Parents of Multiples Suffer Higher Rates of Mental Illness
From the moment a mother and father of multiples discover there is more than just one little bundle of joy on the way they instantly start the multiplication process. Visions of double the diapers, triple the bottles, or even quad strollers start filling their mind. But beyond the expense, something that doesn’t seem to occur in their minds, or in the minds of others is a multiplied risk for mental health issues like PPD, Anxiety, and other forms of depression. Studies are now beginning to confirm that having multiples does not just increase your risk of complications in pregnancy, but also dramatically impacts the emotional well-being of each parent after the birth.
According to the Mayo Clinic having issues like “baby blues”, a feeling of sadness or mood swings after giving birth, is very common and normal. However, when mothers tread the territory into severe, and prolonged depression with symptoms like extreme mood swings, failure to bond with the baby, or even thoughts of harming herself or others she has now passed into the realm of Postpartum Depression. Postpartum Depression is becoming more common as new studies and questionnaires are able to diagnose the condition more frequently. Mothers often struggle to cope with even basic life tasks and can be rendered debilitated by mental illness. In rare, but serious conditions, postpartum depression, or PPD for short, can even transform into a dangerous condition referred to as Postpartum Psychosis.
A study conducted by Brown University found that 48% of participating twin parents said they suffered from mental illness and would have appreciated added care for their mental health, however only 10% actually received that care. In that same study over two-thirds of participants said that their health care provider never even warned them about the mental health risks that come along with having multiples. Another study completed by the School of Psychology with the Queens University of Belfast, for The Journal of Psychosomatic Obstetrics & Gynecology, concluded that overall parents of twins and multiples suffered far poorer mental health than parents of singletons.
Mother of twins, Vanessa Hubbard, manages her toddler twins, Atreyu (left) and Eliana (right), like a pro with quick moves and both arms full, a skill she had to learn in an instant once her twins were born premature over a year ago. (Summer Mincks)
In a similarly themed article published by Twiniversity, a foremost authority for all things twins, it was stated that at least 85% of mothers of multiples will suffer from some form of postpartum depression or anxiety. Interestingly enough a study conducted for the Norwegian Institute of Public Health showcased conclusions that mothers of multiples typically showed no signs of serious mental health concerns like depression during pregnancy and the majority of women involved in the study remained at a stable mental health rating throughout the pregnancy. It should be clear that the study does state that it is apparent that the challenges of having multiples can lead to both prenatal and postnatal stress, but depression only typically occurs after the birth. Add in the concerns of early term labor, and other complications like preeclampsia and gestational diabetes, and it is sure to raise stress in any parent with multiples on the way. However, the study was unsure of the exact cause of higher rates of depression and anxiety after the children were born.
In a report showcased by CNN, the topic of high rates of PPD in mothers of multiples was discussed, but yet again many factors were listed as potential causes. Everything from hormones to physical changes, all the way to lack of sleep, and even just the stress of doing everything in either double, triple or more can easily wear on parents of multiples.
“My babies were born premature.” Vanessa Hubbard, a mother of boy/girl twins, states, “I had my babies, but I couldn’t ‘have’ my babies.” Vanessa recounts her time spent with her twins in the NICU and states that after she was released from the hospital all the stress of the complications and hormonal changes came to a head.
“I fell apart,” she says. “I was such an emotional mess.”
Soon her depression became so intense that she felt suicidal. Her symptoms only slightly eased when her medication for depression was increased. Though the medication curbed the symptoms she mostly needed a support system.
She is not alone in feeling like support was desperately needed during this time. From the time that a mother of twins or more discovers that more than one is on their way, she is instantly confronted with complications. Even worse is that these negative narratives continue on once the babies are born. Vanessa even switched doctors during her pregnancy in the hope of finding a more compassionate practitioner.
Vanessa says from the moment she found out about her twins the doctor was stone cold and emotionless.
“All my planning was gone,” she says, “I wasn’t getting anything I wanted, I was sobbing, and he didn’t even acknowledge my feelings.”
Though she states that her husband was a great support, he worked long hours, and a strong support system would have greatly assisted her both physically and mentally.
“If I would’ve had some extra support it would’ve made a huge difference.”
Vanessa Hubbard plays in the front yard of her Oregon home on a sunny day in September. Her boy girl twin toddlers, Atreyu (left) and Eliana (right) showcase differences in personality while Atreyu seems more than content to relax in his mother's lap while Eliana wants to explore. (Summer Mincks)
Mothers of multiples also have a tendency to feel isolated and alone, especially within the first year of their children’s lives.
So, with such high rates of mental health disorders in parents of multiples, what is the real reason behind it?
Is it societal? Perhaps physiological? Or is this related to a bit of a both?
