Category: Postnatal Education

Holidays and Grief

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Holidays and grief are often inevitable after losing a baby. There will be several times during the year which are very difficult for bereaved families – birthdays, anniversaries, weddings, to name some but probably the most difficult holiday will be Christmas. Automatically the mind conjures up ‘family’, presents, food, noise and a festive air! For bereaved families, this can be a very difficult time of year.

The following are some ideas that may assist you through stressful milestones and special occasions.

  1. SIMPLIFY! Christmas Holiday stress, even in good years, is from the long list of ‘have-to-do’s’. Reexamine your priorities to begin some new, healthier traditions. Only attend parties you feel are truly important. Ask family members to exchange gifts only for children in the family rather than the adults (or encourage them to make a donation in your child(ren)’s name to a meaningful children’s charity, POMBA Canada or CLIMB, for example. Stop shopping for the adults in the family who probably already have everything they need. Consider not sending cards this year.
  2. Do things differently than your normal routine. Attend your religious service at a time other than you would have normally. Visit your relatives rather than having them visit you. Or, you may take a vacation over this time period.
  3. Begin to build a pleasant time with family and friends. Don’t feel guilty if you do have a good time.
  4. Make sure that there is a balance in your life – eat, sleep, rest, pray, read, work and relax.
  5. Responding to happy greetings can be difficult. To a “Happy Holidays” wish, you may respond, “I’ll try” or “the same to you!”
  6. Do some volunteer work in the name of your child(ren). Visit someone who is unable to get out, make a donation or send flowers in your child’s name.
  7. Light a special candle in remembrance to your lost child(ren).
  8. Donate a new toy or clothing to a children’s shelter.
  9. Try to keep in mind the feelings of your other children and to make it as joyous for them as you possibly can. Speak freely to your family members of what you feel capable of coping with or being involved in.
  10. You may wish to keep a journal of your thoughts at this time, or even as a letter to your lost child(ren).
  11. There is no right or wrong way to handle the day. You may feel ‘safer’ following family traditions or you may wish to begin some new ones or just to deviate for the time being. Your wishes can change year to year.
  12. It is best to try and do what is most helpful for you and your family. If a situation looks especially difficult over the holidays, try not to get involved.
  13. Try not to imagine the future. Take one day or even one hour at a time.
  14. Allow yourself time to cry, both alone and with your loved ones.
  15. Some hospitals may allow you to hang an ornament for your child(ren) on their tree.
  16. SHOP EARLY! Don’t leave it to the last minute and end up feeling overwhelmed.
  17. Holidays and special occasions magnify feelings of loss. It is natural to experience the sadness that these occasions can bring. Try not to block these feelings as it is unhealthy. A good cry to release built-up sorrow can leave you better able to face your day-to-day holiday stress.
  18. Hold onto HOPE! – the anticipation of the holiday is often worse than the actual holiday. Future years will most likely bring some healing and ability to enjoy this time of year again, in ways that are hard to imagine when you are weighted down by sorrow.

Adapted From

  • How to Help Ourselves Through the Holidays; Bereaved Families, Ottawa
  • Canadian Foundation for the Study of Infant Deaths.
  • With contributions by: Elizabeth A. Pector, M.D.

Household Tasks: Teaching the Kids to Pitch In

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Sharon Schnupp Kuepfer, Mom to five children ages 4 to 10, including twins, is the author of a book Homeschooling Moments and Child-Friendly Recipes: A Collection of the Unique Adventures of a Mennonite Family. The following hints for encouraging children to assist in the day-to-day household tasks are adapted from her book and an article in The Toronto Star (27th April, 2002).

Delegate – Each child takes one weekday to help with lunches and suppers. Sharon’s oft repeated rule: “If everyone does a little bit, no one has to do a lot.”

Assign new jobs periodically – As the children get older, they can handle more challenges. A five year old can easily handle the job of bringing the laundry down to basement on washdays. By aged three, Sharon’s twins were capable of putting the clothes in the washer, then transferring them to the dryer. To make the job easier for them, she bought them a two-step stool. They were thrilled!

Assign the same task for long periods – Not only does this lighten the workload, it makes the children competent in their assigned task. Sometimes they may even enjoy the task. At 9 years old, her daughter had had floor care for a year. Not only did she become adept at floor cleaning, she advised that she liked her job.

Use the five-minute motto – Sharon told her children that a job shouldn’t take more than five minutes. It is helpful to a child to realize that a job doesn’t have to take “half a day” to complete. Five minutes to empty the dishwasher, five minutes to sweep the kitchen floor, five minutes to sort the laundry, five minutes to wipe down the bathroom. Soon the jobs are done.

Kids complete chores even if there is company – Company kids are invited to join in the tasks, but don’t have to. Often when company sees your own children working, they will pitch in too. The timer is set for five minutes and everyone works like mad and Sharon finishes what is left. *Everyone contributes to the mess and everyone contributes to the clean-up. 

