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Tips on choosing a stroller for multiples

One of a multiple birth families most important pieces of equipment is a stroller to fit, two, three or more babies, and sometimes toddlers as well. It is also one of the most expensive items you will need. Investing in a good stroller is essential for several reasons:

    • multiple births families tend to use their strollers longer, i.e. not unheard of for the kids to be at least 4-years old. It can be because the babies were premature and therefore smaller at birth or because a parent has better control over where the toddlers might wander. If they can be securely fastened into a stroller this stimplifies the outing.
    • it is impossible to carry two or more tired toddlers, so having the stroller available ensures that all tired kids can be transported with a minimum of fuss;
    • a twin or triplet stroller gets A LOT of use and therefore needs to be of a good quality to withstand a lot of handling in and out of vehicles, and the bouncing of two or more active toddlers.
    • it is tempting to buy the cheaper stroller but keep in mind that your stroller will have to earn its keep transporting two, three or more infants and then toddlers.
    • Buying cheaper may find you 18 or so months later buying another one as the first one gave up the ghost.

Multiple birthd - stroller 2     Multiple births -stroller 1

When considering a stroller, here are some important tips to consider prior to purchasing:

    1. Before making a decision, set it up and down in the store. The salesperson can assist in clarifying the oddiities of collapsing and setting up the stroler. Make sure that you can do it quickly and easily.
    2. Talk a walk in the store using your regular stride. Taller parents have been known to knock their skins on one which does not work well with their stride. Is the handle is too short? Hunching over while pushing a stroller will soon become a pain in the shoulders and back!
    3. Ask what is included in the stroller’s price. Not all strollers come with a rain cover, basket or sun roofs. Sometimes these cost extra.
    4. Double wheels can trap ice or rocks or swivel in opposite directions, making pushing it challenging. Larger, single wheels are an asset in Canadian Winters as they move more easily through snow and slush. It is helpful to know if wheels can be easily replaced if necessary. Ask how they clip on and off and how/where to purchase replacement wheels.
    5. Ask which parts, including frame, may have a replacement guarantee.
    6. A full handle length gives the pusher an advantage in controlling the stroller. The umbrella-style handles are sometimes set too far apart and making pushing them when the kiddies are on board a challenge, especially for shorter parents.
    7. Will it fit into the car? More than one family has pushed their new purchase to their car, a nd….it won’t fit in!
    8. There are pros and cons to each seating style of stroller:
    9. Side by side: Pros: allows you easy access to each baby/toddler when needed. The babies can easily interact with each other and most will fit through store doorways.
    10. Cons: The babies can easily interact with each other and as a certain stage, biting can be an issue or clunking of the other with a toy.
    11. Tandem (front and back seated): Pros: fits nicely through doorways and store isles.
    12. Cons: As the babies grow, it can be difficult to lift up over curbs and it may necessitate a trip around the front of the stroller to lift over a curb. It is impossible to quickly reach the baby fartherst from you in time of need. It is helpful to have the farthest seat positioned facing you in order to be aware of what that child is doing. When facing away from you, the child in front may constantly try to stand up to turn around in order to see what s/he might be missing.
    13. Some strollers are called “twin strollers” but in reality they are for a toddler and a newborn. The area for a newborn does not have adequate space for the legs of a toddler and the toddler area may not fully recline to accommodate newborns.
    14. There are wonderful joggers available for twins, triplets and more. If you like to jog, this may be the best stroller for your needs.
    15. Graduated seat heights make it easier to see each baby in the stroller.

Stroller 1     Stroller 2

Now that you have made your decision, here are a few more handy hints from parents:

    1. If your babies are weight discrepant, rotate them with each stroller use so that the stroller wears evenly.
    2. Your stroller is an expensive item. By taking care of it properly, you can ensure that it’s resale value is high. Protect it against the elements and wipe it down if caught in the rain. If you bought your stroller new, it is well looked after (no rust or rips) and it is clean when offered for sale, you might expect to recoup one-half to three-quarters of your original purchase price, depnding on the make of stroller. Advertising through your local Twin and Triplet support chapter (here is a captive audience) will ensure a good resale price.
    3. As noted, expect to use your stroller for up to 4 years, especially if your babies were premature. When the children are older and get tired while on an outing, you will need a place to safely carry them, and the stroller is the perfect place. When they both (all) want to walk, it is a great place to put the diaper bag and/or purchases.
    4. A stroller is expensive but it does make a great collective gift for a Babies Shower or for relatives to get together to make the purchase. They are also available secondhand through local Twin and Triplet support chapters. Sometimes eBay has them for sale as well.
    5. If you need a quick repair for your stroller, check out the local bicycle repair shop. They are usually able to help out.

Places to look for twin, triplet and quadruplet strollers. These are some of the best Canadian Sites I could find. Please note that some sites come and go quite quickly. Happy shopping!

www.babyproofingplus.com
www.mountainbaby.com

….and don’t forget to check eBay and Kijiji. There are some amazing bargains!

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Considerations when purchasing or borrowing car seats

As parents of multiples, it stands to reason that we will need several car seats. Many of us have other children as well, so car seats can be a huge issue.

The following has been put together to give you some hints to consider before you either purchase or borrow any used car seats in attempt to cut expenses. If you are in any doubt about the used car seat you are purchasing or borrowing, don’t do it. After all, your most precious cargo will be using these seats and they are depending upon you to help keep them safe.

NOTE: This information is provided as a set of guidelines. If you have any doubt about any used car seat, check with Transport Canada (contact information below) or the car seat’s manufacturer.

