Mothering Twins During the First Year of Life: A Metaphor Analysis

Abstract

This secondary qualitative analysis identified metaphorical expressions mothers of twins used to describe their first year caring for their infants. Data from the primary grounded theory study were reanalyzed using metaphor identification procedure and revealed eight metaphors: blur, life on hold, being an orchestrator, being a juggler, being an equalizer, being a quick-change artist, being a milk factory, and open invitation. These metaphors give clinicians an insider's view of the struggle's mothers of twins experience during the first year after birth. Being attentive to the metaphors mothers used can provide a unique approach to helping them. Lactation consultants are key to providing much needed support for mothers who are breastfeeding twins.

In 2018 the twin birth rate was 32.6 twins per 1,000 births. This reflected a 2% decrease from the 2017 rate of 33.3 (Martin et al., 2019). The twin birth rate decreased among non-Hispanic White women by 3% but the rate was mostly stable among Black and Hispanic women. Given that mothers of twins, compared with mothers of singletons, face greater functional demands and fatigue in addition to other pressures such as financial and medical, this population may be a risk for parental stress.

A metasynthesis of qualitative studies of mothering multiples during the first year of life revealed five themes: bearing the burden, riding an emotional rollercoaster, lifesaving support, striving for maternal justice, and acknowledging individuality (Beck, 2002a). Wenze et al. (2015) in their systematic review of 27 quantitative studies concluded that the mental health of mothers and fathers of multiples versus parents of singletons in early parenthood experienced increased symptoms of depression, anxiety, and parenting stress.

Beck (2002b) conducted a grounded theory study on mothering twins during the first year of life. In-depth interviews with 16 mothers plus participant observation in a mothers of multiples support group over 18 months comprised the data. The basic social psychological problem that twin mothers experienced was Life on Hold. Releasing the Pause Button was the four-stage process that women progressed through to resume their own lives. These four stages consisted of (a) draining power, (b) pausing own life, (c) striving to reset, and (d) resuming own life.

Van den Akker et al. (2016) examined mental health in women following birth of multiples due to assisted reproductive technology (ART) compared with naturally conceived multiple births. A meta-analysis of eight papers (2,993 mothers) found that mothers of ART multiple births were significantly more at risk to experience elevated stress and depression than mothers of ART singletons. No differences were found in depression and stress levels of mothers of ART and naturally conceived twins.

In Ireland, Kehoe et al. (2016) confirmed Van den Akker et al. (2016) meta-analytic findings that there were no differences in the stress in 104 parents who conceived twins via ART and those who spontaneously conceived within the past 12 months. In that study, parents completed the Parenting Stress Index (PSI; Abidin, 1995) and General Health Questionnaire (GHQ-12; Goldberg & Williams, 1988). Parents scored around the threshold of the GHQ for clinical caseness of poorer mental well-being. Multiple regression analysis found that social interaction and support were important variables in determining psychological outcomes in parents of twins.

In Italy, Prino et al. (2016) conducted a longitudinal study of the transition to parenthood of twins from pregnancy to 3 months after birth. Fifty-eight parents of twins completed the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987), the State-Trait Anxiety Inventory (STAI; Spielberger et al., 1983), Parenting Stress Index-Short Form (PSI-SF; Abidin, 1995), and Infant Behavior Questionnaire Revised (IBQ-R; Gartstein & Rothbart, 2003) at 3 months postpartum. Analysis revealed a significant correlation between parental anxiety and depressive symptoms and parenting stress and infant's negative affectivity. Compared with fathers, mothers scored higher on parental stress and infants' negative affectivity.

A cross-sectional study in Belgium examined the level of parenting stress in 151 mothers of singletons and 101 twin mothers during the first year postpartum (De Roose et al., 2018). Data collection instruments included the Parental Stress Scale (PSS; Berry & Jones, 1995); Coparenting Relationship Scale (CRS; Feinberg et al., 2012), and Social Support Questionnaire (SSQ; Sarason et al., 1987). For both singleton and twin mothers, the poorer their coparenting relationship was the higher their parenting stress levels. In only twin mothers was increased parenting stress related to decreased satisfaction with social support.

A metaphor analysis can be helpful to clinicians who care for mothers of twins. Examining the language patients use to describe what they are experiencing can be a rich source of insights to help make sense of patients' experiences. Implications for nursing practice can be derived from these valuable insights that metaphors can reveal. No metaphor analysis had been done yet with mothers of twins. The purpose of this secondary qualitative data analysis was to examine the metaphorical language used by mothers of twins during the first year of life.

