Category: Prenatal Education

Grandparenting Multiples: Hints, Do’s and Don’ts

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Lynda gratefully acknowledges the support and input of two Exceptional Grandmothers, Adiva Sotzsky and Sue Purdon, in preparing this article.

I love the bumper sticker that reads “If I had known what fun having grandchildren were, I would have had them first!”

Grandfather with twinsBasically that says it all. A time of their lives that many parents look forward to is to the time they will become Grandparents. While we have enjoyed (and asked ourselves along the way “What the heck am I doing?  I am useless at this!”) the journey of raising our own children, the time of becoming a grandparent, is an exciting and natural progression in Life’s Journey. But wait a minute, there’s more – not only are you to become grandparents, you are to become grandparents to twins, triplets, quadruplets or more. It doesn’t get more exciting than that?

As parents yourselves, you have “been there, done that” and when your grandchildren arrive, it can be very tempting to rush in, offering advice, shortcuts, feedback and opinions regarding parenting style to the new parents. Add to that the 20/20 hindsight of your own parenting experience, and of course you have lots to offer! Who wouldn’t want to share their years of experience with the ones they love and to help them avoid some of the mistakes you made? After all children don’t come with instructions.

Grandmother with multiplesAh, if it was only so simple. Grandparents are an important part of the childrearing equation but grandparents also walk a very fine line. It isn’t unusual for grandparents to either attend the births of their grandchildren and/or to at least move into the family home for a few weeks after the births to help the new family establish routines and get accustomed to their roles as round-the-clock caretakers. The more difficult part of the equation for grandparents, is to support the family while allowing the parents (i.e. their own children whom are now parents) to discover their own balance, make their own mistakes and find their own comfort levels. Grandparents need to remember that, while their children’s parenting choices may not mirror their own, these new parents have a right to learn in the their own manner and also benefit from the expertise and helping hands around them. It is a wise grandparent who knows when to be loving, sympathetic, caring and when to also hold his/her tongue.

Children greatly benefit from contact with the different generations. As a result of such interactions, children have a first hand “peek” into their history, roots and Family Tree, learning about “the olden days” as stories from their grandparents’ lives unfold. We all like to know about our roots and where we come from and children are no exception. Such stories from grandparents offer a sense of belonging, comfort and continuity. Along the way, the grandchildren can also enjoy some special attention from their grandparents. Prolonged bedtimes, favorite foods or the relaxation of parental rules and regulations make the grandparent-grandchild relationship unique.

There is no doubt that being a grandparent is a rewarding and exhilarating experience. But (yes, there is a “but”), there are some very important points to be aware of which can help grandparents be an important, loving, caring, sharing part of their grandchildren’s lives.

Being grandparents to multiples involves some additional layers of which even the most involved grandparent needs to be aware. The following hints and tips have been prepared to assist you in being the best support system you can be, while remaining a positive, caring and extremely important person in not only your grandchildren’s lives, but in the lives of their parents’ as well.

Congratulations on becoming the Grandparents (or Great-Grandparents) of twins, triplets, quadruplets or more!!!

Before your multiple-birth grandchildren arrive, educate yourselves so that you can get an accurate idea of what having twins, triplets or more entails. There are many excellent books on multiple births available which can enlighten you as to what the parents are facing.  You can find some of the titles here.

You may wish to talk to other parents or grandparents of multiples or join your local Multiple Birth Support Chapter. They have regular meetings, educational speakers, can recommend appropriate Internet Sites and much more. Many Grandparents have taken my Multiple Birth Prenatal Classes to learn firsthand how they can be the best support they can be to the new parents. Grandparents have taken the classes and passed along the information and handouts to their children who live in areas of Canada with no such prenatal support systems. They have even sent prenatal information Overseas to their families posted abroad. How’s that for commitment?  Educating yourselves before the babies’ arrival will assist you in becoming a positive and supportive Grandparent and a tremendous asset to the new parents. 

If you are parents of multiples yourselves, you already have a pretty good idea of what the parents will be facing. Nevertheless, it will be important that you remember to be supportive to the parents and not try to compare your own parenting experiences with their current one. Even in one generation, times and parenting practices can change. It is important to remember that the new parents need love, support and their own chance to parent. They don’t need judgments or unsolicited remarks.

Which leads us to: Don’t give advice unless you are asked. Remember that everyone is learning and doing the best that they can. The parents are no doubt already feeling overwhelmed and somewhat out of control. In the heat of the moment, unsolicited advice or judgmental comments will not make things better. It is very tempting to sometimes speak up and offer advice, but the wise person knows when to keep quiet. If you really feel that you may have a piece of helpful advice, wait until a quiet moment and express yourself using supportive, caring and loving words.

Here’s another important rule: Don’t judge your children’s parenting style. The advice and experience that you have accumulated cannot be denied, but it is important to remember that you remain the Grandparent and not the parent. If you do step in and either comment or “take over”, you will be undermining the parents’ authority with their children. While you may not agree with the parents’ choices or decisions, they ultimately, have the final say.

You have an important contribution to make each time you visit. The new parents are on duty 24-hours a day (remember?). They may be sleep deprived, falling apart at the seams, overwhelmed and feeling very guilty about it. You might take the initiative and suggest that the parents take a little break. For example, suggest they go for a walk around the block, to a movie or a local coffee shop for some relationship time. Or you may offer to take one baby for a walk in order to change the family group dynamics for a short while. Even these small respites can be valuable for everyone in the family.

If you are in doubt about how to help out, ASK what you can do to assist. Let the parents tell you what they need. It could be anything from throwing in a load of laundry, preparing a meal, bathing a baby or just listening. Do not underestimate the healing power of listening (with no judgments, of course). You can no doubt remember how overwhelmed you felt at times. While the feelings of being overwhelmed will have not changed, parents feel much better when they feel heard and someone is sympathetic to their situation. Listening goes a long way to getting one back on track in order to tackle the task at hand (Gosh, that lesson can be applied in many other areas of our lives too!).

You may look around and see some jobs that might be done. DON’T WAIT TO BE ASKED. Clean up the kitchen, throw in a load of laundry, pick up a crying baby, make a nutritious meal, cut the grass or shovel the snow. Sometimes an overwhelmed parent can’t voice what they might need but can appreciate someone taking the initiative. 

(Author’s Note: These two previous points seem contradictory and you are right, they are! What you need to evaluate is when to ask what is needed in the way of help and when to be proactive and take on a task without being asked. You will also need not to be critical or act as if you are “taking over.” Didn’t I warn you that you walk a fine line? I have faith in you – you can do it!)

Do not “fight” the parents for the babies. If you live a long distance away and your visits are few and far between, you will relish every moment with your grandchildren. However, “fighting” the parents for the babies’ care, will not win you any brownie points. More often than not, the parents are trying to establish a routine with their babies. Having you step in and try to “wrestle” one away from them, will only make things unpleasant for all of you. If the parents are involved with the children, perhaps offer to do a job around the house (e.g. wash the kitchen floor or vacuum a room or two.). You will be a hero and there will still remain lots of time to interact with and care for the babies.

If you live within driving distance and it is possible, set aside one day a week to come into the home and look after the babies, allowing some personal time for Mom & Dad and any siblings. This is extremely helpful during the initial few weeks after the babies’ arrival. Such was the case with one family and Mom felt secure in that she knew that every Thursday her parents would make the 2-hour drive to her house to care for the babies, feed them, bathe them and do some laundry. All she needed to do that day was to nurse them. If things got hectic earlier in the week, she knew she only had to make it until Thursday when she would receive some much needed adult conversation and loving support. As the children grew, they too began to look forward to their Grandparents’ visits.

