Multiple Birth Families

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The forgotten constituents

Prepared by Donna Launslager, Coordinator, Mapping the future project and Michelle Matte, Consultant, Canadian Institute of child health

"Sufficient unto the day is one baby. As long as you are in your right mind, don’t ever pray for twins. Twins amount to a permanent riot; and there ain’t any real difference between triplets and an insurrection"    (Mark Twain, the Babies Speech, 1879)

This funny but revealing quote from Mark Twain makes us understand how challenging having multiples can be for the growing number of families with twins, triplets or more. Yet, as a consequence of medical advances in the fields of infertility and newborn care, there has been a dramatic rise in the number of multiple birth children born1. Each year over 9,000 multiple-birth babies are born in Canada 2. Compared to single born babies, these infants are at higher risk of death and illness during the prenatal period and in the first few months as they are usually born earlier and smaller 3. In Canada, where multiple birth infants represent 1 in 40 births, multiples account for: 1 in 6 preterm births; 1 in 5 low birth-weight births; and 1 in 4 very low birth-weight births4, 5. Bryan stresses that as these children grow, they are more vulnerable to long-term health problems including developmental delays, behaviour problems, excessive dependency on each other, and rivalry. As well, their parents often experience physical, emotional and financial stress. This stress, in combination with the lack of access to special information and support, places multiple birth children and their siblings at an increased risk of child abuse and neglect 6.

Malmstrom emphasizes that these disproportionate health and psychosocial risks identify women who are expecting multiples as primary targets for efforts to reduce low birth weight and infant mortality, and to support family functioning 7.   Although Canada has one of the best health care systems in the world, multiple births are often overlooked by health care, education, and social service providers.    If the children are to develop and grow at the same rate as single born children, multiple birth families need access to health care, social services, and education which respect their differences from single born children 8.  

Multiple Births Canada has prepared this report for three main reasons: 

• To alert Canadians to the challenges faced by multiple-birth families;

• To raise awareness, among the public, service providers and decision-makers of the met and unmet needs of multiple-birth children and their families; and

• To stimulate the development of preventative health and parenting education and psycho-social services to reduce the risks associated with multiple birth.

In order to more fully understand the services needed by multiple-birth families, Multiple Births Canada (MBC) partnered with the Canadian Institute of Child Health (CICH) to carry out a series of focus groups with parents of multiple birth children ranging in age from birth to five years.    Fifty-one mothers and fathers of twins, triplets and quadruplets participated in seven focus group sessions, in four Ontario regions (north, south, east and west) between September and December 2001. A variety of parenting perspectives were elicited including those of special needs children, single parents, teen parents, francophone families, immigrant families, and bereaved parents. Financial support for this research was provided by the Ontario Trillium Foundation.

This report summarizes the findings of these structured focus group sessions. 

The focus groups revealed many challenges faced by multiple-birth children and their families. Many focus group participants echoed similar concerns and experiences as the woman quoted in the Best Start Book: Reducing the Impact 9. Specifically, barriers such as lack of food security, elevated stress levels, lack of rest, lack of transportation and other accessibility issues, social isolation and lack of support from family and social networks, lack of relevant information about available resources and services, community and structural barriers, and absence of family and community support were highlighted as key issues.

Participants identified numerous burdens associated with parenting multiples:

• Physical strains – Respite is needed during the prenatal and postnatal periods.

• Financial strains – Many multiple families are struggling with poverty. Some studies show that 14.4% of Canadian children live in poverty. Although parents of multiples assume extraordinary financial commitments, they often need to manage the household on only one salary. For example, high priced multiple birth equipment and respite services can put both middle and low income families at financial risk.

"My couple life is totally not existing. My husband has to work all the time so we have enough money."

"I had to quit working because all my money was going to pay daycare."

• Emotional strains – In particular, the stress on marital and family life because of the physical, emotional and financial commitments.

"The first 3 months, we were so tired, we were fighting a lot and didn’t appreciate the kids."

"The public [health] nurse called me to ask if she could come and weigh the babies. I started to cry. She came right away. My husband was crying on the couch, saying he couldn’t do it anymore".

• Social isolation – Because of the time restraints associated with raising multiples, many parents have a difficult time getting out of the house.

• Information and Counselling – More multiple-birth specific information and counseling are needed from preconception to childhood.

• Insufficient information on multiple issues and special needs

• Lack of counselling to help families cope (in any language)

"I wished I would have known that there were prenatal classes for parents expecting multiples. The regular classes were almost totally irrelevant."

"I had to look myself for the information I needed, I couldn’t count only on the public health nurse".

Focus group discussions also highlighted the need for more support as programs which address the singleton population have not met the unique needs of multiple pregnancy, birth, breastfeeding, infant care and respite. 

"I still don’t understand why I could not receive subsidies for breastfeeding since I was on a special diet because of my child’s allergies."

-Not enough support available for -families with triplets or more

- Not much help from government in terms of special UIC or tax credit

- Often peers or staff are misguided and not knowledgeable enough.