RESEARCH DESIGN

Research Question

What are the metaphorical expressions used by women to describe their first-year mothering twins?

Secondary Qualitative Data Analysis

Over 20 years ago, Sandelowski (1997) alerted qualitative researchers that they needed to do more research with the data they already possessed. As she indicated, “we have become inveterate data collectors, having been imbued with the idea that research means collecting new data” (p. 129). Secondary qualitative data analysis involves reusing a primary qualitative dataset to answer new questions relevant to the phenomenon that was originally studied. There are multiple benefits for maximizing the use of an original dataset such as, increasing the generalizability of older qualitative results and reexamining older primary datasets in the light of new insights from other researchers' work (Beck, 2019).

The author's relationship to the primary dataset was that she was also the original researcher of the grounded theory study. There are benefits when the researcher who conducted the original study is the same person who also did the secondary analysis. The researcher is privy to all the intimate details of the primary dataset. As West and Oldfather (1995, p. 456) stated, “direct engagement in interpretive research brings about a different quality of knowing” which they believe cannot be achieved through the eyes of a researcher who was not present in the research setting.

Thorne's (2013) analytic expansion was the type of secondary qualitative analysis conducted in this metaphor analysis. In analytic expansion the primary dataset is used to ask a new question that had not been examined in the original study. A limitation of this secondary qualitative data analysis is that the primary study was published in 2002. A suggestion for future studies is for researchers to conduct metaphor analyses with mothers who are currently caring for twins so that comparison of findings with this older dataset can be made.

Primary Study

The primary study was a grounded theory study of mothering twins during the first year of life (Beck, 2002b). The research questions were (a) “What is the specific basic social psychological problem mothers of twins encounter during the first year after delivery?” and (b) “What social psychological process do mothers of twins use to resolve this fundamental problem?” (p. 596). After receiving approval from the University's Institutional Review Board, 16 women who had given birth to twins within the past year were recruited for the study using theoretical sampling. The mean age of the sample was 32 with a range of 24–43 years. All but one mother was Caucasian, and the remaining woman was African American. Ten mothers were primiparas, while six were multiparas. The majority of the sample (n = 10) had college degrees and six mothers had a high school diploma. When the participants were interviewed the mean age of the twins was 8 months. Glaser and Strauss' (1967) constant comparative method was used to analyze the data.

Metaphorical Data Analysis

The classic definition of a metaphor comes from Lakoff and Johnson (1980, p. 36); “A way of conceiving one thing in terms of another and its primary function is understanding abstract, emotional or other experiences.” Marías (1967) explained that metaphors are a “means of making reality give reverberations” (p. 41). Metaphors provide the foundation of our daily reality. Moring (2001) declared that metaphors are the backbone of writing in a social science discipline. Metaphors communicate the unknown by transposing it into terms of the known. “This is accomplished through comparison” (Moring, 2001, p. 348).

Metaphor is one of the most magical features of a language. Metaphors enliven a text and create a sense of understanding by giving abstract concepts, tastes, colors, smells, and emotional resonance. Metaphors fix them in our minds and make us feel we understand them (Flaherty, 2004, p. 230). Metaphors connect reason with imagination and underlie creativity. Metaphors provide a multifaceted perspective in research and Moser (2000, pp. 4–6) listed some of these. Metaphors (a) influence information processing, (b) are holistic representatives of understanding, and (c) reflect social and cultural understanding. Moser went on to stress that using qualitative analysis of metaphors helps the full potential of this type of analysis by enabling the understanding of the metaphorical analyses in the context of the narrative text.

In Lakoff and Johnson's (1980) cognitive linguistic view, metaphors allow the understanding of one conceptual domain in terms of a second conceptual domain. Source and target are the names given to these two domains. Lakoff and Johnson (1980) offered the formula of A IS B where A is the target domain and B is the source domain (more concrete and familiar). The source domain aids in the understanding of the target domain. These two parts of a metaphor differ from each other but are connectable and facilitate meanings of each other by means of the lens each provides on the other (Chenail, 2012). The capitalized IS reflects the experience of a group on which a metaphor is based. An illustration of this formula from the current metaphor analysis is: A mother of twins IS Being an Equalizer.

