Majalah Multiple Births Neonatal Guide Web

7/28/2019 Majalah Multiple Births Neonatal Guide Web

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Multiple Births-A pArents Guide toNeoNatal Care

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introduCtionBabies in a multiple pregnancy are much morelikely to experience some level o additionalcare in hospital ater birth, known as specialor neonatal care. A recent survey (Tamba2009) ound that over hal the parents o twinshad at least one o their babies who neededextra help ater birth.

The Twins and Multiple Births Association(Tamba) in conjunction with Bliss, the specialcare baby charity, have produced this guideto help prepare and support multiple birthparents. We hope that the inormation helps

you to understand the reasons your babies may be born early, small or poorlyand the type o care they will receive.

Parents can eel very overwhelmed by the prospect o their babies beingunwell ater birth. We have provided you with inormation about the neonatalenvironment along with advice on how to start getting to know your babies as wellas how to care or, and eed, more than one. We also look at the issue o transersto other hospitals and the possibility o babies needing to be in dierent units.

Going home can be exciting but may cause you some anxiety as you adjust tothe transition rom hospital. We have included some inormation about practicalissues and establishing a routine or your new amily.

The guide shares the experience o parents who have been on neonatal unitswith multiple babies and we hope that you fnd their stories useul and reassuring.

You can fnd additional support through both Tamba (www.tamba.org.uk ) andBliss (www.bliss.org.uk) and we have reerenced specifc resources throughout.

I you have any concerns about medical issues relating to your pregnancy orbirth, please remember that in the frst instance you should always seek advicerom your neonatal team, midwie or doctor.

K r Ceo tamba a A C Ceo B

W wld lik t thank th Mthrcar and Rbn Fndatin, th ChtrldRyal Hpital Trt and Mrrck r thir nancial pprt, r tam advir(litd at th nd), and pcially r parnt cntribtr wh tri prvidvalabl inight int th car mltipl.

ACKnoWledGeMents

Whilt vry car i takn in prviding inrmatin, pla nt that it i a gnral natr and t hat radr hld k prinal r xprt advic a

apprpriat t thir pcic c ircmtanc. Nithr Tamba r Bli accpt any liability, inclding liability r any rrr r miin

www.tamba.org.uk / 3


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www.tamba.org.uk / 5

Before your BaBies are BorNAntenatal care or multiple pregnancies .........................06Why are babies o multiple pregnancies born early? ......07Anticipating the birth o premature babies .....................07

after your BaBies are BorNVisiting the neonatal unit ............................ .....................08Emotions ..........................................................................10

Forming a relationship .....................................................10Developing amily relationships.......................................10Siblings .............................................................................11Support ............................................................................11Family members ...............................................................13Separate babies ...............................................................13Transer to other neonatal units ..................................... .14Care in a neonatal unit ........................... ..........................14feediNg your BaBiesLearning to eed...............................................................16Simultaneous or tandem eeding ....................................16Staggered eeding ...........................................................17Breasteeding and expressing .............................. ...........17Breasteeding more than two ............................... ...........17Bottle eeding ..................................................................18Routines and ongoing eeding ........................................18

goiNg homeMothers going home .......................................................20Going home with one baby .............................................20Bereavement ....................................................................20Planning your babies discharge ........................... ...........20Preparing to go ................................................................21Sleep time and sae sleeping ........................... ................21Emotions ..........................................................................22Support ............................................................................22Ongoing care ...................................................................22

aCkNowledgemeNts aNd glossary..................26-27

Contents


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6 / NEONATAL CARE www.tamba.org.uk / 7

Fr parnt t b, prgnancy i anxciting and by tim. Y will bprparing yrl and yr amily r thnw arrival, a wll a making practicalarrangmnt ch a bying qipmntand rganiing hlp. A mltipl birthparnt y hld al prpar mntallyr many pibl tcm, incldingth chanc that th babi may ndm rm pcial car at birth. Itmay b l t k inrmatin byattnding antnatal cla and jininga lcal twin clb. Tamba hav ndthat parnt wh ar prpard r th

BeFoReYouR BABIesARe BoRN

arrival mltipl cp bttr with thaciatd prr and dmand, andar thrr mr likly t njy thirarly parnting xprinc. Fr lggtin t hlp y prpar ryr babi pla Tamba HealthyMultiple Pregnancy Guide availabl atwww.tamba.rg.k

All prgnant wmn ar rd thpprtnity t attnd antnatal cla,inclding bratding wrkhp. I yrmatrnity nit rn a twin r mltiplcla it i bt t bk nt a cla wll inadvanc yr d dat. Tamba al rantnatal cla which incld practicaladvic abt parnting mltipl. Y mayal b abl t mak a viit t yr lcalnnatal nit; it can b hlpl t mt thta, lk at th aciliti and qipmntand t ak any qtin.

