no medical intervention is usually necessary. The mother, the placenta or the surviving co-multiple may absorb any miscarried fetal tissue within a few days.

VTS does not generally affect the ability of a woman to conceive again, although there could be underlying genetic or health issues that should be explored with a physician.

While VTS usually poses no problem physically for the mother or the surviving child(ren), it is not uncommon for mothers to have feelings of disappointment, grief and loss as they had anticipated and looked forward to a multiple-birth.3  As the pregnancy continues with at least one healthy child, these mothers may be told that the loss isn’t important or to focus on their healthy baby. It can be difficult for mothers to find acceptance or a safe place to grieve this loss as family and friends fail to understand that a unique parenting experience has also been lost as well as a much-wanted child. Women and their partners experiencing VTS are encouraged to seek counseling if feelings of depression, sadness, or anxiety continue.  Local and national parenting support groups may offer networking opportunities for parents who have suffered from VTS.

Vanishing Twin Syndrome (VTS), Part 1

See Part 1 of this article, Vanishing Twin Syndrome (VTS)

References

1) De la Fuente, G., Puente, J., Garcia-Velasco, J., & Pellicer, A. (2011). Multiple pregnancy vanishing twin syndrome. In Biennial Review of Infertility (pp. 103-113). Retrieved from http://link.springer.com/chapter/10.1007%2F978-14419-8456-2_9?LI=true

2) Heim, S. (2007) It’s Twins! Charlottesville, VA: Hampton Roads Publishing.

3) American Pregnancy Association. (2007). Vanishing Twin Syndrome. Retrieved from http://americanpregnancy.org/multiples/vanishingtwin.html

Additional Resources

Mothering Multiples, by Karen Kerkhoff Gromada, La Leche League International

The Art of Parenting Twins, by Patricia Maxwell Malmstrom and Janet Poland, Ballantine Books

Twins! Pregnancy, Birth and the First Year of Life, by Connie L. Agnew, Alan H. Klein and Jill Alison Ganon, Harper Perennial

Quick Tips for Toilet Training Multiples

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Having twins, triplets or more can make toilet training challenging on a couple of fronts.  Keep in mind that toddlers will not train if their muscles are not ready and mature enough.  Boys usually take a little longer than girls to train.  For girls training may begin around 2 years old, and for boys anywhere between 2 and 4 years old.  Additionally the multiples may take their cue from each other and if one won’t train, the other or all will not train.  OR, there may be no competition factor at all and each will train when they are physically and mentally ready to do so.  Training can be somewhat more challenging when the multiples are mixed gender.  Training can be easier if one or more of the children really dislike their messy or wet diaper.  If this is the case, that child is already half way to wanting to train.

Here are some ideas to help move things along when you feel the children are ready to consider training:

  • Both parents need to keep positive, no raised voices, make the children and yourselves part of the solution and not part of the problem.  An adventure, if you will.
  • Get a potty per child, either different colours or tape their name on the appropriate potty.  Taking them along on the buying expedition can help them be positively involved.  Some parents like the seats that fit on the toilet and they do work well, but with multiples you may have at least two children at a time wishing to go so having potties as an alternative can be beneficial.
  • Leave the potties in a prominent place, in the bathroom, their bedroom or anywhere else you feel they can be seen.
  • Have the discussion about why they are there and what they are used for.
  • If anyone uses one, even a little bit, “high five” and praise.  The other(s) may or may not express interest.
  • Don’t compare the children to each other.  Doing so only creates negative comparison and competition.
  • If you have figured out the time of day they are most likely to have a bowl movement, you can coax them on the potty slightly ahead of time and read books until there is success.  Some parents offer their children a treat for any success.  If there is no success, just call it a day and make little fuss.  You can try again tomorrow.
  • If you find that you are meeting with any resistance for potty training, back off for a couple of days and then begin again.  Depending upon the child, as each multiple is different, you may need to give her space and time to get on board.

Do Twins Run in the Family?

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A question I am asked a lot.  Here are several factors to influence whether or not twins run in families:

1)    How many children you already have, i.e. after having two or three, Mom may have at least twins;

2)    Age of Mom at conception, i.e. chances are higher of spontaneous conception (without fertility assistance) after the age of 30 and even higher after the age of 35 years.  Having said that, I have worked with a 16-year old and an 18-year old, both of whom conceived twins spontaneously.

3)    The closer they are to you in your Family Tree, the more likely it will be that you will conceive at least twins.  So, if your grandmother or aunt had twins versus a second-cousin the chances of conceiving multiples would be higher.

4)    MULTIPLES DO NOT SKIP A GENERATION.  That is an Old Wives’ Tale.  Important to be aware of.

5)    Dizygotic (fraternal) twins occur because the Mother dropped at least two eggs in her fertility cycle and both were fertilized.  There is always enough sperm available for fertilization, but there needs to be at least two eggs.