• Special needs (Bereavement, child with special needs, ESL parent, low-income, single, teen or immigrant parents):

- Parents are not getting enough support and information from peers and professionals.

Our focus groups revealed numerous barriers that limit access to appropriate services, including:

• Lack of transportation resources including twin strollers, car seats and/or physical assistance

• Location – Families living in northern and rural areas are often isolated from services and support

• Money - Lack of ability to pay for essentials such as clothing, equipment and housing, and services such as respite, in-home help and affordable daycare

 – Families living in rural areas or communities without a MBC chapter are often isolated from services and community support, and have difficulty making connections with other families with multiples for peer support.

• Lack of knowledge about resources such as Multiple Births Canada

- During the course of the focus groups it became apparent that the specific needs of multiple-birth families is frequently not recognized by professionals, the general public, or governments.

- Many families were not aware of Multiple Births Canada or local chapters, or have them confused.

- Health care providers often do not refer families to MBC or have a misconception about services offered by MBC and its chapters.

The following recommendations are based on ideas generated by focus group participants as ways to effectively support and educate multiple-birth families, service providers and the general public. These recommendations are organized around three major themes:

The following recommendations reflect the thinking and wishes of those individuals who participated in the focus groups. Comments made during focus group discussions confirm that no single intervention will adequately address the issue of multiple births. Just as the challenges identified were numerous and varied, so too must be the prevention strategies. 

Providing vital and timely information to multiple-birth families is essential to help them cope and make good decisions about parenting. The following essential resources would provide guidance to service providers in developing and designing information for these vulnerable families:

1. Fact sheets addressing multiple-birth issues, on paper and on web, and in many languages

2. Guidelines for professionals (multiple pregnancy, bereavement, the early years, special needs, school issues, facts about multiple births)

The following are recommendations concerning changes needed in the current service delivery systems to better support families:

1. More respite is needed for multiple-birth parents at all levels of government (e.g. public health, home care, doulas)

3. Corporate discount arrangements are needed (e.g. Wal-Mart, Zellers) to help reduce the financial burden faced by families of multiples.

4. More collaboration with community support networks (e.g. having spaces available for multiples in same day-care centre)

5. Better coordination of formal and informal supports (e.g. develop an inventory of services and supports available)

6. More referrals to community supports (e.g. parents of multiples support groups, perinatal networks, non-profits, parent resource centers, thrift stores)

In order to increase the level of understanding of multiple birth issues and needs among professionals, governments and the general public, which will ultimately improve information, services and supports available to multiple birth families, we need:

- Revenue: longer UIC (multiplied by number of multiples, prenatal rest: special UIC) and tax credits

4. Media work to heighten awareness of multiple-birth issues and needs

5. Increase memberships and get funds for subsidized memberships

As reported by the many families who shared their experiences, raising multiples can be rewarding as well as very challenging. In order to provide the best information and services for these families and their children, MBC needs the partnership and the financial support from the three levels of government: local, provincial and national. It is only through a collaborative and multi-sector approach that families of multiples will see their basic needs met and their lives fulfilled.

For more information about the Mapping the Future Project, contact Donna Launslager at Multiple Births Canada, P.O. Box 432, Wasaga Beach, Ontario, Canada L0L 2P0, Phone (705) 429-0901 Toll Free: 1-866-228-8824 Email: mtf.coordinator@multiplebirthscanada.org

2 Statistics Canada, Health Statistics Division. Births and Deaths. (1979-1999) Ottawa: Statistics Canada, Health Statistics Divison.

3 Bryan, E., Denton, J. & Hallett, F. (1997). Guidelines for Professionals. Multiple Pregnancy. Multiple Births Foundation, London, England.

(2002). The Health of Canada’s Children: A CICH Profile, 3rd Edition, Ottawa, Ontario.

5 Joseph, K.S., Kramer, M.S., Wen, S.W., Alexander, D. (1998). Determinants of Preterm Birth in Canada from 1981 through 1983 and 1992 through 1994. New England Journal of Medicine 339: 1434-39.

6 Bryan, E., & Hallett, F. (2001). Guidelines for Professionals. Twins and Triplets: The First Five Years and Beyond. Multiple Births Foundation, London, England.

7 Malmstrom, P.M (2001). The Twin Service Network: Promoting Regional Multiple Birth Resources. Twin Services Consulting, Berkely, California.

8 Council of Multiple Birth Organizations of the International Society for Twin Studies (1995). Declaration of Rights and Statement of Needs of Twins and Higher Order Multiples.

9 Best Start (2002). Reducing the Impact: Working with pregnant women who live in difficult life situations. Toronto: Best Start - Ontario’s Newborn and Early Child Development Resource Centre, Ontario Prevention Clearinghouse.

Multiple Births Canada would like to acknowledge and express gratitude to the following organizations for their contribution to Mapping the Future Project and Documents: