How We Became A Family

from RESOLVE.org  Listen to the great interview actress, author, and activist Elisabeth Röhm had with RESOLVE’s President/CEO Barbara Collura.  The “Law & Order” actress and author of Baby Steps: Having the Child I Always Wanted (Just Not As I Expected) discusses her family building journey and why she is a vocal advocate for the infertility community. Listen now.

 

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Are there more twins in the world? It has been widely assumed that there has been an increase in twins over the years, largely attributed to fertility treatments. It seems like there are twins everywhere you turn; perhaps you notice more and more families with double strollers out and about in the mall or more frequent announcements in the media from celebrity parents celebrating the birth of twins. Television shows like "Kate Plus Eight" (formerly "Jon and Kate Plus Eight") or "Texas Multi Mamas" shine a spotlight on multiple birth. Schools report record registration of twins and multiples and educators wrestle with the issue of classroom placement. The increasing incidence of twins has even generated legislation to ensure that twins' rights are protected in school.

The Increase in Twins

A 2012 study takes a more specific look at the data and establishes some trends about the increase in the twin birth rate in the United States between 1980 and 2009. A National Center for Health Statistics (NCHS) brief from January 2012 provides the following information: • In 1980, 1 in 53 babies was a twin. • In 2009, 1 in 30 babies was a twin. This represents a 76% increase in the twin birth rate in the thirty years from 1980 - 2009. The study estimated that an additional 865,000 more twins were born during this thirty years than if the twin birth rate had not increased during those decades. To put this in other terms: • In 1980, the twin birth rate was 18.9/1,000. • In 2009, the twin birth rate was 33.3/1,000. In those terms, it is evident that the twin birth rate increased from less than 2 percent of babies born in 1980 to over 3 percent of babies born in 2009.

Twin Birth Rates Across the States

All areas of the United States experienced a rise in the twin birth rate, but rates continue to differ among the states. This chart shows the twin birth rate in each state of the United States, comparing the rates in 1980 and in 2009 and the percent change over the years. Rates rose by at least 50 percent in 43 states and the District of Columbia, and five states (Connecticut, Hawaii, Massachusetts, New Jersey, and Rhode Island) saw the rate rise by more than 100 percent. The states with the highest twin birth rate in 2009 were: • Connecticut (45.9/1,000) • Massachusetts (45.2/1,000) • New Jersey (44.2/1,000) • New Hampshire (40.3/1,000) • New York (38.3/1,000) The states with the lowest twin birth rate in 2009were: • New Mexico (22.3/1,000) • South Dakota (24.6/1,000) • Arizona (26.6/1,000) • Nevada (27.4/1,000) • Vermont (27.5/1,000)

Reasons for the Increase in Twins

So what explains the increase in the number of twins? Many assume that it is simply an increased utilization of reproductive technology. However the study identified another significant influence.Several factors have been identified as contributing to increased twinning. One study identified consumption of dairy products as a factor. (Cattle are given growth hormone to increase their production of milk and beef. When women ingest the milk from these animals, their own hormones react, stimulating ovulation.) Another associated rising obesity rates with increases in twinning, citing that overweight or tall women are more likely to have twins. The 2012 study of twin birth rates identifies maternal age as a leading factor contributing to the increase in twins. The largest increase in twin birth rates was realized among women over the age of thirty. It says "Historically, twin birth rates have risen with advancing age, peaking at 35–39 years and declining thereafter (4). Since 1997, however, rates have been highest among women in their 40s." The study illustrates the difference in twin birth rates according to age. In 2009: • Women aged 40 or over: 7 percent of all births were a twin delivery • Women 35-49: 5 percent of births were a twin delivery • Women under age 25: 2 percent of births were a twin delivery. This increase correlates to a shift in the age distribution of women giving birth during the thirty years of the study. Where only 20 percent of women giving birth in 1980 were over age thirty, the same population accounted for 35 percent of births after 2000. "The increasingly older age of mothers over the decades would be expected to influence twin birth rates because of the higher spontaneous (i.e., without the use of fertility therapies) twinning rates of women in their 30s." The study estimates that one-third of the increase in the twin birth rate can be attributed to this elevation in maternal age.