Let them work when the mood strikes – Sharon wanted to spend some time with her only son. “What shall we do?”, she asked him. “Let’s organize the closets”, he responded. While Sharon had had a play task in mind, she didn’t argue with his suggestion.

Be a role model – Even when the kids were not in the mood to work beyond their regular chores, Sharon cleans regularly. In this way, the kids observe that there are other tasks around the house that also need attending to.

Be consistent – Sharon notes that she is a stickler for having the tasks completed. Unless the child is very sick (or has another good reason), tasks must be done!

Make moves and minutes count – Sometimes multi-tasking is really helpful and even the children learn how to double up on their chores. Sharon’s seven-year old daughter advised “While I am waiting for my hot chocolate to get warmed up, I do my dishwasher. This way I have less to do later on.”

Make sure you have the right cleaning and organizing tools available – Make sure that you have the right tools on hand to complete tasks. Purchasing a good dust mop, for example, saved Sharon’s daughter a good deal of time daily when mopping the floor. It’s no good to begin cleaning the mirrors or glass, for another example, if you do not have the right products on hand to do so.

Multiples in School

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Pat Preedy became interested in school issues around multiple birth children in 1992 when nine sets of twins showed up at her school in Solihull, West Midlands, England to begin primary school. This brought the number to ten sets when added to the set already enrolled.

Pat Preedy, Ph.D., Key Note Speaker, Multiple Births Canada Conference, Ottawa, 23rd May, 2003, Submitted by Lynda P. Haddon

Pat began working with Professor David Hay of Australia and together, luckily for parents of multiples worldwide, created an important resource Web Site,www.twinsandmultiples.org, for parents asking the important question: should they be together or separated? Taking their research even further, Pat and David have also provided important feedback for educators in assisting each co-multiple to be the best they can be.

Pat began her talk by explaining that she and David had identified three main categories of multiples: Extreme Individual, Mature Dependent and Closely Coupled. Here are the traits as they identified them:

Extreme Individual

  • likes own friends, doesn’t share friends
  • plays mostly alone
  • opts out of the interaction if his co-multiple is successful
  • polarises his/her behaviour, goes to extremes (angel/devil)
  • is excessively competitive
  • dislikes co-multiple(s)
  • refuses to dress alike
  • tries to dominate

Mature Dependent

  • shared and separate friends
  • are happy either separated or together
  • supportive of co-multiple(s)
  • has developed as an individual with own identity
  • may choose the same or different interests from co-multiple(s)

Closely Coupled

  • unhappy when separated, want to be together most/all of the time
  • respond to each others’ names/group name, e.g. “Twinnie”
  • cannot recognize his/her image in the mirror
  • uses twin “language” (cryptophasia)
  • each slows down/speeds up to keep together, especially in school
  • few or no individual friends
  • combines to form a unit
  • dress and behave identically

Pat presented some ways to assist and support multiples in becoming individual thinkers, both by parents and educators alike

  • make individual eye contact so that each child is aware that you are speaking only to him/her.
  • use the child’s name at the beginning of the sentence, followed by your request or instructions. This gets his/her attention and there is no confusion for the children as to whom you are addressing.
  • ensure that each child speaks for her/himself and that the other does not do all/most of the talking/responding.
  • if you are having difficulty in “getting through” to one, both or all of the children, use play to engage them in conversation. Through playing a game with them, the parent or educator can create scenarios and engage a child, asking how they might respond, or what they might be feel if such a such a situation were to arise. When done through play, most children will let their guard down and express what they are thinking. A play situation vs an actual situation permits relaxed feedback from the child.

Pat reminded us that one of the “problems” experienced by multiples is their lack of privacy from each other. Pat cited an example: if the parents send one multiple to camp, they are usually sending two or three. Hence multiples do not have the same experience as if only one child was going to camp. Sent together they do not have time away from each other, are not encouraged to make individual friends or develop individual interests. They are inadvertently set up to continue to rely on each other and hence experience a lack of privacy from each other.

Pat stressed that both parents and teachers have the ability to assist multiple birth children in becoming the best they can be. Both need to be aware of the categories of twins as identified above and into which category each set of multiples may fall. When it can be determined as to how the multiples may be linked, both parents and educators can be properly assist and support the children reach their full potential. Pat advised that failure to recognize the challenges that multiples face from either being together or separate in their early schooling years is “unconscious incompetence.”

Pat’s talk was well attended by 100+ delegates, mostly parents, whose children are at or near school age and whom want to make the right decisions regarding their children’s class placement. Even though advance notice of Pat’s presentation was made several times to the local School Boards, including those up and down the Ottawa Valley and Eastern Quebec, attendance by educators was disappointing and pretty well limited to those with multiple birth children.

Schools don’t yet realize the part they can play helping/supporting multiple birth children and their parents with placement challenges. Nor do they recognize their important support role in assisting multiple birth children in making the transition into school and in separating from each other. The lack of representation for Pat’s Key Note and Workshop presentations from daycares, educators, principals and School Boards reinforces for me, that Boards underestimate and may not recognize the importance of their roles in class placement decisions, in being informed regarding the issues around multiples in school and therefore indeed function in an “unconscious incompetence.”