Make a nutritious meal. Double the recipe and put some away in the freezer. It is very difficult for parents with twin, triplet or quadruplet newborns (and sometimes singletons too) to have the time to cook meals. This could work out very well as you all sit down to share the meal, stories and the day’s events with each other.

This Rule is a Golden One: Do not play favorites amongst your grandchildren. In reality, it may be that you do prefer one grandchild over another but IT IS ESSENTIAL THAT YOU DO NOT LET YOUR PREFERENCE SHOW. Children pick up very quickly if they are the favorite or not. To not feel like a favored child is extremely difficult on a child’s self-esteem and can result in long-term negative feelings and even to bad feelings and jealousy between the children themselves. Treat each grandchild equally. Every grandchild deserves to feel cherished and loved by all of the adults in their lives.

If you live in the same area as your children and grandchildren, you may be able to take a baby/child home overnight on a rotating basis. Be sure and have age-appropriate toys, books and clothing on hand. Find out what interests each child and gear your play towards his/her interests. You will need to be prepared to engage in appropriate age level play. Each of you will benefit from this one-on-one time and you will learn much about your grandchild that you never would have noticed in the group setting. (WARNING: In the process, be prepared to rediscover your own inner child as rhymes, stories and songs come back to you from your own and your children’s childhoods!)

If you do not live in the same area as your grandchildren, learn to work the computer! Once you get the hang of it, you will enjoy this rewarding and very easy way to keep in touch. Connect to Skype or Face Time and e-mail and write to your grandchildren often. You will make important connections that you, and they, will cherish for a lifetime. The Internet is a wonderful medium for sharing uptodate photos of your grandchildren with friends and family. With a scanner, photos can quickly and cheaply be sent so you can see the changes in your grandchildren as they grow and thrive. Computers today are user-friendly and it takes no time at all to learn how to work your way around them. My 85-year old mother and nearly 89-year old father-in-law were regular computer users and our children thought their grandparents were “cool” for knowing how to use them. Shop around for competitive prices and give it a try.

Remember that your multiple birth grandchildren are individuals even though they share the same birthday. They will not necessarily have the same interests, talents or abilities. Keep in mind their uniqueness, individual interests and capabilities, especially when buying them gifts. Grandparents often like to be fair and spend equal amounts of money on each grandchild. Depending upon what you are purchasing, it may be more advantageous to focus on their individual interests rather than the amount of money spent on each gift. 
 Or if you feel strongly about spending equally, make up the difference in price of gifts with a cash top up.

Speaking of gifts: Don’t necessarily feel that you need to purchase the same gift for each child. Variety gives the children a broader toy/book base from which to choose. However if you notice that each grandchild prefers a particular toy, you may purchase two (or three or four) in order to reduce any arguing over it. In such cases, put each child’s initial on the bottom of the toy so that it is clear to all who owns it. We all know that a child often wants the exact toy that their sibling is currently enjoying. By putting initials on the toy, you can patiently explain that his/her toy is on the shelf and ready to be played with. You might also consider purchasing a game that everyone can play together. Be prepared to join in if you choose this latter route.

Don’t be overly worried if you cannot tell your multiple birth grandchildren apart if they look quite a bit alike. Even monozygotic multiples are not completely alike despite what you hear. Focus on their differences and not how alike they are. Spending time with each child alone will enable you to quickly recognize those differences (e.g. hair whorl, a mole or freckle, shape of earlobes, body language.)

Grandchildren love to hear about their parents especially when their parents were young. So dust off those memories, give them a good shake to get rid of the cobwebs and reconnect to your own experiences with your own children. You will love sharing every second and your grandchildren will love listening (WARNING: Habit forming. Be prepared to have to repeat your stories time and time again.).

Don’t forget singleton siblings of your multiple birth grandchildren. As you can appreciate, they will need extra love, hugs and encouragement as they make the transition from “centre of the universe” to big brother or sister. Your attention, inclusion, patience and understanding can be very important at this critical time in their young lives as they adjust to the new family structure. Your ongoing support will provide them with the reassurances that they continue to be an important and much loved part of the family.

Make sure that you are aware of the many unique Safety Issues around multiples. Two, three or four toddlers can physically accomplish many tasks that a singleton could not. Together they can push a chair across the kitchen floor in order to climb up on the counters. One child will have “the plan” and the others will help carry it out (how they communicate “the plan” to each other remains a mystery). Remember when you are looking after them that when one falls down and skins his knee, you remain responsible for others at the same time. While attending to the child in need, you will need to be aware of the proximity of his/her co-siblings. The consequences of not doing so could be dire. To learn more about safely looking after your multiple birth grandchildren, check out the article Multiples and Safety. Being aware of the possible pitfalls ahead of time could save someone’s life. You may want to think about taking a First Aid Course before the grandchildren visit you.

As we age, it may be necessary for grandparents to take any of several types of medication, e.g. blood pressure control pills, daily aspirin for heart problems, diabetes control medications, vitamin supplements, iron pills and/or many others. Over the years your home has also become less “child proof” and some of these medications may be found on bedside tables. When your grandchildren are visiting, make sure that all medications have been collected and have been put out of reach of their exploring hands. Many children are poisoned each year by ingesting medications that they have found while visiting Gramma and Grampa. Don’t let your grandchildren become one of those statistics.

There are often two sets, or more, of Grandparents (and sometimes even Great Grandparents) in the equation. If this is your situation, don’t compete with each other as to who is or who can be the “better” grandparents. Don’t bother with who gave the better or bigger gift or even who spent more hours with them. Negativity takes a lot of energy. Don’t make the parents have to choose sides. To follow this path will cost all of you in many ways. Take your energy and focus on the beauty of the gift of grandchildren that you share in common. You are all important to your grandchildren and to their parents. Each grandparent provides unique experiences for their grandchild. Take this time and opportunity to experience harmony, family, loving, and caring. Everyone will benefit.

There is an African proverb: It takes a village to raise a child. Each of us can make a positive difference in a child’s life. It would be tragic to not take these opportunities to do so. Grandparents and great-grandparents are an integral part of the support system that children need so they can grow and flourish.

Differences Between Multiple and Singleton Pregnancies

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How is a Twin Pregnancy Different from a Singleton Pregnancy?

What a great question.  There are distinct differences between the two, and taking a multiple-birth specific class, either in your community, on-line or by DVD will answer many of your questions.

As each pregnancy is different, even for the same woman, there may be differences woman-to-woman and/or situation-to-situation.  IF YOU ARE NOT SURE ABOUT ANY ASPECT OF YOUR PREGNACY, PLEASE CONSULT YOUR PHYSICIAN IMMEDIATELY.

Woman 22 weeks pregnant with twins
22 weeks pregnant with twins

Here are some expected differences.