  • Car seatCar seats have carried a manufacturer’s date for some years now. The date is usually stamped on the manufacturer’s label on the back of each car seat. Make sure each car seat is not more than 10 years old. Our Canadian extreme temperatures, over time, break down the plastic in seats and, depending upon how old they are, they may not be as safe as when they were manufactured.
  • If a used car seat is 8, 9 or 10 years old, you may wish to pass onit as multiple birth children tend to use their equipment somewhat longer than a singleton child. In these cases, the ‘best by’ date is nearly past and you may not wish to have to repurchase newer seats at a later date, thereby doubling your expenses.
  • Each seat should have its manufacturer’s instructions showing how to install the seat into a car and how to correctly place a child into that seat. No instructions, then pass it by! If you are purchasing a new car seat, keep the instructions to go along with the car seat when/if you pass it along yourself.
  • Assess the interior of each seat. Are any of the straps worn, buckles missing? If yes, pass on the seat. Is the interior pad torn? If yes, consider the cleanliness of the car seat. Hygiene within a car seat, as well as safety, can be an issue.
  • Check the tether strap for forward-facing car seats, i.e. the strap that anchors the seat to the car frame. It needs to be in good condition.
  • Make sure you know if the used car seat has been in a car crash whether or not there was a child in the seat at the time of the crash.Even in the case of a minor accident, there could be stress fractures to the seat. If you can’t determine an accurate history for the seat, don’t risk using it.
  • If you have a car seat that has been involved in a car crash, even without a child in it, it is now deemed unsafe. Make sure that it is safely destroyed. Don’t risk putting it out at the curbside in case someone else picks it up to use. By the same token, NEVER pick up a car seat from someone else’s curbside.
  • Do notpurchase a new or used car seat manufactured in the United States. American seats do not meet Canadian safety standards.
  • Make sure to read Multiple Birth Canada’s Fact Sheet “Car Seat Tips” for other important information regarding car seats and your children. Learn how to assess when each child is ready to graduate to the next size car seat. Remember that each child may not be ready to graduate to the next size car seat at the same time.

FOR FURTHER INFORMATION ON CAR SEATS, contact Transport Canada at 1-800-333-0371 or visit their Website at www.tc.gc.ca/roadsafety/childsafe/notiavis/en/index.htm

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Bedrest

Question: I am pregnant with multiples and have been ordered to bedrest by my doctor. How will this help my babies? How will I pass the time? How can I relieve the boredom?

It isn’t unusual for a woman expecting multiples to be placed on bedrest. There are many reasons why this might be necessary. They include: water retention spotting, high blood pressure, signs of premature labour, one or more of the babies not growing at a satisfactory rate (e.g. weight discrepancies between the babies, babies not developing at the same rate or gestational diabetes, a pregnancy-related diabetes). Bedrest produces many benefits for both mother and babies. It relieves the pressure on the cervix and assures that calories and nutrients that would normally go to the mother’s activities are diverted to the babies.

There are several different levels of bedrest:

  • At home in bed or lying down, being allowed up for very short periods of time;
  • Hospitalized and allowed up for bathroom privileges only;
  • Hospitalized and not allowed to leave the bed;
  • Hospitalized and the bed tilted with your feet upwards (tredelenburg position); and
  • Hospitalized weekdays and allowed out on the weekends with specific instructions.

It is not always easy to be hospitalized. You may have other children at home and this can be traumatic and upsetting for everyone. Stress related to additional child care situations can be harmful. Use your support systems: family, friends, neighbours. People love to help but aren’t always aware of what you might need.

If you are permitted to leave the hospital, this can help alleviate some of the pressure of not being available for your child(ren) while maintaining a safe environment for your unborn babies. When explaining to your child(ren) why Mom is not at home, use clear, comforting, age appropriate language. Whenever possible, take the child(ren) to the hospital for a visit, allowing them to see for themselves where Mom is and what her day involves. If your child(ren) doesn’t want to go to the hospital, try to accommodate their wishes. Keep the child(ren)’s routine the same, whenever possible.

There are many things that you can do to help pass the time while on bedrest:

  • Read and learn all about multiples and your unique and special situation;
  • If you have access to a laptop, check out many of the helpful web sites regarding multiple births: Multiple Births Canada;
  • Keep a calendar by your bedside to cross off the days;
  • Pick one night a week to do something special with your partner: order in supper, watch a movie;
  • Knit, crochet, needlepoint, write letters, phone friends;
  • Keep a daily journal. It is very rewarding and fulfilling to look back on this period of time and share it with your children.
  • Ask if there are any other mothers expecting multiples also on bedrest. Sharing with someone in the same situation can provide comfort, companionship and a chance to share experiences.

For mothers expecting higher order multiples (triplets, quadruplets or quintuplets), it is almost inevitable that an extensive period of your pregnancy will be spent on bedrest. Be aware of special exercises which will help decrease joint and muscle stiffness in bed. One mother of twins hired a massage therapist a couple of times during her 9 weeks on bedrest. Ask to speak to a physiotherapist while in the hospital. Doing exercises will assist you after the babies birth and assist your recovery. You may also need ongoing physiotherapy after the babies are born if any of your muscles have atrophied. Walking may be uncomfortable initially because of pelvic bones shifting back into place and sore, achy muscles. As well, softened skin on the balls of the feel may need to harden again.

This time spent on bedrest can make a positive difference in the health of your babies, assisting them in gaining weight and completing their development. Each day your babies remain in utero, is one less day they will need to spend in a Special Care Nursery. There can be no safer environment for your multiples than that which your body can provide.

Most of us are highly motivated, busy, active people accomplishing a great deal. It can be quite difficult for a person who is used to activity to be forced to remain quiet and in bed. Many women still feel healthy but are forced into an “illness” role. It is not uncommon to experience negatives feelings in this situation. It is important that a support network be used to discuss these feelings. You are not alone. Many multiple support groups offer a bedrest support line, staffed by women who have been in your situation. Contact your nearest multiple birth support Chapter for further information.

