One in every 100 pregnancies is a multiple birth pregnancy. Usually it is twins, sometimes triplets. The number of multiple births has increased considerably over the last few years. That is partly a result of the fact that women become mothers later on in life. The chance of double ovulation increases with age. Another explanation is the fertility treatments that are available. These also increase the likelihood of multiple births.
The probability of a preterm birth is greater than with a singleton pregnancy: between 55 and 60% of multiple births are premature. In singleton pregnancies this is 5.5-6%. A low birth weight also occurs more often: more than half of the multiple births have a birth weight of less than 2500 grams. In singleton births, this is 4-5%.
- Twin-to-twin transfusion syndrome: A special situation that may occur in a multiple birth pregnancy is the twin-to-twin transfusion syndrome. This occurs in twins who share the same placenta and where there are connections in the placenta between the blood vessels of both children. Those vessel connections allow blood to go from one child to the other. When the blood is pumped back again, it is in balance and there is no danger. But when the recipient child does not pump blood back or only a small amount, the other child (donor) will receive too little blood. This situation is dangerous for both the children. It is possible to treat this syndrome during the pregnancy.
- Different care needs: A doubly worrying time follows a multiple birth. Often the two (or more) children need different treatment and care. Although hospitals try to avoid it, it may turn out that for the best possible care they have to be separated and even be sent to different hospitals. Sometimes one of them goes home sooner than the other. In all of these situations, parents can feel overwhelmed by all sorts of emotions and also have to make many complicated decisions. Who do you need to be with the most and when? Are you strong enough yet to go back and forth between different hospitals to be with your children as much as possible?
- Extra tiring: Multiple birth parents regularly indicate that for them it is also more difficult to get attached to one or the other. For instance, your attention is focused on the weakest of the two. Or the child who is home already demands all your care and attention (also at night), which leads you to becoming exhausted. In any case, the arrival of premature twins or multiple babies means an extra tiring period. Even when the children are home, this requires extra energy and may lead to more sleep deprivation. Consult the doctors and nurses about what care and feeding you can and cannot handle at home; this can be taken into consideration. It is important to indicate that your personal circumstances have to be taken into consideration, especially if you were ill during the pregnancy or if you are a single parent with a smaller help network.
Babies need a lot of physical contact. Carrying your baby in a sling or ergonomic baby carrier is a practical and pleasant way to strengthen the bond between you and your baby. Carrying brings about more interaction between you and your baby and through that helps bonding; by being close you get to learn and understand your baby’s signals better.
Full-term babies, as well as premature babies receive vaccinations. These are the vaccinations offered to all Zambian children as per the national guidelines. There are important diseases that can be prevented by vaccinations. The first vaccination given is the OPV (0) and BCG vaccine at 0-13 days after birth, however for premature babies BCG vaccine is deferred till discharge from the hospital. All other vaccinations starting at 6 weeks chronological age are given as per the vaccination schedule.
Around the age of 6 weeks receive OPV 1, RV 1, DPT/Hib 1, HepB 1 and PCV 1. Four weeks later, at 10 weeks of age OPV 2, DPT-HepB-Hib 2 and RV 2 are administered. After 4 weeks, at 14 weeks of age, OPV 2, DPT-HepB-Hib 3 and PCV 2 are given. Following this the next vaccination is at 9 months which includes Measles 1 and Rubella, PCV 3 and OPV 4(If OPV 0 was missed). At 18 months, Measles 2 and DPT are administered.
It can be hard when your baby is taken into the department of neonatology. In addition to the many emotions that it brings, some practical questions come up too. How do I arrange it with my work? Do the same rules for a leave of absence apply to both my partner and me? Will I get maternity leave? In most situations you can have regular consultations with a medical social worker. Practical matters like leave of absence will be discussed. If your baby is in hospital for a longer period and you and/or your partner have a job, then maybe you will have questions about the possibility of taking a leave of absence. Maybe you will wonder what the best way to discuss your situation with your employer is. Or you might wonder if you are entitled to a leave of absence when your baby is in hospital. It is important that your employer knows about your situation. Tell your employer by phone or in person that your baby is being treated in hospital and what the consequences are for your work. When your employer is aware of your situation, you can discuss the following possibilities for leave with him/her:
- Calamity leave.
- Short leave of absence.
- Short-term care leave.
- Long-term care leave.
- Maternity/paternity leave.
It is also possible that you do not feel able to work because of your child’s situation. For instance, because of physical or mental complaints. If this is the case, you can call in ill. Tell your GP about it. Your employer can ask you to phone the occupational physician or you might automatically receive an invitation for a consultation with the occupational physician. If you want to get in touch with the occupational physician yourself, you can request that. The occupational physician will tell your employer about the consultation. The employer can ask for a medical declaration for your baby. You can ask your doctor yourself for this medical declaration. If, after all these steps, you still have questions or need mediation between you and the employer and/or company doctor, you can discuss this with the medical social work service.
During your maternity leave you will receive maternity leave. How long your maternity leave will last and how much the benefit will be depends on the legislation and your own personal situation. Normally you are entitled to 16 weeks leave. You can find more information on this on the website of the Employee Insurance Agency. If you are employed, you can apply for maternity leave via the Work and Care Act (WAZO) if after birth your baby has to stay in hospital for longer than one week. You can download the form to apply for this benefit on the Employee Insurance Agency (UWV) website. You will need a declaration from the hospital to do so. A medical social worker can help you with this. Here you will find other criteria you need to meet in order to apply to receive this benefit. If you are self-employed, then you might be eligible for Self-Employed Regulations.
