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  • Octuplets and Other Babies
  • What's the Matter With Multiple Births?

  •   MORE STRESS ON MOMS: When babies come in twos or threes, the pressure more than doubles.

    Beth Fidotne with her twins Beth Fidoten, with her 3-year-old twins, Jacob and Annie. (The Post)
    By Randi Hutter-Epstein
    Tuesday, February 23, 1999; Page Z12

    It is eight o'clock on a warm evening in late winter. About 15 women are sitting in a circle on the floor of a community room on the Upper East side in Manhattan. They seem tired. They look stressed. Some are in jeans and sweat shirts. Others are fresh from the office.

    One by one they say their names, ages of children and work status. It feels like an Alcoholics Anonymous meeting. These women, in their thirties and forties, do not suffer from a medical illness. Yet they gather once a month--much the way hundreds of other women nationwide do--because they share one thing in common: They are mothers of twins. Many of these mothers used fertility drugs. Others had their twins the old-fashioned way.

    Across the nation, indeed across the globe, mothers of multiples are reaching out for camaraderie, not to mention secondhand baby equipment. Sometimes they meet in cyberspace, sharing virtual coffee or cocktails. (They type symbols that look like mugs or martini glasses.) Sometimes they meet in real life, sharing real bottles of wine or pizzas. Wherever or however, the intention is the same: to provide mothers of multiples a place to share the emotional, practical and medical aspects of raising litters of children.

    All mothers from time to time feel drained from sleep deprivation and guilty that they are not the perfect parent, or stressed from trying to balance work with raising a family. But mothers of multiples believe their situation is more than multiplied by two. Recent studies lend credibility to that impression. Twin pregnancies are more stressful on the body compared with a single pregnancy because of the physical weight of twins as well as greater hormonal fluctuations.

    Beth Fidotne with her twins The writer, Randi Hutter-Epstein, with her twins and their older brother. (The Post)
    What's more, raising twins creates dilemmas for a family. When, for example, and how often should multiples be separated from each other? Rivalry among twins can also be more intense than among singletons. These issues can become so divisive for a family, some experts suggest that women considering fertility drugs receive counseling on the emotional impact of multiples. While the financial impact of the fertility treatment--which can run upwards of thousands of dollars--is well known, the psychological consequences for parents and the children is often overlooked.

    "When it's a total meltdown and I need to talk to a friend, I'd call a twin friend [mother of twin] first. We understand each other, we tend to let each other off the hook," said Karyl Casiero, the former president of the Brooklyn Mothers of Twins club.

    Personal Experience


    I must confess my own bias. I am an MMOT, a Manhattan Mother of Twins. Martha and Joseph were born in June 1996, joining their 2 1/2-year-old brother Jack, and golden retriever, Charlie.

    In the beginning I wasn't sure what the fuss was about. Sure, having two babies at the same time is more complicated than one at a time, particularly when it comes to nursing and bath time. Still, I know a lot of exhausted, guilt-ridden mothers of singletons.

    I soon found out about multiple stress. By the time the twins were 8 months, I had bonded with other mothers of multiples. I was never a regular at meetings, but had lots of heart-to-heart telephone conversations with members. Here in New York, I can stroll down Broadway and see plenty of mothers of twins. We smile at each other the way gang members or Porsche owners must share glances. We're in the same club. But our gestures mean: "I understand your fatigue, I know what your day is like." We share intimate details about breast-feeding and labor pains. I've even hugged another MMOT I barely know.

    What's going on here? Do twins--or rather, their moms--really have special needs? Are we just needier people? Have our hormones gone so far out of whack we will reach out to anyone willing to provide a morsel of positive feedback?

    Psychologists say all mothers could benefit from a psychological boost now and then, but mothers of multiples do experience more stress and fatigue. They say that mothers of twins are more prone to feelings of inadequacy, isolation and guilt compared with mothers of singletons.