Multiples in School: Parent Tips

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Two concerns that arise for parents with multiple-birth children are whether they should be in the same class at school or separated, and which type of placement would benefit each child’s personal development.

In some schools there may be enough classes of the same grade to facilitate each child being in separate classes. It isn’t unusual for some schools to make the blanket policy that all multiples must be separated. In order to assist you with your decision making, the following offers some considerations for both leaving the children together as well as for separating them.

Pros to Separation

Although there is no substantial evidence to support the policy that multiples must be placed in separate classrooms in order for them to grow and develop as individuals, there are sometimes some circumstances which would indicate that separation is advisable. Here are some examples for when separation may be in the best interests of each child:

  • constant “togetherness” is hindering the development of social skills in one, both or more;
  • a “division of labour” exists;
  • insensitive comparisons by teachers, peers or even each other have led to feelings of inadequacy in one or more of the multiples;
  • the multiples form a “power unit” which is causing disruptive behaviour;
  • the kids use their multipleship to exploit, cheat or play tricks;
  • one or more of the multiples appears to resent the lack of privacy resulting from sharing a classroom;
  • one multiple proves to be a constant distraction to the other;
  • in opposite-sex multiples, the female is overprotective or “mothering” of the male co-multiple;
  • in skill grouped classrooms where the abilities of one multiple are far above those of his co-multiple; and
  • the multiples WANT to separate.

Wise parents and educators will realize that some of the above issues may be evident in one year and not the next. Evaluations/observations of multiples’ behaviour and development need to be regularly monitored.

Cons to Separation

Sometimes there are valid reasons for keeping multiples together:

  • major emotional upheavals may have occurred within the family, e.g. death, divorce, moving house, etc;
  • only one classroom is available;
  • unequal education due to two different teachers employing different methods of teaching;
  • multiples are at or near the same skill level in a skill-based classroom.

Recommendations regarding school placement

  • It is not recommended separating multiples who want to be together. Forced separation can damage self-esteem, inhibit language development and delay learning.
  • It is not recommended to automatically separate multiples in their first year of school. Such a separation adds to the stress of starting school and may actually increase the multiples’ need to be together.
  • All multiples need as much independence as they are ready to handle. Multiples flourish when allowed to separate on their own timetable. Together or not can be evaluated each year. As the multiples grow older, they themselves, will also have input as to whether or not they should be together.
  • Encourage multiples to choose separate classes and/or other activities as they gain confidence in the school situation.
  • Decisions as to whether or not the children should be together is best made by a “team” approach – the parents, the teachers and the principal. Educators need to realize that parents know their children best and it is important, for an easy transition to school, that a parental opinion be considered.
  • If multiples are in the same classroom due to lack of other classes, they can be in separate settings within the room;
  • The placement of each set of multiples needs to be evaluated on a family by family basis, placement evaluation needs to occur on a annual basis with parents, teachers and principals included in the decision-making. At some point, the children themselves will also have input into the decision.

Some Additional Considerations

  1. If your children look a lot alike or very similarly, dress them differently to make it easier for both teachers and peers to easily identify them. Different hair cuts or styles for girls can help too;
  2. Avoid referring to them as “the twins” or “the triplets” as this labels and reinforces them as a group and encourages the public to see them as such rather than the individuals they are;
  3. For parent/teacher interviews, make sure each child is described in comparison with their peers and not solely as compared to each other;
  4. If possible, scheduling parent/child interviews separately can be helpful in allowing you to focus on each child individually;
  5. Be a positive voice for your children and recognize their individual strengths as well as what may make the situation more challenging vis-à-vis them being multiples.

Pat Preedy (UK) provides this important note for Parents: “The critical thing is developing “mature dependence” which needs to begin as soon as the children are born. For multiples who are mature dependents, it actually doesn’t matter whether they are together or apart – they function as individuals and enjoy being a multiple.”

Sources

  • Multiples in School , Multiple Births Canada, Revised 1999
  • Placement of Multiple Birth Children in School , A Guide for Educators, National Organization of Mothers of Twins Clubs, Inc., 1991

Additional Resources

Multiples in School Support Kit, Multiple Births Canada www.multiplebirthscanada.org

Website

www.twinsandmultiples.org, Educational Web Site for Multiples in School, Pat Preedy, M.Ed., B.Ed. (UK) and Professor David Hay (Australia)

Books

  • Parenting School-Age Twins and Multiples , Christina Baglivi Tinglof, 2007
  • The Joy of Twins by Pamela Patrick Novotny, 1988
  • Twins, Triplets, and More , Elizabeth M. Bryan, 1992
  • The Art of Parenting Twins , Patricia Maxwell Malmstrom and Janet Poland, 1999

 

Multiples in School: A Guide for Educators

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Parents of twins, triplets or more face a challenge as their children begin school: should they be together or separated?