AntenAtAl CAre forMultiple preGnAnCiesWhn y ar xpcting mr than nbaby, y will rciv an incrad lvl antnatal car bca th rik actraciatd with mltipl prgnanci; thican b hlpl and raring. Y will brd rglar ltrand can t chckth grwth yr babi and t hw thy ar dvlping. I y hav any

An ltrand can twin

cncrn abt yr babi mvmntr ntic anything nal, talk t yrhalth prinal and thy can chck itt r y.

Why Are BABies ofMultiple preGnAnCiesoften Born eArly?Mltipl prgnanci d incra th rik cnditin that may ca prmatrbirth. A rcnt tdy (2009) by Tamba,idntid th mt cmmn cnditina: high bld prr (26%); vaginalblding (24%); pr-clampia (16%); twint twin tranin (6%); and prgnancy-indcd diabt (4.6%). Th, in additint pntan nt dlivry (which cann ccain b cad by inctin), arthght t b th main ran why twinand triplt ar brn arly. Thr i mrinrmatin n all th cnditin

in Tamba Healthy Multiple PregnancyGuide. Yr midwi r dctr will babl t dic th dvlpmnt yrprgnancy and al addr any cncrnat yr appintmnt.

smtim, thr i n bvi ca prtrm labr. evn i th ca iknwn, it i tn nt pibl t prvntth nt arly labr. Bt advanc incar hav rltd in bttr tcm rbabi wh ar dlivrd arly.

AntiCipAtinG the Birthof preMAture BABiesI yr mdical tam think that yrbabi ar hwing ign cming arly,

y may b givn trid mdicatin(ally in th rm tw injctin)t hlp prpar th babi lng rbrathing. I y a r in labr, mdicatinmay b d t try and dlay r lwdwn th nt. D nr that ydic yr itatin lly with yrmidwi, dctr r nnatal nr

thrght thi prid.Vry arly babi may nd immdiat

pprt with thir brathing, and rapidtranr t th nnatal nit, r lngrtrm car. A parnt, y may bdiappintd at nt bing abl t hldyr babi immdiatly atr th birth.

Y may al b cncrnd that yhav nt bndd initially a y hadplannd. Hwvr, th rt w mmnt cntact, prci a thy may b,hav littl infnc n hw y and yrbabi will rlat in th lngr trm.Babi brn vry arly will tn nd carin th nnatal nit r wk r mnth y will hav tim latr t hld thmcl and dvlp th bnd.

A baby in an incbatr

For me, the most astonishing thing about having thebabies, was this enormous responsibility and the immediatedesire to do everything they needed.

We were advised to visitthe Neonatal unit beore theywere born. It was much less oa shock to go there ater thebirth, as we were already awareo the environment

D tak a pht yr bmp


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VisitinG theneonAtAl unitAtr th birth, n th nnatal tawill cm t tll y abt yr babiadmiin and hw thy ar ding. Thymay al bring y a pht yr babit kp with y. I thi dnt happn,d ak yr midwi t nd t hw thyar; a parnt y hld b ncragdt b with yr babi a n apibl. A a nw mthr; y mayrqir aitanc, y hld rciv thia n a i practical atr th birth.

sm nnatal nit ribbn tidntiy y a a parnt wh ha nt ythad an pprtnity t mt yr babi.sta will r pprt and raranct try and mak yr rt trip t thnnatal nit a ay a pibl. entringa nnatal nit can b a littl alarmingat rt, with namiliar qipmnt andnd. Bt th nnatal ta knw thata nw parnt y may ract in a varity

AFTeR YouRBABIes AReBoRN

way, and thy ar thr t hlp y awll a yr babi.