    "All mothers have an unconscious desire to be the perfect mother to the perfect child, but with twins this is nearly impossible. That is why I do see a special need for support, particularly during infancy when you feel that neither child gets the attention you wish you could provide. You cannot get immersed in that blissful bond," said Leslie Deutch, a New York-based psychoanalyst who has written extensively about twins and is the mother of twin 6-year-old boys.

    Now that my twins are nearly 3-years-old, I realize how exhausted and cranky I was during that first year. The hardest part was feeling housebound. My first son was born in London. We'd put him in a snuggly and go wherever, whenever. My twins rarely leave the Upper West Side of Manhattan.

    For me, life changed dramatically when my babies became toddlers. Two babies at the same time was physically and emotionally draining. I remember one night--about 2 a.m.--when Joseph awoke without waking his sister, a rare occasion. I cherished the moment to give my newborn twin the alone time I thought he desperately needed. I fell asleep on the couch cuddling my son.

    Two toddlers at the same time is also more than double the fun. I can watch Martha and Joseph talking and negotiating with each other all day long. Plus, I've gotten used to thinking double--I plan on at least 40 minutes to get them out the door.

    Multiple Stresses


    Mothers of twins are more likely to suffer from postnatal blues, according to a study of 12,712 mothers published in the British Medical Journal in April 1991. Karen Thorpe, a psychologist at the University of Bristol in England, found that 34 percent of mothers of twins showed a tendency toward depression. Only 23 percent of mothers with children more than two years apart scored high on the depression scale. In cases of closely spaced children (less than two years apart), 29 percent of mothers had scores indicating the possibility of depression.

    Thorpe believes the stress starts in pregnancy because carrying multiple fetuses is by definition a high-risk pregnancy.

    "A human body is not meant to carry more than one fetus at a time, and it's double the hormones," said Janelle Yuska, of Albuquerque, N.M., mother of identical twin 9-year-old girls. "I used to tell my husband I can't even finish a thought. We call it post-twin syndrome. The club became vital for me," she added. "When the twins were six months we lived in an isolated area of Utah and there was not a club there. I felt so alone. I know what it's like to be without support."

    A four-year-study of 11 mothers of triplets--they had used fertility drugs--found that all the mothers suffered extreme fatigue and stress throughout the study period. Four mothers expressed regrets about having triplets. "Because most infertile patients desperately struggling for a biological child are unaware of and unrealistic about what the 'cost' of a triplet pregnancy is, parents undergoing treatment should have adequate information and counseling," concluded Micheline Garel, one of the investigators at INSERM, an institute for health and medical research in Villejuif, France. The study was published in the June 6 issue of "Fertility and Sterility."

    Janet Beryl, founder of the Triplets Connection, said women who have had triplets after fertility treatment have that added burden of guilt because the pregnancy is a medical risk to both the mother and fetuses. "They think, 'Oh my God, did I do the right thing? Did I cause this [the added health problems]?' " said Beryl, the mother of identical triplet 16-year-old boys, who were conceived without drugs.

    Multiples Boom


    Meanwhile, multiples have prompted a growing self-help industry. There is a National Mothers of Twins Club (NMOTC) with chapters in most states. Hundreds of women are expected at the 39th annual convention of the NMOTC convention in St. Louis this July for talks on child development, stress management and plenty of time for mother-of-multiples bonding with dinners, drinks and touring.

    There is a Web site and biweekly computer chats for parents of multiples. There are magazines dedicated to twins and several newsletters.

    "The Internet is my lifeline," said Joni Winfandale, 33, from Annville, Pa., about 25 miles outside of Hershey. Winfandale has children aged 13, 11, 6 and 3 1/2-year-old twins. She corresponds with 22 other parents (one father among 21 women). "Oh my gosh, it's a wonderful network of people who live your life, who understand the joys and frustrations that most people without multiples can't relate to."