Additional Resources:

  • Eating Well While on Bedrest, by Julia Watson-Blasioli and Pauline Brazeau-Gravell, Ottawa Hospital, General Campus
  • Twins! Pregnancy, Birth and the First Year of Life, by Connie L. Agnew, Alan H. Klein and Jill Allison Granon
  • Multiple Blessings by Betty Rothbart, Hearst Books
  • The Joy of Twins and Other Multiple Births, by Pamela Patrick Novotny, Crown Paperbacks, Inc.
  • Finding our Way, life with triplets, quadruplets and quintuplets – A collection of experiences
    Triplets, Quads, Quints Association, Web Site: http://www.tqq.com

“Bedrest” written and developed by Lynda P. Haddon and Sandra Tompkins

 

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What to Bring to the Hospital: ideas for Mom, Dad/Partner, Babies

A common question, especially for first time parents, is “What do I need to pack for the hospital?” Here are some suggestions for all of you:

For Mom

  • Toothbrush and toothpaste
  • Hairbrush/comb and shampoo
  • Any other toiletries you might like, e.g. make-up, face creams
  • Two loose fitting nighties, preferably the breastfeeding kind. You will probably be wearing a hospital gown during for your delivery.
  • Slippers
  • Housecoat
  • You may sleep more comfortably with your own pillow(s)
  • If you want underwear and can’t find anything that fits, try men’s boxers – they are amazing, come in very large sizes and will go above your large belly before birth and above the incision in the evenr you have of c-section
  • Some people like to bring their own music but make sure you also bring earphones so as not to disturb anyone else
  • You could bring a journal for writing in
  • You might bring reading material, knitting or crocheting. These can help pass the time for someone on bedrest or after the babies are born
  • I found it very helpful to have some tiny mints such as Tic Tacs for use during labour. You aren’t allowed to eat or drink (other than some ice chips) and your mouth gets so dry from all of the mouth breathing during labour. Tic Tacs are perfect for this period of time
  • Clothing to come home in

For Dad/Partner

  • If labour is long, you might want some reading material for when your spouse is sleeping or resting
  • Toothbrush, toothpaste and shaving equipment
  • How about a thermos of coffee so you don’t need to leave the birthing room?
  • Maybe a change of shirt, if you are to be there for a while
  • Some hospitals let dad/partner stay over night. Pyjames are a really good idea
  • Phone list of family members and friends you want to call after the babies are born

For the Babies

  • Initially they will probably only need a diaper, which the hospital provides
  • For low birth weight or premature babies, you may wish to purchase little nightshirts that are monitor friendly (the hospital can guide you as to when the babies can wear them)
  • When the babies leave the hospital, you will need a weather-appropriate outfit per child
  • Light blankets (or heavier if it is Winter) per baby to bring them home
  • Rear-facing car seat per child

Resources

  • Multiple Births Canada for information on car seats, and all things multiple births
  • Ever So Tiny – for premature and monitor friendly clothing and Twin Nursing Pillows
  • 2 by 2 Multiples – The fun site to go shopping for your multiples.
  • BabyLinq – An online resource for the popular Maya Wrap Sling baby carrier and other baby items and parenting tips. Geared particularly to the preemie and micro-preemie, their beautiful and soft clothing fits the smallest among us and is versatile enough to be used easily with medical monitors and tubes.
  • Chia’s Breastfeeding Friendly Clothing – Lindy Mertick’s line of breasfeeding clothing is manufactured by her home based business. This website has useful tips, breastfeeding info, mothering support and an extensive on-line catalogue.
  • Extraordinary Baby Shoppe – Great diaper information, diaper bags, items for Mom-to-be (maternity underwear), Mom, breastfeeding, slings, baby food.
  • Graco – Wonderful variety of baby products: strollers, car seats, backpacks.
  • Milkface Nursingwear – Your online breastfeeding resource! Young, modern and fashionable clothing for breastfeeding mothers as well as accessories to enhance your nursing relationship, from nursing bras to baby slings. Special services available to customers in the Ottawa, Ontario, Canada area.
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Multiples and Co-bedding

Co-bedding is the term used to describe putting your babies down to sleep together in the same crib. Most parents co-bed their babies for at least part of the time once the babies arrive home. Our girls slept in the same crib for 4 months until they began to disturb each other. Co-bedding for multiple birth babies just seems to make sense and there are some practical reasons to do so.

Some parents of low birth weight (LBW) or preterm multiples wish to co-bed their babies right after birth in the Neonatal Intensive Care Unit (NICU) but not all hospitals have a co-bedding policy. It’s a tough call and hospitals have some valid reasons for not co-bedding, not the least of which is that the beds may not be big enough to comfortably accommodate two babies. Thankfully though, some Canadian hospitals are rethinking co-bedding issues and as a result, there could soon be some good news for parents of multiples.

Babies co-beddingA quick poll of parents with twins regarding their experiences resulted in the following comments regarding the co-bedding of their babies in NICU:

  • takes less room by your hospital bed, which is important if you are sharing a room;
  • there seems to be less confusion in the nursery as the staff only has to worry about one bassinet;
  • helps the babies conserve body heat, regulate their temperatures;
  • helps the babies settle better as they seem to comfort each other;
  • one mother felt it helped them get over the trauma of their births as they took comfort in being together once again;
  • continuity of their being together from the womb;
  • sometimes babies have been placed in their own bassinet in different nurseries within a hospital setting, making it difficult for the parents to split their time between the two babies and leaving them feeling guilty about whom they were not with. Or the parents would split up to spend time with each baby, thereby not permitting parents to take joy together in their babies;
  • parents generally felt better themselves that their babies continue to be together, as they were in the womb;
  • one family reported that one of their sons was too sick. It just wouldn’t have worked for them; and
  • it is very cute in pictures!

Healthcare professionals have some valid concerns regarding co-bedding

  • if one (or both) babies are sick and are co-bedded, there could be a mix up with their medications. In separate bassinets, the potential for medication error is minimized;
  • if only one baby is ill, there could be cross-contamination to the other baby;
  • if one baby has a birth anomaly, e.g. spina bifida or Downs, it would be better for the babies to be in separate bassinets;
  • there could be unnecessary exposure of a baby to oxygen;
  • there could be sleep disturbances which may impact on a baby’s ability to become healthier;
  • bassinets are not large enough to hold two babies;
  • one baby may interfere with the tubing of the other baby; and
  • there could be temperature instability between the babies.