Y may b a littl rprid whn ymt yr babi - prmatr babi canb xtrmly tiny and may b thin, withlittl bdy at. sm al hav n bdyhair and viibl bld vl. Bt withtim and gntl car, yr babi will grwand dvlp. Talk with th nnatal nitta abt hw lng y hld anticipatyr babi bing in pcial car and hwy can gt t knw thm bttr. I thyar vry prmatr, it may initially b byhand hlding. A thy grw and dvlp,y can b taght hw t cmrt andd thm a wll a tak part in thir dailycar. At th initial tag yr babi willb cmrtd by th nd yr vic,mll and y cntact.

Vry arly babi will prbably b in anincbatr and will lk vry mall. Thymay hav tb and mnitr attachdwhich allw th ta t hlp car r thm.Th incbatr prvid th babi with awarm nvirnmnt, ntil thy can maintainthir wn tmpratr. It al prvidan nvirnmnt which hlp rdc thrik inctin. Nnatal car prvida pcialid tam padiatrician andnr wh can giv mdical and dingpprt t y and yr babi. sta willb happy t xplain th qipmnt thatthy ar ing t car r yr babi. Frmr inrmatin abt what t xpctn th nnatal nit, pla ak r a cpy th Bli Parent Information Guide.

Lking atr yrlv i a pririty.Try t at rglar mal a wll a nack,drink lt fid and tak plnty rt.Thi hlp a mthr rcvry and willait with xpring r bratding.It will al nr y bth hav thnrgy rqird t manag yr tim na nnatal nit.

early bnding mmnt


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eMotionsIt i imprtant t rcgni that anw parnt y will b daling withcmplx mtin. Cmmn lingincld jy, gilt, ar, wrry, latin radn and mtim n mtinat all. I y cncivd yr babiby rtility tratmnt thi may rmindy th rllr catr mtiny xprincd. I y had a dicltprgnancy; y may jt b rlivd thatth babi ar hr, and that thy argtting th bt car that thy can. Itcan al b natral t hav fctatingmtin, t l xhatd, latd rpt, r trn btwn ldr childrnand thir nwbrn ibling. Rmmbr tgiv yrl prmiin t xpr yrling, whatvr th may b and tmak tim t dic th tgthr.

forMinG A relAtionshipon th mt cmmnly akdqtin t Tamba r phn hlplin(Twinlin 0800 138 0509) i hw will I babl t lv tw babi? Indd, manyparnt ingl babi in nnatal carrprt having dlayd bnding. Parnt twin rprt that thy l dirntlytward ach baby; thr i m v idnct indicat that mthr ar bilgicallyprgrammd t prr th trngr,biggr twin. Hwvr, d nt allw

yrl t b cncrnd, a th arlydirnc ally rlv thmlv.Givn tim yr lv r all yr babihld dvlp and frih.

All parnt wh hav mr thann child knw th cnfict cratdby diring nd, bt a a parnt mltipl babi y may initially wih yhad mr hand. Thr ar many dirntway daling with mr than nbaby at a tim; r xampl taggringd and wrking tgthr t managth timing car. Thr ar mrggtin in th Tamba Gid, Twins,Triplets and More The First Year. In timand thrgh yr xprinc, y willtart t nd yr wn way.

deVelopinG fAMilyrelAtionshipsIt i imprtant t nd way t hlp y tadjt t bing a largr amily. A n a iti pibl t d , y may wih t hava amily phtgraph with yr nw babi.Individal pht th babi particlarly thir mall hand and t ar pcial. Tryand crat amily tim r cddl, and kincntact. Clbrating a wk li can hlpcrat arly amily bnding mmri.

Y may lik t ncrag yr twint bnd with n anthr at thi arly

A athr prrming car

tag. Thr i gd vidnc t hwthat twin grw and dvlp bttr whnbddd tgthr. I yr babi ar nttgthr, laving a pht y and thirc-ibling nar thir ct may hlp dvlpthi arly bnd.

A nw parnt y will b dalingwith th cmplx mtin invlvdwith having a baby that nd nnatalcar. D try t mak tim r ach thrand talk abt hw y ar bth ling.