Apart from registering the birth at the city council, you have to report your baby’s birth to your health insurance company, if you have it, also to your life insurance company. You can check with your health insurance company if you have extra insurance and have a right to incubator aftercare. Contact the medical staff for assistance with signing up for the National Health Insurance Management Authority scheme.
The law states that births should be registered within one month following birth, but a registration is considered late only after 12 months. Parents can initiate birth registration at the health facility where the child was born (if the facility provides such services) or at the DNRPC office in their district. As a first step in the registration process, parent(s) or guardian(s) must present their National Registration Card. After the applicants have been identified, registration agents at health facilities complete the Notice of Birth, to which they attach a document issued by the maternity ward. Registration agents at health facilities complete the Notice of Birth; these are transferred regularly to the DNRPC office in the appropriate district. Based on the notification of birth from health facilities, the district registrar enters a new registration record into the birth registration book.
- Who has to register the birth?
- The father or duo-mother should register the birth. What if the father or duo-mother is not able to do so? Then the registration must be done by someone else who was present at the birth. What if there was no one else there? The registration can also be completed by: someone resident in the house where the baby was born.
- Head of the institution (for example, the hospital).
- What do you need?
- Your baby’s birth names
- Date and time of birth; your own valid ID- National Registration Card
- Declaration of birth by the hospital or the midwife
- If applicable, a copy of the certificate of legal recognition of an unborn baby (you received this copy at recognition)
- Your marriage or partnership booklet, if you wish the municipality to register your baby in it
- A proof of registration stating your marital status, if you live abroad.
The legal recognition of a baby usually means the following:
- A legal bond is formed between you and your baby (family legal relationship).
- You have to look after your baby (care obligation) until he turns 18 years of age.
- You and your baby become each other’s lawful heirs.
- You choose (together with the partner) your baby’s surname at the moment of legal recognition.
- Your baby will probably get your nationality. This depends on your nationality and the law in that country.
Parental authority for a child means the following:
- Raising and looking after the child.
- Paying for upbringing and care.
- Official acts on behalf of the child.
- Liability for damages.
- Managing the child’s assets.
Child Health Care (CHC) is there to promote health and a safe growing up for all children in the Netherlands. This is also for premature, SGA and ill children. Together with the parents, the CHC will follow your child’s growth and development from the pregnancy till the age of 19. Your child will receive vaccinations according to the Dutch vaccination programme at the CHC, as well as screening, such as hearing and eye tests. During the consultations at the CHC, the development of gross and fine motor skills, mental development, speech, language and emotional development are all examined. How you are doing as a family is also discussed. The CHC has prevention as a starting point. This means that they aim to prevent problems from developing or help is given as early as possible to prevent things from getting worse. If needed, CHC can lead to care.
- Joint follow-up outpatient clinic and Child Health Care: In some hospitals the CHC consultation hours are combined with those of the paediatrician. In this way you do not have to go to appointments as often and there is close cooperation between the CHC and the Paediatric department. If there is no such joint consultation hour in your case, then you can – in addition to the appointments at the hospital – just go to the Child Health Care appointments.
In complex and/or multiple developmental problems, the paediatrician will involve professionals with the right expertise.
A frequently asked question is when can premature, SGA or ill children go to daycare. There is no general, simple answer to this question. Of course, it strongly depends on the medical history. Did your child have serious (lung) problems? Does he need special care or treatment now?
You can discuss this with the paediatrician; there are also things you can take into consideration yourself.
Do you have alternative possibilities? For instance, grandparents, nanny, for other people around you?
Every year on 17 November, we raise awareness for the huge impact a premature birth has on parents and families: World Prematurity Day.
Probably everybody around you is doing their best to imagine your situation, and to support you. But sometimes it can be nice to talk to others who have been through the same as you. For example, you could find understanding and recognition among parents whose child was also in hospital after the birth.
In addition, you can get in touch with other parents via social media.
If you need any help processing your emotions, do not hesitate to consult the doctor or nurse.
For many, the journey through a neonatal unit can be overwhelming and stressful. The unit staff are always here to support you and answer any questions you and your family may have.
The following list of charities can provide further support and information on various topics. Some of the charities also have parent groups and networks that can connect you with others who have gone through similar experiences to yourself. We have found that some families contact other support networks from early on, while others contact them later in their journey when things have settled. Others wait until they have gone home and are looking back on their experiences and find that they would like further support. Each family is different, and the support is there no matter where you are in your journey.
Sites on breastfeeding
The weeks fly by and before you know it you are expected back at work. Find more about after birth leave right (mother and partner) here:
Disclaimer
Welcome to the RISEinFAMILY website! We hope that this website will give you the information you are looking for.
For readability in the website sometimes “he” is used when it is about the child. Of course, it can be the other sex too. In addition, the mother is could be addressed more often than the father in the text. Please understand that the information is meant for all types of carers and parents. When we write about parent(s) or the mother and father, also two fathers, two mothers, single parents, foster parents and other carers are meant.