There may be a specific time when NICU hospital staff would decide, or it might be hospital policy, not co-bed multiple birth infants. Such a decision occurs when one, or both babies, is ill (usually due to their prematurity) and to be in close proximity might have an adverse affect on one or both of their health, e.g. disturb their sleep, thus impeding healing. In such cases, a co-bedding decision is based on the best possible outcome for each baby.

Once the babies are home, most parents of multiples, have co-bedded their twins (and sometimes triplets or quads) for various ranges of time. What usually brings co-bedding to an end is when one baby or toddler continually disturbs the other, as in one likes his sleep and the other likes to play and may be looking for a playmate. At the end of the day in this scenario, there are at least two cranky babies and two cranky parents, which makes for a very cranky household. The solution = separate beds, maybe even separate bedrooms, and pronto!

Co-bedding at home offers some other distinct advantages for both babies and parents

  • the babies usually enjoy being together and will often settle down quicker and more easily. As the babies grow, parents may continue to have their multiples share a room, each in their own beds, because they enjoy being with each other. Don’t be surprised to find them sleeping in one bed together when you go to get them up in the morning;
  • co-bedding cuts down on the amount of laundry with washing only one set of sheets and blankets at a time instead of two or three;
  • you can go to one spot in the room and attend to a baby while the other still has full visual contact with you;
  • initially some parents keep one crib upstairs and one downstairs (for the daytime naps). Not having to go up and down the stairs several times a day helps preserve energy levels; and
  • even parents with triplets have co-bedded their babies, initially lying each baby across the crib. A bonus is easy access to each baby as needed.

If you want your premature or LBW twins co-bedded while they are in the hospital, check out your hospital’s policy before you deliver. Ask your attending physician to make the corresponding note in your chart indicating that you want the babies co-bedded if at all possisble. The more often we ask for what we want or need, the more often the hospitals will listen and change will be implemented.

P.S. They do, indeed, take great pictures when they are snuggled up together in the same crib.

Got a co-bedding story you would like to share? Send me your story.

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Helping Family Pets to Adjust

A real concern for parents is introducing their “first child”, i.e. the family cat or dog to a new baby. There is an adjustment period for the family pet when a new baby arrives, the walks may occur with less frequentcy and the new parents can’t shower the open love and attention on it as they once did. With the arrival of twins, triplets or more, the family pet(s) can really suffer as it is takes a back seat to the needs of all of the new babies.

“How can I help my dog (or cat) adjust to the babies and not feel jealous?” is a very common question in our Twins Plus Prenatal Classes. These important and loving members of our family need our time and attention as well.

Helping your cat or dog adjust to the new arrivals can be made easier with a few simple steps. Here are a few ideas to help you and your pet make the transition:

  1. Some parents have pulled back a little on the affection they display to their pet in the last 4 weeks or so of their pregnancy. This helps him with the adjustment to the “lack of spontaneous availability” that will occur when the babies arrive home.
  2. Some parents have played tapes of babies crying, gurgling, laughing and “talking,” so that their pet gets used to the sound and various changes in pitches of the tiny voices.
  3. After the babies are born, take ONE receiving blanket (the soft, colourful, flannel blankets) PER child to the hospital and wrap each baby in one. At the end of the evening/visit, take the blankets home and place them on the floor for your pet to smell, roll/sleep on and become acquainted with the new babies’ odour.
  4. In spite of the fact you are busy with the new babies, try to walk the dog at a set time each day so that he becomes used to it and can rely on this time for your attention.
  5. Make sure your dog has a quiet place away from active babies or to sleep uninterrupted.
  6. While you are feeding a baby or changing a diaper, talk to your pet as well. This helps the animal feel a part of the group and lets him know that the babies are also a part of that group.
  7. Many parents worry about cats climbing into the crib, carriage or bassinet and smothering a baby. It is very rare that such would happen but if your cat does like to sleep with you, you may need to be proactive. Set up another separate sleeping area for it, at all times and make sure the door to the babies’ room is closed or you are nearby to watch the cat. If you are worried about the cat, try and find a permanent home for it or until the babies are a little older and a cat climbing into a crib may not then be such an issue.
  8. If you are decorating a nursery, do it early so that the dog can get used to the new room. Take this opportunity to teach the cat not to climb into or sleep in a crib.
  9. Allow your dog the opportunity to smell the new baby items, equipment and toys. It helps him incorporate these new smells into his expanding world.
  10. Not all animals and babies are compatible. One couple had two Rottweilers which they felt would be aggressive towards their babies. They wanted to get rid of one and keep one. With much feedback and advice from professionals, they agreed to find new homes for both dogs. Don’t take any chances. If you know in your heart that it won’t work out, find a new home for your pet. Your babies’ lives may depend upon it.
  11. With patience, time and love, most animals adapt very well to the new arrivals. It doesn’t take them long to realize that the babies are extension of the family itself and they soon become enamoured of the babies and sometimes very protective as well.
  12. It is also necessary to watch out for and protect our pets from the children. Toddlers don’t realize how rough they can be; pulling hair, ears or tail or stepping on a tail or foot. What is good about having animals around at an early age is that we can teach our children to be gentle and kind towards pets.

Resources

www.preparingfido.com
This Site offers a taped cassette of baby sounds which you can play for your pet to get him accustomed to various baby sounds.

www.petplanet.co.uk/petplanet/behaviour/behaviour_predatoryinvolvinginfants.htm– additional ideas regarding your pets

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Keeping the Couple in A Relationship After Multiples

Your relationship after multiples: A new baby brings emotional and financial challenges, new routines, loss of sleep, and so much more to a relationship.  Even more complex issues are added to to a relationship after multiples. Once a diaper has been changed and a baby fed, burped and soothed, we aren’t finished – it needs to be done again, and possibly again and again.  It is estimated that every time we add a baby to the mix, we are adding a baby and a half’s worth of work.