Y hld al try t mak any parntaldciin rlating t yr babi tgthr,whnvr pibl. Thi nr y arbth invlvd in th car th babidring thir tim in hpital, and thi willhlp t crat a trngr bnd.

siBlinGsovr hal all mltipl ar brn t parntwh alrady hav n r mr childrn.sm nnatal nit allw brthr anditr t viit bt thr d nt, in rdrt minimi th rik inctin bingintrdcd. I yr thr childrn ar ablt viit thy may nd th nnatal nitalarming r rightning, it i imprtantt prpar thm. Th arrival twin rmr can triggr jaly in ldr ibling,pcially i y ar pnding all yrtim at th nnatal nit. It i imprtant

r bth parnt t try t pt aid mtim r yr xiting childrn. Bk cha Princess Poppyand TheBaby Twinswrittn by Jany Li Jn, r Big SisterDora writtn by stv Aitkin, may hlpibling accpt having nw babi.

supportIt i imprtant t ak thr r hlp ay nd it, whthr rm nnatal tar amily. Aking amily t hlp t withcaring r cmrting will ait thmin dvlping a rlatinhip with yrbabi. Family and rind can rpractical and mtinal hlp dring thidiclt tim which may b day, wkr mnth.

It may al hlp t talk t ppl

Pht t rmmbr hw mall thy tart

I spent hours looking romone incubator to the otherand not knowing how to splitmysel. I called Twin line andthe lady helped me to nameall the difcult emotions Iwas eeling, especially howvulnerable and torn I elt.

Having yr babi tgthr will aid dvlpmnt

I have mixed memoriesabout their time in theNeonatal Unit. I loved thegood times - getting to holdthem both and watching themgrow. However, I still choke upwhen I think o how close wecame to losing Lauren.


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wh babi ar ging thrgh a imilaritatin; yr nnatal nit may havc mting r pprt grp.Many thr l cntact and mthd pprt ar nd in th Bli ParentInformation Guide that y can btainrm yr nnatal nit. Y may lik ttalk t Tamba Twinlin (0800 138 0509)r Bli Family spprt Hlplin (0500618 140). Bth chariti al prvidl nlin rrc inclding wbit,mag bard and Facbk pag.

fAMily MeMBersRlativ can ally viit th nnatalnit, bt thi may b limitd t nly twppl at a tim. Grandparnt, ant,ncl and rind can b grat rcritr aitanc with childcar, lit t thhpital and mal. At th am tim,rmmbr that a parnt y ndt c n th halth y and yrbabi. Try nt t bcm vrwhlmdby any i that may b acting thrppl arnd y.

sepArAte BABiessmtim n baby might b admittdt th nnatal nit, r tranrrd t

anthr, whil th thr baby r babiar abl t tay in th matrnity nit. Iti prctly natral in thi itatin tgiv yr attntin t th baby y arabl t car r. Thi itatin can cratprblm with viiting and tablihingrtin and it i nrmal t l trn. Thta hld b abl t pprt y in

jggling yr babi nd and prvidth hlp y bth nd t bnd withthm. Cnidr altrnating ding tim,

Family pprt

I spoke to a breasteedingmidwie on day 4, who wasreally great. She told me not toworry about trying to eed Islaat this stage (I was expressingmilk or her), but insteadjust ocus on giving loads ocuddles and skin-to-skin, whichis what I did. Ater that, it waslike a huge weight was lited,

because at the end o the dayDad or the NNU nurses wereable to give eeds i I wasntthere, but no one else couldbe her Mum!

An arly baby rciving car


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babi bing in th nnatal nit, achwill rciv individal attntin. Thymay nd tratmnt r twin t twintranin, r b mall (intratringrwth rtrictin) r imply bprmatr. A parnt y can dictratmnt and car, and b invlvd whnth tratmnt plan i pdatd by th

nr and dctr. D rmmbr y arallwd t ak r pdat at anytim andy hld l mpwrd t rai anypcic ara cncrn rlating t ach yr babi.