Some schools have a policy based on the separation of multiples. Such a policy doesn’t allow for input from the parents nor the children themselves. Not all multiples want to be together and some do well together and need to be able to at least catch a glimpse of their co-multiple across the room to be the best they can be. The important thing is for them to develop “mature dependence.”

In order to assist Educators, the following offers a brief overview of both points of view, i.e. together or separate, and provides additional research material at the end of the article.

Reasons for Separation

While there is no substantial evidence to support the policy of separation in order for each child to grow and develop as individuals, sometimes circumstances exist which would indicate that separation is advisable. It is helpful to recognize that some behaviours may be an issue one year and not the next.

  • Their constant “togetherness” is hindering the development of social skills in one, both or all;
  • A “division of labour” exists;
  • Insensitive comparisons by others have led to feelings of inadequacy in at least one multiple;
  • A child’s problems are attributed to the fact that he is a multiple;
  • The multiples form a “power unit” causing disruptive behaviour;
  • Multiples exploit their multipleship to cheat or play tricks;
  • One multiple appears to resent the lack of privacy resulting from sharing a classroom;
  • One multiple proves to be a constant distraction to the other(s);
  • There is (excessive) competitiveness between the multiples;
  • In opposite-sex multiples, the female is overprotective of her male co-multiple(s);
  • In skill grouped classroom activities where the abilities of one multiple are above that of his co-multiple(s);
  • The multiples WANT to be separated.

Reasons for Not Separating

  • Major emotional upheavals have occurred within the family – i.e. death, divorce, move, new siblings, etc.
  • Only one classroom is available;
  • Unequal education due to different teaching styles of the educators;
  • Multiples are at or near the same skill levels in a skill-based classroom;
  • The multiples do NOT want to be separated. Forced separation, with all of the other “firsts” children face, especially in their first year of school, can add undue stress, regression and affect self-esteem.
  • Separation in the first year of school should not be an automatic decision. The added stress of separation with all of the other firsts (e.g. leaving Mom, rules, increased noise levels, schedules, new friends, etc.) might actually reinforce their need to be together.
  • Allow multiples as much independence as they are ready to handle. They flourish when allowed to separate on their own timetable.
  • Encourage them to choose separate classes as they gain confidence in the school situation.

Tips for Teachers of Multiples

  • Encourage them to sit apart for different class activities if they are in the same classroom. This assists you in identifying who’s who and discourages them from completing each other’s work;
  • Look for differences in the multiples, not sameness, e.g. voice differences, left/right handed, birthmarks, hair growth. Being able to address each multiple by their individual name, assists them in recognizing that they are individuals;
  • Refer to each child by their own name. This helps you identify each child and sets a good example for their peers to also address them individually;
  • Expect differences in test scores, neatness, behaviour but don’t be surprised if they are very similar;
  • Avoid insensitive comparisons, e.g. “You are not doing as well as your twin.” This sets up both multiples to have poor self-esteem;
  • For parent/teacher interviews, compare each child to their peer group and not to each other;
  • if you are having difficulty in telling the children apart ask the parents to dress them differently. This helps everyone recognize their individuality.
  • If one multiple (especially monozygotic [identical] multiples) is markedly behind his co-multiple, investigate the cause:
    1. Check to make sure that each multiple is doing his/her own work.
    2. Plan a conference with the parents to explore the situation.
    3. Don’t rule out the possibility of a learning disability in one of the multiples.

Recommendations Regarding School Placement

It is best if each set of multiples is evaluated each year to ascertain which is the best situation for them, i.e. together or apart. The final decision as to which it will be needs to be made by the parents, the teacher, the principal and at some stage, the children themselves.

Compiled and adapted from “ Placement of Multiple Birth Children in School, A Guide for Educators” a publication of National Organization of Mothers of Twins Clubs, Inc., 1991

Additional Resources

Multiples in School , booklet by Multiple Births Canada,www.multiplebirthscanada.org
Multiples in School Support Kit by Multiple Births Canada http://www.multiplebirthscanada.org
Twinline Services, “ Twins in School: Together or Apart”, Berkeley, CA, 1983

Website

www.twinsandmultiples.org, Educational Web Site for Multiples in School, Pat Preedy, Ph.D., M.Ed., B.Ed. (UK) and Professor David Hay (Australia)

Books

  • Parenting School-Age Twins and Multiples , Christina Baglivi Tinglof, 2007
  • The Joy of Twins , Pamela Patrick Novotny, 1988
  • Twins, Triplets and More , Elizabeth M. Bryan, 1992
  • The Art of Parenting Twins , Patricia Maxwell Malmstrom and Janet Poland, 1999

Occipital Plagiocephaly

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Two of my triplets (they are aged 8 weeks) have flat spots on one side of their heads. How did this happen? What can we do about it?