  • A multiple birth pregnancy is nearly always considered “high risk,” meaning that doctors will be more vigilant to ensure Mom and babies are doing well.  “High risk” is a normal label for parents expecting multiples and not necessarily anything to worry about;
  • As a “high risk” pregnancy, Mom can expect a greater number of doctor’s visits, fetal monitoring and blood tests.  As the pregnancy progresses, doctor’s visits will increase from once a month to every other week during the second trimester and once a week until birth in the third trimester;
  • Moms will be checked for excessive nausea, appropriate weight gain, edema (swelling), gestational diabetes, twin-to-twin transfusion (including in sets of triplets and more) if the babies are monozygotic (identical), preeclampsia, and the babies will each be monitored to make sure they are growing and developing properly;
  • Morning sickness can be more severe and begin earlier with multiples and like a singleton pregnancy, it may last only the first few months or continue through the complete pregnancy.  Each woman is different;
  • Mothers expecting multiples will get bigger faster and be in maternity clothes much earlier than with a singleton;
  • Mothers expecting multiples report feeling tired more often and earlier.  If you think about it, Mom is creating and growing several fetuses at once, plus maintaining her own system with its many body changes to accommodate these babies.  It is tiring work;
  • Nutritional requirements are different for a multiple-birth pregnancy and your doctor or nutritionist will be able to explain how much weight gain is ideal for you in each trimester.  Your particular weight gain expectation will be influenced by how many fetuses you are carrying.
  • Most multiples are born preterm, i.e. before 38 weeks, and will be smaller at birth than a singleton.  The more infants Mom is carrying, the earlier they are likely to arrive;
  • It is not unusual for multiples to be delivered by c-section.  The more babies carried, the more likely there will be a c-section.  For twins, a vaginal delivery usually depends on the position of the lower baby.  If the baby’s head is down, there may be a chance for a vaginal delivery.  In a small percentage of cases, one baby may be delivered vaginally and the other may be breech and need a c-section for delivery;
  • Moms, especially in the latter stages of their pregnancy, may find their balance compromised due to the position of the babies, the number of placentas and fluid retained.  Take very good care when walking or using stairs; and
  • Mothers may need to spend some time on bed rest either at home or in the hospital.  Your doctor will let you know should you fall into this category.

To find out more about pregnancy differences, check out my Suggested Reading List at https://jumelle.ca/prenatal-education/suggested-reading-list-for-parents-expecting-twins-triplets-and-more-2/

 

 

Singleton Siblings of Multiples – Older & Younger

Posted by on in Postnatal Education, Prenatal Education, Raising Multiples, Singleton Siblings of MultiplesLeave a comment

It is normal for parents to worry about their singleton child(ren) when twins, triplets or more expected. Involved preparation for the singleton is imperative, but there are no guarantees that there will be a smooth transition. In spite of the parents’ best preparation efforts, the new arrivals can be a challenge for singleton siblings, especially if they have been the centre of attention for some time.

Initially the multiples’ arrival may not impact the siblings too much but give it a week or 10 days and the realization sets in that Mommy and Daddy are not as available and there may be changes in behaviour. One 3-year-old singleton declared, “OK, that’s enough. Take them [his twin siblings] back to the hospital now!” Another 3-year-old yelled at his parents, “I only want one!” Reactions aren’t limited to the younger set: A 15-year-old girl put herself in foster care when her twin sisters arrived, and a 17-year-old young man didn’t speak to his parents for weeks staying in his room as much as possible when his siblings arrived.

Not all singletons react negatively to the babies’ arrival and some, especially if they are a little older, may react with delight and fascination. They can also be willing to help out and run little errands.

Here are some examples of, but not limited to, possible behaviour changes which may be exhibited by singleton siblings:

  • refuses to give up the bottle/reverts back to the bottle;
  • wishes to breastfeed again;
  • seeks attention when you are least able to provide it and rejects you when you are available;
  • there could be problems with toilet training, i.e. a set back or refusal to use the potty;
  • speech regression or refusal to speak;
  • clingy and/or excessively whiny;
  • plays rough with the babies;
  • may pinch, hit or bite them when alone with them; or
  • unresponsive to direction, refuses to co-operate.

There are some ways to support your singleton child(ren) and assist him/her in coping with the new arrivals:

  • avoid calling the babies, ‘the twins’ or ‘the triplets’. This label automatically leaves out any singleton children and gives the impression that those with this label are more special. Correct others each and every time they use the label. As the parents others will take their cue from you;
  • presenting the multiples as a package ensures they are perceived as a package. Continually dressing them alike and/or giving them rhyming names reinforces the “package” mentality and the singleton child(ren) is left out;
  • arranging special play dates or preschool for an older child allows him/her to have him/her own special time, activities and things to talk about;
  • include him/her in the decoration of the babies’ room—“What colour paint should we use, lavender or blue?” Limit the choice to two you can live with;
  • allow her to help put the babies’ clothes in the dresser drawers;
  • don’t get caught in the trap of using your older child(ren) as “gophers.” They can quickly resent being sent on an excessive number of fetches. This doesn’t mean they can’t help—“Could you please get Daddy a diaper for your sister?”—but don’t get caught in the habit of using them on a continual basis;
  • provide lots of positive feedback. “You were SO helpful today!” “You are so special to me and have been such a good boy/girl today.” “Thank you for being so patient;”
  • if there is bottle or toilet training regression, just go with the flow. Don’t make issues of it. Handing him a bottle even though he already can drink from a cup plays down the issue rather than having it escalate out of control and become a full-blown temper tantrum. It won’t take long for him to realize that he is not a baby and a bottle can be hard work. Leave the potty out in plain view, but don’t over focus on it;
  • set aside some time each day for her. It can be bath time, bed time and story, grocery shopping, play time but the important thing is for her to be the full focus;
  • if you can’t be available when he requests attention, buy a little timer and give it to him. Set it for 15 minutes (or what works for you) and say, “When the bell rings, we will read (play) together” and then try hard keep your promise;
  • if you can’t keep your promise, and there will be times when you can’t, let your child(ren) know that you are sorry and realize you have broken your promise but will make it up to them as soon as you can. Two things are important here:
    • 1) you have taken responsibility for your behaviour, and
    • 2) you have taught your child it is OK to take responsibility for one’s behaviour and there can be a new plan. Such an acknowledgement helps a child learn that others have limits and they were not to blame. Children tend to internalize things when they don’t work out as planned and see themselves as being “bad” for things not working. Clearing the air is important. But do try to make it up to them as soon as you can;
  • you can give your child(ren) some feelings of control in life by giving them simple choices: “What would you like to wear today, the red outfit or the blue?” “What would you like for breakfast, cereal or toast?”

Multiples in public cause a stir and attract a lot of attention. It will be important to include your other child(ren) in the conversation when necessary. A simple, “This is their older sister and she is such a help.” goes a long way to including the other child(ren). After some strangers had made a fuss about her triplet siblings and not even spoken to her, one 4-year-old asked her Mom, “Didn’t they see me standing there?” It is important to advocate for all of your children.

Splitting up the kids for an outing can provide a welcome change to the group dynamics. Take an older child and one baby to do groceries. It gives everyone a change of pace, or just one baby to do groceries. You are setting up value time for one-on-one getting to know each other.

Give your singleton child(ren) time to make the adjustment to the arrivals. Be as patient as you can. Just as it will take parents time to get into a proper routine, it will take a child(ren) time to adjust to the changes in his/her own routine.

Younger Siblings of Multiples

Some parents go on to have singleton children after the birth of their multiples. These singleton children are born into the situation and may have less adjustment to make as a result but there are no guarantees. When two or three siblings are all having a birthday party at the same time and you are not, feelings can be hurt and the tears flow. Patience and understanding works wonders. Some parents will buy that child a gift too. I am of the feeling that the world will not make room for you just because your feelings are hurt. Cuddling and words of explanation may be a better approach than expecting a gift on your siblings’ birthday and is an important learning tool that the world does always cater to you and those disappointments can be survived. Explaining that her birthday will come and she will get to blow out the candles on her own cake, separates the events and gives each child a chance to have a special day of his/her own. Who better to explain life’s realities than a loving parent?

Even young children can talk about their frustrations and if you feel that your younger child is struggling with the attention focused on the multiples, put the words in place to open a conversation. “I am feeling that you are may be a little frustrated by the attention going to your brothers. Would you like to talk about that?” You may be surprised by what you learn, have opened the channels of discussion, learned what the issues are and have an opportunity to talk things through. Win/win.