Fertility Treatments and the Twin Birth Rate

Fertility treatments are largely assumed to the cause behind the increase in twins, and this study supports that theory. The study cites infertility treatments as being responsible for about two-thirds of the increase in the twin birth rate from 1980 to 2009. Fertility therapies include the taking of fertility stimulating drugs or procedures to assist conception, such as in-vitro fertilization. The influence of fertility treatments is somewhat associated with the issue of advanced maternal age as women over the age of thirty are more likely to seek fertility assistance, the study acknowledges. In the three decades during which twin birth rate data was studied, medical technology made fertility therapies more successful and more accessible. The use of reproductive assistance became more prevalent in the 1980's and 1990's. However, the processes have been refined in recent years to restrict the number of multiple births that result as an outcome of fertility therapy, recognizing that multiple birth is associated with elevated health risks and accompanied by greater health care costs. Source: Martin JA, Hamilton BE, Osterman MJK. Three decades of twin births in the United States, 1980–2009. NCHS data brief, no 80. Hyattsville, MD: National Center for Health Statistics. 2012.

Attachment parenting with multiples in the very beginning was the most challenging times of our lives. Yet practicing the "attachment parenting" philosophy has proven success for us and our family. Our parenting book by Dr. Sears, at the time, didn't have any entry dedicated to multiples! We were on our own. Attachment Parenting is a philosophy based in the practice of nurturing parenting methods that create strong emotional bonds, also known as secure attachment, between the infant and parent(s). This style of parenting encourages responsiveness to the infant or child's emotional needs, and develops trust that their emotional needs will be met. As a result, this strong attachment helps the child develop secure, empathic, peaceful, and enduring relationships. Attachment Parenting is rooted in sound science and common sense. The principles of A.P. provide a framework of an overarching philosophy –listen to your baby and trust your instincts. Disclaimer: Attachment parenting is not a one-size-fits-all recipe for raising children. Parents must use their own judgment and intuition to create a parenting style that works for their family. The philosophy of Attachment parenting offers various practices that each family can work with that best fits their needs.

 

For example, Attachment Parenting philosophy advocates holding "wearing" your baby as much as possible, breastfeeding and co sleeping. Each family will determine what is the best way that they can introduce this philosophy into their daily parenting practice.

For our family, these were choices that we made through an accumulation of trial and error, refinement and ultimately became a method that worked well for us.

Wearing: Wearing your baby with a singleton, is fun, practical, and feels very natural. We found that using a sling, was the easiest to manage getting on and off. You could also use a harness of sorts or anything that will allow you to keep you baby next to your body as much as possible, but these were too cumbersome for us. Baby wearing creates an attachment to your child in creating a safe, nurturing and comforting bond between baby and caretaker. My husband and I both loved wearing our first-born in a sling with everything we would do. We would carry him almost 90% of the time until he started to grow much bigger, until he was about 1yr old and then it decreased to about 40%. Simultaneously, I was pregnant with the twins on the way and my increasing belly size prevented me from carrying him so much. With twins, baby wearing is a bit more challenging but very do-able. With triplet infants, I don't know. I can only report what we did in our family. We had to hire full-time help with our babies as I could not care for twin infants and a 14 month old alone.

Fortunately I didn't have to work outside the home, and could focus on the children. I was introduced to a wonderful, experienced mother (60 yrs old and raised 5 children) who was from Guatemala. Five days a week she lived with us and helped us to manage through the "survival years". Bernard's family is a combination of Spanish-Mexican-Polish-American. We both had lived in Mexico for many years previously in our lives before we met, so Spanish is a second language for both of us, and the child/family centered culture of Latin America has always appealed to us.