An important property of a metaphor is compactness (Ortony, 1993). Metaphors fit a large amount of information into a compact package. In describing a metaphor this condensed information is unpacked.

The Pragglejaz Group (2007) developed the metaphor identification procedure (MIP) to aid researchers in identifying lexical themes in natural discourse that indirectly express metaphors. Lexical units can be only one word but also multiword units such as compound nouns. The MIP consists of four steps:

1. The researcher reads the complete text to provide a general understanding of its meaning.

2. The researcher next identifies the lexical units in the text. A lexical unit relates to words of a language.

3. For each lexical unit the researcher specifies the contextual meaning. The contextual meaning is the term's meaning in context. Here the researcher takes into account what precedes the lexical unit and what comes after it. If the lexical term has a contextual meaning that contrasts with a more concrete basic meaning, the researcher needs to decide if the contextual meaning can be understood when comparing it.

4. If the answer is “yes” to step 3 then the researcher marks the lexical unit as metaphorical.

Below is an example of the MIP used in this metaphorical analysis of mothers' descriptions of caring for their twins during the first year of life:

The/twins/got/up/the/second/time/in/the/morning/around/8am/.If/we/were/going/out/that/morning/, I/had/to/orchestrate/everything/.As/soon/as/I/finished/nursing/we/would/get/right/in/the/car/because/they/were/feeding/every/2–3/hours/.I/felt/like/a/milk/factory/so/I/had/to/worry/about/time/.I/didn't/want/to/have/to/breastfeed/both/babies/in/public/.I/had/to/time/our/errands/so/we'd/be/back/home/by/the/next/feeding/. (Beck, 2002b).

Out of the 83 lexical units in these five sentences, two lexical units were judged as being used metaphorically: orchestrate and milk factory. After all the lexical units were identified in the corpus, they were categorized into the metaphors most often used by mothers of twins to describe their first year caring for their twins.

Procedure

The corpus consisted of 209 typed pages from 16 transcripts of interviews. Each line was read focusing on identifying the lexical units that included metaphors women used to describe their first-year mothering twins. Once all the lexical units were identified, they were sorted into different metaphors. The audit trail of this metaphor analysis was reviewed by a graduate assistant in the PhD program in nursing who concurred with the findings.

RESULTS

In the secondary analysis eight metaphors were identified that women used to describe their lives as mothers of twins during the first year after giving birth. Charteris-Black (2012, p. 213) views metaphors “like a series of brush strokes so that no single metaphor adequately expresses the stroke.” In Figure 1 are found the series of brush strokes of the eight metaphors that together paint a realistic picture of women's first year as mothers of twins. Metaphors condense a large amount of information into one compact package. Each of the eight metaphors are unpacked using the mothers' descriptions.

Figure 1. Eight metaphors of mothering twins during the first year of life.

Mothering Twins IS a Blur

The metaphorical expression used by mothers to explain what their life was like during the first 3 months of their twins' lives was that it was a blur. Women's memories during this time period were unclear and foggy. As this mother shared, “I can do without the 0–2 ½ month old stage. That was the blur stage. All day and night I was just changing diapers and feeding. The whole day was just like a big blur.” Contributing to this blurriness was the never-ending cycle of their daily life. It was unrelenting. The following quote helps unpack this metaphor: “Like every 2 hours feeding, changing, and bathing. The cycle of the same routine over and over again. The twins would wake up and we do it all over.” During the blur period mothers were exhausted and at times overwhelmed as this woman admitted, “Sometimes I get so exhausted. I get so tired I just can't keep my eyes open, so I call my mother to take over. It's nonstop. At times it can be overwhelming and sometimes I want to cry.”

The fogginess in remembering their daily life in the first months of their twins' lives is captured by the following quote:

No one day sticks out in my mind. They are all a blur. Sometimes I just don't know where the day went and if someone asked me what did I do, I don't know what I did. It is like a blur.

Mothering Twins IS Life on Hold

During the first year of their twins' lives mothers felt that they had to pause their own lives. Women's self-care activities such as, yoga and exercise classes, were put on hold. Some days women did not even have time for a shower as this quote illustrates: “During first 3 months it was like being a servant of two very demanding people. There wasn't even time to sit down and eat let alone take a shower.” There was no time left in the day for these leisurely activities. Some women who loved gourmet cooking had no choice but to put that aside. Many dinners now consisted of scrambled eggs, peanut butter, and jelly sandwiches, or carryout. This mother revealed that “your life has to go on hold. You can't be selfish and think about yourself. If you really want to give your babies the best, you have to self-surrender.”

