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Resources Centre / Twins Tips Introduction / Twins Tips / Premature Birth - Twins & Triplets in Special Care (SCBU)
Premature Birth - Twins & Triplets in Special Care (SCBU)
In the UK. we have around a 7% premature birth rate with over 40 per cent of all twins and multiples needing some special care - largely because twins are born earlier than single babies and are usually small. Special Care Baby Units (SCBU) aim to provide the care that babies would have had in the womb. supplementing this with help with breathing. feeding and warmth. Babies usually need special care if they weigh under 1.7kg. are less than 32 weeks or have any medical problems.

Twins and Multiples Birth Data
Average pregnancy length
Singletons 40 weeks
Twins 37 weeks
Triplets 34 weeks
Quadruplets 32 weeks
Average birthweight
Singletons 3.5kg
Twins 2.5kg
Triplets 1.8kg
Quadruplets 1.4kg

Premature Birth
Babies born early need special care and monitoring to help them to gain weight and mature fully outside the womb. Babies born before 37 weeks are defined as "premature". while those born between 24 and 28 weeks are "extremely premature". Before week 24. babies are significantly less developed. although a small proportion do survive - at 23 weeks there is a 17 per cent chance. rising to 39 per cent at 24 weeks. Advances in neonatal care mean the outlook is improving all the time. According to UK charity Bliss. about 80 per cent of extremely low birthweight babies - those under 1kg (2.2lb) - now survive; 20 years ago. it was about 20 per cent.

Causes of Premature Birth
There isn"t always a clear reason for premature birth. but possible causes include a previous premature birth. diabetes. smoking or poor nutrition in pregnancy. twin or multiple pregnancy. and cervical incompetence (when the cervix dilates and opens too early). This can be treated with a stitch placed around the cervix muscle at 12-14 weeks to keep it closed. which is removed at week 36 or cut in the event of early labour.

The most common cause of premature labour. though. is premature rupture of the membranes (PROM). The trigger is often unknown. but possible factors include vaginal infection. excessive amniotic fluid. or carrying twins or multiples. If you think your membranes have ruptured. consult your doctor or midwife immediately: you may go into labour. be given antibiotics to prevent infection or delay birth. or be induced if there is infection or danger to the baby. Before labour. you may be given drugs to help the baby"s lungs to mature more quickly.

Other complications that may necessitate an induced early delivery include diabetes. intrauterine growth restriction (IUGR). placenta praevia and pre-eclampsia. If the situation is putting you or your babies at risk. they may be delivered by Caesarean section.

Below are some of the more defined known causes of premature birth:
  • Pregnancies with twins. triplets or more babies. are very likely to end early.
  • Stressful events like long distance air travel. the death of a relative or friend. or moving house late in pregnancy can also start labour early. There is no evidence that normal day-to-day stresses of living can bring on premature labour.
  • Many babies arrive in a neonatal unit because of some emergency. It may be that the mother started to bleed or had high blood pressure. or that there was some problem with the umbilical cord or placenta.
  • Pre-eclampsia occurs in about 1 in 14 pregnancies and causes around a third of all premature births. It can be dangerous. particularly if it develops rapidly. The main symptoms are headaches and swollen feet. which are associated with high blood pressure. Although bed-rest can help. the only way to stop pre-eclampsia is to deliver the baby early. Pre-eclampsia is more likely to occur in first time multiple pregnancies.
  • In some cases the mother's waters break early. starting the delivery process. If labour starts while a baby is less than 35 weeks. the doctors will probably give two sets of drugs. One is to delay the labour for a day or two. while the other is to help the baby's lungs to mature quickly so that they will function better after delivery.
  • In a few cases. an antenatal screening test might show that a baby is not growing well in the womb. normally because of a shortage of blood flowing to and from the placenta. If doctors believe that the baby is going to be safer outside the womb. they will advise you to have the baby delivered early. In this case it may be recommended that you have a caesarean section as it puts less stress on the baby.

