Prenatal behavior of multiples: implications for families and nurses

Each twin and higher order multiple leads an extraordinary life before birth. The literature has revealed that the intrauterine environment differs for every multiple fetus and helps to shape the individuality of each multiple-birth child. From early in pregnancy, it appears that a multiple develops his or her own temperament and each set of multiples establishes an individualized pattern of tactile communication between or among themselves. The same behaviors, traits, and intermultiple interactions seen in pregnancy also have been observed in infancy and beyond. Intermultiple communication continues after birth, and preliminary evidence suggests that co-bedding assists the majority of newborns to make the transition from intrauterine to extrauterine life. The response of a multiple to the death of a co-multiple during pregnancy or after birth may be influenced by the relationship they shared in utero. Nurses and other health care providers have a role to play in informing multiple-birth parents about the latest knowledge, thereby assisting parents with the attachment process and specific parenting issues. In addition, nurses now have a solid foundation on which to create and implement care strategies that promote the healthy development of each multiple-birth infant and the intermultiple relationship.