Sometimes an issue of the multiples ganging together and “bossing” a younger sibling occurs. If such is your experience, appropriate guidelines will need to be put in place so that the younger one is not bullied. Explaining to everyone that “Mom and Dad set the rules, not the kids” and “two (or three) against one amounts to bullying” can be helpful. Be prepared to go over these rules on at least a semi-regular basis and perhaps to have consequences in place when necessary, e.g. no TV/internet tonight, put 25 cents into the jar for each occasion.

It is human nature to adjust and most of us get over having siblings. Being guided by the loving adults in our life can make the journey more tolerable.

*Lynda’s Note:  If you are thinking of having another child and your multiples were spontaneously conceived (i.e. no infertility assistance), know that your chances of spontaneously having multiples again is increased by an additional 50%.  So, it will not be unusual to have another set.  Great to know ahead of time!!!

Additional Resources

The Singleton Siblings of Multiples, Multiple Births Canada, booklet 1999, 2001, 2007  www.multiplebirthscanada.org

A Doctor’s Guide to a Healthy and Happy Multiple Pregnancy

Posted by on in Book Reviews, Pregnancy, Prenatal EducationLeave a comment

Expecting two or more? Dr. Franklin has a light-hearted, easy to understand writing style, generously laced with humour. Her book takes you through each stage of the pregnancy. She includes chapters on learning the news that you’re having multiples, “…and What To Do About It”, she addresses issues you might expect to face in each trimester of your pregnancy, focusing on nutrition, exercise, and preparing for the babies.

Expecting Twins, Triplets, and More: A Doctor’s Guide to a Healthy and Happy Multiple Pregnancy, Rachel Franklin, M.D., M.O.M.* (*Mother of Multiples), 2005, St. Martin’s Griffin, N.Y., 221 pages

Expecting Twins, Triplets, and More is like having a friend, who also happens to be a doctor, share her experience and expertise to help you best take care of yourself and your babies at this very special time. Dr. Rachel Franklin’s practical wisdom helps you understand the unique circumstances of multiple pregnancy and birth. Throughout and after your pregnancy,  Expecting Twins, Triplets, and More will act as an invaluable resource on what to expect, how to cope, and how to enjoy the journey.

Here are some of the topics Dr. Franklin covers in her book:

  • Telling family, friends, and coworkers the news
  • Choosing a doctor
  • Exercising and eating well
  • Coping strategies trimester by trimester
  • Preparing for labor and delivery
  • Understanding potential complications and their solutions
  • Navigating the NICU (Neonatal Intensive Care Unit)
  • Celebrating the births and bringing home the babies

Multifetal Pregnancy Reduction

Posted by on in Bereavement Support, Loss of a baby, infants or children, Pregnancy, Prenatal Education1 Comment

Note: The term used by the International Society of Twins Studies (ISTS) is “Multifetal Pregnancy Reduction” and is the one used here. For the Reader’s information, this procedure may also be referred to as “Selective Reduction”.

Couples who are expecting three or more babies may wish, or be advised, to consider reducing the number of viable fetuses to two. The reduction procedure is usually performed between the 10th and 12th weeks of pregnancy by injecting one or more of the fetuses. Fetal reduction increases the chance of a mother having one or two healthy babies instead of a miscarriage or very premature delivery of three or more babies who are much more likely to die or to suffer from long-term disability.

The balance of risk and advantage will be different for each couple but nevertheless for all there will be a sense of responsibility and much anxiety. For couples considering multifetal pregnancy reduction, there are additional issues that compound their anxieties.

Firstly, many couples have struggled with becoming pregnant, sometimes for years. Here they are pregnant, with some type of fertility assistance, but they are carrying triplets, quadruplets, quintuplets, sextuplets or more. To now have to consider reduction (killing?) of some (or even one) of the babies that they have strived so hard to conceive, goes against all of the time, energy, disappointment, heartbreak and money that was invested in getting pregnant in the first place.

Secondly, when it is determined that there are three or more fetuses, the timeframe for the multifetal reduction choice is often very narrow, sometimes as short as only 3 or 4 days. In that small window, the parents have to learn all they can about the procedure, perhaps connect with others who have had the procedure, learn about the risks to mother and the remaining fetuses and come to grips with losing (aborting? killing?) one or more of their unborn children. This is enormous pressure to endure, to come to terms with and to decide upon in a few, short days.

Thirdly, and as yet perhaps one of the most unstudied and unrecognized issue, are the possible long term psychological effects on the parents and by extension, the children as well of choosing a multifetal pregnancy reduction procedure. Some of the questions that have been bandied about my parents having had the procedure are: “Did we kill our son?” (this from parents who had two beautiful daughters from a triplet pregnancy); “Am I a murderer?” “How and when do we tell the others (surviving children)?” Some parents have reported fantasizing about the baby(ies) that was reduced and wondering about the sex of that child(ren), if they would have looked like their co-multiples and even if they should tell the siblings about the reduction. Some parents have named the reduced child(ren) in an attempt to come to terms with their decision and to find some peace regarding this socially unrecognized loss.

Regarding telling the other children about the procedure and what it could entail, once again the answer will be individual and personal. If you have shared with other family members that you are carrying many fetuses and are considering multifetal reduction, then have the procedure and wish to keep hush regarding your decision, it may already be too late. If parents choose not to tell their surviving children but have conferred with other family members regarding the procedure, then there is always a risk that someone will tell, even inadvertently, your surviving children. Secrets in a family are extremely hard to keep and usually fester and erupt at a most inopportune time and sometimes awkward moment. It stands to reason that parents considering the multifetal reduction procedure would want to confer with other family members who love and care for them, as they struggle with emotions, guilt, worry and anxiety over their babies. To share personal information and then to expect silence may be too much. A child who discovers, from someone other than his parents, an important piece of his history can become confused and angry regarding this important piece of his life which has been kept from him.

With families being more open these days and encouraged to speak of their dead baby, this could be helpful all around. It is usually better for children to know from the start that they were once a part of a set. The reaction of each child will be unique and personal and parents will need to provide age appropriate feedback and information to their children’s questions. The beauty of this approach is that, a child asks at his or her own rate and in a manner that meets his or her needs at that time. Expect questions at all stages of their lives.

When considering multifetal pregnancy reduction, there are many questions and the answers will need to be considered individually and as will affect each family’s personal situation. Here are a few common questions:

I am expecting quadruplets and am being asked to consider reducing to twins. I know it is possible to carry healthy triplets, what do we do?

You are correct, many families have carried triplets to a healthy outcome. There are many considerations and only you, your partner, informed healthcare professionals, perhaps other multiple births parents, genetic counselling can help you reach a decision.

Some things you might consider:

Ascertain the health risk vis-à-vis the mother and all of the babies. If one (or more) fetuses have anomalies, you may feel that reduction is the decision to make, thereby giving the healthy fetuses a better chance at a healthy gestation and life.

Learn the survival statistics

  • 70% of quadruplets survive. Of that figure, 50% of them have disabilities ranging through a series of impairments such as blindness, to cerebral palsy. The average gestation for quadruplets is 28 weeks.
  • 85% of triplets survive and 10% impairment rate can be expected, with an average gestation of 30-33 weeks.
  • 98% of twins survive with a 5% impairment rate and the average gestation is 35-38 weeks (NOTE: a singleton gestation rate is based on 40 weeks).*

*Statistics quoted from research paper by V.M, quadruplet Mom who reduced to triplets and gave birth at 34+ weeks to three beautiful, healthy babies. Their weights ranged from 3.12 lbs. to 4.9 lbs. and the family brought them home from the hospital within 15 days.

Did we do the right thing?

