How to cope with twin babies
How to cope with twin babies
Giving birth to twins and more can be riskier than with one baby, so it's worth being prepared for things not going according to your birth plan. Maybe you wanted a natural birth, but now you're booked in for an elective caesarean.
Try to bear in mind that any last minute changes are made with the health of you and your babies in mind.
Once they're born, one or more of your babies may be in the Neonatal Intensive Care Unit (NICU). While this is relatively common with twins and multiples, it can trigger upsetting feelings within you – guilt, fear, anger – and can be tiring. So get as much rest as you can between visits, and if you have a baby in the ordinary ward too, ask your partner or parents to be with her.
Once you're all home, organisation is the key to keeping your sanity. Get into a routine around the babies' sleep patterns, and take up every single offer of help with chores (or employ someone if you can afford it), so you can get to know your babies. Having twins or more is exciting and fascinating, so leave yourself enough time and energy to enjoy it.
You'll be glad to hear that, if you're giving birth naturally, labour with twins or more isn't twice or three times as long…or twice or three times as painful. If you suspect labour has started, contact the hospital straight away and ask to be checked. Things can move pretty rapidly with twins and more, so you want to be in the right place when they do.
The first stage is the same as with singles. But the second stage is different, because you repeat it until all the babies have been delivered. As long as there are no problems, you should be able to have your first baby put onto your chest before the others are born.
Another difference is when you're likely to go into labour. Early labour is six times more common in twins, and 11 times more common in triplets. Bear in mind that full term with twins is 37 weeks, with triplets 34 weeks, and with quads, 32 weeks. And many babies arrive before that:
- 30% of twins come before 37 weeks
- 30% of triplets before 32 weeks
- nearly half of quads are delivered before 32 weeks.
You're also more likely to have a premature birth if it's your first pregnancy, or if the babies are in the same chorionic sac. But the good news is that your doctor or midwife will know all about this and will be monitoring you carefully.
Natural or caesarean?
The decision about whether you have a natural birth or a caesarean won't be entirely down to your preference. Worldwide a large number of twins are born naturally, but the more babies you're having the more likely it is you'll have a caesarean. This happens for lots of reasons:
- The babies are lying in positions which may make it difficult for them to turn head down once the first baby is born.
- With more than one baby, there's a greater chance of placenta praevia (where the placenta grows to cover the exit route of the cervix).
- There's a higher risk of cord prolapse (when the umbilical cord drops down in the womb and gets trapped and flattened by the baby's head, so restricting the supply of oxygen and nutrients).
- The babies may be too small and vulnerable to stand the pressures involved in a normal vaginal delivery.
Your midwife and consultant will be aware of all of these factors and in the weeks before the babies are due it's best to discuss this all with them and get their advice. That doesn't mean you just have to do what you're told – it's always worth asking why.
What's definite is that even if you finally opt for a natural birth, your labour will be more high-tech than with a single baby. This is partly because the babies have to be monitored separately, so that any complications can be spotted early and treated straight away.
Having twins doesn't rule out a home birth – although triplets may – but it's risky. Discuss your options with your specialist or midwife.
Choosing pain relief
With twins or more the choices of pain relief are the same as with singles, but many doctors have found that in multiple births an epidural has a lot of advantages. These include being able to turn second or third babies round inside the womb without causing extra pain and being able to quickly carry out emergency caesareans if things get difficult. Also with epidurals, if you do end up having a caesarean you can be awake and your partner can stay with you throughout the birth.
Three's a crowd...
The birth of twins or more is an exciting event for the hospital too, and so student midwives and doctors may want to watch. This means there can be quite a crowd in the room.
As well as your birth partner, the midwife and the obstetrician there could be an anaesthetist if you're having an epidural, plus a paediatrician for each baby. If this feels like too many already and you don't want students there observing, speak to your doctor or midwife in advance.
As in any pregnancy, mums-to-be can suffer morning sickness, indigestion, heartburn, piles, backache, varicose veins, swollen hands and feet and tight, itchy skin (see our section on Pregnancy Problems). But when you're carrying more than one baby all of these can be worse. That's perhaps because there are more hormones circulating in your bloodstream, or your body is carrying a much heavier load. The remedies for coping with them are the same as for single babies.
After the births
Once your babies are born, and provided there aren't any problems, you'll be able to experience that wonderful sensation of having them placed on your chest. Not only will you be able to feel their skin against yours, but you'll get your first incredible look at your newborn children. Depending on the kind of birth you're having, you might be able to put each one to your breast while you're waiting for the next to arrive.
Even if you've had a healthy pregnancy, your babies will probably be a little smaller than most newborns. The average birth weight for twins is 5lb 8oz (2.5kg) each, while for triplets it's 4lb (1.8kg) each, and for quads it's 3lb (1.4kg) each. And don't be surprised if your babies are different sizes. It's quite usual.
Spending time in special care
The chance of one or more of your babies having to be in the Neonatal Intensive Care Unit (NICU) is quite high. According to a TAMBA (Twins and Multiple Births Association), around 40% of twins and 97% of triplets go into special care. The reasons they're there will dictate how much you can touch and hold them, but you will be able to be with them as often as you want. Ask to have their beds put near each other so that you can easily see all your babies.
It's not easy if one or more of your babies goes into special care but another doesn't. It can be especially difficult if one baby is particularly sick and needs to be in a different hospital altogether. You will understandably feel torn between them.
If your well baby is in the same hospital, ask if she can be moved nearer the SCBU so it's easy for you to pop out and see her. Or take her with you when you go to visit her sicker brother or sister. But if none of this is possible, try to reassure yourself that your sicker baby needs more of your care and attention, and ask your partner or parents to be with the well baby.
How to tell which baby's which
Even if your babies aren't identical, it's going to be difficult to tell them apart at the beginning. Gradually, as you get to know them over the coming days, you'll begin to spot little differences – perhaps one's face is a little thinner, another has an obvious birthmark, or one startles more when disturbed. You'll also soon be able to tell their cries apart. But until that happens, there are some little tricks you can use to make them different so that you and your visitors can easily tell which is which:
- Put a different toy with each baby so that friends and family begin to associate a baby's name with a particular toy.
- Give each baby a different bracelet.
- Give each baby a colour that's their own, so they'll always be associated with it. Then give them a blanket or clothes with that colour in it.
It's really important to use their names and encourage people to think of them as individuals right from the beginning. This means that as they grow older they can develop their own personalities, and function apart from each other, rather than always being lumped together as 'The Twins' or 'The Triplets'.
Bonding with your babies
If you'd like to breastfeed your babies you can. You'll make as much milk as the babies demand, so don't worry that you won't have enough. The difficulty comes in getting into the right position, especially if you have triplets or more. So you'll need lots of help and support, especially at the beginning when you're learning to attach the babies. Ask your midwife for help, or contact the support group, Breastfeeding Mother's Support Group.
If you have twins you can feed them separately or together, but it saves a lot of time if you find a way to feed them together. It may not always be possible, especially if they're different sizes. The most popular position is the 'rugby ball' – the babies' heads towards the middle, their bodies held under each arm. That way you can control their bodies and cuddle each one. But you'll need to find yourself a really comfortable chair, lots of cushions – including a v-shaped one – and some help to pick them up and latch them on until you get used to it.
With triplets and more you might be able to breastfeed two and bottle-feed the others on a rota basis, perhaps expressing your own milk for the bottles. Or you may feed all of them at different times, especially if some are smaller than others and need more regular feeds.
Although the basics are the same as with single babies, breastfeeding more than one is more exhausting and you'll burn more calories. So make sure you rest, have lots of water to drink, and eat well. And don't expect miracles. Getting the hang of breastfeeding can take time, but the benefits are great, especially for smaller, premature babies.
Bottle-feeding allows you and your partner to take it in turns with each baby, and he can feed on his own in the night or before work in the morning. That way he'll feel he's getting to know the babies at the same time as you. Or visitors can take a turn while you rest or spend some special time with another baby.
