title: Higher order multiples--socioeconomic impact on family life.
abstract: OBJECTIVE
  Assisted reproduction led to an enormous increase of multifetal gestation. Apart from the obstetrical risks the physical, psychological and socioeconomic problems in families after the birth of higher order multiples often lack attention.
  
  
  METHODS
  Anonymous questionnaires were sent to 92 families who had delivered higher order multiples at our hospital (1983--1998). In a retrospective analysis (rate of return: 70%) the study group included 54 families with triplets, nine families with quadruplets and one family with quintuplets. The questionnaire was divided into three sections: a joint section to be answered by both parents together, and two identical sections for each separately.
  
  
  RESULTS
  Most parents suffered from severe physical and psychological exhaustion mainly caused by worries about the multiples' development, handicaps and acute and chronic diseases as well as by personal and by financial problems. Nearly all of the families had to rely on additional manpower and on financial support. The inability to cope with the "self-inflicted" family-situation as a consequence of "optional" infertility treatment led to feelings of guilt.
  
  
  CONCLUSIONS
  Aside from psychological guidance, the need for personnel aid as well as financial and material support in families after the delivery of higher order multiples is striking.
authors.affiliation: Department of Obstetrics and Gynecology, UK S-H, Kiel University Hospital, Brunswiker Strauss 10, 24105 Kiel, Germany. astrauss@email.uni-kiel.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Strauss
authors.forename: D
authors.initials: D
authors.lastname: Winkler
authors.forename: K
authors.initials: K
authors.lastname: Middendorf
authors.forename: C
authors.initials: C
authors.lastname: Kümper
authors.forename: S
authors.initials: S
authors.lastname: Herber-Jonat
authors.forename: A
authors.initials: A
authors.lastname: Schulze
mesh_terms: D002648:Child; D002657:Child Development; D004243:Divorce / Q000706:statistics & numerical data; D005192:Family Health; D005260:Female; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D007246:Infertility / Q000628:therapy; D007899:Leisure Activities / Q000523:psychology; D008297:Male; D009099:Multiple Birth Offspring / Q000523:psychology* / Q000706:statistics & numerical data*; D010290:Parents / Q000523:psychology; D011247:Pregnancy; D012189:Retrospective Studies; D035781:Siblings / Q000523:psychology; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000191:economics / Q000453:epidemiology*; D011795:Surveys and Questionnaires