This is such a difficult question and there are no easy answers. Even though the timeframe for decision whether to have the procedure or not is so short, be sure and do your homework. Below are some Internet Sites to visit, talk to other families who have considered the procedure, learn as much as you can about the procedure and the possible ramifications. Knowledge is Power and permits you to make the best possible decision for your personal situation.

I must go back to V.M. thoughts and wisdom. As V puts it:

Someone once said to me “make the decision from your head, not your heart”. I agree with the intent of that comment. An informed decision is the best decision. However, you can never really feel good about such a decision, and you will never be 100% certain of your choice. You can survive this and one day you will be at peace with it. Recently I was able to answer a question that had tormented me from the beginning. “How do I ask forgiveness or understanding from that lost child – the one I never gave a change at life?” The answer – there is no need to ask for forgiveness for a child loves unconditionally. The love we have for that child was and is equally returned. It was through love that my husband and I conceived and it was with love that we reduced. It is the love not the loss that I chose to hold onto. Somewhere between your head and your heart, what you know and what you feel, you will find the answer. Allow yourself to listen to both.

We have lost a child(ren). We hurt so much and we cannot share nor openly talk about our pain.

Multifetal pregnancy reduction is one type of loss that is nearly impossible to ‘share’ with others let alone have them fully understand the anxiety and dilemma that has been faced. We conceived many babies and chose to reduce one (or two, or three). While our dream has been drastically altered, we may choose to keep our personal feelings to ourselves and if not, our loss(es) may not be acknowledged, recognized or even fully understood by others in a manner that we might feel fitting or helpful. A sense of isolation coupled with the grief of the new reality can combine to make the pain greater.

It may not be unusual, like a miscarriage, for others to have difficulty in relating to your loss. “Well it wasn’t a baby yet” or “you have others” may be expressed to you. Try and find a caring and understanding person to share your pain and grief with. It might be a special friend, grief counsellor, religious leader, family doctor or bereavement support gorup. Grief is personal and knows no timetable. Grief is a journey not a destination and may require some support at different stages of your life. It is important to recognize the pain, possible feelings of guilt and grief and to work with them, address and acknowledge them. Only then can we move on, forever changed and with a new reality. Don’t be afraid to cry or seek appropriate professional support, if need be.

Sources

Bereavement: Guidelines for Professionals, These guidelines focus on the particular issues raised by the loss of a twin, triplet or more by Elizabeth Bryan, MD, FRCP, FRCPCH and Faith Hallett, The Multiple Births Foundation
Selective Reduction: Research Tools for an Informed Decision, by V.M.
Twins! Pregnancy, Birth and The First Year of Life by Connie L. Agnew, M.D., Alan H. Kein, M.D., and Jill Alison Ganon, 1997, Harper Perennial

Miscarriage

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Miscarriage is the unplanned ending of a pregnancy before the 20th week of the pregnancy. 15 to 20% of all pregnancies end with a miscarriage. 75% of miscarriages occur within the first trimester (12 weeks) for several possible reasons: improper attachment to the uterine wall, imperfect fetus either genetically or more usually, by a chance mutation of cells at the time of conception. 25% of miscarriages occur during the 13th to 20th week. Usually the fetus is normal but there may be other problems: improper attachment of the placenta, uterine difficulties or an incompetent cervix.

There may be several reasons for a miscarriage as discussed above or a mild virus, more serious disease or infection may be the cause. Environmental facts and malnutrition of the mother are two more possible causes.

Many times there are no definite reasons for a miscarriage and we, who prefer answers, may have some difficulty in coming to terms with that fact.

If you lost one more or all of your babies through miscarriage, you may feel empty, angry or let down by your body. Even worse, you may find that family and friends don’t properly acknowledge the pregnancy or the depth of grief. In fact, society tends not to think of miscarriage as a real loss. People tend to think that because you didn’t know the baby, you shouldn’t feel too sad. The loss is downplayed and the parents are often advised to “try again.” If parents are to have any hope of healing, many of those whom have dealt professionally with pregnancy loss or studied it, agree that parents need to grieve their baby’s loss if they are to heal.

If it is possible to see your child, ask the hospital staff in this regard. They are best suited to advise you. Even if the baby can’t be viewed, it might be wrapped in a blanket and brought to you to hold. The physical sensation of holding your child gives you tangible memories of the baby’s real existence as a part of your family. Other mementos, such as copies of early ultrasound photographs of the multiple pregnancy with all fetuses intact, are cherished by many families.

If it is not possible to see the baby due to the miscarriage at too early a stage, it still may be possible to arrange formal burial or cremation with the cooperation of the hospital and a funeral home. If this is not an option for you, it is helpful for many families to hold a memorial ceremony, either officially with religious involvement or personally with only family and friends. You might decide to plant a tree(s) in a special location in memory of your child(ren).

It is important to find a safe place to grieve your loss. You may join a bereavement support group, see a therapist who specializes in pregnancy loss issues, find a caring friend or relative to share your feelings and emotions. Research has shown that parents who do not talk about a tragedy pregnancy take much longer to resolve their grief.

Women usually will grieve longer than men and want to speak of the miscarriage for weeks or months afterwards. Mothers may be receiving adequate care and attention afterwards, but bereaved fathers are sometimes overburdened and overlooked. Not only must they console the mother who just suffered a loss and who may be seriously ill herself, but they must also deal with their child(ren)’s death and memorial arrangements while also juggling household duties and possibly a job as well.

This article was written with grateful input and assistance from:
Dr. Elizabeth Pector, Illinois, U.S.A.

Sources

Bereavement in Multiple Birth, Part 1: General Considerations, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, November, 2001
Miscarriage, pamphlet prepared by Canadian Mental Health Association, Windsor, Ontario, Canada
At a loss, article by Kimberly Pfaff, printed in The Walking Magazine, September/October, 2001

Reading Resources

Twins, Triplets and More, Elizabeth M. Bryan, M.D., St. Martin’s Press
Guidelines for Professionals: Bereavement, Bryan, EM; Hallett F, Multiple Births Foundation, London England www.multiplebirths.org.uk
Living Without Your Twin, Betty Jean Case, Tibbutt Publishing
Bereavement in Multiple Birth, Part 2: Dual Dilemmas, Elizabeth Pector, MD; Michelle Smith-Levitin, MD, The Female Patient, Vol. 27, May, 2002
The Worst Loss: How Families Heal from the Death of a Child, by Barbara D. Rosof, Henry Holt
Empty Cradle, Broken Heart: Surviving the Death of Your Baby, Deborah L. Davis, Fulcrum Publishing
Men & Grief, Carol Staudacher, New Harbinger Publications
Trying Again: Guide to Pregnancy After Miscarriage, Stillbirth and Infant Loss, Ann Douglas and John R. Sussman, M.D., Taylor Trade Publishing
Empty Arms: Coping with miscarriage, stillbirth and infant death, Sherokee Ilse, Wintergreen Press

Other Organizations

Nutritional Guide for Multiple Birth Pregnancy

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Food Group
Milk and milk products
Breads and cereals
Fruits and vegetables
Meat, fish, poultry and alternatives		 Number of Daily Servings
4-6
8-12
6-10
2-3

Please refer to Canada’s Food Guide for information on portion sizes.

Use in moderation: Fats and oils (example: butter, margarine, salad oils)

This nutritional guide will provide you with about 2000-2600 calories. It meets the nutrient needs for the second and third trimesters of the average, healthy woman expecting twins or triplets. The foods listed here are to guide you only, as the needs of each individual will vary. If this is not enough food for you, more servings can be selected from the food groups. Small, frequent meals, with snacks, may help you eat the larger volume of food and aid with the control of heartburn.