    Roxanne O'Brien with her twins Roxanne O'Brien with her three-year-old twins Conor, left, and Aidan. (The Post)
    There are lunches and meetings and retreats. Beth Fidoten, an advertising executive and mother of 3-year-old twins in New York, attended a luncheon for parents of twins in media and ad sales. "Informally, someone got a job through the network," she said.

    New Yorker Roxanne O'Brien, mother of 3 1/2-year-old identical twin boys and a 6-year-old boy, goes on an annual moms-only retreat with mothers of multiples she met online. "We have an e-mail loop with mothers of twins throughout the country and last year four of us met in Connecticut. We gabbed, drank pots of coffee and shared photos of the kids. This year we're going to New Orleans."

    There are even clinics that specialize in multiples. In England, Elizabeth Bryan, a pediatrician, restricts her practice to twins, triplets, quadruplets and up. Bryan launched the first medical clinic dedicated to multiples. Now there are similar clinics in Sweden, France and Japan.

    "Studies show that it [having multiples] does seem to be more stressful. I think it's the emotional stress of having to relate to several children at the same time and a lot of mothers end up with more children than they planned for," said Bryan, of Queen Charlotte's and Chelsea Hospital in London.

    The boom in multiple births is fueled, in part, by fertility drugs that spur several eggs per monthly menstrual cycle rather than the normal one egg per month. Twinhood is no longer a rarity, with births of twins climbing 37 percent from 1980 to 1996, according to the most recent statistics of the Centers for Disease Control and Prevention (CDC) in Atlanta. Triplet births soared 344 percent in the same time period.

    Development Issues


    Deutch, the psychoanalyst, said mothers of multiples "can feel very inadequate as mothers. They experience terrible, disabling guilt. You have two babies going through the same developmental periods at the same time, needing the same kind of attention and hugs precisely at the same time."

    For instance, she added, if you are nursing both babies, "perhaps one baby is capturing your attention and the other is searching for your face and can't make eye contact with you. You can't turn away from that baby, and yet you have that wrenching feeling knowing the other baby is longing for your gaze.

    "You have a feeling that you'll never have enough to give even if you give every ounce of strength and you feel drained."

    The stresses are compounded because multiples are often born prematurely, with accompanying medical problems, she noted. According to the CDC, twins account for only 2 percent of all births, but 17 percent of low-birth weight babies and 12 percent of infant deaths.

    Susan Meadvin, CSW, a Manhattan therapist and twins specialist, explained that the special needs start in pregnancy because it is high-risk. "Immediately after birth, the world says 'this is hard,' and you don't get a lot of positive support," she said. "In New York, many twin mothers are older and had been on fertility drugs, so there is already a feeling of 'differentness.' "

    Mothers of multiples may also take more time to recover from the birth. "There is also the issue of body image, there is more weight gain, more discomfort, and the body doesn't go back so quickly," said Meadvin.

    "Twins may be scrawnier than the average child, so they may not meet your expectations of what a child should be like," she added. "The cost of two babies is astronomical. Mothers may feel anxious that they are not giving enough or do not have enough to give."

    During infancy and toddler years, twins groups tend to focus on the mothers' needs, Meadvin said. As children enter school, the clubs shift to the needs of the children. One key issue is when to separate multiples and under what circumstances. Experts in child development note that siblings have to establish their individual identity in a family. Twins and triplets have a much harder time setting their boundaries, in part because parents and caregivers often treat multiples as one, and partly because many multiples, particularly identical twins, treat themselves as a single unit. But from the beginning, or by the age of 1, twins should spend time alone so they can start to develop different interests and opinions. Educators usually allow twins to stay together in the nursery school years, but encourage separation by kindergarten.

    Elizabeth Bryan, the British pediatrician, wants prospective parents to know that there is a complex culture surrounding the phenomenon of multiple births. She presents monthly slide shows, full of trivia, advice and biology. She mentions famous twins of literature from Tweedledum and Tweedledee in "Alice in Wonderland" to Shakespeare's twins in the "Comedy of Errors."

