greater expectations a prenatal session for parents expecting twins, triplets or more

GREATER EXPECTATIONS A prenatal session for parents expecting twins, triplets or more

Welcome to the club

So lets get started.. -Please feel free to take a bathroom break when needed, weve all been there -Help yourself to water and snacks. -If you have any questions please feel free to ask, or write it down so you wont forget. -All pictures are real life people in natural settings.

Who we are. Heather: Mom to Maggie, Katie and Twins Matt & Cassie Valerie: Mom to Triplets Chloe, Carter and Cameron Christine: Mom to Carter and Twins Jack and Addison Laura: Mom to Twins Spencer and Celia and Triplets Regan, Taylor and Jocelyn And you are..

Tell us how you found out you were having twins/triplets??? Guess What?? Were having twins!! Guess What?? Were having triplets!!! Ref: MBC Youre Having Multiples

F.Y.I. We are not providing medical advice but just information based on our experiences. Our goal is to provide you with information pertaining to multiples.

About POMBA OUR MISSION To improve and promote the health and well-being of multiple birth families before, during and after pregnancy

Topics Welcome Statistics Risks Prenatal Pre-term Labour Bed Rest Feeding Equipment Delivery NICU Going Home Mom and Dad MBC POMBA

Statistics 12,000+ multiple birth babies born each year in Canada- approx: 6000 sets of twins, 100 higher order Between 1974 and 1990 birth of twins up 35%, triplets increased by 250% MZ 3.5 per 1000 births worldwide of same sex multiples are MZ and DZ Without fertility treatment the Incidence of MB in Canada Twins 1 in 82 births (Japan 1 in 500, Nigeria 1 in 18) Triplets 1 in 6,400 births Quadruplets 1 in 512,000 births Quintuplets 1 in 41 million births Ref: MBC Incidence of Multiples

Increase in Multiples Fertility treatments Older moms Once you have a baby, chance of multiples goes up--- More babies higher chance Once you have multiples, chance doubles or triples of having them again 15-17% of multiple births result from fertility treatments. However 60% of triplets, 90% of quads, and 99% of quints result from these treatments.

Zygosity Used to describe different types of multiples This affects pregnancy management and care Monozygotic Dizygotic Trizygotic Used to describe one or more placentas present Monochorionic- same placenta Dichorionic- own separate placenta Chorionicity Ref: MBC MB TerminologyRef: MBC Biology of Multiples

Dizygotic or Fraternal Two separate eggs fertilized, just like siblings who are born at the same time. They have their own placenta which may or may not fuse together.

Monozygotic or Identical One egg, one sperm which happens to split. They will always be the same gender.

Split between Day 1 and 4 Split between Day 3 and 9 Split between Day 9 and 15

Diamniotic monoamnioTic

Complications Unique to MZ Monochorionic- Monoamnioic Multiples Umbillical Cord Entanglement Conjoined Twins- 1 in 50,000 mulitiples Twin to Twin Transfusion Sydrome (TTTS) 15% of monochorionic/diamniotic pregnancies Less often in monochorionic/monoamniotic Both babies can end up in trouble because one is lacking in nutrients while the other is receiving too much. Ref: MBC Monochorionic Multiple Pregnancy and Twin to Twin Transfusion Syndrome

Prenatal

The Roller coaster of emotion is absolutely normal. You may feel happy, excited, scared, upset, nervous, guilty all in the same day. This will continue to go up and down until well after they are born. How you are feeling???

You may be more forgetful and clumsy. This is normal and will return to normal, some day. You may have increased nausea and vomiting early in the pregnancy and this may last longer than with a singleton. You are more likely to be tired. Rest whenever you can.

High Risk -A twin or a triplet pregnancy is nearly always considered high risk. -Dont worry, this is a good thing its like a security blanket. -Mom is followed more closely. -Mom can expect more ultrasounds, more blood tests, fetal monitoring. -Mom has different nutritional needs. -Can expect more appointments More of EVERYTHING!!!!