Following are some sample Menus which incorporate foods from the Canada Food Guide for a Multiple Pregnancy.

Breakfast
1/2 grapefruit
Shreddies and Milk
Whole wheat toast with margarine		 Supper
Pasta
Tomato meat sauce
Grated cheese
Steamed zucchini or broccoli
Milk pudding
Lunch
Baked beans or chicken leg & bread, margarine
Spinach and Tomato Salad with salad dressing
Banana
Milk		 Snacks
Yogurt
Bran muffin
Cheese and crackers
Hard boiled egg
Fresh fruit

Adequate fluids are important and 6-8 glasses of fluids per day are recommended. Alcohol should be avoided and caffeine consumed in moderation (e.g. coffee, tea, chocolate, soft drinks)

You will need an iron and folic acid supplement for your multiple pregnancy and these are prescribed by your doctor. Your doctor, dietician or nutritionist can advise if there is a need for further vitamin supplementation and if so, which ones.

Salt (sodium) should not be restricted. Moderate amounts may be used at the table or in cooking.

WEIGHT GAIN FOR MULTIPLE PREGNANCIES

Studies have shown that women who gain 26-35 pounds (16-21 kg) with their twin pregnancies, have healthier babies. The weight gain pattern for twins and a singleton in the first trimester is the same. You can expect to gain 1-4 pounds (0.05-2kg). In the second and third trimesters, you can expect to gain about 1.5 lbs. Per week (0.75kg). By 24 weeks gestation, you will likely have gained 24 pounds and by 32-36 weeks, 32-40 pounds.

REMINDER: All weights noted are suggested amounts recommended for the average, healthy woman.

Triplets and Quadruplets: A suggested weight gain for a triplet or quadruplet pregnancy has not been documented. However, one could deduce that a triplet suggested weight gain should slightly exceed that of a twin pregnancy, while a quadruplet weight gain be slightly more than the triplet pregnancy.

NOTE: When weight gain is too low, it could negatively affect the outcome of a pregnancy. Low weight gain affects the hormonal response to the pregnancy and therefore limits intrauterine growth. It is recommended that if any point in your multiple pregnancy you should feel that you are unable to eat one of the good groups, or are not sure whether you are eating properly, whether you have sufficient vitamin supplements or are unable to gain the recommended weight, ask your doctor for a referral to a dietitian.

Adapted and Compiled From:
Canada Food Guide

Nutritional Guidelines for a Multiple Pregnancy, by Pauline Brazeau-Gravelle and Julia Watson-Blasioli, printed by the Ottawa General Hospital; May, 1997

Calgary Foothills Hospital, Clinical Nutrition Services.

Twin to Twin Transfusion Syndrome

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Two cords tangledTwin to twin transfusion syndrome (TTTS) is a random abnormality of a monochorionic placenta that causes one identical twin to receive less than normal amounts of blood supply during pregnancy while the other receives too much. The babies share blood vessels in their placenta that cause an imbalance of blood flow and nutrients between them.

There are degrees to the severity of the syndrome, but it is always life-threatening due to the fact that it can worsen at anytime during pregnancy. Below is a summary of the difference between dizygotic (fraternal) and monozygotic (identical) twin pregnancies. TTTS can only happen with monozygotic twins, or as a pair in a higher multiple pregnancy, that share a single monochorionic placenta.

NOTE: The following information is provided for your information only and does not necessarily reflect each person’s individual situation. If you have any concerns whatsoever about your pregnancy, please consult your physician immediately.

There are two types of twins:

TwinsDIZYGOTIC (DZ)
two eggs meet up with two sperm. These babies are technically siblings who happen to have been born at the same time. They are commonly known as “fraternal”. They always have one placenta each and are called dichorionic (DC).

MONOZYGOTIC (MZ)
one egg meets up with one sperm. These babies are always the same gender and are commonly known as “identical”. MZ pregnancies can experience high complication rates, particularly if the twinning process occurs more than 4 days from fertilization resulting in a single monochorionic placenta share by two or more babies.

There are two types of monochorionic pregnancies that can be affected by twin to twin transfusion syndrome:

MONOCHORIONIC-DIAMNIONIC

When the embryo randomly splits between 4-8 days after conception, the pregnancy results with two babies each in their own amniotic sac (diamnionic) as well as sharing a placenta (monochorionic). The majority of these pregnancies proceed without complications. However, approximately 15% of the time, the babies will share blood between them disproportionately and warning signs of the syndrome will appear on ultrasound (see warning signs below). The syndrome can occur with two or more babies in a higher multiple birth pregnancy as long as the babies share a single monochorionic placenta.

MONOCHORIONIC-MONOAMNIOTIC

When the embryo randomly splits between 8-12 days after conception, the pregnancy results with both babies sharing a single placenta (monochorionic) but the babies are in the same amniotic sac (monoamniotic). This type of pregnancy can still result in TTTS but it is more difficult to diagnose with the babies in the same sac. Also, there is a greater concern that the babies’ cords will become entangled. It is estimated that approximately 50% of the babies will pass away from cord entanglement. It is recommended that mothers be hospitalized at 24 weeks for 24 hour monitoring of the babies until they are born.

One of the warning signs of TTTS shown on ultrasound is a size difference in the babies. One baby, the donor, becomes restricted in growth receiving less then normal blood flow. The donor baby does not urinate very much and has little to no fluid in his or her amniotic sac. Sometimes the baby is referred to as a ‘stuck twin’ or having oligohydramnios. Subsequently, a much larger blood flow goes to the co-multiple, referred to as the recipient twin. Due to the shared, interconnecting veins and arteries in the single placenta, the blood disproportionately flows through the donor twin and collects in the recipient twin, who is unable to efficiently rid his or herself of the extra blood. The recipient baby urinates frequently causing too much amniotic fluid or polyhydramnios. Because of this abnormality in the placenta, both babies’ well-being can be severely compromised.

PLACENTAL SHARE

It is important to understand that one reason babies can become growth restricted is that the babies may share the placenta itself unequally. The donor baby could have less then half of the placenta to nourish it. This is one reason why The Twin to Twin Transfusion Syndrome Foundation advocates weekly ultrasounds from 16 weeks through delivery of the babies. If a baby has a small placental share, and you cannot know prior to birth for sure what the placental share is, the baby will get to a certain gestational week and it will stop growing. The baby will not get enough blood and oxygen from it s share of the placenta to ‘get bigger’ than the size that it is. The rate of growth for the babies is extremely important and is often overlooked. The sharing of the blood from the syndrome also adds to size differences of the babies. TTTS is often combined with an unequal placental sharing.

Some treatment options are available

AGGRESSIVE SERIAL AMNIOCENTECES removal of the excess fluid around the recipient which may need to occur several times;

LASER SURGERY which identifies the connecting blood vessels in the shared monochorionic placenta and cauterizes them with a laser beam. The babies are being separated in the placenta so each will then get their blood supply independently from the other. The scope used is inserted through amniotic cavity of the recipient baby. There are specific criteria that must be met based on ultrasound findings.

BEDREST AND NUTRITION which is explained below and combined with the therapies listed above.

What Can We, as Parents, Do?

