Development of twins

1. Development of twins • Twins in most respects will do as well as a single baby, but the one area they can fall behind is language development. • With twins, the mother tends to talk to both of them together, so there is less one-to-one communication. • she will be much busier and the temptation to leave the twins to amuse them selves is much greater.

2. Talking to each other, the twins act as each other's role model for language (unlike the singleton baby, who has his or her mother). • If one child speaks a word incorrectly the twin will copy it, reinforcing the mistake. • This is how the so-called ‘secret language’ of twins develops, otherwise known as ‘cryptophasia’ or ‘idioglossia’. • It is essential that each twin is spoken to individually as much as possible. • Eye contact is vital in any relationship but especially for language development.

3. If one twin is more responsive and makes eye contact more easily than the other, the mother may respond much more readily to this twin without realizing it.

4. Identity and individuality • Parents of twins should be encouraged to think of their children as individuals. • The distinction between twins can start in the postnatal ward with differently coloured blankets, or different small soh toys. • As they grow up, dressing them in different style of clothes, giving them different hairstyles can make children individual. • People should be encouraged to refer to the children by name, or ‘the girls’ or ‘boys’ and not ‘the twins’. • At birthdays or Christmas, separate cards and different presents help to retain individuality. • The twins should be given the opportunity to spend time apart.

5. Siblings of multiples • An elder brother or sister of twins may find their arrival very difficult, especially if they have had a number of years of undivided parental afention. • Parents must be alert to the feelings of their other children and include them as much as possible in all activities with the twins. • A single older sibling may see the parents as a pair, the twins as a pair, while he or she feels isolated.

6. It can be very helpful to find a ‘special friend’ for the older child, for instance a godparent, or other friend.

7. A good idea is for the parents to arrange not only for the twins to have a present for the older child but for the older child to choose a present for each of the twins. • Two different small cuddly toys as the first presents the twins receive can become very special gifts.

8. Triplets and higher order births • The increasing number of surviving triplets and higher order births will produce many more families needing special advice and support from healthcare workers

10. A woman expecting three or more babies is at risk of all the same complications as one expecting twins, but magnified. • She is more likely to have a period in hospital resting before the triplets' birth and they will almost certainly be born preterm. • Perinatal mortality rates are higher for triplets than twins and the incidence of cerebral palsy is also increased • Triplets or more are almost always born by CS.

11. The midwives must be prepared to receive several small babies within a very short time span. • It is essential the paediatric team be present as specialist care may be required. • The dangers associated with these births are asphyxia, intracranial injury and perinatal death. • The main difficulties these families experience are insufficient practical and financial help and the lack of awareness of their problems by professionals.

12. The emotional stress and anxiety of the birth, having babies in the NICU and the worries of coping with the babies when they go home will seem overwhelming if no arrangements for extra help have been made before the babies are born. • Taking triplets out for a walk or any expedition can need major organization, even without the parents having to cope with uninvited comments from passers-by. • Some of these can be insensitive and hurtful, making inferences about fertility and the parents bringing extra work on themselves.

13. The midwife must ensure that the mother's health visitor and, if necessary, a social worker are involved in her care. • If the family needs extra outside help, this must be organized before the babies are born. Applications to the council for rehousing may also be needed.

14. Disability and bereavement • Perinatal mortality and long-term morbidity are both more common among multiple births than singletons. • The perinatal mortality rate for twins is about four times that of singletons, and for triplets,). • The grief of parents following the death of one of a multiple expected

15. It often feels ‘easier’ to concentrate on the survivor(s), thus denying the parents essential time and space to grieve. • All too ofter people say that they are lucky because they still have one healthy child (or more). • No one ever says that to parents who lose one of their two or three singleton children • The conflicting emotions the parents will feel and the need to grieve for the child who has died, while wanting to rejoice at the birth of the healthy twin, can be confusing.

16. Birthdays and anniversaries and the constant presence of the survivor(s) are all reminders of the dead child. • The parents may need help in relating to the survivor(s). Addresses of organizations that offer support should be made available to the parents. • Where one or more of a multiple set has a disability it is ohen the healthy child who needs additional special afention. • He or she may feel guilt that it was something they did that caused the twin's disability and may be resentful of the afention the other one needs, or of the loss of twinship. • Any of these may lead to emotional and behavioral problems if not addressed early on.

17. Multifetal pregnancy reduction (MFPR) • This is the reduction of an apparently healthy higher-order multiple pregnancy down to two or even one embryo so the chances of survival are much higher. • It may be offered to parents who have conceived triplets or more, whether spontaneously or as a result of assisted reproduction.

19. The procedure is usually carried out between the 10th and 12th week of the pregnancy. • Various techniques may be used, either inserting a needle under ultrasound guidance via the vagina or, more commonly, through the abdominal wall into the fetal thorax. • Potassium chloride is usually used, although some doctors prefer saline. Whichever technique is used, all embryos remain in the uterus until birth. • Usually the pregnancy is reduced to two embryos, but in some cases to three or even one • Any parents who have been offered this treatment must be given counselling, which should include:

20. the advantages and disadvantages of reducing the pregnancy • the risks of continuing with a higher multiple pregnancy • the risks of MFPR • the effects on the surviving children • how the parents may feel afterwards • help for the parents to reach the right decision for them • organizations who can help them • the offer of long-term support if and when required.

21. Selective feticide • This may be offered to parents with a multiple pregnancy, where one of the babies has a serious abnormality. • The affected fetus is injected as described in MFPR, but this is not usually performed until much later in the pregnancy so allowing the healthy fetus time to grow and develop normally. • Counselling must again be offered to the parents. The full impact of either of these procedures and their bereavement will often not be felt until the birth of all their babies (including the dead baby) ohen many weeks later. • .

22. Moreover, unlike the termination of a single pregnancy, the parents will be more aware of what could have been as they watch the survivor(s) grow up. • When it comes to the labour, midwives must be ready to offer the appropriate care and understanding of the parents' bereavement. • The bereavement should be clearly indicated in the notes so it is not forgofen when the mother comes back for her postnatal check and for future pregnancies

23. Sources of help The support provided by social services varies greatly so it is always advisable for families with triplets to apply. • Healthcare workers should be prepared to write lefers supporting any applications these families have made.

24. The first born child receives a higher allowance than subsequent children. In multiple pregnancies, it is only the first born child that receives the higher allowance.

26. The Multiple Births Foundation (MBF) • The MBF offers advice and support to families as soon as their multiple pregnancy is diagnosed, as well as to couples considering treatment for infertility. • It offers information through its antenatal meetings for couples and professionals. The MBF also provides information and support to professionals through its education programme study days, courses, lectures and publications.

27. Facts about multiple births • Multiple pregnancy • Bereavement • Special needs in twins • Twins and triplets: the first five years and beyond

28. -TAMBA (Twins and Multiple Births Association) • The clubs are run by parents of twins and are the best source of practical advice and support for parents expecting twins or more. • TAMBA :listening and information telephone service for all parents of twins, triplets and more