Triplets, an Unusual Case

A mother of young identical male triplets described a harrowing pregnancy that included bloating, spotting, and a 15-week diagnosis of triplets with cleft lip (all three boys) and cleft palate (one boy). Each baby’s cleft was in a different location, and each showed the trait to a differing degree. Their geneticist informed the family that this was the world’s first case of identical triplets with cleft lip/palate.

Cleft lip and palate affect approximately 1/700 newborns and may be associated with either genetic or non-genetic factors. DNA testing revealed that the triplets did not have the genetic variety; in fact, the origin of their clefts is uncertain.

Breast-feeding poses a considerable challenge to higher-order mothers of multiples. It was even more difficult in the case of the young triplets. In an informative and moving essay, their mother recalls the frustration and determination that made breastfeeding her boys possible. Initially, she was unable to obtain information as to the feasibility of breast-feeding her children, either from physicians or from other parents. Still in the hospital, she attempted unsuccessfully to pump her breast milk, despite discouragement from a nurse who implied that such efforts would be “fruitless.” Meanwhile, the babies were being fed small amounts of a sugar solution.

She returned home, leaving the premature triplets in the hospital. Another nurse (also a mother of twins) advised her to place a photo of the boys in front of her and to try again. This time it worked, and she began a regimen of pumping and delivering the milk to the hospital at regular intervals. Then, prompted by a lactation consultant, she attempted to actually breastfeed the babies. This proved impossible for the baby with the cleft lip and palate since he could not create the necessary suction; he continued to receive the pumped milk. However, the process worked beautifully with the other two boys. When they reached 22 months of age, all three had surpassed their developmental milestones.

This family’s experience is important for researchers, parents, and physicians to hear. When I interviewed her, she spoke again about the time that she was first able to pump milk. She wonders whether the photograph of the boys may have triggered maternal feelings that allowed the milk to flow. I asked her why other parents were not helpful in this regard; she believes that they were discouraged from trying to breastfeed their children as she had been. Furthermore, she was not allowed to touch the babies until three hours after they were born, compounding her difficult situation. Touching them would have created stimulation, causing them to burn calories.

The triplets’ clefts have been surgically repaired and are hardly noticeable in two of the boys. The three are terrific friends, and while they fight occasionally they quickly defend each other if anyone comes between them. When they start school next year they will be in the same class and play on the same hockey team.