  1. Make sure your obstetrician has plenty of high-risk pregnancy experience.
  2. Make sure that your obstetrician uses intensive ultrasound to determine the chorionicity (DC or MC) of the babies as early as possible in the pregnancy. If the babies are like-sexed, you need to know if they share a placenta or each have their own. If they share a placenta, weekly ultrasounds are crucial in the care of your babies and you may have to really fight to have them. Don’t take no for an answer. If the babies are unlike-gender, they must be fraternal twins and cannot have TTTS. Keep asking questions until you are satisfied and understand the answers.
  3. If your babies are monochorionic, take really good care of yourself. One way is to follow advice from Dr. Julian De Lia who pioneered laser surgery almost 20 years ago. He is now recommending adding protein drinks to your diet, such as 3 cans of Boost drinks a day. He feels that TTTS can make mothers malnourished adding to the fluid problem around the recipient babies. Drinking the protein can help get the protein in your blood back to normal. Many women have seen improvements from this. Nutrition is completely overlooked by most doctors. Bedrest is also strongly encouraged along with adding liquid protein. Bedrest is defined as laying horizontally on your left side and getting up to eat, shower, use the bathroom, and go to appointments. Laying on your left side takes pressure off of your cervix and helps increase blood and oxygen to the placenta to help your babies.
  4. Make sure that your cervix is checked weekly. This is also overlooked by many doctors. If your cervix length shortens to 2cm or less, a cerclage or stitching of the cervix can be done up through 25 weeks. This has saved many pregnancies. Laser surgery can still be done after a cerclage only through the 26th week.
  5. If early signs of TTTS appear, or there is a sudden increase in your size, ask for a perinatology appointment immediately. Your feto-maternal medicine specialist will know about the options for treatment. Ask what they think about possible laser treatment and whether this is a possibility for you. Once again, don’t take no for an answer. It is also encouraged by The TTTS Foundation to contact the laser doctors on your own so you get the correct and up-to-date information directly from the doctors who perform the procedure.
  6. Understand a monochorionic placenta and what TTTS is. Understand specifically what is happening to your babies with measurements of their size difference, your fundal height, the biggest pocket of fluid around each baby, where your placenta is located in the uterus, their doppler readings and your cervix. Create a medical plan of action with back-up plans so you can be as prepared as you can for each appointment.

Warning Signs of TTTS

  •  a large-for-dates uterus
  • water in baby(ies) body (heart failure called hydrops)
  • a single placenta
  • same sex babies
  • growth discordance, babies are growing at different rates
  • too much amniotic fluid in one sac and too little in the other
  • being 16-26 weeks pregnant with fundal height of 30 cm or more
  • a doppler reading for the babies which is absent diastolic or reverse flow
  • a cervix which is thinning and shortening to 2cm or less
  • sudden weight gain and/or swelling in the mother’s body

The TTTS Foundation says that without treatment, the death rate for twins who develop TTTS at mid-pregnancy (16 to 26 weeks gestation) may be as high as 80-100, mostly as a result of premature delivery. The later the condition develops in the pregnancy, the better chance the babies have since they could be delivered if signs of distress are present. Your health care professional is the best source of information regarding your personal situation and can discuss fully with you how your situation can be managed. However, remember that the ultimate decisions for your children are yours.

Please also note that TTTS can occur with monozygotic (identical) sets of babies in triplets, quads or quints and not just twins.  If you are pregnant with multiples, you need to know if you are carrying any monozygotic babies and if they have TTTS.

Definitions

Diamniotic twins: twins who have developed in separate amniotic sacs. They may be either dizygotic or monozygotic.
Dichorionic twins: twins who have developed in separate chorionic sacs. They may be either dizygotic or monozygotic.
Dizygotic twins: twins formed from two separate zygotes.
Fraternal twins: see dizygotic twins
Higher order multiples: triplets, quadruplets, quintuplets or more
Hydropic (hydrops): a condition due to the abnormal accumulation of serous fluid in the tissues or in a body cavity
Identical twins: see monozygotic twins
Monoamniotic twins: twins who have developed in a single amniotic sac. These twins are always monozygotic.
Monochorionic twins: twins who have developed in a single chorionic sac. These twins are always monozygotic.
Monozygotic (monozygous) twins: twins formed from a single zygote.
Oligohydramnios: the presence of too little amniotic fluid around a baby.
Polyhydramnios: the presence of too much amniotic fluid around a baby.
Serous fluid: a thin and watery fluid
Zygote: a fertilized ovum.

Twin to twin transfusion syndrome (TTTS): results from abnormalities of the placenta in monozygous twin pregnancies. TTTS results from blood passing disproportionately (transfusing) from one twin baby to the other through connecting blood vessels within the shared (monochorionic) placenta. (TTTS Foundation)

Written by Lynda P. Haddon, Multiple Birth Educator, www.jumelle.ca

Consultation Sources for this article

  • Elizabeth Bryan, M.D., FRCP, FRCPCH, Founder, Multiple Births Foundation, London, England
  • Mariana Herskovitz, M.D., General Practice, Ottawa, Canada
  • Dr. Geoff Machin, Department of Pathology, Kaiser Medical Center, Oakland, California, USA
  • Mary Slaman-Forsythe, BS. MNO, Founder and President, The Twin to Twin Transfusion Syndrome Foundation, Bay Village, Ohio, USA
  • Julia Watson-Blasioli, R.N., B.Sc.N., Ottawa Hospital, General Campus

Sources

  • Multiple Blessings, by Betty Rothbart, 1994
  • Double Duty by Christina Baglivi Tinglof, 1998
  • Twins! Pregnancy, birth and the first year of life, by Connie L. Agnew, Alan H. Kein and Jill Alison Ganon, 1997
  • Twin to Twin Transfusion Syndrome Foundation, literature
  • Dr. Julian E. Delia, Founder and Director of the International Institute for the Treatment of Twin to Twin Transfusion Syndrome, St. Joseph’s Woman’s Hospital, Milwaukee, WI WS: tttsmd.com

Other Resources

Clothing & Equipment Suggestions for Twins and Triplets

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SUGGESTED COMPREHENSIVE LIST OF CLOTHING AND EQUIPMENT FOR A TWIN AND TRIPLET MULTIPLE BIRTH

NOTE: The writers of this Website do not accept any responsibility for the purchase of any of these items nor do they recommend one product over another. In order to ensure the safety of your children, please check out all safety regulations before you make your purchases, especially for secondhand or borrowed items.

aAll of the items contained on this list are suggested only. (Higher number represents triplets.)

You may not need or want each and every item.

  • Car Seats – babies MUST be in properly installed car seats even when being brought home from the hospital. IT’S THE LAW!
  • Appropriate stroller[s] , could be a combination of twin and/or triplet strollers (see Multiple Births Canada’s Strollers Fact Sheet for greater details on stroller brands, types and details.)

JUMELLE: The Best Baby Tracker App Keep easy track of which baby did what, when and for how long. Hints, tips and ideas for coping with 2 or more babies.