While the rate of Sudden Infant Death Syndrome (SIDS) has greatly decreased since parents and caregivers have followed recommendations to put babies to sleep on their backs (“Back to Sleep” programme), another issue has come to the fore.

occipital-plagiocephaly-helmetBabies who lie for long periods of time in one position, can develop flat areas on their heads. It is well known that babies skull bones are very soft until about one year of age.

Further, multiple birth babies can be at a greater risk for occipital plagiocephaly (and/or torticollis) due to “stacking” in the womb, i.e. the lower baby may be engaged in the birth canal with one, two or more babies above it.

The combination of increased pressure from above that lower baby combined with gravity, can place a lot of pressure on the lower baby’s head and neck. In addition, prematurity and supine sleeping (i.e. placing a baby on its back to sleep) increase the liklihood of there being a risk of a flat spot occurring on the baby’s skull.

What is Occipital Plagiocephaly of Positional Orgin?

“Occipital Plagiocephaly” is a medical term for the flattening of one side of the back of the head, often caused by lying with the head in the same position. A flat area may develop very quickly or over several months.

Visually, your child may have one ear that is shifted forward of the other and may also have facial changes, e.g. forehead protrusion or cheek protrusion in more severe cases, on the flat side of the head.
Head Shapes (looking down from above at the top of the baby’s head)

original head shape positional plagiocephaly
Normal head shape Positional plagiocephaly

What can I do if my baby(ies) has a flat area on her head?

With proper positioning encouraged by the parents, the baby’s head shape usually quickly improves on its own. When a flattening of the head is noted, or you notice that your baby(ies) has a strong preference for always turning to the same side, it is important to take some action to rectify the situation.

After discussion with and agreement by your doctor, the following are some ideas for you to try to keep the baby off of the flat side:

  • Make sure that your baby(ies) is placed off of the flat area at all times. This can be accomplished by placing a small, rolled up blanket under your baby’s shoulder, on the same side as the flat area. This will help keep the baby’s head turned away from the flat side. Make sure that the baby’s underside arm is out so that there is extra protection against the baby accidentally rolling on its tummy.
  • Babies tend to look towards the door while lying in their cribs (as they wait for a parent to appear). Move the crib often to change the view of the door. Move toys and mobiles around and away from the flat side of his head. This will encourage your baby(ies) to look towards the toys. You could also regularly change the ends of the bed when putting your baby(ies) to sleep.
  • When holding, feeding or carrying your baby(ies), make sure that there is no undue pressure placed on the flat side.
  • With the new style of baby seats that go from table to car to stroller frame, your baby(ies) can potentially end up spending long periods of time sitting in the same position thereby increasing the chances of a flat spot developing. Be aware of this danger and avoid long periods where your babies may remain sitting in the same position.
  • Provide your baby(ies) with lots of SUPERVISED play on their tummies. This helps build and strengthen neck, shoulder and arm muscles. Appropriate toys can be used to encourage tummy and side lying play.
  • Provide lots of SUPERVISED time to play in a sitting position and in an ‘exersaucer’ as soon as each baby has achieved good head control.
  • Pay attention to bottle-feeding. It isn’t necessary to change a baby from side to side once the spot has been noticed, but the person feeding the baby(ies) will need to make sure that there is no undue pressure placed on the flat spot. For prevention of a flat spot occurring, change your baby(ies) from side to side at each feeding.
  • If you notice that one or more of your babies has difficulty turning her head(s), she may require some neck stretching exercises. Consult your physician who can refer you to appropriate physiotherapists, if this is the case.
  • For the best results, positional therapy needs to be started before the baby(ies) is four months old.

How do flat areas occur?

Before Birth:

  • One or more of your multiple birth babies may be born with flat areas on their heads due to lack of space to change positions in the womb.
  • One multiple birth baby may be engaged in the birth canal while the other(s) is “stacked” on top, putting pressure (gravity) on the lower baby’s head and neck.

After Birth:

  • As newborn skulls are very soft and malleable to help ease the baby through the birth canal, it is not unusual for newborn babies to have an unusual shape to their heads, due to the pressure of birth. This will generally rectify itself by about six weeks after birth.
  • However, some babies show a preference for sleeping or sitting with their head turned in the same position for the majority of time.
  • Some babies may have the additional problem of torticollis, a neck muscle problem, that prohibits them from properly turning their head to another position.
  • Premature babies have softer skull bones.

Does having Positional Plagiocephaly cause problems for my child?

In the majority of cases, having a flattened area will not affect a baby’s brain growth or mental development. When the hair grows in, it will cover the flat spot and it will not be visible. However, if there are visual changes in the baby’s appearance, i.e. one ear may be shifted forward of the other one, on the same side as the flattening, this can make a difference cosmetically with perhaps reduced perceived attractiveness and there is a potential for teasing and/or rejection amongst peers.

What do we do if positioning doesn’t help?

If positioning exercises do not help, it may be necessary for your child(ren) to wear a helmet(s). Your physician will guide you, if this is the case. Each case is different and each child unique but you may count on your child(ren) needing to wear a helmet for six to eight months from when it is initially recommended.

