What Information Should the Multiple Birth Family Receive Before, During and After the Birth?

Abstract

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.

Maternal Perinatal Mental Health and Multiple Births: Implications for Practice

“…There are few comprehensive comparisons of rates of clinically significant anxiety and depressive symptomatology between women with single and multiple pregnancies, but Leonard (1998) in summarising the available literature reports little difference. The exception is among mothers with a multiple pregnancy and at least one older child, 30% of whom were found in one study to be depressed in the last trimester of pregnancy (Hay et al, 1990). Mothers in this circumstance worry about the potential disruption to older children if they are unable to provide normal care because of enforced bed rest in late pregnancy (Hay et al, 1990) and the impact of being displaced by two infants (Bryan & Denton, 2001).…”

“…The exception is among mothers with a multiple pregnancy and at least one older child, 30% of whom were found in one study to be depressed in the last trimester of pregnancy (Hay et al, 1990). Mothers in this circumstance worry about the potential disruption to older children if they are unable to provide normal care because of enforced bed rest in late pregnancy (Hay et al, 1990) and the impact of being displaced by two infants (Bryan & Denton, 2001). Mothers pregnant with twins may have disproportionate feelings of unattractiveness associated with weight gain and fear rejection (Weigel et al, 2000).…”

“…Hay et al (1990) reported that 37.5% of the studied parents reported that the birth of twins had imposed "great stress" on their relationship. These investigators concluded that "the one thing that characterises mothers who cope well … after the arrival of twins is that they have a good secure relationship with a partner".…”

“…Complicated childbirth may incur costs of prolonged hospitalization for mother and or infants. Practical realities including having to purchase a larger car, housing of insufficient size, high medical costs, multiplied costs of infant furniture and equipment are associated with elevated anxiety (Hay et al, 1990;Klock, 2001). Few publicly funded forms of household help are available and families with multiple infants may have fewer financial resources to spend on services of this kind.…”

“…Discussions should include the realities of parenting multiples and not be confined to pregnancy and the intrapartum period (Hay et al, 1990;Weigel et al, 2000). A non-judgmental empathic response from professional staff at time of diagnosis of multiple pregnancy, which does not presume that it will be greeted with joy, is vital.…”