“What about us?” Considering the experiences of multiple birth families on international twins day

4th August 2023

In support of Twins Day, taking place this weekend, we are delighted to share this Voices blog by Dr. Laura Maguire, Senior Lecturer in Post-Qualifying Healthcare Practice and Course Leader: Specialist Community Public Health Nursing (Health Visiting and School Nursing) at Birmingham City University. Laura shares an overview of the unique experiences of parents of twins and higher multiples, with some helpful tips and resources to support health visiting practice and ensure families receive high quality care and support.

Parenting twins and higher order multiples (triplets and more) is a unique familial experience accompanied by specific challenges. Health visitors have an essential role to play in supporting families to navigate the different aspects of raising two or more children simultaneously and therefore make a valuable contribution to improving health outcomes for multiple birth families. This Voices blog provides an overview of their unique experiences with some helpful tips and resources to support health visiting practice and ensure families receive high quality care and support.

Globally the number of families with twins or higher order multiples has increased. This is due, in part, to a rise in medically-assisted reproduction, delayed childbearing, and advances in obstetric and neonatal care. In England and Wales, multiple births account for 13.7 in every 1,000 births and are associated with increased complications for women, birthing people, and their babies. The good news is that most multiple pregnancies will be uneventful and result in healthy babies.

Throughout human history multiple births have been a source of fascination and wonder, with a day dedicated annually to celebrate the uniqueness of twins and higher order multiples. National Twins Day is recognised internationally on the first weekend in August. The largest global celebration is undoubtedly the annual ‘Twins Days’ festival located in Twinsberg, Ohio, USA, where thousands of twins and higher order multiples, their families and researchers come together to share multiples-related experience and information. Twins and higher order multiples generate both considerable public attention and research interest but often this population of families is overlooked in terms of the support they receive.

Potential impacts of a multiple birth to families

Expecting and parenting multiples can be a worrying time for many parents, as there may be added risks that require additional support and care. NICE guidance states that multiples are more likely to be born preterm, be of low birth weight, and experience feeding difficulties. In addition, the most recent MBRRACE-UK 2022 report reveals that twins experienced over twice the risk of stillbirth and three times the risk of neonatal death, compared to singletons.

Also, multiple birth babies are:

• more likely to be admitted to a neonatal unit – having potential to affect bonding, attachment and mental health of parents,
• up to six times more likely to have cerebral palsy,
• and face developmental challenges during early childhood.

Whilst having a child with a disability or developmental delay will be experienced differently by parents – and it is important not to presume how someone might feel about this – having more than one baby/child to care for at the same time, whilst managing their additional needs, can increase the stress of parenting.

Parents of multiples are also at higher risk of perinatal illness, greater sleep deprivation, higher financial burden, and social isolation, particularly in  the first 3 years. All these factors can make parenting even harder. Despite this, multiple birth families don’t always receive the support they want and need, and cite some barriers when attempting to access services. Such barriers include feeling the service did not meet their needs as a multiple birth family, or that professionals did not understand them, and also practical challenges such as being able to leave the house with multiples.

Providing support to multiple birth families

A theme to emerge from my doctoral research, which explored the experiences of multiple birth families during the first five years¹, is that parents of multiples had a clear sense of their differing experiences as a multiple birth family and that interactions with knowledgeable and supportive professionals, including health visitors, were highly valued.

“She [health visitor] was absolutely brilliant…she created a safe space for me to be able to say exactly how things were having twins”
Parent of 2-year-old twins

Parents wanted practitioners, including health visitors, to:

• be sensitive to their potential higher support needs
• identify how services can improve the care and support offered to multiple birth families
• provide consistent and evidence-based information
• and to signpost to other services and specialist support where needed

There remains a substantial amount of work to be done to improve the care and support that the multiple birth community receives. Health visitors are uniquely positioned to be able to contribute to such improvements and recognise the unique familial experience of parenting multiples.

The updated SCPHN NMC standards state that health visitors must apply an evidence-based approach to their practice and propose new and innovative ideas to improve the health and wellbeing of children and families . Embedding good clinical practice when supporting families with twins and higher order multiples is therefore imperative.

As thousands of twins and higher order multiples gather this weekend to connect, celebrate, and share information and research about multiples, as health professionals can you take a moment to reflect on what contributions you can make to improving health outcomes for multiple birth families? Or how you can increase your understandings of the needs of multiple birth families, so that your practice develops in a way that serves multiple birth families better?

Some further resources for health visitors supporting multiple birth families:

• The Elizabeth Bryan Multiple Births Centre was established in 2017 as a collaboration between Birmingham City University and the Multiple Birth Foundation. A particular aim of the Centre is to develop an evidence base to support the provision of care and support offered to multiple birth families across the life course. The Centre has an established Specialist Interest Group for health and allied professionals who support multiple birth families, you can sign up here. In addition, an online CPD module has been developed focusing on care and support from conception to one year.
• Twins Trust is an organisation which supports multiple birth families, but also has a wide range of resources to support healthcare professionals.
• Future Learn: Loss of a Baby in Multiple Pregnancy: Supporting Grieving Parents – an online course by The Butterfly Project provides guidance on how to provide bereavement support.

Dr. Laura Maguire | Senior Lecturer in Post-Qualifying Healthcare Practice | Course Leader: Specialist Community Public Health Nursing (Health Visiting and School Nursing) | Faculty of Health, Education, and Life Sciences | Birmingham City University

1.Maguire, L. (2021) Displaying Multiple Birth Family: an exploration of how first-time parents negotiate the realities of multiple birth family during the first five years
[unpublished thesis] Birmingham City University