LISTEN TO YOUR BODY Slow down When you can take a break, take a break If you need a nap, take a nap. Put your feet UP DRINK LOTS OF WATER

Body Changes and Discomfort lack of sleep backache/ back strain shortness of breath indigestion, reflux hemorrhoids varicose veins risk of dislocated hip pelvic pain urinary frequency swelling & fluid retention abdominal separation leg cramps risk of falls Carpal Tunnel

Things to try to ease some of the discomfort. NAPS Snoogle Pillow/Body PIllow Small meals Pregnancy Belt Prenatal Yoga Massage Stretching Chiropractor Sleeping in recliner Lie around as much as possible Stay off your feet Stay hydrated Eat lots of fiber TUMS Elevate feet when possible Watermelon for swelling Watch where you walk

Prenatal exercise Above all, listen to your doctor and your body. It is often not necessary to give up all exercise and activity you do. Walking and working out can still be great. Dont take up any new activity without consulting doctor. Water exercises are a great low stress activity. Even if on bed rest, keep stretching and moving muscles.

Nutrition Its normal to snack and graze. As you get further along in pregnancy, there is less room for larger meals. Always keep healthy snacks on hand. Almonds are a great midday snack for the protein, as well as apples. On the flip side, if the only thing you can keep down is a cheeseburger, eat a cheeseburger. Some times you can only eat certain things. If that is the case, eat what you will keep down. Smoothies and shakes are a great thing, full of nutrients and refreshing. Melons can be great to fight nausea and reduce swelling. Ice cream is a great before bed snack. Keeps you full longer, high in calcium. Prepare and freeze meals ahead. Ref: MBC Nutritional Guide

Why is weight gain so important? Your weight gain affects your babies weights during pregnancy and at birth Better fetal growth means healthier babies Weight of uterus, platcenta and 2 babies is over 20 pounds Most women lose their pregnancy weight within the first year of their babies lives

Maternity clothes Alternatives to NEW Consignment places Our All 4 Kids sale is great place too. Dont go overboard buying too much as you will grow quite quickly and may only get a week or two out of shirts. Beg borrow and steal. Use plus sizes and mens shirts too

Work concerns When to leave work?? Check out your work policy about sick leave. Most doctors will have you off work by 28-32 weeks more for precaution, earlier with higher order multiples or complications. Often will depend on you type of work, how demanding etc. Also will depend on you and how you feel. Remember, two/three babies means more hormones, possibly more morning sickness etc. There is currently a couple taking on the government to have IE benefits change to reflect multiple pregnancies, thus allowing both parents to take leave.

Finances Babies are expensive Consider adding diapers to your grocery shopping now. Look for sales and stock up Dr. Office will often give formula samples Get on mailing list for coupons Use point programs- Shoppers etc Contact companies directly for multiples Use POMBA and MBC discount lists Consider shopping in MI for diapers Most expensive isnt always needed http://www.babycenter.com/baby-cost-calculator

RISKS Risk for the mother Pre-eclampsia-- 1in 10 single vs. 1 in 3 multiple Gestational Diabetes-2-3 times more likely Hyperemesis Gravidarum- prolonged nausea Iron Deficiency Anaemia-VERY common Preterm Labour- twins, nearly all triplets Ref: MBC Possible Risks: Part 1 Risk to the Mother

Risks to Children Restricted Growth and Early Delivery Average length of multiple pregnancy 35-36 weeks twins 32-33 weeks triplets 29-30 weeks quads Average Weight Twins 5 lbs Triplets 4 lbs Quads 3lbs Ref: MBC Possible Risks: Part 2 Risk to the Children

Reducing the Risks Good Prenatal Care Healthy Eating Weight Gain Staying Healthy REST Know signs of Preterm Labour Communication with Partner Prepare for Childbirth and Parenting **BUT remember sometimes there is NOTHING you can do. Dont let guilt eat you up. Ref: MBC Possible Risks: Part 3 Reducing the Risks

Worries & Concerns What we worry about Physical changes of pregnancy Fears about births Complications, hospitalization Prematurity Coping at home Loss of income, extra expenses Adjustment for older children

Managing Worries Set priorities Set expectations Set short-term goals Call in favours Plan, plan, plan Organize your house Find support Concentrate on the positive Communicate with loved ones Use relaxation Simplify your lives

A contraction every 10 minutes or more often within one hour (five or more uterine contractions in an hour) Watery fluid leaking from your vagina (could indicate that your water has broken) Menstrual-like cramps Feeling generally lousy Ref: MBC Signs and Symptoms of Premature Labour

Low, dull backache Pelvic pressure that feels like the baby is pushing down Abdominal cramps that may occur with or without diarrhea Unusual or sudden increase of vaginal discharge Blood from your vagina Call/visit OB triage anytime after 14 weeks at 519-254-5577 X 55528 located at Met Hospital for any further information or concern.