While Bernard was at work during the days, Julia and I cared for the babies. We each would carry a baby in a sling or in our arms. This was much easier for Julia to do this than me, which became true for most things in the beginning. With her experience, her calm personality, her easy smile and great sense of humor, she became my teacher, my daily companion, and someone that I appreciated more than I could ever express to her. We switched off holding each baby, exchanging throughout the day, making sure that all three were given full attention to the best of our abilities. Sometimes we had to place one baby in the bouncy seat while one of us would cook or clean or fold clothes. Or one of us would have both babies in our lap while the other played with our toddler.

They were long long long long days, that were managed in 15 minute increments, with 15 minute tasks. Everything became easier when I began to tell myself that any challenge of crying or screaming, or boredom, or the mundane constant repetition of chores, would be over in a matter of minutes. "This will all pass in a matter of minutes, stay calm, carry through" "chop wood, carry water" the basic fundamental actions of living and breathing, becoming a parent, being responsible for these little beings, caring and attending to all their needs, being present moment to moment.

Feeding: When it came to breastfeeding, I could only nurse our children for a short period of time (6 months for our fist born, and about 3 weeks for the twins), then we bottle fed. With the twins, I mostly pumped and then froze the breast milk. This routine didn't last long as pumping or feeding was all that I was doing throughout the whole day and it was too demanding for me. I was sleep deprived, drained, and a blurry-eyed-weak-minded-walking zombie. We used part breast milk-part-formula for the last 3 weeks, eventually to all formula by week 6. I had to let go of the "ideal feeding" which was surprisingly pretty easy for me. I got relief once this decision was made, and most importantly, our family got relief once this decision was made. Survival life got a bit easier. Some things have to give, and it was the best for us all. I consoled any doubts of not feeding them breast milk by making up for it in my thinking. I knew that their nutrition was being met with formula. But it was the psychological scientific data that supported attachment parenting style -the baby wearing, co sleeping that we were also doing, that gave me solace. I hope that this thinking will do the same for other mothers who decide not to, or are unable to breastfeed. Here are some excerpts from articles that exemplify this:

From: The Science of Attachment Unproven claims and unanswered questions about attachment parenting Breastfeeding, maternal responsiveness, and secure attachments Some cheering news for moms who want to breastfeed...but can't: Although breastfeeding has many health benefits, there is little evidence to suggest that breastfeeding makes mothers more responsive to their babies. Nor is there evidence to suggest that breastfeeding makes babies more likely to develop secure attachments. Instead, it appears that women who want to breastfeed are predisposed to show more sensitivity to their infants—and more sensitive mothers are more likely to have securely-attached kids (Britton et al 2006). In other words, breastfeeding doesn’t cause maternal sensitivity and secure attachments. It’s the other way around. Maternal sensitivity causes moms to breastfeed and to behave in ways that promote secure attachments.

Sleeping: When it came to co sleeping, we chose to have our children sleep with us in the family bed using a side attached Arms Reach co-sleeper  when they were infants. When the twins were born, we used two co sleepers. (I contacted a local second-hand baby items store and found one) We attached one to my husband's side of the bed, where our first-born son slept who was 14 months old at the time. And then the other co-sleeper on my side of the bed where the newborn twins would sleep. Our toddler slept between us in the bed. If you decide to co sleep as we did, be prepared to rotate in the family bed. Sometimes you'll start off on one side of the bed, and end up on the other, vice versa... it's an "active" night-time routine that's not for everyone.

Here are some basic safety guidelines for co sleeping from Zero to Three: Deciding where and how your child sleeps is a very personal decision and reflects a family's beliefs, values, and ideas about child-rearing.  While many families enjoy sleeping with their baby and safely practice co-sleeping (also known as "shared sleeping" or the "family bed"), it's important to note that many adult beds and bedding materials are not designed for sharing with an infant.

If you choose to have your baby near you when you sleep, you might consider using a co-sleeping attachment on your bed or placing a bassinet right next to your bed. This will allow you to be close and reduce the risk of SIDS.

