title: Multiple birth families with children with special needs: a qualitative investigation of mothers' experiences.
abstract: Multiple birth remains prevalent, with prematurity and subsequent disability being common complications. However, little is known of the experiences of mothers living with the combined circumstances of multiple birth, prematurity, and special needs. This paper reports an exploratory study using the qualitative technique of thematic analysis, to describe and interpret the experiences of 10 mothers of prematurely born multiple birth children with diverse special needs. Mothers were shocked to learn they were carrying multiple fetuses, including those who underwent in vitro fertilization with dual embryo transfer. Most experienced protracted concern over one or more babies' survival during pregnancy, and prescribed bed rest was frequently associated with increased anxiety and other adverse psychological effects. Some experienced disenfranchised grief, such as those grieving the opportunity to bear a single child. The contrast with experiences of mothers of healthy, term singletons caused considerable distress. Feelings of detachment and unreality were common in the immediate postpartum period, possibly due to transient depersonalization. Having more than one newborn created practical and psychological problems during the neonatal period, particularly when infants were separated due to differences in medical status. The extent to which hospitals accommodated the multiple birth relationship varied and significantly affected mothers' postnatal experiences. Mothers often felt guilty, particularly regarding inequality of care and attention they were able to provide to each child. This was especially problematic for multiples discordant for special needs status. The presence of one normally developing child complicated adjustment to the other's difficulties, and several experienced chronic sorrow. Serious maternal mental health difficulties were common but not universal. Available formal supports were generally perceived as inadequate, addressing some, but not all, of the mothers' needs. Further work is needed to advance understanding of the relationships between mothers and their multiples, and to explore the implications of special needs within multiple birth families.
authors.affiliation: Developmental Medicine, The Royal Children's Hospital, and Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia. multiplestudy@gmail.com
authors.forename: Christie E
authors.initials: CE
authors.lastname: Bolch
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
authors.forename: Mark P
authors.initials: MP
authors.lastname: Umstad
authors.forename: Jane R W
authors.initials: JR
authors.lastname: Fisher
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D019988:Children with Disabilities; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007407:Interviews as Topic; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000523:psychology*; D036301:Qualitative Research; D015203:Reproducibility of Results; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology; D014739:Victoria