What might happen if you go into premature labour? Steroid shots are given to mom to help develop the babies lungs Bed Rest can be ordered- At home or in Hospital Medications can be given to relax uterus and try and stop contractions IV Fluids can be administered Antibiotics if infection is present

Ref: MBC Bedrest

Reasons for bed rest

What are the reasons for bed rest? High blood pressure, such as pre-eclampsia, and eclampsia Cervical changes incompetent cervix, and cervical effacement Vaginal bleeding Premature labor Multiples Gestational diabetes Placenta complications Infection For more information about any of these medical conditions please talk to your doctor. BED REST IS NOT FOR ALL PREGNANCIES, YOUR DOCTOR WILL DECIDE WHAT IS BEST FOR YOU AND YOUR BABIES!

How can bed rest help? Normalize body Lower blood pressure Stop pre-mature labour Increase blood flow to placenta Decrease stress Prevent cervix from shortening Prevent or delay delivery

Except that this is best for you and your babies Establish a routine Allow friends and family to help Get organized Watch entire seasons of old shows Write thank you cards Read- Books about multiples are available in our Library Pick baby names How can I make the best of bed rest?

Questions to ask the doctor: There are many different levels and restrictions to bed rest: Be sure to get a clear idea of what you can and cant do. HOME Can I get up to prepare food? Can I take a bath or shower? What position should I be in while I'm resting? Can I drive? How much walking is safe? Sexual activity? HOSPITAL Can I get up to use the bathroom? Can I walk the halls? Do I have shower privledges? BOTH What can I do to increase blood circulation?

Feeding Options Breast Feeding exclusively Bottle exclusively Pumped Milk/Formula? Breast/Bottle Pumped Milk/Formula?

Ref: MBC Breastfeeding Fact Sheets- 11 titles

Breastfeeding Multiples Good for babies & mothers Personal choice Support: MBC Breastfeeding Support Network POMBA Breastfeeding support AskDrSears.com La Leche League Meetings Lactation Consultants & Doulas TeleHealth Ontario

BRAND NEW RESOURCE

Why breastfeed? Babies who are breastfed are healthier less likely to be overweight IQ allergies diseases of the bowel (Chrohns & Colitis) risk of SIDS, ear infections, and more

Breastfeeding is good for Moms too! Breastfeeding helps the uterus return to its normal size quicker after delivery While breastfeeding hormones are released which help mom feel calmer, more relaxed Helps mom lose baby weight gained during pregnancy much quicker Breastfeeding risk of breast & ovarian cancers and developing osteoporosis (weak brittle bones) Helps promote bonding with babies

How the breast works Supply and demand. The more your babies drink, the more your breasts will produce. Supply is highest in the middle of the night (great for those 3am feedings!) After a shower/bath Express in between feedings to prevent engorgement Massage breasts to encourage flow of milk

Breastfeeding Well Babies Start as soon as possible May wish to feed each baby separately at first until comfortable Latch best nurser first then other baby once able to tandem nurse. Nurse each baby 8-12 times/24 hours Alternate breasts Look for: 6-8 wet diapers per baby per day 4-6 stools per baby per day once milk has come in Stools should be yellow, toothpaste consistency and may look seedy once milk has come in

Breastfeeding Well Babies Set up a nursing station with comforts and conveniences Use a nursing pillow for twins Do not expect to do anything other than feed, sleep, and eat in first few months Nursing moms require more calories and fluids than in pregnancy Drink something every time you nurse

Parallel. In this position, the babies are pointing in the same direction, such that one baby's head rests on the other's abdomen. For example, Baby A lies in a cradle position at the right breast, with head in the crook of your arm and feet pointing toward your midline. Baby B is tucked under your left arm either in a football hold, or else held such that his head is in your left hand and his bottom is tucked under your left elbow.