6)    We do not know what happens to the fertilized egg to have Monogygotic (identical) multiples occur.  It is rare, but not impossible, to have monozygotic triplets and quadruplets. The Dionne Quintuplets are the only recorded monozygotic quintuplets.  I have a girlfriend who is a triplet and her brothers are monozygotic so what ever happened to their egg in the womb causing it to split, did not happen with hers.  We do not always get to know everything.  Also interesting with her birth is that they were their parents’ first children and they went on to have 7 more children, none of whom were multiples.

7)    Multiples can have multiples.  Happens more often than one would think.

8)    If you have one set of multiples, there is a very good chance you will have another set in a subsequent pregnancy.  We had one special Canadian family with 9 children, including 4 sets of twins!

9)    Multiples begin at some point in families and start somewhere, so perhaps you are the lucky couple.

10)   Just so you are aware, the gender of twins is generally broken down in thirds:  1/3 are boys, 1/3 are girls and 1/3 are boy/girl.

This amazing photo below shows how one family’s lineage worked out.  It was shared by my friend Bonnie.

The lovely monozygotic young ladies in the back row are her daughters.  Next to them stand their monozygotic twin cousins (sons of Bonnie’s youngest sister).  In the front row are Bonnie’s husband’s nephew’s boy/girl twins.  Next to them are dizygotic boys, belonging to Bonnie’s  brother’s daughter.  This family has two sets of monozygotic twins and two sets of dizyogtic twins…….so far!

Family with generations of twins

The Crying Baby: What is Baby Trying to Tell Us?

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The Crying Baby:  What is Baby Trying to Tell Us?

Crying babyA baby’s main means of communication in the early weeks and months of life is to cry.  It doesn’t take too long for parents to note that not all of their baby’s cries sound the same.

Some are easily recognizable, e.g. hunger, anger and others which may not be so easy to “translate.”  As your multiples are individuals, it may be that one or more will not go through the same reactions at the same time.

What Do We Know?

  • All babies cry, even healthy ones receiving excellent care.
  • By crying, babies can express their pain, hunger, anger, fear and boredom, but sometimes they will cry for no specific reason.
  • By approximately 3 months of age, crying usually drops off as babies find other ways of communicating, e.g. babbling or cooing, and spend more time exploring their environment.
  • Continued crying can be anxiety provoking for parents and make parents feel worried, upset, incompetent and overwhelmed about their ability to meet their babies’ needs.
  • When babies cry excessively and are inconsolable, they are commonly referred to as “colicky.”
  • A colicky baby might cry for 3 hours a day, at least 3 days a week, for 3 weeks in a row.

5 Characteristics

There are 5 specific characteristics of normal, excessive crying or infant colic:

1)  The crying is unexpected, unpredictable and inconsolable;

2)  It often starts at the end of the afternoon or early evening;

3)  Can last 35-40 minutes or a long as 2 hours;

4)  Increases as the weeks go by and is most intense when baby is about two months old, then decreases until about the age of 5 months; and

5)  The baby/babies seem to be suffering.

These characteristics can make parents feel powerless, discouraged and incompetent.  It can create problems with the parent-child relationship because the parent may become less involved and less comforting with their child.*

*Adapted from a brochure by Centres of Excellence for Early Childhood Development, Crying:  Listen, they’re talking to you!

What Can Parents Do?

Situation:  Pay attention to your child’s crying and listen if you can identify any differences between what you are hearing.  If an infant is hungry, for example, the crying will sound quite different from when s/he is angry or fearful.

Response:  Respond quickly and calmly to the child and hold them close to your body as often as possible to see if the crying calms down.

Situation:  If you find yourself provoked by and anxious due to inconsolable crying.

Response:  If you become upset, overwhelmed or frustrated with the incessant crying, pull back for a few moments.  Put your child in his/her crib, leave the room, take a deep breath and return a few minutes later when you are calmed down.   If you are unable to calm yourself down, ask someone else to take over.

Babies will often respond positively to Kangaroo care** or being swaddled.  Trying either or both techniques may help calm a crying baby.

Letting a baby cry through the event on his/her own is not a good idea.  Picking up a crying baby as early and calmly as possible for cuddling can prevent things from escalating.  Humming or shushhhing gently into baby’s ear may help him/her calm down.

If you are feeling particularly overwhelmed, bundle babies into their carriage and walk around the block or go to the park.  Talking to other parents can be helpful for you and fresh air and a changed environment with new interactions, will often settle babies.

If your baby or babies continue to cry excessively for no apparent reason and do not respond to cuddling, Kangaroo care or swaddling, make an appointment with their doctor to ensure that the babies are healthy and there is not some underlying reason for their feelings.

Ask for help if you need it.

**Kangaroo Care:  Baby or babies are placed naked, except for diaper, onto Mom or Dad’s bare chest and securely/warmly wrapped onto the chest.  Babies are generally calmed by hearing parent’s heartbeat, as well as the warmth and feeling of security with the closeness.  The position simulates being in the womb and can be soothing for them.