Cobedding Twins and Higher-Order Multiples in a Hospital Setting

Cobedding twins or higher-order multiples is the practice of placing siblings in the same crib, bed, or incubator. Cobedding multiples in a hospital setting was first reported in the 1940s and has been the standard of care in much of Europe for more than a decade.¹ Cobedding multiples in hospitals was not commonly practiced in the United States until anecdotal reports of cobedding began to appear in American newspapers in the mid-1990s.^2,3 At the same time, there was growing concern about the effects of the NICU environment on infant health and development. Studies have suggested that outcomes among low birth weight infants improved when behavioral cues were used to restructure the environment and modify caregiving interventions.^4–6 As a result, the practice of developmentally supportive care emerged. Proponents of cobedding multiples believe that cobedding should be a component of developmentally supportive care because it may ease transition from intrauterine to extrauterine life by allowing for the continuation of the interactive development and coregulation that may have occurred between siblings while in utero.^7–14

As cobedding multiples has become more widely practiced in hospitals in the United States, the rate of multiple births has increased substantially.¹⁵ In 2004, 3.4% of all live births in the United States were multiple births. In that year, the twin birth rate reached a record high of 32.2 twin births per 1000 total live births, which represents a 42% increase from 1990 (22.6 per 1000) and a 70% increase from 1980 (18.9 per 1000). There were nearly twice as many live births in twin deliveries in 2004 as there were in 1980. The rate of higher-order multiple births in 2004 was 176.9 multiple births per 100000 total live births, which represents a 378% increase from 1980 (37.0 …

Address correspondence to Kay Marie Tomashek, MD, MPH, FAAP, US Public Health Service, Epidemiology Activity, Dengue Branch, Division of Vector-Borne Infectious Disease, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, Puerto Rico 00920. E-mail: kct9{at}cdc.gov