In The Event You Co-Bed Twins and Multiples within the NICU

 

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The practice of letting babies sleep together in the same crib or incubator is called cobedding and can be done with twins, triplets, or other multiples. 1  While there are benefits to letting multiples sleep together in the NICU, there may also be drawbacks to cobedding. Reports of twins sharing a bed in the neonatal intensive care unit (NICU) first appeared in the lay literature about 15 years ago (Elliot, 1996; Sheehan, 1995).

An unstable premature twin showed signs of improvement in heart rate, breathing, and sleeping when placed close to her sibling in the same incubator (Sheehan, 1995, 1996). Handbook of Neonatal Intensive Care by Merenstein and Gardner (widely considered the “NICU bible” in the US) says that support for cobedding is mainly anecdotal, with little research to back it or refute it. They do cite one recent study that showed a decrease in apneic episodes, but it only involved seven sets of twins. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies.

Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU. In an ideal world, all twin pregnancies would reach that magic 36-38 weeks, and the likelihood of NICU (Neonatal Intensive Care Unit) time at this gestational point is very low. According to the March of Dimes, however, the average gestation for twins is.

Your Twins’ NICU Stay – 5 Things You Should Know On the 24 th of July, my wife and I were blessed with identical twin girls. As most parents of multiples know, twins usually are delivered early. On July 23 rd, during one of our bi-weekly scan.

It’s very possible you could have one twin in the NICU, while the other twin is home with you. This happened to our family and it was stressful. In our case, the twins were born at 35.5 weeks, and they were both brought to the Continuing Care Nursery.

This meant they required extra care, but not to the same level as the NICU. Spoiler alert: my twins spent 10.5 and 11 weeks in the NICU, but today they are completely healthy. The NICU can be a terrifying, intimidating place, but it can also be a warm, supportive resource. The more you can prepare for a possible NICU stay, the better equipped you’ll be if that day does arrive. The best thing you can do is plan ahead to find the highest level NICU in your region, in the event that your babies do need to spend time there.

In addition to a birth plan, make what I like to call a BUMP plan (a baby urgent medical plan) that clearly lists the closest NICU IIIC (the highest level). Although co-bedded twins appeared to have lower pain scores 30 seconds after heel lance on a scale of 0 to 21 (MD-0.96, 95% CI-1.68 to -0.23; two studies; 117 pairs of twins; I 2 = 75%; evidence of low quality), they had higher pain scores 90 seconds after the procedure (MD 1.00, 95% CI 0.14 to 1.86; one study; 62 pairs of twins).

List of related literature:

Currently, there is no evidence to establish cobedding of multiples outside the NICU as a safe or unsafe sleep practice.

“Perinatal Nursing” by Kathleen Rice Simpson, Patricia A. Creehan, Association of Women's Health, Obstetric, and Neonatal Nurses
from Perinatal Nursing
by Kathleen Rice Simpson, Patricia A. Creehan, Association of Women’s Health, Obstetric, and Neonatal Nurses
Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008

As a consequence, multiples have a fivefold increased risk of stillbirth and a sevenfold increased risk of neonatal death (Scher et al., 2002).

“Avery's Diseases of the Newborn E-Book” by Christine A. Gleason, Sandra E Juul
from Avery’s Diseases of the Newborn E-Book
by Christine A. Gleason, Sandra E Juul
Elsevier Health Sciences, 2017

Multiples have higher rates of preeclampsia.

“Maternal-Fetal Evidence Based Guidelines” by Vincenzo Berghella
from Maternal-Fetal Evidence Based Guidelines
by Vincenzo Berghella
CRC Press, 2017

Offering the option of a multifetal reduction procedure to patients carrying triplets is medically reasonable, but whether this is perceived as a valuable option by the patient will depend on many factors, including the family’s social, financial, ethical, and religious considerations.

“Obstetrics: Normal and Problem Pregnancies E-Book” by Steven G. Gabbe, Jennifer R. Niebyl, Joe Leigh Simpson, Mark B Landon, Henry L Galan, Eric R. M. Jauniaux, Deborah A Driscoll, Vincenzo Berghella, William A Grobman
from Obstetrics: Normal and Problem Pregnancies E-Book
by Steven G. Gabbe, Jennifer R. Niebyl, et. al.
Elsevier Health Sciences, 2016

The risk of fetal loss increases with gestational age, so most monochorionic monoamniotic twins are delivered electively at 32 to 34 weeks.