To Sum Up

  1. It is possible that more than one of your multiples may show signs of occipital plagiocephaly.
  2. With routine change of baby’s head position right from birth, the problem can be prevented;
  3. With early recognition and treatment after birth or at two to four months of age, positional therapy may be all that is required in the majority of cases;
  4. Only in the more severe cases will the use of a helmet be indicated.

Definitions

  • Occipital Plagiocephaly: a one-sided occipital flattening that results in marked skull asymmetry.
  • Torticollis: shortening of the neck muscles on one side of the neck, making it difficult to turn the head. Rectified by stretching exercises.
  • Uterine Constraint; Uterine Packing; Stacking: All of these terms may be used to describe the positioning of multiple fetuses within utero. I have chosen to use ‘stacking’ in this text.

Additional Resources

  • Najarian, S.(1999). Infant Cranial Molding Deformation and Sleep Position: Implications for Primary Care. Journal of Pediatric Health Care, 13, 4, 173-177.
  • Neufeld, S. and Birkett, S. (1999). Positional plagiocephaly: A community approach to prevention and treatment. Alberta RN, 55, 1, 15-16.

Websites

Adapted from a pamphlet prepared by: The Children’s Hospital of Eastern Ontario, Ottawa and from: “Your Baby’s Head Shape”. 1999. The Alberta Infant Cranial Remodelling Program – Stollery Children’s Health Centre (CHA) and Alberta Children’s Hospital (CHRA)

With guidance and input from Karen Dube, Nurse Practioner/APN, Ottawa, Ontario.

Multiples are Individuals Too

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In 2007 Oprah had a show focusing on multiples. There was a delightful family with sextuplets who shared the challenges of raising six babies at one time. The family was obviously full of love and delight with their family, yet they also provided honest feedback on the difficulties and exhaustion they faced with their unique family. They have two older children to add to the mix.

Oprah also interviewed 28-year old triplet men whom had an interesting background and achievements whose father died unexpectedly when they were 10 years old. They have two older brothers and their mother raised her five sons on a teacher’s salary after their father died. She focused on three places her children should always be: at home, in school or in church. Get this: all five sons are lawyers and achieved top of their class marks, not only in high school but university as well! It is thrilling to hear of the achievements of this special and unique family, under challenging circumstances.

So here’s my but. One cannot take away from this single mother’s love and devotion to her children, especially under extenuating circumstances. And the love of the sons (one older brother and the mother were also present) towards their mother was very evident. So what was bothering me? It took me a little while to figure it out.

Parenting multiples is a challenge. With two or more babies arriving at once and struggling to meet their needs, it is difficult to find time for one-on-one and let alone learn the unique characteristics, desires and interests of each child as an individual. Some of us have other children too, making quality individual time all the more difficult to schedule.

What stood out for me was that at age 28, these young men are a unit. As they explained, they were always in the same class, graduated high school top of the class, two were Valdictorians. They admitted that they were never sports minded.  They went to the same university, all taking Law, in the same classes and graduating top of their class. They were pleased to note that they try to meet three times a week for lunch.  They were dressed in spiffy suits, looking very similar, and while two were wearing black shoes, one was wearing brown. I was excited to see this obvious bit of individuality.  No one spoke of dating, girlfriends or wives.

I’m not trying to tell people how to live or even make a judgment regarding their choices but in this particular case, I was left feeling sad about the lack of any expressed individuality (beyond shoe colour) of these three bright men. I believe that part of a parent’s responsibility, and particularly those of us with multiples, is to honour their birth bond while encouraging and nurturing individuality.  Such balance is essential to a child’s well-being. I was left with the impression that the men and their relationship as it stood, precluded their need or desire to look outside their relationship for any other relationship comfort or connection. In other words, they received all of their connection and safety within their own relationship and hence had no need to look elsewhere. I admit I do not know this family other than what was portrayed on the show.

As can happen with multiples and the media, this “unit” of 3 persons was celebrated and acclaimed, I felt not as much on the merit of their individual achievements, but primarily on their merits as being triplets. This is dicey because what they have each achieved is something any parent would be proud of, yet once again, the public has not appreciated these multiples as individuals but mainly as triplets. Because they have been continually presented as a package to the public, it is their “package” that has been celebrated rather than whom they are as individuals.  I believe they were recognized firstly as triplets rather than bright, capable, highly achieving individuals. I also believe that parents call the shots on how their children are perceived. It is the responsibility of the parents, or parent, to encourage their multiples in every aspect of their lives, including the nurturing of their individuality.

One of the beauties of having multiples is the factor of built-in playmates, something quite different from raising a singleton child when parents actively seek community situations where their singleton can learn to socialize, share and take turns.  The failure to encourage our multiples to reach outside of their unique situation and embrace something else, be it activities, interests or individual friends, robs them of a chance to learn to live and adapt to the world outside of their relationship. Parents needs to be aware and take appropriate steps that each of their multiples is given a chance to shine alone. If not, they can be robbed of an opportunity to grow and develop as individuals, and that would be such a shame.