Parents try hard to meet the needs of the new babies, the house, make meals, do laundry, grab a shower, a quick bathroom visit at an opportune moment and fit in some much-needed sleep.  As parents juggle work outside the home and the physical, mental, emotional and financial demands of 2, 3 or 4 new little ones, their relationship, can be pushed aside and virtually ignored.  Without meaning to, the martial relationship is often one of the last items parents tend to as it falls victim to the “parenting relationship.” Sleep deprivation is HUGE with multiples and escalates the “cranky” factor.  After the kiddies are seen to, it takes effort to remember to look after a spousal relationship too.

Remember to take care of your relationship, even as you are working on your parenting techniques. When parents LOOK AFTER themselves and each other, the children have the benefit of two happier, healthier adults who are important role models.  Always taking a back seat or leaving the spousal relationship to fend for itself negatively affects the whole family.  An important lesson is taught when we show the kids by example how to look after their parents’ relationship.

Things that can help.  Advice from parents of multiples:

  • Before your babies arrive, look around for some multiple-birth-specific classes in your community and sign up for them as soon as you know you are having multiples.  Both parents need to attend.
  • Connect with other parents of multiples.  Learning from those whom have specifically walked the walk is extremely helpful.
  • Line up help before the babies arrive in a form that will work for you.  Some choices are:  a nanny during the day, during the night, live-in or live-out.  One family had each grandmother stay for 3 weeks each after their babies’ arrival.  The 6 weeks of extra hands and experience made it easier to establish routines and get some much-needed sleep.
  • It is important for each parent to be actively involved in the children’s’ care.  Don’t wait to be asked to get involved.
  • Recognize that each of you may have a different way of doing a task. Appreciate the different skills that you each bring to the role of parenting and baby care and allow each other to complete the task in your own style. Many parents have expressed their pleasure at watching their partner redefine him/herself as a parent.
  • If there is an issue between you, communicate.  Don’t assume the other can read your mind about what tasks need completing or anticipate exactly what needs to be done.  Speak clearly to each other, e.g. “Could you please help change babies?”
  • Plan time for each other on a regular basis. Plan a regular Date Night when grandparents or a local teen can come to sit for a couple of hours.  It doesn’t have to be huge, a trip to the coffee shop or walk around the block by yourselves could work, but the important thing is that it is just the two of you. It could be that you stay home to watch a movie, cuddle, talk, share a glass of wine and a pizza or foot/back rubs.
  • Even when out together, expect to talk about the kids.  It’s okay because you are a team, discussing what works, what doesn’t seem to be working, or concerns you might have about eating, sleeping habits and such.  The good news is that the discussion occurs on your own terms and cements your desire to be the best parents you can be.
  • It can be a challenge to communicate about parenting styles with three toddlers running in different directions.  Be prepared to have to deal with the present and talk about parenting styles at another opportunity.
  • If you can afford it, get help to complete some tasks around the home, e.g. cutting the grass, shoveling the snow, cleaning the house, perhaps grocery shopping.  Some of the tasks can be done by older neighbourhood children, or place a notice at your local high school or library to find an available teenager whom would like to make a little extra money. Having someone else, even in the short term, assist with these tasks, allows you to focus on the babies and each other.
  • If it is felt that your relationship is really suffering, consider professional counseling.  It might be covered through one partner’s expended health benefits, and if not, this medical expense can often be deducted at Income Tax time as a health care benefit.  Don’t wait to seek appropriate help until it is too late.
  • It’s amazing how quickly out of control things can get when one parent doesn’t know the ground rules set out by the other parent and the kiddies learn pretty quickly to play one parent against the other creating havoc and perhaps an argument between the parents. If necessary, check with each other and present a unified front to the children.
  • As one couple shared:  Yes multiples can stress a marriage especially if the relationship is not solid in the first place.  A relationship takes a lot of work, commitment, unconditional love and each parent giving 110%.  Teamwork is essential.

Getting through those initial days and weeks can be a challenge, especially as the sleep deprivation builds up and fuses shorten.  Keeping a supportive eye on each other is essential to ensure that the love, trust, respect and companionship that brought you together in the first place is not misplaced.  Things will improve as the kids become more independent and sleep through the night.  Promise!

For even more information, check out the results of Multiple Births Canada’s Survey Multiples and Impact on Couple Relationships on their Web Site at www.multiplebirthscanada.org.

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Health Canada Warning Regarding Use of Crib Bumper Pads and Baby Quilts

Health Canada recommends in their “Crib Safety” fact sheet that crib bumper pads never be used. This position is supported by the Canadian Paediatric Society, the American Academy of Pediatrics and The Canadian Foundation for the Study of Infant Deaths. The rationale behind this statement is that crib bumper pads, and other products such as quilts, duvets, sheepskins, pillows, stuffed toys, and position maintaining devices, affect the flow of fresh oxygen around the infant and can also pose a smothering hazard if the child’s face is in close contact with them.

Article reprinted with permission from The City of Ottawa.

The American Academy of Pediatrics, in their position paper, hypothesis that certain infants may have a maldevelopment or delay in maturation in a part of their brainstem involved in ventilatory response, chemosensitivity and blood pressure responses. When these infants become compromised (physiologically) during sleep (perhaps from overheating or lack of oxygen as a result of being in contact with or too close to one of the above listed products, or a combination), they are not able to arouse themselves enough to prevent hypoxia and death. The re-breathing of air may in fact be a contributing factor.

Multiple births- bumperCrib bumper pads were first introduced many years ago as a method of protecting infants from head entrapment in unsafe cribs where the slats were too far apart. Since 1986, cribs are manufactured with slat widths that are impossible to get an infant’s head trapped in. Therefore, the bumper pads are no longer necessary.

As well, many years ago when bumper pads were first used, infants were dying as a result of SIDS, but the research as to why this was happening was not as advanced as it is today, and researchers had not yet discovered the link between bumper pads and re-breathing or decreased air flow. Luckily, we have that information today from a vast body of scientific research, and it is very important that we convey this information to parents who question the recommendations.