“Cloherty and Stark's Manual of Neonatal Care” by Anne R. Hansen, Eric C. Eichenwald, Ann R. Stark, Camilia R. Martin
from Cloherty and Stark’s Manual of Neonatal Care
by Anne R. Hansen, Eric C. Eichenwald, et. al.
Wolters Kluwer Health, 2016

All multiples are at risk for preterm labor, preterm delivery, gestational diabetes, hypertensive disorders of pregnancy, fetal growth restriction, and cesarean delivery.

“Obstetrics: Normal and Problem Pregnancies E-Book” by Mark B Landon, Henry L Galan, Eric R. M. Jauniaux, Deborah A Driscoll, Vincenzo Berghella, William A Grobman, Sarah J Kilpatrick, Alison G Cahill
from Obstetrics: Normal and Problem Pregnancies E-Book
by Mark B Landon, Henry L Galan, et. al.
Elsevier Health Sciences, 2020

When multiples are delivered, it is best to have a separate resuscitation team planned for each infant.

“Klaus and Fanaroff's Care of the High-Risk Neonate E-Book” by Avroy A. Fanaroff, Jonathan M Fanaroff
from Klaus and Fanaroff’s Care of the High-Risk Neonate E-Book
by Avroy A. Fanaroff, Jonathan M Fanaroff
Elsevier Health Sciences, 2019

Simoes and co-workers showed that pregravid obesity appears to predispose women to gestational diabetes during twin pregnancy and that there is no advantage in terms of birth weight in twins born to diabetic mothers.51 All mothers of multiples are at considerably greater risk of preterm labor and delivery.

“Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant” by Richard J. Martin, Avroy A. Fanaroff, Michele C. Walsh
from Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant
by Richard J. Martin, Avroy A. Fanaroff, Michele C. Walsh
Elsevier Health Sciences, 2014

The mother should be reassured that this is not unusual with multiples; in time, a close relationship with the other baby or babies will develop.

“Mayes' Midwifery E-Book” by Sue Macdonald, Gail Johnson
from Mayes’ Midwifery E-Book
by Sue Macdonald, Gail Johnson
Elsevier Health Sciences, 2017

Women with multiples are 13 times likelier to give birth before 32 weeks than women with a singleton.3 Perinatal mortality is increased in the infants from multiple pregnancies because of increased rates of congenital anomalies, growth abnormalities, obstetric complications specific to multiples, and prematurity.

“Fetal and Neonatal Physiology E-Book” by Richard A. Polin, Steven H. Abman, David Rowitch, William E. Benitz
from Fetal and Neonatal Physiology E-Book
by Richard A. Polin, Steven H. Abman, et. al.
Elsevier Health Sciences, 2016

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
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Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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  • Those mom and daughter moments with Gemma and Cara. They must be my favourite, having good time together making s’mores and talking. It’s just so cute.

  • Omg congratulations my dear��������❤️always my dream to have twins in future ����❤️much love for y’all. New subscribe let’s support each other��❤️

  • I LOVED this vlog! I swear I smiled the entire time. First, let me say you look ah-mazing! How is it possible you had two babies in your belly just 23 days earlier in this video?? 2nd, those two baby boys are so freakin adorable!!!!! So alert! So tiny and so perfect. I loved when your husband said, I knew I always wanted to be a dad! So happy for you both! I do follow you on Instagram so I know they’ve grown a lot already. So are they identical twins or fraternal? Do they test them to see if their DNA is the same? Or do they just go by how they were situated in the uterus? Just curious! Take care! And don’t forget to eat!

  • congratulations!!!!hello beautiful, sorry for the late reply! your comment went to spam! sure we can support each other. I will subs now hope u too

  • Oh I relate to this I almost died and got an oxygen tank while laboring. But thankful enough to God he saved me. Cute twins you have hello babies ����

  • My daughter had a baby at 29 wks. She thinks she has post traumatic stress disorder from having a nicu baby. He is almost 4 now and does have severe autism from a traumatic birth.