Nnatal nit ally llw a baicrmla r th car babi whichincld: kping thm warm, (tn bying an incbatr), mnitring thm,nring thir calri intak, and irqird, pprting thir brathing. Fr

Babi rciving phtthrapy

skin-t-kin cntact

When I was pregnant I kindo expected that whateverhappened it would be as apackage and what happenedto one would happen with theother - seems silly now!

plitting car btwn y a parntr aking amily t viit babi n ithrward. Thi will hlp y t pnd timwith yr babi and allw thr t binvlvd in thir car.

trAnsfer to otherneonAtAl unitsT nr yr babi ar card r in thmt apprpriat plac, it may mtimb ncary t tranr y t a dirnthpital whilt y ar prgnant, dringlabr r atr dlivry. Thi ccr iyr lcal nit d nt hav par ct,cint ta rrc r cannt prvidth lvl car ndd.

Hwvr, it i imprtant r amilit b lly inrmd thir right andchic. Parnt hav th right t xplri th tranr i abltly ncary r ithr ar any thr ptin. In thir rcntToolkit for High Quality Neonatal Services,th Dpartmnt Halth (in england)tat that: prvidr hld mak vryrt t kp a mthr and hr baby/babi in th am hpital dring thirrpctiv admiin.

I y ar cncrnd that y arbing tratd nranably thn ymight lik t ak th lcal Patint Adviry

Liain srvic (PALs) t pprt y inxpring yr cncrn. Nvrthl,y hld bar in mind that in crtaincircmtanc, t r tranr cld

jpardi yr babi wllbing.

CAre in A neonAtAl unitI yr babi ar in a nnatal nit, it ilikly t b an mtinal and trltim. Hwvr, thr can al b apitiv id t it. A nw parnt ywill hav tim t rcvr llwing thbirth, and y will b abl t larn thkill ndd t car r yr tiny babi.Halthcar ta will b thr t hlp ycp with thi nw xprinc. At yrwn pac y can practi parntingkill ch a hlding, cddling, nappychang, dring, bathing and dingwith yr babi.

Th arlir yr babi ar, th mallrand mr ragil thy will b. Thy aral mr likly t nd t tay in thnnatal nit r a lngr prid tim.Thir prmatrity can lad t an incradliklihd cmplicatin ch annatal jandic, (tn tratd with apcial bl light calld phtthrapy), ran inctin, tn tratd with antibitic.

Whatvr th ran r yrA tranr incbatr

Car in th incbatr

mr inrmatin abt hw yr babyr babi will b card r in th nnatalward, ctin 4 th Bli ParentInformation Guide.

Whn yr babi can lav thincbatr, kin-t-kin cntact (tn calldkangar car) will hlp y all bnd andyr babi dvlp. Thi mthd invlvplacing th baby r babi lying nakd,xcpt r a nappy, againt yr cht.skin-t-kin cntact hlp th baby cntrlit tmpratr and brathing a wll ahlping rglat th hart. It ha al bnhwn t incra grwth rat. Whil yrbabi ar in th nnatal nit y willnd hlp with gtting thm in and t thi caring pitin. It may b bttr twrk t hw y can har kangar cartim btwn bth y (n baby ach)t prmt bnding.

Th Bli Parent Information Guideincld m rthr ggtin nhw t bnd with babi in th nnatalnit. Frthr inrmatin n tching yrbabi whn thy ar till in th incbatrand kangar car i availabl thrghth Bli wbit.

Br y tak thm hm, mtbabi will hav tablihd a dingrgim. Having ch a rgim will nrthat thr i tim btwn d r yand yr partnr t d thr tak rgt m rt.


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FeeDINGYouR BABIesleArninG to feedPrtrm babi may nt hav dvlpdth ability t ck, may nd t b dvia a pcial tb. A th babi dvlpth ability t ck, th vlm milkgivn via a tb will b gradally rdcd.Initially, mt mthr tart with dingn baby at a tim; thi i gnrally aira it allw tim t larn, and giv n-t-n tim with ach baby.

Whn ding mltipl, it iimprtant r mm t gt hlp rmth nnatal nr a wll a dad andthn latr amily and rind, thy canhlp pitin th babi, wind, changnappi and giv cddl.

siMultAneous ortAndeM feedinGMt ding pitin r mr than nbaby invlv bing pprtd by pillw.sm mthr nd a hard pillw that ti atth back r a ling an advantag. It can b alittl danting at rt t hld tw babi atnc, bt ta in th nnatal nit will hlpwith thi. Try th pitin pictrd blwt nd n that it y and yr babi.