In unpacking this metaphor, phrases like “tied down,” “homebound,” and “confined” were often used by mothers:

The first few months I was pretty much housebound. I was so tied down caring for the twins there was no time left or opportunity to go out and do any of the things I love to do for myself like go to Pilates class.

As this mother shared, “You just have to think in terms that this is a year out of your life. You're not going to do anything; you're not going to go anywhere. You have to mentally prepare for that” (Beck, 2002b, p. 599).

Mothering Twins IS Being an Orchestrator

In order to survive raising twins during the first year of their lives, mothers repeatedly explained that establishing a routine is essential. It is only by means of detailed planning that this occurs. Women used the metaphor of an orchestrator to explain this aspect of their lives. Like an orchestrator whose thorough planning prepares an orchestra to successfully perform, so a mother needs to manage and monitor her day in order to care for her twins. As this quote highlights:

I think that I have orchestrated in a way that I have a routine and a schedule down that makes my life a little easier. In order to that, you need to let go of some things that use to be a priority like cleaning the house or cooking gourmet meals.

Even though women were exhausted by the end of the day, their schedule was not done yet:

Like at night I have this ritual of doing everything at night. Like organizing their bottles and making their meals, setting up their meals so that when they are hungry I just go and get it and come back. I make sure all the diapers are stacked up. Everything is right there so I'm not running anywhere to find it. I make sure that the diaper bag is full at all times.

Mothers with twins cannot just go at the spur of the moment and take the twins out on errands. This also took orchestrating as this mom revealed, “When I went out of the house with the twins, I needed to get everything. I needed to be organized and prepared ahead of time. You just can't take off and go on the spur of the moment.”

An important part of a mother's routine was trying to get their twins on the same schedule: sleeping, at the same time, feeding at the same time: “We try and keep them on the same schedule as much as possible or else we'd be total machines. When one wakes up to be fed, we wake the other one up too to be fed.”

The challenging component of managing a schedule is that as the twins grew, the schedule needed to be revised as the woman explained:

The number one key is a routine. It takes months to get a routine down because things are changing constantly with their schedules. At first they eat every couple of hours and that changes so your routine is constantly changing.

Mothering Twins IS Being a Juggler

In developing a routine that worked for them, mothers needed to learn how to juggle a number of things at a time. For example, this mother explained that it took her about 2–3 weeks to learn how to juggle breastfeeding her twins:

My son was colicky, and he was a quick nurser. She was a very relaxed nurser. He gets right down to business. So, for her I would have to go back 10 minutes later just to give her a little bit more to kind of catch up. So, trying to juggle all that.

Being a problem solver was part of becoming an expert juggler and learning how to adjust quicker. Mothers experimented with different approaches and at times needed to be creative:

My biggest problem trying to breast-feed the twins at the same time was keeping my son awake. I couldn't get up and walk him around because my daughter was feeding on the other breast. So, what I would do is just keep a wet face cloth close by and I would just wipe his brow or if I had to I would lift his T-shirt and wipe his tummy with that and it would usually keep him awake. (Beck, 2002b, p. 603)

Mothering Twins IS Being an Equalizer

Women struggled with trying to give enough of themselves to each baby individually. So much of the time spent with the twins was shared time. Bath time, for example, was done at the same time. Mothers felt like everything was rushed and shared:

One problem I find is to try and give each equal time. There is a lot of jealousy. I put them both on the floor on a comforter and I try to make them laugh or give them a toy, so I look like I am giving them both attention and equal time.

“You really want to give both babies as much individualized attention as possible. You try your best to divide your attention equally to the babies. It is so important not to favor one twin over the other.”

It is especially difficult when both infants are crying. Here is one strategy a mother used to provide equal time:

You really can't soothe both at same time. I pick one up for 5 minutes and that mellows him out. Then I pick her up for 5 minutes, so I am consoling them for about the same length of time.

Mothering Twins IS Being a Quick Change Artist

Caring for not only one infant but two infants required, as one mother shared, to be a quick change artist. Women became skilled at quickly switching from one aspect of caring of twins to another. Many times, the infants did not have the same moods at the same time. One infant could be smiling while the other infant screaming. When caring for each of these infants mothers' facial expressions needed to be swiftly changed. Quick change artist was a metaphor also used in Anderson and Anderson's (1990) grounded theory study of mothers of twins.