April, 2007

Timely Medical Response When a Baby Dies

Posted by on in Lynda Weighs In, Postnatal EducationLeave a comment

For nearly 20 years, I have provided grief support and resources to parents losing one, more or all their multiple-birth children. On their behalf, I reflect on a situation which warrants some discussion.

There are some healthcare professionals who, while Mom is pregnant and for follow-up after birth, encourage appointments and answer questions; yet, if there is a loss by or at delivery they stop being accessible after the initial one or two postnatal visits; they refuse to provide a timely medical response.

Yet again, I heard from a Mom who, four months after the birth of her twin survivor, has no word on lab test results in spite of several calls to her doctor’s office.  She is afraid to call again because the staff has become cool and abrupt.  Another Mom said, “It’s been a year since the autopsy and I still don’t have any results. I’ve had to hire a social worker to follow up on the results because I’m so overwhelmed with grief and anger, I can’t function.”  And, from another Mom, “I know the office dreads my call.”

Think of the parents. They are trying to deal with a twin (triplet or quadruplet) survivor(s) [and perhaps other children as well], come to terms with and grieve the death of their baby(ies) and hopefully learn why he/she/they died. After repeated attempts to get information, some parents may be perceived as pushy or emotional, however handling the baby’s(ies) death requires getting report results from their doctor’s office and not making them feel side-lined, minimized or ignored.

We know doctors are busy, but why is it that bereaved parents sometimes cannot get timely feedback on autopsies, lab results from blood work/placental examination or other situations where the medical world explores why the baby(ies) died? Sure, some tests take time; however, initiating a call to the parents at least once in a while, until the answers come in, would be sensible, considerate, and an acknowledgement of the families’ grief and pain.

It’s true, some causes of death cannot be explained and parents may never learn why their baby(ies) died. If this is the case, then don’t those parents still deserve to hear, “In spite of all the tests, we don’t know why your baby(ies) died.”? Surely parents have been through enough already!

Even if certain tests take months for results to come back, let the parents know. Often parents fantasize about why their baby(ies) died, sometimes blaming themselves or each other. Such a situation puts an added strain on the marriage and marriages crack and break. As well, a preoccupation with getting results affects availability and parenting abilities for the surviving children.

One would think that being compassionate would be easy, and I suppose most days it is; but when one is too busy (and I strongly suspect that is a big part of the problem for many doctors, nurses and hospital staff), then compassion can fall by the wayside and it is the most vulnerable who suffer as a result.

Keeping Walker and Losing Willis

Posted by on in Postnatal Education, Stories of loss from parentsLeave a comment

My husband Michael and I found out we were having twins on October 20, 2006 which also just so happened to be the day we were married. I was attending school in Tuscaloosa, Alabama at the University of Alabama and I started to feel so sick I could barely eat. I knew right then that I was pregnant, I just knew.

Michael and I were both excited and we went to the courthouse and got married as soon as we left the doctor’s office that day. We were just glowing and tell everyone down  at the courthouse that we were expecting twins.  Nothing could bring us down that day.

We spent the next few months guessing what sex they would be.  On December 4 we found out they were both boys. We named them Walker and Willis after each of our grandpas. I loved both of those babies with all my heart.

I continued to still be sick even in my fifth month and had trouble keeping food down, but I told God all the time I would suffer through whatever if only he would keep my babies safe. I really believed that he would. I never expected the news we got on January 3 when I went back in for a routine ultra sound.  Twin A no longer had a heart beat and from that moment I just went into complete shock. I started crying right there on the ultrasound table and I just couldn’t believe it. The doctor came in and told me he was sorry, he said we now had to focus on getting Walker here safely.  He sent me to a specialist who said that Walker looked very healthy and that Walker might even go full term.

I was so thankful to still have Walker fighting as he did, but of course I always thought of Willis and wondered what happened to him. I even wondered if it was my fault. I wondered why God would not want me to have both of my babies.  My mother in law told people that I needed to stop talking about Willis and focus on Walker. That really hurt, how dare her. Willis was just as much my baby as Walker, and he was Walker’s brother. I will never stop talking about him.

At home, I began to have anxiety attacks. I would wake up at night and just panic because I would not feel Walker move. Most of the time I would just shake because I was so nervous and scared for Walker. After several late night visits to the hospital and an ultrasound that showed Walker was not doing very good, they sent me to Huntsville where the specialist was to remain in the hospital and be monitored until Walker was born.  The nurses were so wonderful to me in the hospital.  They comforted me and tried to reassure me that Walker looked wonderful on the heart monitor.  And at night when they would hear me crying they came in there to hand me tissues and get me whatever I needed. I don’t know what I would have done without my nurses.