  • Thanks so much for the support even when you’re so busy with those precious babies! I always wanted twins, but no luck!
    What a lucky momma you are!❤️

  • @caitlyn you really give birth to beautiful twins..
    I just saw your comment on my video, I think you delete..
    but no problem… thanks, and yes just started my youtube journey with a makeup channel, and i really need youtuber support like you,
    you are amazing makeup artist i just saw your video, and lot more see, i learn lot from your video, thankyou… again…
    Please support my youtube channel… thankyou

  • Thank you so much for your previous comment! I didn’t get the notification until just recently but i really appreciate it! Congrats omg your birth!!

  • It’s so funny how each of the babies have different happy sounds Reese squeals and Wren she has a quiet growl squeak mix and Royal just has an all boy growl! Their personalities are really showing as they get older!!!

  • oh my goodness caitlyn, congratulations!!!! i cannot begin to imagine how it must have been for you to go through all of this during this time! but both babies look adorable and hope all is well beauty xxxxxxxxxx

  • Same DNA, same personality and same style. How much identical could you guys be? I could watch your channel until your children goes to college. You’re family is so cool and adorable.

  • I love the moments with Darik and Dylan, they look the exact same as adults.. when Dylan had the camera for a minute I thought it was Darik

  • The more I see them, the stronger the baby fever gets and the more my grandmother tells me no more kids ���� so incredibly glad they’re finally home ❤️

  • Babies gotten so big so fast I can’t take it lol!!! Cara you’re amazing! I love how you dress all of your children! Please if you can let us know where you get the bows and outfits

  • Not sure how I misses this?!? But I’d like a million copies of Gemma singing Let it go please LOL!!!! Cara. You are amazing and I absolutely love the way you are with Gemma ❤

  • Cara is a pro. I.was worried about the walk with Gemma and all the munchkins but the sling for the win. Babies adorable and so happy for bathtime. Darik and Dylan, thanks for that ATL accent. I spit my water out when you said that southern Hi walking in restaurant. You all make my day. XOXO ❤

  • The cutest babies,the most handsome twin brothers,the most beautiful mom and wife,the sweetest family,the Chatfam�� Stay blessed y’all.

  • I live for Wrens button nose….they’re all so cute but her nose melts me. You’re so blessed to have so many beautiful and healthy babies.

  • God bless you Cara power momma!!! Gemma ����a delight to watch!! So independent great job Momma and Papa. Twins are always so cheerful and singing!

  • Gemma is sooo adorable i like her and babies Reese Royal and Wren sooooo cute but mama is cute but looks tired but is very proud awesome family dad is very funny too lol

  • I’m so glad I found this video. I’m having twins in January. I have been wondering/anxious about how it will be during this pandemic versus my previous deliveries. Thank you for sharing.

  • Amé la parte en la que hablaron en español!!! Hablaron muy bien �� Ya hace un tiempo no veía un vídeo con Dylan!! Los quierooo!!! �������� Su relación de hermanos es ❤!! Y Cara siempre hermosa!!! Gemma y los trillizos siempre tan ��!!

  • When I switch Your video and my baby girl( 1.9 y) hear Gemmas voice,she is running to me and smiles���� babys so cute and growing so fast❤️❤️❤️❤️

  • It’s so cute how Gemma stops to pick up something on the walk. It was so funny and adorable. Same with her putting her feet in the water.

  • I also had to watch the “Dont Shake your baby” video and a video about “Safe Sleeping” when I had my son last year. He wasn’t a Nicu baby so I’m assuming it’s the new regular. We also had to fill out a question paper about the videos. It had to be the most annoying thing and I ruined the first question paper and was so tired I couldn’t stay awake for the video ��

  • When my daughter was in the Nicu for iugr ( she had nothing wrong except being 3 pounds 12 oz at birth and 35 weeks) we had to stay 18 days. It was a good experience bc she had her own room and for the second half of her stay her room had a shower, full bathroom and couch that made into a bed. We were at uams in Little Rock. I was told she couldn’t go home until she was 4 pounds bc of car seat regulations but they let her leave a couple ounces shy of that:). I stayed every single day and night with her but my older two kids were teenagers so that’s why I was able to do that. I saw a lot of sad things like parents not visiting their baby and I did have one not very nice nurse but 99 percent of all the drs and nurses were so kind! I also didn’t have to leave at shift change. I love your videos. ❤️❤️