  • Single stroller(s) in case you wish to take only one child out at a time
  • Rocking chair
  • One crib can do for at least the first few weeks or possibly months. Purchase other(s) as needed. The babies initially won’t bother each other, and this purchase method spreads out costs and saves on laundry. Be sure that all mattresses are of a good quality.
  • 1 or 2 Playpens- especially important if you have an older child(ren) or large pet. While travelling or visiting, playpens can double as cribs.
  • 1 or 2 Baby Swings. They can take up a lot of room when set up and are difficult to store. Not all children like swings, so try to borrow extra if you need to.
  • Change table – not always essential. A low dresser and padded top will also work fine!
  • Sunshades for vehicle windows
  • 2 or 3 day cradles
  • 3 to 6 dozen cloth diapers (also useful as shoulder burp cloths)
  • 12-18 pairs of plastic pants (or current outer-style plastic pants)
  • 4-6 packages of newborn size disposable diapers
  • Diaper inserts or liners
  • 1 or 2 diaper pails. Diaper pail rinse (1/2 cup white vinegar per half pail full of water as a presoak works as urine neutralizer in diaper pail)
  • Handiwipes – soft wash clothes work just as well and are cheaper in the long run. Some babies have a skin reaction to what is in handiwipes
  • 8-12 receiving blankets
  • 6-9 baby blankets
  • 8-12 bibs
  • 8-10 fitted crib sheets
  • 10-12 quilted pads, plastic on one side
  • 3 per baby, Nighties – you may wish to use nighties until the umbilical cord stubs fall off.
  • 4-6 baby towels, complete with hoods if you wish – you can use regular towels
  • 8-12 small, soft face cloths
  • A few comfortable outfits each for visiting
  • Sweaters, bonnets, bunting bags, socks, booties, hats – amounts dependent upon the season
  • Snowsuit per child. If your babies are born in the Spring, wait until Fall to purchase suits so you will purchase correct sizes.
  • Rectal/digital thermometer
  • Large diaper bag, convenient sized bag or backpack (allowing your hands to be free), for outings – check out the Luggage Department as some carry-on baggage may suit your needs
  • Mild baby soap, Vaseline, Q-tips, rubbing alcohol (for naval), Penaten/Zincofax cream, baby shampoo, mild laundry soap, baby nail scissors, baby oil/lotion (Purchase small sizes initially in order to ascertain whether or not your babies will have any allergies)
  • A batheze leaves your hands free to wash the baby (bath rings are not recommended as the suction cups can easily come detached while in use).
  • A plastic bathtub, should you wish to use one. The large tub area frightens some children and a plastic tub can fit directly into the bathtub to make the area smaller. Can be recycled as the children grow – put on the lawn with water in Summer for play, to hold toys, bathe dolls.
  • Appropriate crib toys and age-appropriate colourful toys.
  • Nightlight(s), baby room monitor
  • Padded head rest per baby (fit into car seats to stop babies’ head from rolling around)
  • 1 or 2 Baby Snuglis, one for each parent and the third baby in a stroller
  • Large horse-shoe shaped pillow for feeding two babies
  • 6 large bottles per baby. These can be used for pumped breast milk or if formula feeding
  • small bottles for pumped breast milk, water or juice
  • 4-cup measuring cup (for measuring water for formula)
  • Bottle and nipple brush
  • Formula is available by the case at drug stores and supermarkets. Shop around for the best prices. Try to make a deal with the store manager to buy larger quantities and receive lower prices. Prices change week to week, even at the same store. These are called ‘Lost Leaders.’
  • 1 baby book per child to record day-to-day milestones, camera/video camera, computer back up stick so photos are not lost

NOTE: Bumper pads and Baby Quilt Comforters are not recommended due to concerns regarding Sudden Infant Death Syndrome (SIDS) related to crib deaths. This is be a big concern when dealing with premature infants. Their inability to throw off the baby quilt should it cover their face or push away from the bumper pads puts them at great risk of smothering.

Clothing & Equipment List for Quadruplets and Quintuplets

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A SUGGESTED COMPREHENSIVE LIST OF CLOTHING AND EQUIPMENT FOR QUADRUPLETS AND QUINTUPLETS – MULTIPLE BIRTHS

NOTE: The writers of this fact sheet do not accept any responsibility for the purchase of any of these items nor do they recommend one product over another. In order to ensure the safety of your children, please check out all product safety regulations before you make your purchases and especially when using second hand or borrowed items.

The clothing and equipment items contained on this list are suggested only. (Higher number represents quintuplets.)

You may not need or want every item.

  • Car Seats – It’s the Law! Babies MUST be securely placed in properly installed car seats even when being brought home from the hospital.
  • Appropriate stroller[s] , could be a combination of twin and/or triplet strollers (see Multiple Births Canada’s Strollers Fact Sheet for greater details on stroller brands, types and details.)

JUMELLE: The Best Baby Tracker App Keep easy track of which baby did what, when and for how long. Hints, tips and ideas for coping with 2 or more babies.

  • Single stroller(s) in case you wish to take only one child out at a time
  • Rocking chair
  • Two cribs can do for at least the first few weeks. To spread out expenses purchase additional cribs as the need arises. Babies enjoy being co-bedded and saves on one set of sheets at laundry time. Be sure that all mattresses are of a good quality.
  • 2 or 3 Playpens- especially important if you have an older child(ren) or large pet. While travelling or visiting, playpens can double as cribs.
  • 2 or 3 Baby Swings. Not all children like swings, so try to borrow extra if you need to.
  • Change table – not always essential. A low dresser and padded top will also work fine!
  • Sunshades for vehicle windows
  • 4 or 5 day cradles
  • 7 to 9 dozen cloth diapers (also useful as shoulder burp cloths)
  • 24-36 pairs of outer-style plastic pants
  • 8-10 packages of newborn size disposable diapers
  • Diaper inserts or liners
  • 4 or 5 diaper pails. Diaper pail rinse (1/2 cup white vinegar per half pail full of water as a presoak works as urine neutralizer in diaper pail)
  • Handiwipes – soft wash clothes work just as well and are cheaper in the long run. Some infants have skin reactions to what is in handiwipes.
  • 16-20 receiving blankets
  • 12-15 baby blankets
  • 16-20 bibs
  • 12-14 fitted crib sheets
  • 10-12 quilted pads, plastic on one side
  • 3 per baby, Nighties – you may wish to use nighties until the umbilical cord stubs fall off.
  • 8-10 baby towels
  • 14-16 small, soft face cloths
  • A few comfortable outfits each for visiting
  • Sweaters, bonnets, bunting bags, socks, booties, hats – amounts dependent upon the season
  • Snowsuit per child. If your babies are born in the Spring, wait until Fall to purchase suits so you will purchase correct sizes.
  • Rectal/digital thermometer
  • Large diaper bag, convenient sized bag or backpack (allowing your hands to be free), for outings – check out the Luggage Department as some carry-on baggage may suit your needs
  • Mild baby soap, Vaseline, Q-tips, rubbing alcohol (for naval), Penaten/Zincofax cream, baby shampoo, mild laundry soap, baby nail scissors, baby oil/lotion (Purchase small sizes initially in order to ascertain whether or not your babies will have any allergies)
  • A batheze leaves your hands free to wash the baby (bath rings are not recommended as the suction cups can easily come detached while in use).
  • A plastic bathtub, should you wish to use one. The large tub area frightens some children and a plastic tub can fit directly into the bathtub to make the area smaller. Can be recycled as the children grow – put on the lawn with water in Summer for play, to hold toys, bathe dolls.
  • Age-appropriate colourful toys.
  • Nightlight(s), baby room monitor
  • Padded head rest per baby (fits into car seats to stop baby’s head from rolling around. Especially useful with premature babies. The head rest should not infere with the car seat straps.
  • At least two Baby Snuglis, one for each parent. If you have caretakers, you may wish to purchase/borrow more.
  • 6 large bottles per baby for use with pumped breast milk or if formula feeding
  • small bottles for pumped breast milk, water or juice
  • 4-cup measuring cup (for measuring water for formula)
  • Bottle and nipple brush
  • Formula is available by the case at drug stores and supermarkets. Shop around for the best prices. Try to make a deal with the store manager to buy larger quantities and receive lower prices. Prices change week to week, even at the same store. These are called ‘Lost Leaders.’
  • 1 baby book per child to record day-to-day milestones, camera/video camera, back up stick so photos will not be lost

NOTE: Bumper pads and Baby Quilt Comforters are not recommended due to concerns regarding Sudden Infant Death Syndrome (SIDS) related to crib deaths. This is be a big concern when dealing with premature infants. Their inability to throw off the baby quilt should it cover their face or push away from the bumper pads puts them at great risk of smothering.