Double Football. This position is especially suited to the nursing pillows. Each baby lies tucked under an arm, with heads to the front and such that they can reach the nipple without turning. With a nursing pillow, you may be able to do this one "hands-free" once they latch on.

Double Cross Cradle. In this position, each baby is held in a classic nursing position, with head in the crook of your elbow and feet in your lap. One baby's feet will lie on the other's feet or abdomen.

Successful Breastfeeding Supply & Demand system Nurse your babies more often Use breast pump after feedings Sleep when able Drink lots of fluids and eat well Talk to a lactation consultant *Before* you deliver babies as well as after if ANY problems. Babies have growth spurts and will increase amount and number of feeds

When babies cant breastfeed Use breast pump as soon as possible provided by hospital during your stay Pump at least 8 times every 24 hours Learn to store breast milk safely Preterm breast milk is different and specially formulated Kangaroo Care Ensure your babies get your colostrum (premilk) also known as liquid gold provides perfect nutrients for newborns large amounts of living cells that provide your child with immunity against many harmful agents It is full of antibodies for your babies

Tips on Pumping: Pump immediately after a feed increases supply gets hind milk which has the most fat Pump on lowest setting that extracts milk, not highest setting you can tolerate. Pump for at least 15 minutes each side if trying to increase/maintain milk supply at least 8x/24 hrs Pumping, like breastfeeding, should not hurt Buy a pump from a knowledgeable person who can ensure you have the right pump and fittings for your breasts and for your individual needs. Consider purchasing a hands-free pumping accessory kit to makes it easier!

Bottle feeding multiples Hold and cuddle your babies for all feedings Try different nipples for fussy babies One advantage is that anyone can feed babies Prep water and bottles in advance Rotate bottles in the fridge First in, First out Never microwave formula or breast milk Warm in hot water or even crock pot Due not reuse left overs

How much does Formula cost? Formula cost for 1 Year for a single baby is low average $2/day to high average of $7/day. So Twins=3,000.00-6,000.00/Year! Additional costs for a premium formulas like Enfamil A+ can add 20-30% to that amount Plus the added costs of bottles and other equipment. Be Prepared

Equipment Ref: MBC Clothing and Equipment

Car Seats Rear facing weight appropriate seats needed. No head inserts Practice using and tightening your seat ahead of time DO NOT buy car seats in the U.S. Car seats must be replaced after even the smallest car accident. Even if there was not a child in them at the time. Do not use infant carrier car seats beyond the weight restriction All children may not be ready to move up a seat at the same time. Do what is safest, not easiest. Bulky snowsuits should not be used in carseats Check Ministry of Transportation for up to date car seat information.

Ref: MBC Strollers Strollers

-Both parents need to try it out. - Is it tall enough, short enough for you both -Can you steer, fold up, pick up on your own. -Does it fit in your car? Ask at the store if you can take it to try it in your trunk. -The most expensive is not always the best. -There are pros/cons to each option. -You will need to decide for yourself which option works for you. -Consider one or more single strollers

Car seats Infant 0-20lb Car Seats convertible Bouncy chairs** Infant Bath tub Monitors*- 1/room High chairs or booster chairs Circuit of FUN Bottles Cribs / Cradles / Bassinets Crib Sheets** Receiving blankets** Wash cloths** Diaper bag(s) Change Table What do we NEED?? What do we WANT?? Ask around to see what other people are using.

Baby shower. Consider having your baby shower between 24wks and 32wks You dont need 2 or 3 of everything Register for things that you will need in the first year. Convertible car seats Ask your guests to add a pack of diapers to their gift or a home cooked frozen meal

Delivery

What to pack Bring for Mom health card, robe & nightgown, nursing bras, underwear**, toiletries, hairbrush, hair dryer, sanitary pads*, outfit to wear home **Put a note of the last minute items for someone to grab and pack for you if you arent able to do it yourself. Bring for Dad snacks, camera, pajamas, sleeping bag, pillow, some cash, phone list, hospital parking passes Bring for multiples Enough sleepers, onesies, extra hats, socks & mitts to last a few days in preemie or newborn size. Going home outfit. Lots of receiving blankets for car seats. Bring for older child(ren) Welcome gift from babies

Labour & Delivery How will I deliver??

