Advances in the management of the multiple pregnancy and delivery must be accompanied by corresponding improvements in service access outside key centres and especially in the information families receive about what may happen during or after the pregnancy. A major review of birthing services in Victoria has focussed attention on four areas where the quality of information is often inadequate. 1) Prepregnancy and the standard of counselling about the incidence of multiples as a result of fertility drugs and in vitro fertilization procedures and about problems which may accompany a multiple birth. 2) Antenatal: At what stage of the pregnancy should parents be told of the multiple pregnancy and how should monitoring of the mother and procedures such as bedrest take into account what are often conflicting demands within the family? 3) Perinatal: Families are frequently illprepared for a cesarean delivery and for the procedures for premature multiples. The problem is often compounded by separation of the mother from one or both twins. While bereavement services are improving, much still needs to be learned about handling congenital abnormalities in one or more multiples. 4) Postnatal: Irrespective of the level of prenatal advice, families greatly underestimate the workload with multiples. The resulting stress contributes to the incidence of postnatal depression, child abuse and divorce now being reported from multiple birth families. Some suggestions are made from social psychology and genetic counselling about how families can best handle risk information to achieve the goal of neither under- nor overestimating the risks at these different stages of the multiple pregnancy.
The multiple birth family is more likely to have a dispute with the education system than with any other service. So many potential areas of conflict exist over the abilities and behaviour of multiples and over such issues as separation or keeping back one twin. One reason for disputes is the lack of good data to adequately reflect the different perspectives of parents and teachers and the differing needs of families: the same solution does not apply to all. To provide the first large-scale data base and building upon an initial survey of 85% of all primary school teachers in South Australia, the LaTrobe Twin Study and AMBA worked with Education Departments to set-up in each state Education Research Teams (ERTs) of parents of multiples who were also teachers. The ERTs were crucial in three phases. 1) Developing and circulating questionnaires and publicising the nationwide survey. 784 families and 1264 teachers of their children completed these questionnaires, many reporting that simply having to address the issues raised in the questionnaire was a valuable learning experience. 2) Exploring the data base. Issues arising included the very different bases on which parents and teachers judged separation desirable, with teachers emphasising the unsubstantiated claim that separation is essential to individual development. Separation became more common over the first three years of schooling but 20-25% of twins separated one year were back together the next. 3) Running regional meetings of parents, teachers and administrators to discuss the results and to pool experiences and plan policies at the local level. A need clearly exists to improve the level of consultation between families and school personnel and to ensure the widespread availability of information which identifies key issues in making decisions for that multiple birth family.
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