Breastfeeding The advantages of breastfeeding twins are the same as for singletons but as twins have a higher tendency to be born preterm and SFGA, it is even more important that they should be breastfed. As well as the medical and nutritional advantages, there are practical reasons too, many of which are outlined in Additionally, as time is limited for a mother of twins in the early days, twins can be breastfed together, when the feeds will take only a lifle longer than with a single baby. Some mothers will, however, prefer to feed separately.

Separate feeding It allows her to give one-to-one attention to each baby, something mothers of twins feel they have very little time for. It is easier for the mother, as she has both hands free to position and attach one baby at a time. If she does feed separately, it is recommended that she adopts a routine where whichever baby wakes first is fed and the second one is woken straight afterwards so keeping her feeds together

Simultaneous feeding It saves time as both babies are feeding together, though the mother will need to be organized, and will need help in the early days to get both babies attached to the breast. If the mother does want to feed the babies together, it is advisable to try this before going home from hospital, where a midwife can stay with her throughout the entire feed, providing advice, support and an extra pair of hands.

The woman will need additional pillows to support her back and take the weight of the babies, to avoid putting strain on her arms and back Routine is the key to coping with two or more babies. It may take 4–6 weeks for a feeding routine to get established

Mother–baby relationships -Mothers with a multiple birth ohen worry they will find it more difficult to bond with each baby equally. -This is a common concern and reassurance that their feelings are not unusual should be given. - Once the mother gets to know her babies these feelings usually disappear. If, for example, they are of markedly different sizes, a mother may favour one over the other, or if one baby is in the NICU while the other is on the postnatal ward with her, she may find she bonds with the one on the ward much more quickly

In such cases the mother should be encouraged to spend as much time as possible with the baby on the NICU and to visit as soon aher the birth as she feels able. If she has had an operative birth, she may find it difficult to care for two babies and extreme tiredness or anaemia will exacerbate the situation. She may have feelings of guilt if the birth and immediate postnatal period have not gone as she had planned.

The midwife should be alert for such circumstances and help the mother to divide her afention between both babies and to give plenty of reassurance that she is not the first mother to feel the same way.

Mother–partner relationships -A mother who has had twins or more will inevitably turn to her partner for help with the care of the babies, and many families work well together in the care and upbringing of their children, despite the added strains and stresses a multiple birth puts on a family. In some cases her partner may feel that she is devoting too much time to the babies and not enough to him, thus making him feel excluded, especially if when he comes home from work she is too exhausted to take any interest in him. The strain on any relationship when a new baby is born can be quite difficult for the couple to adjust to, but with a multiple birth it is even worse. The midwife should always encourage the partner to be involved in the daily care of the babies, either in hospital or at home.

Care of the mother -Involution of the uterus will be slower because of its increased bulk. ‘Aher pains’ may be more troublesome and analgesia should be offered. A good diet is essential and if the mother is breastfeeding she requires a high protein, high calorie diet. It is quite common for breastfeeding mothers to feel hungry between meals and they should be encouraged to keep sensible snacks to hand for such times.

A dietician may be able to offer help A dietician may be able to offer help. The physiotherapist or midwife should instruct the mother in her postnatal exercises. The midwife must give the mother of twins extra support. -Teaching her simple parenting skills and encouraging her to carry them out with increasing assurance will build up her confidence. -The mother may feel ‘in the way’ if her babies are in a NICU and require a lot of intensive care.

-She may have feelings of guilt because of their prematurity and feel it was something she did or did not do that caused them to be born early. She should be given the opportunity to talk her feelings through.

On the NICU she should always be kept up to date with the care and condition of her infants. Most NICUs now have a named nurse caring for each baby so parents know who to talk to. If one infant is very ill or dies, theparents will experience additional psychological problems. Some NICUs have psychologists as part of the team and parents can be referred to them.

-Most units have a rooming-in policy so mothers can stay in the hospital with their babies for two or three nights before they are transferred home, to give them a chance to take over their total care and prepare them for coping at home.

-Best practice is that twins or more should all be transferred home together from the NICU but this is not always possible. -If they go home at different intervals, greater demands are placed on the mother, as she has to care for one baby at home and still visit the sick baby in hospital. -It is advisable for a mother of twins to organize help at home for the first 3–4 weeks after transfer. -Initially, this may be in the form of her partner taking time off work.

If relations or friends have offered to help, the mother should be sure to let them know what kind of help she is expecting from them before it is needed. If the parents are fortunate enough to be able to afford paid help, then they can say exactly what it is they expect to be done. There is no statutory help available for twins or triplets in England and Wales. The community midwife will contact the mother aher transfer home from hospital to arrange visits.

The health visitor will also arrange to see the mother and her babies aher the community midwife has transferred care to the health visitor. At home the mother must be encouraged to rest and catch up on her sleep especially during the day, and eat a well-balanced diet. A good routine is the only way of coping with new babies and all mothers should be encouraged to establish one as soon as possible. It may be wise to discourage visitors in the first week at home while the mother adjusts to the new circumstances.

-Her partner should be encouraged to help as much as possible. -Isolation can be a real problem for new mothers. -The thought of gefing two babies ready to go out can be quite fearful. Studies have shown the incidence of postnatal depression to be significantly higher in mothers of twins Stress, isolation and exhaustion are all significant precipitants of depression); mothers of twins are therefore more vulnerable

11/10/2018 ANCY KURIAN , I MSc.(N)