Babi with na-gatric ding tb

Graphic rprdcd with kind prmiinrm Th Mltipl Birth Fndatin

stAGGered feedinGsm parnt prr t tim d that thy ar taggrd by a w mint,waking th l hngry twin atr dingth rt. Thi can allw mr individalidattntin r ach baby and th thr babycan b rckd r cmrtd, i awak.

BreAsteedinG AndexpressinGBratding ha many advantagr babi, bt pcially th n thnnatal nit. Fr vry prmatr rmall babi, brat milk i particlarlyvalabl a it bt th baby immnytm. It al hlp t prtct againtgatrntriti and cht inctin, a wlla pplying th crrct mix at, prtin,carbhydrat, vitamin and minral.Hwvr, in m circmtanc, prtrmrmla may b ndd and th ta inth nnatal nit will advi y n thi.

A a mthr xpcting mr than n

baby, y may lik t dic antnatalmilk xprin which i dn by hand.Th mall qantiti cltrm rarly brat milk can thn b trd t in th rt w day hlping t avidth rmla milk. Mthr will ndhand xpring th cltrm t b mrccl than ing an lctric pmp.A lactatin tablih, it i adviabl txpr with a brat pmp at lat 8 timin 24 hr, t tablih yr milk pply.sta will advi y n hw t d thi.

BreAstfeedinGMore thAn tWoI y hav triplt r mr, it i till piblr y t bratd yr babi, btcrdinatin and timing bcm mrimprtant. Mt mthr triplt will a rtin and a rta ytm, ding nparatly atr th thr tw. With qad,thi ytm will b bad n th rt twbabi llwd by th lat tw.


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Th brat i capabl prdcingmilk n a dmand and pply bai, it can b pibl r mthr t d amany babi a thy prdc. Gidr ding mltipl ar availablrm Tamba and th Mltipl BirthFndatin at www.mltiplbirth.rg.k.

Bottle feedinGsm hpital hav rcivd, r arwrking tward, th Wrld Hathorganiatin (WHo) Baby Frindlyaward r pprting bratding. Tb ccl in achiving thi award,halth prinal mt nr that allprgnant wmn hav inrmatin abtbratding t nabl thm t mak a

chic. I y ch t rmla d yrbabi it i a rqirmnt Baby Frindlythat y ar taght hw t d thi aly.sm hpital with th award may aky t bring in yr chn rmla, btwill pply y with tril bttl andtat. I y ch t bttl d y maytill nd it cmrtabl t tandm d inth pitin hwn r t th dingpattrn dcribd.

routines Andon-GoinG feedinGHwvr y d yr babi, mtbabi will hav an tablihd dingrtin whn thy lav th nnatal nit,which y may ch t llw at hm.

Y may lik t dic with yrpadiatrician, nnatal pprt nrr halth viitr what rtin wld wrkbt r y and yr babi, rmmbrthi will chang a thy grw anddvlp. Mr gidanc n hw t dyr babi can b prvidd by a halthviitr, a brat ding cnllr, thNatinal Childbirth Trt (NCT), La LchLag, Tamba, Bli r th MltiplBirth Fndatin.

on-t-n attntin at hm

simltan r tandm bttl ding

Fding triplt bcm a mattr timing


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hm prir t yr babi. Twin andtriplt ar tn rady t b dichargdat dirnt tim. Hwvr, i thi gap ilikly t b airly cl thn th hpitalmay b abl t kp thm tgthr. Ithr i a larg gap in thir prgr thnthi may nt b pibl.

prepArinG to GoNnatal ta will b availabl t aitparnt thrgh thi tag. Manynnatal nit hav pcial rm whry can bth tay vrnight with yrbabi. Thi hlp t prpar y ryr rtrn hm by bilding cndncin yr ability t car r yr babiwitht aitanc. Bli ha prdcda pcial inrmatin pack that hldb availabl rm yr nnatal nit (rvia th Bli wbit). Thi cntain thbklt Going Home, The Next Big Step a wll a a rang gnral inrmatinabt th tranitin rm hpital thm. I y hav any cncrn ncy ar at hm, y hld cntactth nnatal nit, yr halth viitr rgnral practitinr r advic. Fr a lit practical ida inclding clthing anditm r th hm, Tamba HealthyMultiple Pregnancy Guide r nd thcpy nlin via th Tamba wbit.

sleep tiMe AndsAfe sleepinGCrrnt advic ggt it may b btt kp th babi in yr rm withy bth r th rt ix mnth. Manymltipl har a ct initially and rarchd ggt that th babi tnd tdvlp imilar lping pattrn, ntwaking any mr tn than babi whlp apart.