Special Care Baby Unit (SCBU)
Depending on their needs. your babies will be admitted to an intensive or high-dependency neonatal care unit. a special care baby unit (SCBU) or. if he is born before 35 weeks. a neonatal intensive care unit (NICU). where he will receive 24-hour care. If your babies were delivered by caesarean section. or rushed to another hospital immediately after the birth. it could take a few days before you manage to see them. This can be very distressing and you may want your partner or a friend to visit your babies and tell you how he or she is. They may also be able to bring you a photo of your babies as many neonatal units have instant cameras for this purpose.

It can be a shock when you enter a neonatal unit if you have not been before. try and arrange a visit beforehand through your ante-natal classes to help you prepare. Having premature or sick babies can be very traumatic. but the staff know you are under stress and are there to help you. as well as your babies.

How will my babies look ?
Premature babies may appear thin with very little body fat and look quite different from most full-term newborn babies that you may have seen before. This is simply because they are at an earlier stage of development because they were born early. They may have a fine covering of dark hair called lanugo. It is normal and has been stimulated by the baby receiving some of the mother's hormones while in the womb and will soon disappear.

What types of problems may they have ?
Babies born prematurely are more prone to a range of ailments. including jaundice. breathing difficulties. hearing and vision problems. low blood sugar. infection and hypothermia. Your babies may be placed in an incubator to keep warm. linked to monitors to continuously check their condition and given oxygen or light therapy if needed - exposure to blue light breaks down bilirubin in the blood. which causes jaundice and. in high levels. carries risk of brain damage.
If your babies are too small to breastfeed they may be fed through his nose via a tube. If their digestive tract isn't yet fully developed. they"ll be put on intravenous nutrition. Try to express breast milk. so that they receive its nutrients and protective antibodies and you establish your milk supply. For twins. you should pump every 3 hours even at night. which is hard going but by providing breastmilk this will go a long way in helping your babies to grow strong and healthy so it"s really worth the effort.

Twins UK have designed The Ultimate Express Yourself TwinKit to provide all the equipment and accessories required for successful expressing for twins or more. Although you will have access to hospital grade pumps in Special Care. you may find that having your own double electric pump provides you with more flexibility and you can also use this at home to keep you milk supply flowing.

Caring for your babies in Special Care
Spend as much time as you can cuddling and stroking them; skin-to-skin contact ("kangaroo care") has been found to be extremely beneficial for development. Premature and sick babies undergo many medical procedures and this can cause them some discomfort. Babies" parents are the best people to balance this with a positive. reassuring touch.

Taking part in your twin babies' care will also help you bond with your babies and help you to feel needed. At first. the staff may do most of the work but over the next few days they will encourage you to become involved and understand what is happening to your babies. As you learn. and your children grows stronger. you should be able to do more and more.

What are the Positives ?
Although your babies are alive and being looked after. you may feel you missed out on a normal pregnancy. or worry that you can't go straight home with your babies as you had hoped. You may even have one baby discharged and the other left in Special Care which can also be distressing for parents. However. there can be a positive side as you can take the time that your babies are in Special Care to recover from the birth and get ready for their homecoming.

Babies who have been in Special Care are often in a routine by the time they leave hospital so stick to it if you possibly can. A useful tip is to keep a daily diary of all the events. this is done by the nurses in Special Care but you can continue this at home and it will help you keep track of both babies feeding and sleeping behaviours as well as medications given. It will give you the peace of mind that your babies are developing properly and it is a great help for other carers who can see what the routine is at a glance. Twins UK have a specially designed Twins Daily Care Schedule that contains 3 months supply of daily sheets that record all of your twin babies activities in one place.

Many people find this to be an emotional time and the support of family and friends can help. The next weeks and months are likely to have days of stress and worry. so it's good to find people who can support you and one or two people that you find it easy to talk to.

BLISS - The Premature Baby Charity
BLISS is the UK"s National Charity for Premature Babies and provide information and support to parents. There may also be a BLISS branch in your area where you can meet with other parents who have been through a similar experience.

Twins UK have a small range of specialist feeding equipment like the Haberman Feeder and Cup Feeders that can help babies with feeding difficulties.

Please follow the link for more information on Premature Twins & Triplets

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