Parents will also often comment that if they do not use bumper pads, their infant’s hands, feet or legs will get stuck in the slats. This in fact can also happen with the use of bumper pads, as baby’s can get their feet, legs etc. lodged in between the slats either above or below the level of the bumper pad. Although it is possible for the infant to get their hands, leg, etc. caught in between the slats, this event will not result in any serious injury. In fact, the infant will either dislodge the body part themselves, or will make a noise so that the parents can respond and help to remove the part. On the other hand, the risk with bumper pad use is much more serious and can in fact result in the death of the child.

It is also important for parents to be reassured that the risk of sustaining a bruise or injury to the head if the infant rolls into the side of the crib s next to non-existent. The force that would be required to cause such damage is not possible for an infant to produce.

Lynda’s Note:  I used to have website addresses here for further information but due to the fact that it is very difficult to keep up with changing web site locations and addresses, I have removed them since they change so often.  Please Google “bumper pad use, risks” or anything else you can think of to find current resources.

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Useful Multiple Births Definitions

Now that you are pregnant with multiples, you will be hearing many different terms, diagnoses, or ‘name calling’ by the healthcare professionals, local support chapter, perhaps in your multiple-birth prenatal class or in the resources you have been reading and researching.

We have included a list of multiple births definitions and the most commonly used names and phrases you might hear. Whenever you have not clearly understand any of the feedback you have received, don’t be shy. Speak up and ask for clarification on anything and everything you don’t understand.

Multiple Births Definitions

Amnion:
Inner lining of sac containing the developing fetus.

Amniocentesis:
Removal of a portion of amniotic fluid, either to test for chromosomal abnormalities that could indicate Down Syndrome or other disorders, or to relieve polyhydromnios.

Cesarean Section (C-section):
Surgical method of childbirth in which a woman’s abdomen and uterus are incised and the baby is delivered transabdominally.

Chorion:
Outer lining of sac containing the developing fetus.

Conjoined Twins:
Monozygotic twins where separation into two individuals is incomplete so their bodies are joined together at some point.

Cryptophasia: 
The secret language of twins.

Diamniotic Twins:
Twins who have developed in separate amniotic sacs. These twins may be either dizygotic or monozygotic.

Dichorionic Twins:
Twins who have developed in separate chorionic sacs. These twins may be either dizygotic or monozygotic.

Dizygotic (Or dizygous) Twins:
Twins formed from two separate zygotes. Commonly known as “fraternal twins.”

Embryo:
The developing baby during the first eight weeks of pregnancy.

Embryo Reduction:
See Fetal Reduction.

Epidural:
Anesthetic injected in a space at the base of the spinal cord.

Fetal Reduction:
The reduction of the number of viable fetuses/embryos in a multiple pregnancy (usually within a higher order multiple pregnancy) by medical intervention.

Fetus Papyraceous:
A fetus which dies in the second trimester of pregnancy and becomes compressed and parchment-like.

Fraternal Twins:
See Dizygotic Twins.

GIFT:
Gamete Intrafallopian Transfer – assisted conception method.

Higher Order Multiples:
Triplets, quadruplets, quintuplets or more.

Identical Twins:
See monozygotic twins.

IVF:
In vitro fertilization and embryo transfer – assisted conception method.

Intrauterine Growth Retardation:
Impeded or delayed fetal development and maturation due to genetic factors, maternal disease or fetal malnutrition caused by placental insufficiency.

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 (or monozygous) twins:
Twins formed from a single zygote. Commonly known as “identical twins.”

Multifetal Pregnancy Reduction:
See Fetal Reduction.

Multiple Pregnancy:
A pregnancy with more than one fetus.

Neonatal Death:
A death within the first four weeks after delivery.

Neonatal Intensive-care Unit (NICU):
Hospital unit containing special equipment for the management and care of premature and seriously ill newborns.

Oxytocin:
Hormone prescribed to stimulate contractions in order to induce or augment labor and to contract the uterus to control postpartum bleeding. Pitocin is a trademarked name for oxytocin. Oxytocin also causes contractions within the breasts which squeeze the milk down the ducts to the nipples so the baby can feed.

Placenta:
Vascular organ through which fetus receives oxygen, nutrients and antibodies to infection and excretes carbon dioxide and waste products.

Premature/Prematurity:
Delivery before 37 completed weeks of pregnancy.

Prolactin:
Milk-producing hormone released by the pituitary gland in response to a baby’s sucking.

Polyhydramnios: 
Abnormal condition of pregnancy characterized by excess of amniotic fluid.

Preclampsia:
Abnormal condition of pregnancy characterized by the onset of acute hypertension after the twenty-fourth week of gestation.

Preterm:
See Premature.

Selective Fetocide:
The medical destruction of one or more fetuses in a continuing pregnancy.

Selective Reduction: 
See Fetal Reduction.

Singleton: 
Child born from a nonmultiple pregnancy.

Stillbirth:
A baby born at 20 weeks gestation or later, who shows no sign of life.

Superfecundation:
Conception of multiples as a result of two acts of sexual intercourse in the same menstrual cycle.

Superfetation:
Conception of multiples as a result of two acts of sexual intercourse in different menstrual cycles.

Toxemia:
Hypertensive disorder of pregnancy including presence of bacterial toxins in the bloodstream; also called preclampsia.

Trizygotic:
Fetuses formed from three separate zygotes.

Twin-to-Twin Transfusion Syndrome (TTTS):
A condition in which blood from one monozygotic twin fetus transfuses into the other fetus via blood vessels in the placenta. Can also occur among monozygotic multiples in a higher order multiple pregnancy.

VBAC: 
Vaginal birth after cesarean.

Vanishing Twin Syndrome:
Unexplained loss of one multiple fetus during the first trimester, despite the survival of other(s).

Zygosity:
Describing the genetic makeup of children from a multiple birth.

Zygote:
Fertilized egg.

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Possible Risks for Mom of a Multiple Birth Pregnancy

Question: I am pregnant with multiples. What are the possible risks to me carrying multiple babies?