Whos in the delivery room? (More like whos not???) Doctor or Doctors Nurses (1 per baby + 2 for mom) Respiratory Therapist NICU Nurses (1 per baby) Anesthesiologist (if C-section or epidural) Maybe medical students Husband/Partner +1

Heart and contraction monitors

After a vaginal birth - Use the peri care bottle provided by the hospital -An ice pack inside a newborn diaper makes for a good perineal relief Take pain meds at needed -Do your kegels -Take the stool softeners offered by the doctor -Wait 6 weeks before sexual intercourse -Rest when you can

After a C-section -Take the stool softeners offered by the doctor -Put a small pillow on your tummy when youre getting up, have to sneeze or cough -Have someone check the incision for infection -Dont lift anything heavier than your babies -Driving recommendation per your doctor -Youve just had major abdominal surgery take it slow -Wait 6 weeks before sexual intercourse -Rest when you can

How long in the hospital? Vaginal birth: No complications 1-2 days C-Section: No complications 2-3 days FYI: IF YOU ARE NOT FEELING READY TO GO HOME TELL YOUR NURSE AND DOCTOR

Full Term Healthy Babies Hospital Tips Room in Go home with you Ask for warm blankets Can share basinet Visitors Partner can sleep over Supplies are kept under the bassinet ASK for what you need Breastfeeding help

Welcome to the NICU Having a baby that is premature or ill can be very stressful and frightening for parents and their families. The NICU at Windsor Regional Hospital is designed to care for your babies special needs. As a modified level 3 NICU, most moms and babies will stay together. Only babies delivered under 26 weeks or with complications will be transferred to higher level nurseries while you stay might here and recover.

Multiple infantsprepare yourself Consider taking a tour of the hospital. For some people this is calming, for others it causes more stress. Ask to see a delivery room and the NICU. If they get an IV, needles etc. Remember that babies dont have anxiety, they cant anticipate getting an IV or blood work Babies that are under 33wks gestation usually receive a PICC line, this PICC line will last up to 3 wks Babies born under 30 weeks will receive doses of surfactant-making it easier for babies to breath on their own and reduce damage to lungs.

Spending time with your babies: Even if you are prepared, when you first come to the NICU, the first sight of your babies lying in warmers and attached to many wires and tubes may be very concerning. Its very common for premature babies and ill babies to be fragile looking. With time, your babies will gain weight, grow and you will become more comfortable handling them.

Here's some equipment that you "might" see in the NICU: A warmer will help the babies maintain their temperature for the first few hours/days

The isolette is an enclosed bed which helps controls the baby's temperature and keeps them warm

The cardio respiratory monitor allows staff the closely the baby's heart rate, oxygen saturation, respiratory rate and blood pressure.

Infant ventilators breath for the baby when the baby is too sick or too weak to breath for itself.

The nasal CPAP Continuous positive airway pressure-- is another method of delivering oxygen under pressure to the baby through short prongs that fit in the baby's nose secured with a hat that fits on the baby's head

Nasal prongs or cannula is the least invasive form of respiratory support. The baby is breathing on their own but needs additional airflow to keep the lungs open or additional oxygen to maintain good oxygen saturations.

To ensure the babys nutrition they might be fed through a tube that goes into his/her nose and down into the stomach. This can be fed with formula or breast milk.

Kangaroo care Infants are held skin to skin against the bare chest of a parent. This is best practice for premature infants. The benefits include: Stabilization of heart rate and breathing. Improved oxygen saturation. More rapid weight gain Maintaining body temperature Increases alert time Promotes bonding with parents

Soothers Sucking is good for preemies to have soothers. It builds their cheek muscles which will then further help them in their feeding.