Thi rarch al ggt thatct-haring twin hav nt bn linkdt an incrad rik ct dath rsIDs (ddn inant dath yndrm).Crrnt gvrnmnt advic r ct dathprvntin ggt that y hld ntlt yr babi gt t ht (th idalrm tmpratr bing 16-20 dgrcli). Babi hld lp n thirback, with thir t t a rm ba t tpthm wriggling ndr cvr, cvrd withparat blankt. Mt nwbrn twin/triplt/mltipl tart by lpingid by id at th t th ct. A thbabi gt largr thy may tay in thipitin r lp had t had. Thbth cmply with th t t th t th ct rcmmndatin aimd atrdcing ddn inant dath yndrm.

Rarch by Dr Hln Ball nd that

Twin c-lping parat blankt

Car aty whn ging hm

GoING HoMeMothers GoinG hoMeMthr ar tn rady t b dichargdhm br thir babi. Thi manthat daily viit t hpital will bcmth rtin, mtim r an xtnddprid tim dpnding n thgtatin yr babi. Thi can b vrytiring r bth parnt and it may hlp tnlit th pprt rind and amily.sm parnt nd a rta ytm hlptaggr viiting and aid tranprt t andrm th hpital. Thi will b particlarlyhlpl i yr baby r babi rmain inhpital r vral wk r vn mnth.

GoinG hoMe Withone BAByIt i qit cmmn r n baby t brady t g hm rm th hpital brth thr/. Thi can b a cningtim r parnt mltipl a it canb tramatic t lav a baby bhind. Iti crcial r y t cntin bndingwith th babi r baby that rmain inhpital; thi i bt achivd by kin-t-kin cntact whn y ar viiting. Y maylik t lav a pht nar th baby ct,and al tak n hm r th rmaining

amily mmbr. It can mtim llik avritim t b pnding tim withth baby at hm, bt it imprtant trmmbr that y will n b abl thav yr babi tgthr again. Tratingtwin and mltipl a individal i gdr thir lng trm dvlpmnt.

BereAVeMentunrtnatly twin r mltipl birthbabi hav a tatitically highr chanc nt rviving. Parnt mltiplcan nd thmlv in a tat mtinal cnfict, particlarly a thymay adly l jt n thir babi.Thir ling bravmnt mayb cmbind with ling jy andrpnibility r th rviving baby rbabi. Tamba hav a gid r parntwh hav lt a baby. Additinally, thyr a brinding rvic and a pprtgrp. Dtail th ar availabl atwww.tamba.rg.k/bg

plAnninG yourdisChArGeMt parnt l a littl anxi whntaking mltipl babi hm r th rttim. Thi i pcially tr whn nr mr hav bn in nnatal car ran xtndd prid r i y hav gn

Annie was discharged when she was 10 days old. We hadbeen rushing around two hospitals trying to be with our newbabies. In act Annie had come home so that Gemma couldbe brought back rom Great Ormond Street to our local SCBU.Although it wouldnt seem ideal to take multiples home atseparate times, I have to say that in some ways it was helpul.As these were our frst babies, it meant that we were able tolearn and adapt to one at a time, which ater all we had beenthrough was no bad thing!


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lping tgthr id-by-id r had-t-had i n mr riky r twin babithan lping apart. Mr advic na lping can b nd in thBli/FsID Back to sleep laft andat www.id.rg.k.

eMotionsIt can b vry mtinal having mltiplbabi pcially whn n r mr havpnt tim n a nnatal nit. Mthr mltipl, and th with xprinc nnatal car r wh hav had thad l a baby r babi, ar mrlikly t xprinc ptnatal dprin.Thi may tart t dvlp in th pridllwing th birth r rtrn hm,althgh it can tn tak tim t rac.