A usual part of every young person’s fantasy is envisioning their future, future job, car, house, partner and possibly children. While the majority don’t necessarily envision having twins, triplets or more, multiple births are a definite possibility. Several factors weigh in when considering whom will have multiples: the age of the mother when she conceives (women over 35 years old are more like to spontaneously conceive multiples); if Mom already has had several children; if multiples run in your family; or if fertility assistance was used to help you get pregnant. If none of these situations describe you, consider the fact that multiples start with someone, so why not you?

A multiple birth pregnancy is automatically called “high risk”. While this term generally has a negative connotation, it is also a security blanket, so to speak, for parents expecting multiples. Mom is followed more closely, can expect more ultrasounds, blood tests, fetal monitoring, has different nutritional needs than if she was carrying one baby, can expect a greater number of visits with her doctor and may be referred to obstetrician to deliver the babies, all in the wish to ensure a happy, healthy outcome to this multiple birth pregnancy.

While any pregnant woman might experience some concerns during her pregnancy such as gestational pregnancy diabetes, anemia (water retention and subsequent swelling), vaginal bleeding, preeclampsia (rise in blood pressure, sudden weight gain, water retention) and kidney infection, there remain other possible concerns in a multiple pregnancy and the following looks at some of these possibilities. The goal is to look at each topic and to familiarize yourself with some of the warning signs. An immediate call to your doctor enables early detection of any concerns and ensures timely and appropriate treatment. They are not listed in any particular order.

NOTE: This information is not intended to replace expert medical advice. If you have any concerns about any aspect of your pregnancy, PLEASE CONSULT YOUR DOCTOR IMMEDIATELY.

While some women may experience slight bleeding within the first few days after the fertilized eggs have implanted, it can be heavier with multiples. This bleeding is completely normal and is often mistaken for a light period before the pregnancy is confirmed. More serious bleeding later in the pregnancy may signal a miscarriage. With multiples, the risk of miscarriage before the 20th week of pregnancy is slightly higher than with a singleton. There is also a slight chance that one or more of the fetuses could miscarry (see Vanishing Twin) and the pregnancy continue with the healthy delivery of the remaining baby or babies.

As compared to a singleton pregnancy, many women report increased nausea and vomiting in the initial stages of the pregnancy, as well as feeling extreme fatigue. Much of this is due to the vast amount of hormones that are raging through Mom’s body as the babies are establishing themselves. Many women state that they generally begin feeling better after the fourth month. As in a singleton pregnancy, for some women nausea can last for the duration of the pregnancy. In the third trimester, fatigue is a common complaint as is the inability “to get comfortable” and “to get a good night’s sleep”. The increased baby load and the awkwardness of the size and shape of Mom’s abdomen, makes it a fatiguing load to carry.

Incompetent Cervix

A possible reason for bleeding early in the pregnancy is a condition in which the cervix spontaneously and painlessly opens early in the pregnancy. This is believed to be the cause of many second-trimester miscarriages. When detected early enough, an incompetent cervix can be sutured closed. For a mother pregnant with multiples, early detection is essential due to the increased pressure on the pelvic floor as her babies grow. Of course the higher the number of babies she is carrying, the earlier and greater the pressure on her cervix. It is not unusual for Mom to be put on bed rest and/or be required to spend some time in a tilted bed (tredelenburg position), with the lower body elevated above the head, relieving pressure on the pelvic floor.

Placental Problems

This is the most common reason for complications and bleeding after the 20th week of pregnancy. A condition called abruptio placenta occurs when the placenta partially detaches from the uterus before delivery. This may result in some bleeding and some abdominal pain.

With placenta previa, the placenta can implant low in the uterus, partially or completely covering the cervix. Placenta previa presents as painless bleeding and because the placenta is covering the cervix, a c-section may be necessary. This situation is more common in multiple pregnancies owing to the increased number and/or size of placentas present.

Iron-deficiency Anemia

The majority of women pregnant with multiples eventually develop iron-deficiency anemia, a condition characterized by low levels or iron in the red blood cells which carry oxygen to the tissues. The risk increases with each additional baby that is carried, particularly if you had low or borderline iron reserves before becoming pregnant. Symptoms include fatigue, light-headedness, pallor and shortness of breath. If untreated, anemia can adversely affect the babies’ growth, as well as increase your own risk for complications both during the pregnancy and after the birth. Because of the risk of iron and/or folic acid deficiency, the doctor may prescribe supplements in order to ensure that deficiency will not be a problem for Mom and her babies.

Gestational Diabetes

Common in women who are over the age of 30 years, overweight or have a family history of diabetes. Expectant mothers of multiples develop this kind of gestational diabetes two or three times more often than Moms carrying singletons. Gestational diabetes will clear up after birth.

Intrauterine Growth Restriction

Multiples usually grow slower than single babies while in utero and, additionally, do not always grow at the same rate as each other. This can be a result of unequal sharing of the available maternal nutrition. Depending upon nature’s distribution of the maternal nutrition available, the babies may therefore grow at different rates. Such a discrepancy can be revealed through ultrasound and may be evident quite early in the pregnancy.

Preeclampsia

Characterized by a rapid rise in blood pressure, the presence of protein in the urine, sudden and extreme weight gain and swelling of the hands and face from fluid retention. While this condition occurs in about one out of ten singleton pregnancies, it occurs in nearly one in three multiple gestations. It typically occurs in the second half of pregnancy. Bed rest is usually the recommended treatment. Severe cases may require hospitalization and medication will be given to lower your blood pressure.

Preterm Labour

A major concern in a multiple pregnancy. This is probably the most common concern that anyone pregnant with multiples might face. Approximately 50% of twins, 90% of triplets and virtually all quadruplets are either preterm or of a low birth weight. Among infants born prematurely, nearly one in ten do not survive. Although the majority of premature babies do very well, they are at a somewhat higher risk of a variety of medical problems, some of which are lifelong. These can include hearing loss, vision problems, developmental disabilities and delays. The more premature the babies are, the more severe the complication could be: e.g. cerebral palsy. Discuss with your doctor the signs and symptoms of premature labour. Both you and your partner need to be fully aware of the signs and symptoms of premature labour as well as the appropriate course of action to take should you feel that you are experiencing preterm labour.