If you prefer to have your baby in bed with you, consider the following guidelines:

• your mattress should be firm and flat
• your baby should not be able to fall out of the bed or slip between a mattress and wall or headboard
• sheets and blankets should be very light
• your baby should not be kept too warm
• your baby should be on his/her back

Co-sleeping is NOT recommended if the adult in bed smokes, has been drinking, has a cold, is very large, is a heavy sleeper, or has taken medication that might make them sleep deeply. In addition, pets should not be in a bed with a baby. If other children are present in the bed, the parent should sleep between the older children and the baby. Also, couch sleeping should be avoided. Co-sleeping can be a joyful and loving experience for parents and children alike.  The guidelines above can be used to ensure that co-sleeping is done safely and in a way that encourages everyone to have a good night's sleep.

Sleep deprivation for parents and caretakers can be debilitating. How does one learn to function without much sleep? Once the twins were born, we quickly found that we were in above our heads. We researched frantically. We were looking for the most up to date information on the neurological processes of the brain pertaining to sleep. What we learned, is that it's best if a person get at a minimum of 4 hours of sleep at a time for best functioning. Four hours allows enough time for the body to relax and the brain to enter into REM. We now had a plan! We would take "4 hour shifts" allowing one of us to sleep in another room as-far-away-as possible, completely uninterrupted, while the other stayed with the babies.

When it was my turn to sleep alone, it was hard for me at first, until I employed an eye mask, ear plugs, and the white noise of a ceiling fan. And it worked! It's an amazing thing to feel refreshed after getting a solid 4 hours of sleep! On the nights my husband had to be on call for the hospital he had to sleep alone in the other room all night. So, this meant that I was equally "on call". I don't know who had it worse, me being the only one to be with the children all night tending to each and all of their waking, feedings, diaper changes, fits and crying, or him having to be woken by emergencies, and critically ill patients' calls all night. Now that I write this, I thought that I had it worse, but at least I got to have brief moments of sleep during the day. After his 4 hour shifts at night with our new co sleeping family, he then had to go to work every morning and be in public, the -sick and unhealthy public. We both suffered. He tells me it's easier caring for our children because our kids are "cuter" than his patients (no offense).

When they were toddlers we used a large futon on the floor next to our bed, which we all rotated between regularly.  When they turned 4 and 5 we set up "the kid's bedroom" they still share together today, and each have their own individual beds. We use a monitor at night, so if they wake, we can attend to them -if need be. Most of the time they put themselves back to sleep without us. If they can't, they know the way to our bed. We helped them to transition away from our bed and bedroom to being comfortable in theirs. At night, we spend a lot of time with them in their bedroom, reading, talking, listening to music, and sometimes laying with them until they fall asleep.  And so now (they're 6 and 7) when they wake in the night(rarely), they know they can come to us in our bed (instead of us getting up to go to them) and its gotten so much easier and better sleep for everyone.

The main emphasis we wanted to impress upon our children was that they knew that they could come to us at anytime night or day. We've always wanted to parent at nighttime w/equal love and attention as we do during the daytime. To provide comfort and independence. It's not easy, and it's not for every family, but it works for ours. We just do the best we can, because we know that one day, not too far in the distant future, they wont want to be with us -and for good reason as they venture onward with their own independent lives.

For more detailed information: attachment parenting What have you learned from baby wearing, feeding, or nighttime parenting? Is there any approach or method that worked for your family and that you'd like to share?

The 2008 twin birth rate in the United States was 32.6 per 1,000. That's equal to about 1 in 100 people are a twin!

• 138,660 twins were born in 2008
• In 2008, the number of higher order multiple deliveries were 6,268, the lowest number in more than a decade. The number of higher order multiple deliveries by type were:
  • 5,877 triplets
  • 345 quadruplets
  • 46 quintuplets or higher

Impact of Fertility Treatments  Assisted Reproductive Therapies (including in vitro, ovulation-inducing drugs and artificial insemination) account for 17 percent of all twins and 40 percent of all triplets born in 2007.

• 17 percent of twins are the result of fertility treatments.
• 40 percent of triplets are the result of fertility treatments.

Source: National Vital Statistics Reports, Vol 58. No. 24, August 9, 2010