Rachelle Stowers, a Clinical Social worker working in family therapy thinks that the issue starts with the physical demands placed on a woman’s body and then comes to fruition with societal issues.
“I guess I would say my professional opinion is that this is a combination of physiological changes as well as societal constructs,” she says. “I think that anytime a parent experiences a birth different than their expectations, the rates for distress increase. The divorce rates for parents of multiples and/or disabled children are more than double that of the typical population. Correlation doesn’t necessarily equal causation, as you know; however, having multiples increases stress while decreasing time and resources available for self-care strategies. This combined with not fitting into society’s norms I believe contributes to the increased rates.”
Lorien Zahava Behrle, a doula, agrees with this statement but feels that a majority of the issues could easily stem from the treatment mother of multiples face in terms of their own birthing situations and the forced interventions that typically transpire.
“In many cases mothers pregnant with multiples birthing under an OBGYN care and born in the hospital are more heavily pushed or even given no option to let pregnancy continue to term, or until birth comes naturally, or various other medical interventions,” Lorien states. “I speculate this does play a role in fetal development and increasing chances for various neurological illnesses.”
Vanessa Hubbard sweetly kisses her daughter, Eliana, while holding Eliana's twin brother, Atreyu, in her front yard. Through her struggles with severe anxiety and depression after their birth she states that ultimately being their mother as well as a mother to her other children gave her the strength to move forward. (Summer Mincks)
All of these notions and theories come at a very interesting time in our world where the rate of twin and multiple births have been steadily increasing. Some statistics even speculate that the rate of twins born in the U.S. has increased by 76% since the 1980s.
The most common factors said to increase these rates have to do with the higher occurrences of things like in-vitro fertilization and the fact that now more mothers are having children later in life. Once a woman reaches above the age of thirty-five her percentage of having twins steadily increases until menopause.
With the rates of multiple births ever growing, so do the rates of mental illnesses in parents of multiples increase as well. But is there anything we can do about it?
Having proper support is a key factor in assisting mothers of multiples, especially within the first year after multiples are born. Staying active and still feeling like a normal part of society is also crucial for moms of multiples, but the majority admit that this can be very difficult.
Tegan Marshall-Liggins, a mother to triplet boys, began feeling the strains of depression and anger when she realized that the majority of local activities simply were not multiple friendly.
“I feel like society as a whole is not kid friendly,” Tegan explains. “Everywhere you go is hard. I do it every day and take my triplets everywhere, but it’s hard. Grocery carts aren’t big enough, all the crap by the check stands and they aren’t wide enough to keep your kid’s grabby hands away while you are waiting in line for an eternity. People feel like it is okay to ask invasive private questions just because you have multiples. Playgroups, swim lessons, ‘mommy and me’ activities do not cater to multiples, so these are things we are left out of until they are old enough to do it alone. That can be more isolating and disappointing.”
For Tegan, the isolation she felt was the biggest detriment to her mental health.
“Everyone says they will help but nobody really does,” Tegan says. “Nobody invites you anywhere and when they do it isn’t really a kid friendly or easy thing to do. People don’t understand taking three toddlers to a lake is HARD not fun and unsafe by yourself to keep three toddlers safe. When you are with friends you are just chasing kids and don’t have time to talk and socialize like you want.”
Another local mom of triplets, Pamela Weaver, states that for her, she needed time to feel like something other than a mother and with her father’s help she was able to return to school. Returning to school helped her feel like there was more to her life and allowed her to have a proper level of balance between being an individual and being a mother.
“It gave me a balance I was able to step out of the mommy role long enough to rest,” she expressed.
On top of having something to do outside of the realm of motherhood, having the opportunity to meet with a therapist or support group has the potential to decrease the rates of mental health disorders, especially postpartum depression in parents of multiples.
Rachelle Stowers explains further that in her mind decreasing the rate of mental illness begins with pregnancy and continues on with sustained practices like therapy and self-care.
“Improving these rates could be achieved by discussing some of these barriers during pregnancy using an early intervention and prevention approach. This could include developing a follow-up plan to surround supports to allow time and resources for self-care strategies prior to leaving the hospital. Providing education about possible barriers and helping families develop plans around the changes they’ll face having multiples that they may not be aware of,” she says.
She makes a point, especially with the majority of parents of multiples stating that the mental health risks are not often discussed or expressed to them prior to the birth.
It is apparent that in regards to the mental health of new parents, especially parents of multiples, better access to mental health care and therapy starting from pregnancy is needed. By increasing further opportunities for resource provision and affordable mental healthcare the rates of severe mental illnesses like Postpartum depression and anxiety can be dramatically reduced. Then by removing the stigma attached to both multiple births and mental health concerns communities can ultimately improve the overall well-being of parents of multiples and furthermore enhance the likelihood of the children growing into healthy, well rounded, adults.