Extended Bed Rest

It is common, but is not always the case, for Moms expecting multiples to have to spend some time on bed rest. This can be at home, with bathroom privileges and maybe going to the table for meals, or it can be on hospital bed rest with no privileges but to stay in bed. Bed rest at home may be helpful for those families with other young children at home, but those with young children, the doctor may insist on hospital bed rest so that Mom will actually rest. Bed rest can be prescribed when there is a danger that she may go into preterm labour or if she is showing some signs of physical stress. Bed rest and subsequent monitoring of Mom and the babies, may allow the situation to calm down and when (if) things are settled after a week or so, Mom may be permitted more activity.

For Moms expecting triplets, quadruplets or quintuplets there is an increased chance that some of the time will be spent on bed rest. When bed rest is prescribed, this takes pressure off of the cervix, helps to reduce strain on your heart, improves blood flow to the kidneys, which helps to eliminate excess fluids, increases circulation to the uterus thus providing additional oxygen and nutrients to your unborn babies. Further, it minimizes blood levels of catecholamines, the stress hormones that can trigger contractions and conserves your energy so that more of what you eat goes directly to promoting the babies’ growth.

The Disadvantages of Bed Rest

Bed rest may present an increased risk of blood clots. In some cases of extended bed rest, doctors may prescribe injections of heparin, a blood thinner, to lower the risk of blood clots. Prolonged inactivity may highlight or exacerbate heartburn, constipation, leg swelling or backache. Your doctor can provide some suggestions to alleviate some of your concerns. Inactivity may decrease your appetite and as you can appreciate, this will impact on your babies’ development. An extended period of bed rest could pose some financial difficulties with the loss of an income which you can ill afford. Bed rest can be boring and even very difficult for women who are used to being active and on the go.

An extended period of bed rest may affect your muscles. One mother had a massage therapist come to the hospital a couple of times in order to help keep her muscles in shape. It can be difficult to move about properly after the babies’ birth if your muscles are even somewhat atrophied.

It is important to keep in mind why bed rest has been recommended and that the longer your babies stay in utero, the healthier they will be at delivery and the sooner they can go home with you. Bed rest is a time to read, keep a journal, speak on the phone with family and friends, knit or crochet. See the time on bed rest as a “Count Up” to a healthy birth and healthy babies. Some parents may view bed rest as a time to worry, but keep in mind that the babies are growing and this time on bed rest is important to assist them in getting the best possible start to life. Bed rest requires giving up control and allowing others to do for you. Some women have difficulty with being dependent upon others. (See Web Site Page on Bedrest for more ideas.)

Depending upon how long the pregnancy continues and the number of babies Mom is carrying, there is a spectrum of outcomes that she might, to some degree, experience:

  • Foot size may change after the pregnancy. As the babies grow, the continued pressure on Mom’s feet may cause a change in foot size as the foot settles to accommodate the additional weight size. A foot size change will not reverse itself after the birth.
  • Change in body shape. Mom’s body will probably change, i.e. thighs and upper legs will thicken to better support her expanding abdomen. This may or may not right itself with exercise after pregnancy. There will be an expansion of the rib cage. As the babies slowly develop under the rib cage, it expands and after birth, does not always return to its original shape.
  • Due to increased hormone changes, it is not unusual for moles that were normally flush with the skin to appear to “grow” during the pregnancy. This apparent “growth” will disappear after the pregnancy.
  • Hair may be luxurious and healthy during the pregnancy and then, for sometime after the birth, fall out in handfuls and/or become limp and not hold any curl. This will rectify itself over time (3-4 months) after birth. This potential hair loss is attributed to hormonal changes and can occur with any pregnancy, not just with multiples.

As the pregnancy progresses and the babies grow, keeping your balance can be a cause for concern. Mom’s enlarged and extended abdomen changes her centre of gravity and it is important to be very careful about maintaining your balance, especially when going down the stairs or when it is slippery outside. Late in my own pregnancy, on a wonderful Summer day, I turned quickly and my tummy kept going, while I did not. I landed flat on my face but did manage to get my arms around by stomach before I fell. The fact that I was laying on my arms didn’t permit me to push myself upright. Luckily it was the weekend and my husband was home. He heard my yell as I went over and rushed to help. Another Mom reported falling down the stairs at 16 weeks pregnancy as her twins were both lying to one side of her abdomen and therefore her balance centre was off. Always hold the railing when descending the stairs.

Some Moms have reported that due to positioning within the womb, a baby may lie on arteries or nerves to her lower extremities. This can be quite uncomfortable and limit Mom’s mobility until the baby moves and then the discomfort usually corrects itself.

Knowing ahead of time what might occur permits us to take quick, timely appropriate action in order to rectify the situation. While many of the above possibilities may not happen to you, it is wise to be informed and able to make the best possible decision based on your individual situation. Knowledge is power.

Bibliography

  • Twins, Triplets and More: Their Nature, Development and Care, by Elizabeth Bryan, London, Multiple Birth Foundation, 1995
  • When You’re Expecting Twins, Triplets or Quads by Dr. Barbara Luke and Tamara Eberlein, Harper Perennial, 1999
  • Double Duty, by Christina Baglivi Tinglof, Contemporary Books, 1998
  • The Art of Parenting Twins by Patricia Maxwell Malmstrom and Janet Poland, Ballantyne Books, 1999
  • Multiple Blessings, by Betty Rothbart, Hearst Books, 1994

Additional Resources

If you have further questions about risks during pregnancy, please visit askanob.com.

  • Expectant Mom Tips, Multiple Births Canada Fact Sheet
  • You’re Having Multiples, Multiple Births Canada Fact Sheet
  • Twin Care: Prenatal to Six Months, Multiple Births Canada
  • Finding our Way, by Triplets, Quads, Quints Association, 2001
  • This article was written with grateful input and assistance from:
    – Dr. Elizabeth Bryan, Multiple Births Foundation, London, England
    – Dr. Karen Fung Kee Fung, Ottawa, Ontario, Canada