Bringing twins home
Once you're all discharged from the hospital, you can start getting your new family into a routine. It can be daunting to find yourself at home with these babies and no professional help, but you will soon adjust.
Organisation and routine are the keys to keeping your sanity over the coming days and months. With more than one baby, it's extremely difficult to impose a timetable, so take your cue from them. Build your routine around their sleeping patterns and things will soon settle down and start to get easier.
Forget all housework other than the chores that keep your house hygienic, and concentrate instead on getting yourself organised for the babies. It's worth having nappies and a changing mat or table downstairs and upstairs, so that you're not constantly moving things around, having to carry fractious babies from one floor to the other, or leaving them while you grab essentials from upstairs. Twins and more soon learn to be patient while you attend to one of the other babies, but make it easy on yourself, especially in the early days.
Once you're ready to face the world, keep a changing bag ready in the buggy and the car, with just bottles to add at the last moment. This makes getting out of the house a bit easier.
- You'll need the same number of clothes for each baby as you would with a single child.
- You'll only need one cot, initially, because the babies can sleep together, especially in the first few weeks. Or you may want a Moses basket for each baby.
- They'll each need a car seat for coming home from hospital, and you can opt for a twin pram or double pushchair - whether you chose a side-by-side or a tandem style depends on which you find most manoeuvrable, and the width of your front door.
- Baby slings are also really useful, especially if you have more than two babies. With triplets, for example, you could have two in a double pushchair and one in the sling.
Friends and family will be keen to visit to coo over the new arrivals, and many will ask if there's anything they can do to help. Always say 'yes!' and have a list handy in case you can't think of anything useful at the time. Ask them to make the tea or tidy the kitchen while you attend to your babies, or have a shopping list ready so they can add it to their shop.
There's very little free help available for twins and more, so get your partner involved. If a friend or relative volunteers to come round regularly and help with a few chores, accept their offer with open arms. Build that help into your routine so that you can use the time either to spend with your babies, or to rest. If you'd prefer to put things on a more formal footing, you could ask friends to help and pay them. Or perhaps if they have a teenage son or daughter, they might want to earn some cash by helping you for a few hours every week.
When you're deciding what help to get, remember that your babies are your priority, so spend free time with them rather than on chores.
Twins as individuals
- Right from the start it's important to help your babies to be themselves, rather than just part of a pair or group.
- It's very sweet and tempting to dress them alike and give them similar or matching names, but it doesn't help you or others to tell them apart as they grow up.
- Treat them as individuals. Use their names and encourage friends and family to do the same. Ask their grandparents or friends you trust to mind one at a time. Do separate things with them – even if it's just taking one to the supermarket while your partner has the others. You can chat and smile to him while you chose things from the shelves. Making eye contact with you and hearing the sound of your voice really helps each baby to build their own relationship with you.
- Helping them to make their own friends is also a major part of helping them develop as people. They'll become aware of each other around 10 months and will start babbling to each other. By about 12 months they'll be playing together. While they're often very happy playing just with each other, take them out to twins groups or local baby groups where they can meet others and develop their own relationships.
How they'll develop
Your babies will grow and develop at their own individual rate, even if they're identical. Unless they have special needs, by the age of nine even the smallest baby will be about the same height as a single child. They'll also be just as bright as other children.
You may, however, find their language skills don't develop as quickly as single babies. This is partly because babies learn language from adults, and with twins and more, parents and carers don't speak to them as individuals as often. Instead the growing children speak to each other, and constantly mispronounce words back and forward to each other. This becomes so odd sounding that people call it the secret language of twins. Find time to talk to your babies individually and it will really help to develop their language skills.
Most babies who are part of twins and more are absolutely fine. But there is a greater rate of special needs in multiples. These can include:
- cerebral palsy
- congenital heart defects, such as hole in the heart
- delayed mental development or learning difficulties
- attention deficit disorder