Development of twins

1. Development of twins :

2. the mother talk about both of them together • she will be much busier • Talking to each other, the twins act as each other's role model for language (unlike the singleton baby, who has his mother). • If one child speaks a word incorrectly the twin will copy it, reinforcing the mistake.

3. ‘secret language’ of twins, 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

4. Identity and individuality • -Parents of twins should be encouraged to think of their children as individuals. • - Often parents feel a special pride in having twins and buy the same style of clothes, but in different colours. • - The distinction between twins can start in the postnatal ward with differently coloured blankets, or different small soft toys. • - As they grow up, giving them different hairstyles can make children individual.

5. -People should be encouraged to refer to the children by name, or ‘the girls’ or ‘boys’ and not ‘the twins’. • - At birthdays , separate cards and different presents help to retain individuality

6. Siblings of multiples • - Parents must be alert to the feelings of their other children and include them as much as possible in all activities with the twins. • - It can be very helpful to find a ‘special friend’ for the older child. • -It can be helpful if the parents arrange for the twins to have a present for the older child and also for the child to have a present to give to each of the twins. • -Two different small cuddly toys as the first presents the twins receive can become very special gifts.

7. Triplets and higher order births • -A woman expecting three or more babies is at risk of all the same complications as one expecting twins, but more so. • -She is more likely to have a period in hospital resting before the babies are born and they will almost certainly be born prematurely. • - Perinatal mortality rates are higher for triplets than twins and the incidence of cerebral palsy is also increased • -Triplets or more are almost always delivered by caesarean section.

8. 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. • -All mothers of triplets or more should arrange for extra help at home before the babies are born.

9. -The emotional stress and anxiety of the birth, having babies in the NNU and the worries of coping with the babies when they go home • -A mother should never be expected to manage by herself. • -Taking triplets out for a walk or any expedition can need major organization • -The midwife must ensure that the mother's health visitor and, a social worker are involved in her care. • - If the family needs extra outside help, this must be organized before the babies are born.

10. Disability and bereavement • -Perinatal mortality and long-term morbidity are both more common among multiple births. • - The perinatal mortality rate for twins is about four times that of singletons, and triplets, 12 times . • -It often feels ‘easier’ to concentrate on the survivor(s) • - people say that they are lucky because they still have one healthy child (or more). • -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.

11. - Birthdays are all reminders of the dead child. • -Where one or more of a multiple set has a disability it is often the healthy child who needs special attention

12. 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 • - carried out between the 10th and 12th week of the pregnancy. • - 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.

13. - Whichever technique is used, all embryos remain in the uterus until delivery. • -Usually the pregnancy is reduced to two embryos, but in some cases to three or even one .

14. Selective feticide • - one of the babies has a serious abnormality. • -The affected fetus is injected as described in MFPR • - Counseling 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) often many weeks later. • -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 forgotten when the mother comes back for her postnatal check and for future pregnancies.

15. Sources of help • Parents should be advised to contact organizations such as Home Start or the local colleges with nursery training courses, both of which may be able to offer assistance.

16. TAMBA (Twins and Multiple Births Association) • -This is the umbrella organization for the 150 + local twins clubs throughout the country. • -TAMBA also run the following specialist groups: Supertwins (triplets or more); Single parent group; Bereavement group; Special needs group; Health and education group; Infertility group; Adoptive parents group

17. The Multiple Births Foundation (MBF) • offers advice and support to families as soon as their multiple pregnancy is diagnosed, as well as to couples considering treatment for infertility