Early labor began 24 weeks into Mara Stein’s pregnancy, prompting an emergency trip to the hospital. Expecting twins, Stein, a clinical psychologist in Chicago, Ill., knew she was at risk for preterm labor, but never did she expect to be put on strict hospital bed rest and contraction-controlling medications so early into her pregnancy.

For the next six and a half weeks, Stein’s medical team successfully prevented her from going into labor. But on May 30, 1996, the contractions couldn’t be stopped. Ten weeks before they were due, Gavriella and Layla, identical twin girls, were born. Each weighed little more than 3 pounds.

Among multiple pregnancies, early deliveries like Stein’s are not uncommon. At least half of twins and 90 percent of triplets are born prematurely (before 37 weeks gestation). Preterm babies, particularly those born very early and very small, often face medical and developmental issues.

Ahead of the Game
The good news is multiple preemies have an advantage over singletons. “In the womb, multiple babies typically mature faster than singletons because the mother’s body knows what the babies need,” says Patricia Malmstrom, founder of Twins Services and author of The Art of Parenting Twins (Ballantine, 1999). Multiple preemies, therefore, are often better prepared for breathing and developing in the outside world.

Also, premature delivery and low birth weights of multiples are often a result of crowding in the womb and not a mother’s health problem, according to Malmstrom, who has researched twins for more than 20 years. “Babies born small and early because of multiple gestation and not for other reasons are often healthier,” she says.

“A key factor in how well a baby grows and develops is the parents’ participation,” says Pat Grunwald, a clinical nurse specialist at The Center for Perinatal Care at Meriter Hospital in Madison, Wis. Learning to love and care for your tiny, fragile babies will take time, patience and practice.

Bonding in Bulk
For Lauri Griffin, mother of Ben and John, born eight weeks early in Colorado Springs, Colo., bonding with her twins took a little longer than with her first son, Sam. “With preemies, I think you hold back a little at first because you don’t know if they’re going to make it," she says. "It’s also hard to bond when you can’t hold them or nurse them."

Bonding also may be delayed because your energy and time is focused on learning about two (or more) sets of medical problems, communicating with numerous medical experts and juggling family and household responsibilities with NICU visits. And let’s face it: It’s not that easy to sing and talk to your babies with so many strangers in the room.

Fortunately, any nurturing you do in the nursery benefits your parent-child relationship. Softly speaking to and gently touching your babies provides comfort and makes you feel more like a parent. As your babies become more stable, ask to hold them. Depending on their health, you may only be permitted to hold one baby at a time, but let the nurses know you’re anxious to hold them together.

Resting your diaper-clad babies on your bare chest with a blanket covering you both, called kangaroo care, can also help create an extra-special closeness. Continue kangarooing after homecoming, too.

Another practice that is gaining popularity in intensive-care nurseries is co-bedding, or placing your babies together (preferably in their womb position as identified by ultrasound). Although the effectiveness of co-bedding has not yet been studied, parents and nurses report positive results. “We see babies who were previously agitated immediately settle down when they’re together,” says Theresa Kledzik, a registered neonatal nurse specially trained in the developmental care of preterm infants. “Their heart rates stabilize, they regulate their temperatures and they usually fall asleep.”

It’s only natural for babies, who should still be together in the womb, to suck on each other’s hands and intertwine their limbs. “It was just so cute when Ben and John were snuggled together,” says Griffin. “It made it much easier to leave the hospital – and them – when they were together.”

If your NICU doesn’t allow co-bedding, ask if your babies’ beds can be placed near each other, allowing you to visit them both at the same time. Consult your pediatrician about co-bedding after homecoming. Often, one multiple will come home sooner than the other, causing parents to worry about both parental and sibling separation.

“We encourage parents to call, day or night, and we will even put the telephone near Baby’s ear, so he or she can hear a parent’s voice,” Kledzik says.

She encourages parents to ask specific questions: What position is my baby in? Is my baby using a pacifier? To encourage sibling bonding, some hospitals will allow the discharged baby to visit his brother or sister and co-bed.

Growing up Healthy
“A healthy full-term child can overcome a cold, but a cold in a preemie can lead to more serious complications,” says Dr. Judy Bernbaum, director of the neonatal follow-up program at Children’s Hospital in Philadelphia.

To stay healthy, Dr. Bernbaum suggests practicing preventive care by washing hands and avoiding crowds of people who may be carrying germs. Also, ask your doctor about preventive vaccines.

Your babies should have regular visits with their pediatrician and specialists. Even though Griffin’s twins had few problems, they still had follow-up appointments with a respiratory therapist, a cardiologist, an ophthalmologist and physical and occupational therapists. “Preemies need close monitoring of their growth, nutrition and development,” Dr. Bernbaum says.

Developmentally, experts say that most preemies “catch up” by age 2 or 3. Until then, evaluate your babies’ milestones by their “adjusted age” (deduct weeks or months born early from their birth date). Children with more severe delays often take longer. Maureen Van Hoven of Hudsonville, Mich., delivered premature triplets more than four years ago. “When you have multiples, you can’t panic when one is delayed more than the other,” she says. “Each child will develop at his own rate.”

Dr. Bernbaum also stresses that parents should look for progress over time. “If you have concerns, talk with your pediatrician and ask for an evaluation,” she says.

Feeding the Masses
Your breast milk has nutrients designed especially for your preemie multiples and antibodies that help fight infection. But breastfeeding isn’t easy: Your babies may have weak sucking abilities, they may tire easily and your milk supply may be low because of the stress of caring for more than one infant. Many mothers pump and store their milk, then begin nursing when their babies are developmentally ready.

To successfully nurse, you need resources and support. A lactation consultant, feeding specialist or a local breastfeeding support group can help. Remember, any amount of breast milk you provide your babies is beneficial.

By breast or bottle, your babies will probably need frequent meals for good growth, and chances are they won’t always want to eat at the same time (do ask your hospital to try to get them on a regular eating and sleeping schedule before homecoming). Understandably, you may feel overwhelmed and exhausted.

“This is a time when you really have to nurture yourself,” Malmstrom says. Get plenty of rest, eat well and take vitamins.

Taking care of yourself and your babies can be stressful, to say the least. But most parents say parenting multiple preemies gets easier with practice – and it’s time well spent. Griffin, whose twins are now 2, says, “On the days when it’s really hard, I try to think back at their early births and remember how lucky I am to have them. I’m exhausted, but happy.”

Want to see more?

• Are You Prepared for a Preemie? A Guide to Preterm Babies
• Magical Melodies: The Benefits of Music for You and Your Preterm Infant
• Nurturing Your NICU Baby: Comfort for Both Mom and Baby
• Going Home Alone: When Preemies Need to Stay in the NICU
• Early Communications: Decoding Your Premature Baby's Signals
• Talk about it!