There is a Breast Pumping Room where mothers who wish to pump may do so in a private area inside the NICU unit. Pumps are available to borrow from the hospital. You are given you own set of equipment for the pump. It is your job to clean and sterilize it. A fridge is provided to store your breast milk which will then be fed to the babies when they are ready. The staff will supply you with a breast pumping kit, labels and sterile bottles along with lids to store the breast milk safely.

-You can anticipate them staying in NICU until around their gestational due date, NORMALLY. This is if there are no other complications. 37 weeks/5lbs is a average -It can be hard to leave them there when you go home. -Find comfort that they are safe and it is good for them. -No need to feel guilty going home -Feel free to call

The car seat challenge is done on all NICU babies under 35wks gestation. You will need an appropriate car seat to take the baby home in and most likely 3-4 receiving blankets to prop the baby up in. Make sure that your car seat is 0- 20lbs and is an infant carrier. This is a test where the baby must sit in the car seat attached to monitors. It is ensure that the baby is positioned properly in the car seat and can tolerate the ride home safely. Babies can NOT fail this test. Adjustments are made until they can safely ride in the car seat.

Getting ready to go home: Once the babies are strong and are getting ready for discharge, parents can choose to take advantage of the Care by Parent program with the babies. This will help ease any fears that you might have on bringing home more than one baby at once. It's a great opportunity for new parents to experience

Home Sweet Home

Things that no one tells you. -So long living room, they are taking over -Bye Bye sports car, hello mini-van -Kegels really do help -Hair may fall out, even in clumps, this is just a change in hormones -People will ask if boy-girl twins are identical -Youll gain friends and lose some too -Youll look at them often and wonder how there can be 2 or 3 of them -Watermelon can help reduce swelling

Multi-tasking

Tips from Parents of Multiples Prepare for birth and parenting Consider using parental leave benefits Build support network Discuss and plan family matters Organize help BEFORE the babies arrive, in a way that will work for you Connect with other parents of multiples Ref: MBC Expectant Mother Tips

Who is who??? Use wrist bands Nail polish Different colour clothing Assign colours for equipment

Its all in a name -Watch out for rhyming names, this indicates they come as a package and a chance they will lose their own identity. -Try to not refer to them as the Twins / the Triplets / the Babies -Remember that you are naming 2 or 3 individual people, what sounds cute now might not always be cute.

Routines Routines work, if they work for you. NICU feeding schedules will be established Waking both to feed in the night Feed by clock, or feed on demand

Sleeping Many times the babies can sleep together until around 3-4 months when they start to move around in their sleep. Historically hospitals have not allowed this practice but now some viewpoints are changing. Ref: MBC Co-Bedding and Multiples

HELP -When people come over to visit give them a job. -LET PEOPLE KNOW THEY CAN HELP. Make food, fold laundry, do dishes, vacuum, feed babies, etc. -No one coming over will be offended that you are asking to help. -If you dont have access to HELP thats OK, you can do it!!! - Extra help- consider hiring a mothers helper, housekeeper, lawn service, etc.

Bath Time

Ref: MBC First Few Weeks First Few Weeks Set your priorities Rest and Eat ASK for help Keep in contact with family and friends Get out Dont try to be perfect Let things go Find time for mom and dad

Siblings -Start early preparing them -Buy them a set of twin baby dolls -Moms helper role- but not too much -Spend time with them when the babies are napping -Introduce them first when introducing the multiples- or have them introduce the babies -Arrange special outings or events with friends and family Ref: MBC Singleton Siblings of Multiples

Practice swaddling

Mom and Dad

Dads Role HELP with whatever you can. Watch for signs of post-partum depression. Understand that if mom is moody, says something out of the norm, dont take it personally, shes sleep deprived Call from work to check in, come home with dinner. You will get the drive home, lunches, etc as down time. Mom rarely gets any. Try and give her time away from babies. Ask your employer about parental leave over and above what mom gets if possible. Try to book vacation time for when the babies come home. Ref: MBC Dads Role

Marital relationships -Being parents of multiples is more stressful. -Any big event can put stress on even the best of marriages. -Be sure to find the time to protect the relationship. -Take time to communicate, be open. -EVERYONE WILL BE TIRED. -Ask for help rather than assume that someone knows what you need or are thinking. Ref: MBC Parental Relationships and Multiple Births