I ithr y ar trbld by yrling r ar having ngativ thght,pla talk t yr midwi, gnralpractitinr r yr halth viitr. Itimprtant t nd mn wh will litnand hlp y manag yr mtin.

supportD acc pprt t hlp y car ryr babi, r xampl amily, rind,Hm-start, r paid pprt. ( blw).

onGoinG CAreTh llw p yr babi will dpndn thir phyical halth at th tim dicharg rm hpital. Babi withmdical cnditin may b rrrd

f spp Parents Siblings Cousins Friends

Neighbours

sc pp Tamba, twins clubs Multiple Births Foundation Mothers groups Hospital support groups Bliss local support groups Feeding support groups Church or voluntary groups Web based groups Help lines

Pn pp Community midwife Health visitor School nurse General practitioner (GP)

Social worker Sure Start

P pp n Domestic cleaner Maternity nurse or a doula Nanny or an Au pair Babysitter Nursery (for your older children)

Mums dont have to do this all on their own, and thereare so many chores to do (e.g. washing, sterilizing, makingup o eeds) that you can leave yoursel very short o time toactually enjoy the babies.


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Tim t rt

www.tamba.org.uk / 2524 / NEONATAL CARE

ima cag bab avaab m b tambaa B. Aa tamba a vm c, wc

c v ac ag.

B - ca ca bab cat: 020 7378 1122

e: [email protected] s h:f 0500 618 140

www.b.g.krg ca . 1002973

sc g ca sC040878

TWINS & MULTIPLE BIRTHS ASSOCIATION

Tw yar n

Two years on, the girls arehappy little beings, with lotso energy and no obvioussigns that they arrived 10weeks prematurely. We oweso much to the doctors andnurses. Without the supportand inormation providedto us by the sta there, wewould have lived in ear.

t pcialit nit r nging car rrgry. I yr babi ar vry mall,thy will cntin t b mnitrd bya pcialit nr, hpital cnltant,halth viitr and/r a ditician.

Many parnt twin r mltiplwill lk back pn th tim whnthir babi wr in th nnatal nitwith mixd ling, rmmbring thmtinal p and dwn that happndn a daily bai. Bt parnt ar alapprciativ th xprincd halthprinal that hlpd thm lrard and cndnt.

tw a M B Aca(tamba)

t: 01483 304442tw (h) 0800 138 0509

www.amba.g.krg ca . 1076478

sc g ca sC041055Cma n. 3688825


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www.tamba.org.uk / 2726 / NEONATAL CARE

the Authors

Vnc w: Senior midwie,Royal Surrey County Hospital Guildford,Surrey, and mother o twins.

Jnn f:Advanced neonatalpractitioner Royal Surrey CountyHospital, Guildford, Surrey.

an Qn: Senior sister,Neonatal unit, Kingston Hospital, Surrey.

Nc dv: Consultant paediatrician,Royal Surrey County Hospital,Guildord, Surrey.

ACKnoWledGeMentsOur sincere thanks to all the ollowingwho have also helped with this guide.The Tamba reviewers, especially KeithReed and Judi Linney; Dr Carol Cooper,Sandra Bosman, Jane Denton, Director oMultiple Births Foundation. Prooreadingby Jolande Murray. The Bliss reviewers:Jane Abbott, Carmel Bartley and CaleyEldred. We are very grateul to theamilies who sent in photos or sharedtheir experiences.

referenCes Andother inforMAtionAll reerences and relevant organisationsare available on the web-based versiono this document.

GlossAryYou might hear dierent terms or theward where your babies will be caredor. Throughout this document we haveused the term neonatal unit to applyto all types o unit where your sick orpremature babies may be. These arecategorised as ollows:

leVel 1 uNitsAim to provide care or babies aged28 weeks gestation and above and notrequiring intensive care.These units are also sometimes calledSpecial Care Baby Units, SCBUs, SpecialCare Units and SCUs.

leVel 2 uNitsAim to provide care or babies aged 26-28 weeks gestation and above (dependingon local guidelines), including provision oventilation support.These units are also sometimes calledLocal Neonatal Unit, LNUs and HighDependency Units.

leVel 3 uNitsAim to provide care or babies aged 24weeks gestation and above and thoserequiring specialist surgery.These units are also sometimes calledNeonatal Intensive Care Units, NICUs andTertiary Centres.


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