Key points
- Over 70 per cent of multiples babies will spend at least some time in the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) before going home.
- Having premature or sick babies can be frightening and overwhelming; this is not the start to parenthood for which you had hoped or planned. Having more than one baby in the NICU or SCN can add distress to an already stressful situation.
- Having premature or sick multiples may increase a sense of isolation, if you do not know other parents who have had a similar experience. AMBA can put you in touch with other parents who have faced the challenges of the NICU and SCN.
- Breastfeeding premature multiples is possible. Seek as much help as possible from the hospital’s lactation consultant.
Preterm labour
The causes of preterm labour are not completely understood, but carrying two or more babies at a time can be a contributing factor. There is no way to prevent preterm labour, though in some cases early diagnosis and prompt treatment can help to slow or pause the process.
Some warning signs for preterm labour may, in fact, be a normal part of your pregnancy and no cause for alarm. However, it is always safest to consult your doctor or midwife without delay if you have any of the following warning signs:
- Uterine contractions
- Menstrual-like cramps
- Increasing dull, lower backache
- Pelvic pressure
- Abdominal cramping with or without diarrhoea
- Increase or change in vaginal discharge
- Leakage of fluid from the vagina
If you have any of the following danger signs, go to hospital immediately:
- Water leaking or gushing from the vagina
- Blood coming from the vagina
- Contractions that come every ten minutes or less for one hour.
Do not hesitate to contact your doctor, midwife or hospital antenatal unit if you are concerned about possible preterm labour. You are the most important advocate for your babies, and you know your body and your pregnancy best.
Premature babies
Premature babies are those born before 37 weeks’ gestation. Generally (though not always), the earlier babies are born, the more support they will need in hospital before they can come home. Depending when your babies are born, they may spend time in the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN). Many premature babies will be ready to go home around the time of their due date, but some will need to stay in hospital longer than this.
The NICU and SCN
The NICU and SCN can be confronting and frightening places. However, your babies will be receiving exceptional, around-the-clock care from specialised doctors and nurses. Parents are recognised as critical members of the care team - you are your babies’ strongest advocate, and although you are not with them all the time, you know them best of all.
If your babies are born very prematurely or are very sick at birth, you may not be able to hold them straight away. However, all NICUs and SCNs promote skin-to-skin contact between babies and parents - ‘kangaroo care’ - as early and as frequently as possible. Even if you can’t cuddle your babies, you can assist with their daily care, gently touch them, and sing or read to them. Your babies know your voice and are soothed by your presence.
Complications and progress
Premature babies can have a range of medical complications. Generally, the number and type of complications will depend on the gestation of your babies at birth, how much they weigh and how well they are. Some babies are born quite healthy - just too early - while others will have a long road to recovery in the NICU and SCN. Your doctors and nurses will discuss with you the likely medical issues your babies will encounter, taking into account their gestation, weight and general health.
Breasteeding premature babies
Breastfeeding premature multiples is possible. If you are planning on breastfeeding, you will need to express until the babies can learn to breastfeed. Depending when your babies are born, this may involve many weeks or months of expressing before your babies have the energy and strength to breastfeed exclusively. Your midwives and the hospital’s lactation consultant will be able to answer any questions about expressing. A double electric, hospital-grade breast pump is very important. Your local multiple births club will be able to assist you with pump hire and may also have a breastfeeding representative who can direct you to other local resources.
‘Kangaroo’ cuddles (skin to skin) with your babies will help to stimulate milk production. Expressing at their bedside, or watching videos and photos of your babies when you are expressing at home, can also assist.
Emotional impact
Preterm labour often brings a unique form of grief: you have welcomed your beautiful babies but are very worried for their health, and you may feel robbed of many early parenting rites of passage in the first days, weeks and months of their lives. Depending on your babies’ gestation and any complicating medical factors, you may have had some difficult and frightening conversations with doctors and nurses. And in most cases, you will be discharged from hospital before your babies, an extremely difficult scenario and not one you had ever imagined or anticipated.
Your hospital should offer a debrief on your preterm labour. This can help you to understand why things did not go to plan and assist you in gaining answers to questions. If you are not offered a debrief, contact your midwife to arrange one. In the NICU, ask to speak to a social worker if you are not automatically referred by the nurses. The social worker will be able to connect you to a variety of different supports within the hospital and the broader community.
In the NICU, establishing a plan for being involved with your babies’ care and developing a routine can ease feelings of helplessness, and can assist you to bond with your babies during such a challenging time.
The NICU and SCN journey is often called a ‘rollercoaster’, as progress for preterm and sick babies is often not linear. The emotional impact of this rollercoaster is often intensified for multiple birth parents. It can be heartbreaking to see your babies progress at different rates and daunting to face the prospect of taking your babies home at different times (noting hospitals will try to avoid this scenario where possible). It can also feel isolating if the other parents you meet in the NICU or SCN are not multiples parents. Contacting AMBA, your local multiple births club and the charities that offer on-site support to parents, can help you connect with those multiples parents who have experienced an extended hospital stay with two or more babies.