  • I used to buy those salt water sandals for my girls. From Nordstrom’s right? Good to see they still sell them, my girls would get a new pair every Summer. Gemma just captured my attention the beginning of this vlog. I just love how well she plays by herself. She is a Gem!!! ��

  • Omg beautiful and cute family in the world ❤❤❤❤❤❤❤❤besties❤❤if you reading this com i just say you are the best an beautiful. I love you❤❤❤❤❤❤

  • Gemmma is sooo so cute, so innocent and funny baby, and the vlog was bit funny too, u two brothers make me laughed today, great vlog as alwayssssss the babies love much lv to u chatfam❤️ ❤️ ❤️ ❤️ ❤️����������

  • Omg I cant believe this I really really appreciate to thanks fr commenting on my channel I really saw ur channel now n I am completely inspired by to ��tq fr supporting me tq n congratulations fr new baby soo cute god bless u tqsm fr ur love ❤

  • My son is 7 weeks into his NICU stay and my best advice is just stay in the communication loop with your nurses. Ask a million questions and read your babys chart/daily records. You give up so much control in the NICU, so that really helps us feel educated of his current care plan.

  • I just adore you family. Thank you for sharing your journey with us. Plus Gemma has the best tricycle ever. My daughter loved hers as well except we just switched to a bigger bike and she cried alot when she couldn’t ride it anymore because she’s too big.

  • Thank you for this! We are heading into an emergency c-section in the morning with our surrogate at 28 weeks. Just wanted this whole thing thank you for making this for us.

  • i send my support to you…hoping you can do the same…i am a avid fan of your channel….Watched it again full to make our bonding strong. Hugs and warm greetings dear. Stay safe and blessed

  • This is a great video with alot of information that I wish I had gotten sooner my son has been in the nicu for 98days already he also has chronic lung disease I’m so happy I could find a YouTube channel with this type of information cant wait to for more videos

  • No one told me my baby (32 weeker) wasn’t truly mine till she came home. When she was in NICU hardly anything was in my control. Even the pediatrician had to approve the baby wash and lotion I wanted to use on her (and it was gentler and less harmful than the Johnson’s they used)… I asked to use the castile soap used for pump parts but nope. That was one of the minor things. Then they stopped giving her my milk to give her formula. Long story but THAT royally pissed me off bc I was making boatloads of milk for her.

  • I’m so glad my NICU was great with communication and would listen to me (bar one nurse who was quickly removed from my sons care)
    He was in NICU for 75 days and was born at 36weeks, his due date was one of the hardest day’s for me.
    Thankyou for this video. How did you cope with having another baby after a NICU experience. My son is now one and we are wanting to TTC but the fear of NICU has us apprehensive.

  • Again Cara, you crushed it! super mom over here!!! Adorable family! Love seeing the cuties and all of the fun things you do as a family!! Darik and Dylan crushing it in Atlanta!! Love you guys <3

  • What you don’t see is the nurses crying on the car ride home because of those fragile babies. Or the nurses who cry in the break room or medication room because a baby just passed away. They may be talking about shoes at the nurses station, but I guarantee they hurt for those babies and the family members ❤️

  • I think not every woman would had the patience to do the hard job there is behind the camera with four kids. You’re an amazing mum, Cara ❤. And Darik is also an incredible father, when he is also taking care of his children haha ��

  • I think the biggest frustration for me as a NICU parent was how inconsistent it was. Our NICU didn’t have too many strict guidelines so the nurses all just did what they thought was best. I had nurses the first 2 wks of my daughter’s life that would raise the giraffe bed so we could more easily interact with her but then one nurse refused. I was devastated because at that point I had not even held her. My biggest takeaway from your video is that each place can be so different. Our NICU was very different from yours. They made the bottles every feeding. Each section had a nurses station where there were supplies and a refrigerator/freezer. My daughter was off of all O2 support at 2 weeks old. I can’t imagine them forcing her to wear the cannula (she was never on a CPAP) for extra weeks! Even then we dealt with ROP. Overall our experience was great. We had a few nurses that were rude, even a resident threatened us with a long term care facility when we said we weren’t ready to make a decision on the g-tube (guess who didn’t need one ��) and my daughter was close to her due date. She was there 3 months and 2 days (1lb 7 oz at 28 wks) and the good outweighed the bad. I still have flashbacks triggered by smell almost 12 years later. I also only vaguely remember the first few weeks. And for a while I didn’t remember much at all. Thanks for sharing your experience and being willing to support others! It can be so incredibly isolating and it is traumatic. NICU moms need someone who understands.

