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Co-Bedding of Multiples in NICU

by Linda Lutes, M.Ed
Reproduced with permission from Twin Services Reporter,
Spring/Summer 1996

Neonatology is one of the youngest sciences, and the practice of developmental or holistic care in relation to newborns is still in the "preemie" stages. Traditional care of multiples has focused on meeting the health requirements of each baby. Standard practice has been to separate multiples in the neonatal intensive care unit (NICU) and sometimes to place them in different hospitals. Little, if any, attention has been paid to the impact of their separation on the long term mental health of the babies and on their families.

When we take a developmental approach to the population of our NICU's, where multiple births are common, we begin to recognize the unique needs of multiples and their families. We are beginning to ask what it was like for multiples to share a womb from conception until delivery. How did they interact in the womb? How do we affect their development when we separate these siblings who have been developing together since conception? Do we fully understand, recognize, and acknowledge the issues related to the mental health of multiples? Are we mindful of the extraordinary physical and emotional stress imposed upon a family when their babies are placed in separate hospitals or nurseries for care?

Co-bedding of multiples is evolving as a practice which attempts to replicate and capitalize upon their unique prenatal environment and experience. When multiples are swaddled together in the same blanket and boundary they have the opportunity to co-regulate and to continue to progress in their unique interactive development. Some hospitals are putting multiples together while they are still incubated; some are co-bedding them under bili-lights; others wait until they are on minimal or no supplemental oxygen; and others wait until they are in an open crib on room air. Infants that are co-bedded within a short period of time after birth appear to handle the stress of the NICU better than those who are separated. Physicians have reported getting a truer picture of the multiples when they are bedded together, and having families that are happier with fewer complaints.

I encourage everyone involved with multiples to consider the use of co-bedding. Discussion of this concept needs to include physicians, staff, ancillary personnel, infection control and the parents. The majority of the staff come around as soon as they see multiples together. Everything "falls into place."

Editor's note. Linda Lutes, M. Ed., of the University of Oklahoma Health Science Center at Children's Hospital of Oklahoma City conducted a pilot study in six hospitals of the co-placement of multiples in NICU.

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The information in this article is not a substitute for professional medical or psychological advice. Please consult with your health care advisor about specific questions or problems.

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