Making It Through the Postpartum Period as a Parent of Twins or Triplets

Contributors: Lucy Graves, MSN, NP, CBS, is a registered nurse at the Comprehensive Care Center for Multiples at Brigham and Women's Hospital. Marysabel Gomez, MSW, LCSW, is a social worker at the center.

Just as a multiple pregnancy and delivery creates unique challenges for parents, so too does the postpartum period (the time following childbirth). But you and your family don't have to go it alone.

The Comprehensive Care Center for Multiples is available to continue care after your delivery at the Brigham to help your family adjust to life with twins, triplets or higher-order multiples. Our social worker, Marysabel Gomez, takes the lead in addressing any concerns that may arise, calling on the expertise of her colleagues based on your needs.

Gomez and Lucy Graves, a registered nurse in the center, recently shared their thoughts on the challenges that parents of multiple newborns commonly face — and how the Center for Multiples can help. Carla Borges, who delivered twin girls at the Brigham in January 2021, also discussed her first-hand experience.

Baby Blues and Postpartum Depression

Due to hormonal fluctuations and changes in nutrition, exercise and sleep, pregnancy can worsen pre-existing mental health conditions and even cause new symptoms. A multiple pregnancy may cause additional stress, making problems like anxiety and depression even more likely. One survey of more than two dozen studies found that compared with parents of singletons, "parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress" during pregnancy and through early parenthood.

"Baby blues," a feeling of sadness, moodiness and anxiety, usually occurs within a couple days of giving birth and lasts about 2 weeks. These feelings generally go away on their own.

"For 2 or 3 weeks, I was crying every night," Borges recalls. "It was hard to feel happy and connected to the girls. It helped that Dr. [Carolina] Bibbo [a maternal-fetal medicine specialist at the Center for Multiples] hosted an online forum for new moms to go over how we were doing. It gave me hope. And after a few weeks, the fog lifted and I felt more like myself."

Postpartum depression is a more serious matter. It's a medical condition marked by a more intense version of symptoms associated with baby blues as well as symptoms like:

  • Excessive crying
  • Feelings of hopelessness
  • Eating too little or too much
  • Sleeping too little or too much
  • Difficulty bonding with your newborns
  • Restlessness
  • An inability to care for yourself

Symptoms of postpartum depression may emerge in one or both partners a few weeks or up to 1 year after giving birth. The good news? By recognizing the warning signs — and getting the condition diagnosed and treated early on — you can reduce or even eliminate the symptoms and focus on caring for your babies and yourself.

"Having two or more babies exacerbates the stress that parents may feel, " Gomez says. "And many twins or triplets start out in the neonatal intensive care unit (NICU), which adds another layer of risk for postpartum depression. That's why we work hard to educate parents about this condition and make sure they feel comfortable about reaching out for help — whether that's to friends and family, their primary care provider or the Center for Multiples."

The Power of Sleep

Getting enough sleep is critical for parents of newborns, as it has a huge impact on mental health and can even affect lactation. Twins and triplets aren't always so accommodating, especially if they're on different sleep schedules. Borges has been fortunate in that regard.

"Early on, my girls were waking up every 2 to 2 1/2 hours," she says. "But when we put them down, they usually went to sleep right away."

Parents of multiples often aren't so lucky. It's critical to find a way to get the sleep you need. If you have a partner, don't get up together at night for feedings. By "dividing and conquering," you can each sneak in a few extra hours at a time. (This is only possible, of course, if you're pumping and/or using formula rather than exclusively nursing.)

"Other than feeding the babies, sleep should be your top priority," Graves says. "Try to sleep when the babies sleep. Don't worry so much about things like housework — even though it may be hard to do, let that go for a while. And definitely don't be a perfectionist. It's all about getting more sleep."

Breastfeeding and Beyond

The Center for Multiples is part of a Baby-friendly Hospital, a designation recognizing the Brigham's proven patient-centered care and ongoing efforts to educate mothers on infant feeding best practices. Our team includes Sue Bryant, RN, MSN, IBCLC, a dedicated certified lactation consultant with expertise in how to nurse multiple babies. We provide families with expert lactation support and education throughout pregnancy and after delivery.

Borges didn't expect to have much trouble nursing her babies. "I thought I'd be able to feed them at the same time, but I learned that's not possible when they're so little," she says.

With Bryant's assistance, Borges learned how to hold each newborn and provide just the right amount of neck support. It was quite time-consuming — each baby fed for 30 to 45 minutes at a time. In an effort to free up some time, Borges now pumps exclusively.

Borges' experience highlights that there is no universal solution when it comes to feeding newborns. Some mothers rely completely on breastfeeding, while others turn to pumping, formula or some combination of options. Whatever choice works best for you is the right choice.

"Trying to keep up milk supply for two or more babies is hard," Graves says. "Everything is connected — feeding is related to sleep, and sleep is related to mental health — so do what works for you."

If you have concerns about feeding during the postpartum period, we can refer you to helpful organizations and other resources. And if you're concerned about whether your babies are eating enough, your pediatrician can provide answers.

The Brigham founded the Comprehensive Care Center for Multiples, the first center of its kind in New England, in 2020 to meet the specific needs of parents with twins, triplets or higher-order multiples. Learn more about the center.

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