  • My son was a 34 week baby as well he was born healthy no problems because of how healthy he was he also went home 7 days later and they also said he was the smallest baby that was born and stayed at that hospital let alone go home at day 7 just over 4 pounds..i hope baby number 2 is healthy as well

  • Our NICU had a Ronald McDonald room and they provided parents free snacks and drinks. They also had a shower and a washer + dryer. It was nice. I couldn’t stay overnight with my second baby unfortunately. This is why I’m delivering at a hospital with private NICU rooms this time just in case.

    My baby failed her car seat test and went home in a car bed. Had to dish out $150 when we were broke. Insurance should’ve covered it since it was cheaper than even a partial day in NICU, but we were just so desperate to get her home we didn’t fight with them.

  • I’m so glad my NICU was great with communication and would listen to me (bar one nurse who was quickly removed from my sons care)
    He was in NICU for 75 days and was born at 36weeks, his due date was one of the hardest day’s for me.
    Thankyou for this video. How did you cope with having another baby after a NICU experience. My son is now one and we are wanting to TTC but the fear of NICU has us apprehensive.

  • They should have casted Gemma for the voice over of Elsa her let it go solo was amazing! And she’s obviously a natural ���� I love Gemmas big personality

  • My hospital is amazing! I had two nicu babies. The nicu at my local hospital each baby has their own room with a bed for a parent to spend the night. In the morning the drs and nurses go to each room to discuss how babys night went and plans for the day that the parents are encouraged to be present at.

  • I was in the hospital �� and my family stayed in the Ronald McDonald House too but the worst thing was that it was right before Christmas ��

  • Soo..

    The mom has a Twin sister?

    The Dad an identical twin..

    And they Have Triplets??

    Holyy.. The Genes are strong in this fam.

    God bless you guys.

  • I’m crying gosh I’m emotional I remember how I felt with my baby in the NICU. I’m so happy for you two their beautiful congratulations!

  • Beyond precious. Congratulations.
    The 5 dislikes on this video were obviously the nurses who had to say goodbye to these two angels.
    !!!Yay for going home!!!

  • So nice to see you two so happy, when they told you that the babies are going home! (Sorry for my bad english��)
    So much love for those two beautiful angels❤️
    Love from the Netherlands
    ��

  • Omg look at them beautiful boys thank you for sharing with us cant wait to see them grow you guys are going to be amazing parents they are two lucky boys and all the best to you both on this amazing day god bless you

  • New subscriber your babies are so cute❤️ my baby is due in August My first baby I can’t wait to meet my little bean I still don’t know what I’m having almost going into 10 weeks ❤️

  • God bless your babies!!! I have just followed you,  I would be so grateful if you could check out my channel and follow me back on my skincare channel xxxxx lets grow together:)

  • Congratulations!! So happy for you. So curious to know how the last month has gone. Obviously you have been busy. Enjoy every moment, even the hard ones. It goes by so fast. ❤️

  • Cuteness overload??? Is there anything more adorable than identical twins with huge binkies??? And there won’t be a better Christmas EVER. So happy for you guys. ❤️����❤️ twintastic!!!!

  • Wow that’s fantastic news, I’m so so pleased the boys are going home with you xxxxxxx your such a beautiful family, sending you all my love and best wishes xxxxxxxx just fantastic xxxxxxxxxxxxxxxxxx

  • Soo amazing when u finally get to bring ur babies home. My daughter spent 122 days in the NICU at Pittsburgh children’s hospital. Yesterday was a year she has been home. Crazy how time flys, cherish every minute!! Loved watching ur journey and the twins omg adorable!!

  • I am literally getting baby fever right now so cute!!! They are finally in their home and can be getting love from mommy and daddy all the time <3