Starting life as a multiple
This section is only intended to provide some background information for education staff. Much more detail of the medical aspects can be found in the books by Bryan (1992) and by Keith and others (1995). Good coverage of what British parents felt from the time of diagnosis until the babies came home is given by Jane Spillman in Sandbank (1999).
Being told you are expecting twins or especially higher multiples is stressful and is not always handled well by the staff, especially if they are in rural regions where they encounter few multiples in their practice. Comments like “I’m glad it is you and not me” are not the best introduction to life with multiples.
As regards the school, there are two main issues:
(i) disruption to the homelife and therefore the schooling of older siblings. Although not used with mothers of twins e the schooling of older siblings. Although not used with mothers of twins unless there are complications, many mothers of triplets and especially quads or more will be hospitalized for bedrest, in some cases for several months. Imagine what this must be like for a young child, just starting school. Other kids mums are having kids, but they are not lying in the hospital for so long unable to participate in all the things young children need and enjoy. It is particularly significant in rural and remote regions of Australia where the mother may have to be in a hospital with high levels of neonatal services, a long way from the family. The “Three, Four or More” study showed 21% of prospective mothers of twins had two antenatal admissions to hospital and 27% of mothers of triplets, though their stays tended to be longer.
(ii) apart from the questions around preterm birth discussed below, other issues can complicate the pregnancy and perhaps lead to the decision for early delivery. A threatened miscarriage is one and the other is pre-eclampsia (toxemia), the rise on blood pressure and the fluid retention that is common in mothers of multiples, particularly higher order multiples especially if this is their first pregnancy.
There are many issues surrounding medical management of the delivery of multiples such as the rates of Caesarian section and access by the parents to the babies in intensive care. Among the issues that the school needs to consider are:
(i) differences between the multiples associated with birth order or birthweight. Almost every family is asked “Who was the firstborn?” or “Who was heavier at birth?”, but very few parents ask in turn “Why do you want to know?”. There is little doubt that in the past, there were more problems in the second-born, but changes in medical management have changed this. Yet our studies in Australia have shown many families regard their firstborn as “better”, especially if the children are MZ and irrespective of any differences in health-related problems. It as if parents need to identify differences between their multiples and can latch onto minimal differences.
Throughout subsequent sections, the role of such small differences in the comparison and stereotyping of twins throughout childhood and adolescence is emphasized.
As a parent, if you feel the teacher should know who is first-born
AS a teacher if you feel you should ask,
Think about why such information may or may not matter
“Is not telling a solution? One mother we knew would not even tell the children which of them was first-born with the result it became more of an issue than it should have been”.
(ii) one more serious question is the order in which the children come home from the hospital. In the 1970s there was a well-meaning attitude especially a lot of twins then were not diagnosed till the birth of taking one home and used to the baby and then the other one can come. It was recognized that such practices could affect bonding with the second one and they have stopped. But of course there are many situations where there are differences in health status and so one can be ready well before the other(s) to come home. Parents say it is so hard
“Trying to get over the Caesarian while caring for one at home, trying to express milk for the other two, one in the special care nursery and the other still in intensive care, worrying about them and keeping in contact with the medical staff and trying to juggle time between home and hospital. No one told me it was going to be this hard”.
No wonder in such a situation, different patterns of parent-multiple attachment can develop and continue well into school. Does the parent bond more with the one who comes home first or more with the “battler”, the one who has to fight hardest to make it? In the latter case, are behavioral or school problems for the “battler” always and not necessarily correctly attributed to their difficult start?
“What do you expect of him? He had such a hard start to life?”
THIS IS SOMETHING THE SCHOOL NEEDS TO BE AWARE OF!
Pregnancy with twins lasts on average only about 37 weeks and the children are generally 1000 grams lighter than single born. Some, unfortunately, are born much more prematurely and much lighter than this, especially if higher multiples. So while in the “Three, Four or More” study, 62% of twins were born at 36 weeks or more, only in 12% of triplets and 7% of quadruplets or more did the pregnancy last this long. Similarly, 6% of singletons are less than 2500 grams, 50% of twins, over 90% of triplets and almost all of singletons are less than 2500grams, 50% of twins, over 90% of triplets and almost all the even higher multiples. It may take into the school years for multiples to catch-up in size with their peers and this needs to be considered in planning their activities at preschool.
The Special Needs section deals with some of the longterm consequences of preterm birth for multiples. Sadly not all multiples will survive and the subsection on Loss introduces how that the school may have to help support the surviving multiple(s).
What would you do?
“The policy in our education area is that all children start school in the year they turn five. Not only would my triplets be among the youngest in the class, but they were also born at 29 weeks. Thankfully they do not have any disability, but they are still small and they are still catching-up in their language and motor development. The preschool says they cannot stay there any longer-especially as they take-up three places! Neither the preschool nor the school seems to listen when I say that if they had been born when they should have been, they would not be five till the next year. I feel I’m being treated like some neurotic mum, who does not want to let go of her babies, so they can start at school.”
What advice would you give this family?
References: See here