    Bryan talks about an African tribe that believed twins have innate mystical powers and worshiped them--and another tribe that believed twins are possessed by the devil and killed them.

    Psychologically, she points out, multiples have their own timetable of development. It's crucial, she said, to talk to toddlers individually and make eye contact to promote language development, often delayed in twins and triplets.

    Support Network


    Many mothers taking care of multiples say what they need are friends who understand them. New York Lauren Fishbach, 33, is a mother of twin 2 1/2-year-olds and a twin herself. "Every Friday night, I logged into the AOL (America Online) chat group for mothers of twins," said Fishbach. "My kids were preemies, 6 1/2 weeks early. They were so very, very tiny. I never went out. I felt like I was on my own. When you are not getting out and there is no one to talk to, it felt like someone was there. Instant friends."

    But Fishbach's mother, who has four children including Lauren and her twin sister, never bothered with clubs. "It was different then," said Fishbach. "My mother and all of her friends were in their early twenties and having kids at the same time. There was instant camaraderie."

    Today, many mothers are well beyond their twenties. They often work and have careers. Long-term friends may be at different parenting stages or they may not be parents at all. Motherhood kinship seems to be thinning. Even if there is playground time, family and work schedules are not always in sync.

    As a result, mothers of twins, in increasing numbers, are searching for new friends to offer support. Indeed, membership in the national twins club ballooned from 8,000 12 years ago to more than 21,000 today.

    These clubs are not for everyone. Patricia Cafferty, a Briton who lived a few years in Manhattan with her twin toddlers and 6-year-old daughter, said, "I thought it was such an American thing--all this touchy-feely stuff seemed too obsessive." Still, Cafferty conceded that she likes the practical aspects of a support group to get the lists for child care services and equipment.

    Other women said they are too tired to go to the meetings. Personally, when I have a free night, I'd rather go to a movie or a restaurant than to a meeting about twins. But I love knowing I have this support system of caring women out there for me and I enjoy my phone conversations, sharing advice with new mothers of twins.

    In fact, there has been so much interest in Manhattan, our club has breakaway groups, with separate meetings for mothers of twins over 18 months; a group for downtown mothers; and even a nanny-of-twins group.

    At the meetings, mothers share a wide range of ideas about dealing with newborns, from the logistics of bathing two babies at once to recommendations for cheap weekend ventures. Sometimes, there's a memorable tip: Liz Starr, mother of 7-year-old boys, said "when my boys were younger and needed a place to bounce around and get out of the stroller, I'd take them to Jennifer Convertibles. You tell them you're looking at couches and let them bounce around a few minutes."

    Mothers also fill out "mentoring cards"--mothers with particular twins experiences willing to help others in similar situations.

    Susan Lippert-Kasarsky said she would be willing to speak with mothers whose babies require surgery--one of her twins had open-heart surgery. Carrie Nichols said she knows how to wade through the red tape of the public education system to find programs for children with special needs. Other mothers said they would be available to talk about breast-feeding twins.

    O'Brien, who leads the mothers of toddler twins groups, said she's on the Internet every Monday evening from 8 to 10. "We call ourselves loopies because we're in the loop." They send each other one-liners that range from amusing anecdotes about the twins to serious issues about marital or family strife. They also share medical advice.

    "For some people the e-mail becomes an obsession. They're reading their correspondence from twin mothers every day," O'Brien said.

    Adds Deutch: "Mothers of twins are hungry and that's were the irritability comes from. There's a hunger to be restored; marriages take a beating. I think mothers of twins take a beating. They are depleted. And meetings are something like mass feedings. Everyone gets a smidgen."

    RESOURCES:


    National Mothers of Twins Club: 1-800-243-2276, http://www.nomotc.org/ Mothers of Supertwins-triplets, quadruplets, and more:209-474-0885; fax 209-474-2233; http://www.mostonline.org/


    © Copyright 1998 The Washington Post Company

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