Dr. Bailey, the specialist was heaven sent. I don’t know if Walker would be here if it was not for him. He took such good care of us and he is the one who made the decision to put me in the hospital.

On March 6, 2007, at 11:22 p.m., Walker Joseph was born and Willis’ little body was delivered too by C section. Walker was beautiful and was sent immediately to the neonatal, he was only three pounds.  It sounds weird but I really thought more of Willis those first couple of days, because I knew that now I had to start saying my goodbyes to him. After all those months, he had been with me, even in death he remained in me.  Now I had to give him up. I held him close, and talked to him. I wondered why so many times, but that question will not be answered here on this earth, I know there was a reason.

After losing Willis, I remember the hospital staff that handled the birth certificate came and had me review Walker’s birth certificate. I noticed it said he was a single birth and I started to cry. I asked her why it didn’t say twin. She said it was not considered a twin anymore but she would ask for me.  In the end, they would not change it. It hurt but I tried to understand where they were coming from.

Walker is doing well, he is four months now and twelve pounds. He is a blessing, but of course I will always wish Willis was here with us. But Walker fought so hard even when his brother was gone. I often wonder what he thought when Willis was no longer beside him kicking and was no longer moving.  I thank God everyday for Walker and thank my nurses and my doctor that I now have a precious baby.

I often think about how I used to pray that God would take care of both of my babies and I now see that he has. Walker is here with us and Willis is in heaven where no pain will even touch him. That is what comforts me the most. Thank you so much for this opportunity to share about my babies.

Sincerely,

Brooke (Florence, Alabama)

I am blessed with twin boys…

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I am blessed with twin boys that are nearing their fifteenth birthday, and have had two singleton pregnancies since. A couple of weeks after my youngest son turned one in December 2006 I discovered that a surprise was on the way. At an ultrasound at 8 weeks the technician asked *Do you see what I see?* and I thought I was going to faint – it was twins, again! They were measuring right on target and both had strong heartbeats, and more importantly they had their own placentas and sacs. I went searching for my husband on his postal route to show him the pictures, I couldn’t wait until that night to tell him our news!

As the next few weeks went on I had two more sonograms at a perinatolgist’s office as I was seen as high risk because of my age (36). I actually got the nuchal screening done twice, because they felt the first was done a little early. The results were wonderful, and I was actually feeling occasional movement by both babies at that point (confirmed during a scan….one of the babies flipped as the tech was pushing down with the wand and we both felt it).

We were on cloud nine, and was feeling confidant as I entered my second trimester. Then, at my 16 week appointment my doctor couldn’t find Twin A’s heartbeat. I had a terrible feeling that something was wrong because I had actually felt different…less pregnant…in the last week or so. My doctor reassured me that A was probably hiding behind B, and I reasoned that it was possible since both babies’ heartbeats were virtually the same. I was told to come back in two days for a scan (tech is only in the office on certain days).

I was scared to death the day I went in..yet in the back of my mind I felt I was worrying over nothing, I just couldn’t fathom that one of our babies had possibly died when things were going so well. The tech quickly scanned over Twin A and honed in on B’s heart and started talking about how well the baby looked. At that moment I knew something was wrong, so I told her I knew that B was doing well as I could feel him/her and I wanted to see A. She went back to the baby and said *I’m so sorry, but your baby has died.* What I felt at that moment I hope to never experience again. The ache in my heart was worse than any I had ever felt before.

She estimated that he/she died around 14 1/2 weeks. The baby looked so peaceful, curled up like he/she was just sleeping. The technician was sweet and printed a picture for me, and then went back to Twin B to do a thorough scan. It was then that I found out we were expecting a girl, and that she looked wonderful. I was happy, but not like I should have been. Instead I cried for my lost child, I wanted answers that couldn’t be given.

I had been rear-ended a week before Twin A had died, but saw the doctor that day. They had found both heartbeats on the doppler and I wasn’t having any pain or bleeding so all my doctors think it had nothing to do with it. I was told that I may bleed or cramp, and that Twin A would probably reabsorb so there wouldn’t be anything left to test after the birth.

I have been monitored closely, and have slowly watched my little girl grow while her brother/sister still remains. Now that I’m 35 weeks, I have been told that I will deliver Twin A (named Jordan) after the live twin (Alexandria), but they really don’t know what to expect. They also couldn’t tell me what we need to do to make arrangements since the loss occurred before 20 weeks. We can’t afford any type of burial, and I was told by my one of my doctors that it may not be worth the cost to have him/her cremated. But I most certainly am not going to allow the hospital to just *dispose* of our child either. Every day I tell myself that I am going to call a funeral home, but I can never bring myself to pick up the phone.

Some days are better than others, some family and friends have been better about the situation than others. I have been told to get over it and to focus on my live children, yet they can’t possibly fathom what it feels like to carry a child that lives and one that has died. I’ve already been through the shock and anger, and am able to focus more on the coming birth of our daughter, and am so grateful that she’s doing well…yet I feel cheated. I should be preparing for two babies, not one.