When finishing breastfeeding both infants, at times one infant would fall asleep while the other infant was in a playful mood. Here is another example of how mothers needed to quickly change their facial expressions from one infant to the other.

You just try to distract the baby who as in a playful mood by smiling at him and giving him a toy while at the same time decreasing any distractions towards for the baby who was asleep.

Mothering Twins IS Being a Milk Factory

In the beginning, all mothers did all day and night was nursing every 2 hours. This woman recounted:

I felt like a milk factory. I was constantly breastfeeding, and I didn't have time to make a sandwich or anything. What I did was stuffed myself with like 5 double stuffed Oreo cookies and that's why I put on a little bit of weight. (Beck, 2002b, p. 601)

Another mother confirmed this, “I felt like all I was doing was being a milk machine. First one cried and then the other, and then back to the first one. Basically, that is what I am, a milk machine.”

Mothering Twins IS an Open Invitation

Women repeatedly recounted that whenever they took the twins out to a store or the mall it was like an open invitation for people to bombard them. The twins drew so much attention. “I mean I can't get through a store. If I want to go shopping I have to plan on a lot of time because everyone is stopping you to see the twins and asks questions.”

At times mothers got annoyed because they needed to get their shopping done. They were on a schedule to get the twins back home before they needed to breastfeed. Women used different strategies to avoid this open invitation such as, “A lot of times now if someone's around I will bring anybody with me and take two strollers so that one has one and that takes the attention away and you only have one to deal with.”

If a mother doesn't have someone else to go to the mall with her, she places the two infants facing each other so they are more private and not in full view of everyone. People are fascinated with twins and stop mothers all the time.

This mother shared, “I go to the mall on a day when I know I don't care how much time it's gonna take us. You absolutely do get bombarded. For the most part I enjoy it if I'm not in a hurry.”

DISCUSSION

In a systematic review, Wenze et al. (2015) found that parents of multiples compared with parents of singletons reported significantly higher symptoms of depression, anxiety, and parental distress. Clinicians who are vigilant to listening to metaphors women with twins use, can be privy to an insider's glimpse into their daily lives. Unpacking the eight metaphors identified in this secondary qualitative data analysis provides direction for specific interventions clinicians can design. Especially during the first 3 months postpartum, mothers struggle with a number of aspects caring for their twins, such as breastfeeding, that their metaphors pinpointed. Lactation consultants can provide essential guidance and support as mothers learn to breastfeed not one but two infants. Women who described feeling like a milk factory certainly can benefit from strategies lactation consultants can share with them.

Striving for maternal justice (Anderson & Anderson, 1990) is one such formidable challenge facing mothers described by the metaphor of the Equalizer. Women want to be fair and equal in the amount and quality of attention they give their twins. The unrelenting cycle of feeding, changing diapers, and so on, can lead to exhaustion. The metaphor used by women of the Orchestrator highlighted the essential tasks of planning and establishing a routine in order to keep their heads above water. The rest of the metaphors revealed in this analysis, such as the Quick Change Artists, Milk Factory, and Open Invitation, also point to key interventions for mothers of multiples.

The true experts in caring for multiple infants are mothers themselves who have done this. These women can provide practical and concrete strategies they used to successfully survive the first year postpartum. These tried and true successful strategies can be a lifeline to help women cope with the physical and emotional overload of caring for multiple infants. Lactation consultants can put new mothers in contact with women who have successfully breastfed multiple infants. Local support groups for parents of multiples can be organized to provide much needed support especially during the first few months caring for twins. Social interaction is crucial for mothers who described being confined as their lives were on hold. This metaphor analysis focuses on mothers, but fathers certainly are in need of this support too.

These eight metaphors can help clinicians provide realistic and knowledgeable guidance for new mothers of multiples. By unpacking these metaphors clinicians are able to walk a mile in the shoes of a mother caring for twins during the first year of life. Persons may use their metaphorical expressions to articulate their everyday experiences in order to communicate more effectively with nurses and other clinicians. Use of metaphors by women to explain their experiences mothering twins can help create a common language that can provide a foundation for shared understanding with their health-care providers.

Biography

CHERYL TATANO BECK is a distinguished professor at the University of Connecticut School of Nursing. Her program of research is devoted to postpartum mood and anxiety disorders.

DISCLOSURE

The author has no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author received no specific grant or financial support for the research, authorship, and/or publication of this article.