After babies come Home Find time to be alone together Treat each other with respect and kindness Support each other Go with the flow Communicate clearly and directly Find time alone to discuss parenting challenges Get help to complete some tasks Monitor each others moods Share your joys Remember to laugh Nurture self Consider professional counselling if really suffering

Post Partum Depression The medical dictionary defines Postpartum Depression as: A form of severe depression after delivery that requires treatment.. A woman with PPD may have feelings similar to the Baby Bluessadness, despair, anxiety, irritabilitybut she feels them much more strongly than she would with the Baby Blues. PPD often keeps her from doing the things she needs to do every day. When a woman's ability to function is affected, this is a sure sign that she needs treatment. Ref: MBC Postpartum Depression and Mothers of Multiples

one in ten new mothers suffers from PPD (a new mother being one with a newborn infant, not necessarily a first time mother) PPD is five times more common in mothers of multiples than mothers of singleton newborns. based on these two statistics, we can estimate that there is a greater chance that PPD will affect new mothers of multiples. Study in 1983 revealed a mother of 6mth old triplets needs an average of 197.5 hrs per week, of a possible 168 to take care of her children and home. 76% of all mothers of newborn twins felt constantly exhausted as compared to only 8% of mothers of singletons.

Blues feelings can include: feeling tired and exhausted bouts of crying for inexplicable reasons insomnia feeling easily irritated Signs of PPD can include: crying for no apparent reason chronic fatigue or hypersomnia loss of appetite feeling overwhelmed and hopeless doubt or guilt compulsive over the babies care ignoring the babies care feeling worthless, unable to cope anxiety attacks inability to concentrate, indecisiveness in the extreme, thoughts of suicide

REMEMBER Awareness of the signs and symptoms is the best defense against PPD BOTH parents need to know the signs and symptoms o PPD, and if necessary, the partner nees to take the initiative and make a doctors appointment for mom PPD is an illness and can be treated PPD affects everyone in the whole family By looking after yourself, you are also looking after your family Although rare, fathers can experience PPD too.

Multiple Births Canada www.multiplebirthscanada.org MBC benefits include the only national multiple birth magazine. Available free online with your membership. National Discounts-Including Summer Access to Fact sheets on many multiple birth related topics An advocate to the government on multiple birth issues. User Name: MBC member Password: multiplekids2014

Support Networks Adult Multiples Network *Breastfeeding Support Network Father Support Network *Francophone Support Network *Higher Order Multiples Support Network LGBTQ+ Support Network *Lone Parent Support Network Loss Support Network *Preterm Birth Support Network *Special Needs Support Network * These networks also have Facebook groups.

P.O.M.B.A. 10 ways we can help: Advice and support Guest speakers and presentations Social events and children parties Special parent events Research Discounts ALL4KIDS clothing and equipment sale Community services support Newsletter Lending library

Monthly Meetings/Facebook We meet the second Tuesday of each month (not July and August) 3 rd Tuesday in MARCH Support Questions and Guest Speakers NEW- Questions and Answer on Facebook POMBA Windsor/Essex County & Twins Triplets and Quads Usually each meeting continues out for drinks and appetizers Lending library available at meetings Monthly newsletter Discounts

Family Parties Halloween Christmas Easter Swimming Summer Picnic

Adult Activities Parents Night Out Moms Night Out Moms Cottage Weekend Chick Flick Movie Night

All4KIDS Sale- April 2014 Buy and Sell gently used clothing and equipment Members shop early 6pm on Friday and 8am on Saturday. Members sell first www.all4kids.ca

Support of Parents Been there done that Advice that is given from experience Moms and Dads that have multiples We get things friends and family with singles dont understand. Open environment for asking questions

Thanks for coming Remember this class comes with a membership to POMBA that is good until your babies turn 1. Upcoming meetings and events.. -Sunday, July 20 th PICNIC -Tuesday, September 9th: General Meeting -Tuesday, October 14 th : General Meeting -ALL4KIDS Sale October 17 and 18 th.

greater expectations a prenatal session for parents expecting twins, triplets or more

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