Category: Pregnancy

Bedrest

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Question: I am pregnant with multiples and have been ordered to bedrest by my doctor. How will this help my babies? How will I pass the time? How can I relieve the boredom?

It isn’t unusual for a woman expecting multiples to be placed on bedrest. There are many reasons why this might be necessary. They include: water retention spotting, high blood pressure, signs of premature labour, one or more of the babies not growing at a satisfactory rate (e.g. weight discrepancies between the babies, babies not developing at the same rate or gestational diabetes, a pregnancy-related diabetes). Bedrest produces many benefits for both mother and babies. It relieves the pressure on the cervix and assures that calories and nutrients that would normally go to the mother’s activities are diverted to the babies.

There are several different levels of bedrest:

  • At home in bed or lying down, being allowed up for very short periods of time;
  • Hospitalized and allowed up for bathroom privileges only;
  • Hospitalized and not allowed to leave the bed;
  • Hospitalized and the bed tilted with your feet upwards (tredelenburg position); and
  • Hospitalized weekdays and allowed out on the weekends with specific instructions.

It is not always easy to be hospitalized. You may have other children at home and this can be traumatic and upsetting for everyone. Stress related to additional child care situations can be harmful. Use your support systems: family, friends, neighbours. People love to help but aren’t always aware of what you might need.

If you are permitted to leave the hospital, this can help alleviate some of the pressure of not being available for your child(ren) while maintaining a safe environment for your unborn babies. When explaining to your child(ren) why Mom is not at home, use clear, comforting, age appropriate language. Whenever possible, take the child(ren) to the hospital for a visit, allowing them to see for themselves where Mom is and what her day involves. If your child(ren) doesn’t want to go to the hospital, try to accommodate their wishes. Keep the child(ren)’s routine the same, whenever possible.

There are many things that you can do to help pass the time while on bedrest:

  • Read and learn all about multiples and your unique and special situation;
  • If you have access to a laptop, check out many of the helpful web sites regarding multiple births: Multiple Births Canada;
  • Keep a calendar by your bedside to cross off the days;
  • Pick one night a week to do something special with your partner: order in supper, watch a movie;
  • Knit, crochet, needlepoint, write letters, phone friends;
  • Keep a daily journal. It is very rewarding and fulfilling to look back on this period of time and share it with your children.
  • Ask if there are any other mothers expecting multiples also on bedrest. Sharing with someone in the same situation can provide comfort, companionship and a chance to share experiences.

For mothers expecting higher order multiples (triplets, quadruplets or quintuplets), it is almost inevitable that an extensive period of your pregnancy will be spent on bedrest. Be aware of special exercises which will help decrease joint and muscle stiffness in bed. One mother of twins hired a massage therapist a couple of times during her 9 weeks on bedrest. Ask to speak to a physiotherapist while in the hospital. Doing exercises will assist you after the babies birth and assist your recovery. You may also need ongoing physiotherapy after the babies are born if any of your muscles have atrophied. Walking may be uncomfortable initially because of pelvic bones shifting back into place and sore, achy muscles. As well, softened skin on the balls of the feel may need to harden again.

This time spent on bedrest can make a positive difference in the health of your babies, assisting them in gaining weight and completing their development. Each day your babies remain in utero, is one less day they will need to spend in a Special Care Nursery. There can be no safer environment for your multiples than that which your body can provide.

Most of us are highly motivated, busy, active people accomplishing a great deal. It can be quite difficult for a person who is used to activity to be forced to remain quiet and in bed. Many women still feel healthy but are forced into an “illness” role. It is not uncommon to experience negatives feelings in this situation. It is important that a support network be used to discuss these feelings. You are not alone. Many multiple support groups offer a bedrest support line, staffed by women who have been in your situation. Contact your nearest multiple birth support Chapter for further information.

Additional Resources:

  • Eating Well While on Bedrest, by Julia Watson-Blasioli and Pauline Brazeau-Gravell, Ottawa Hospital, General Campus
  • Twins! Pregnancy, Birth and the First Year of Life, by Connie L. Agnew, Alan H. Klein and Jill Allison Granon
  • Multiple Blessings by Betty Rothbart, Hearst Books
  • The Joy of Twins and Other Multiple Births, by Pamela Patrick Novotny, Crown Paperbacks, Inc.
  • Finding our Way, life with triplets, quadruplets and quintuplets – A collection of experiences
    Triplets, Quads, Quints Association, Web Site: http://www.tqq.com

“Bedrest” written and developed by Lynda P. Haddon and Sandra Tompkins

 

Possible Risks for Mom of a Multiple Birth Pregnancy

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Question: I am pregnant with multiples. What are the possible risks to me carrying multiple babies?

A usual part of every young person’s fantasy is envisioning their future, future job, car, house, partner and possibly children. While the majority don’t necessarily envision having twins, triplets or more, multiple births are a definite possibility. Several factors weigh in when considering whom will have multiples: the age of the mother when she conceives (women over 35 years old are more like to spontaneously conceive multiples); if Mom already has had several children; if multiples run in your family; or if fertility assistance was used to help you get pregnant. If none of these situations describe you, consider the fact that multiples start with someone, so why not you?

A multiple birth pregnancy is automatically called “high risk”. While this term generally has a negative connotation, it is also a security blanket, so to speak, for parents expecting multiples. Mom is followed more closely, can expect more ultrasounds, blood tests, fetal monitoring, has different nutritional needs than if she was carrying one baby, can expect a greater number of visits with her doctor and may be referred to obstetrician to deliver the babies, all in the wish to ensure a happy, healthy outcome to this multiple birth pregnancy.

While any pregnant woman might experience some concerns during her pregnancy such as gestational pregnancy diabetes, anemia (water retention and subsequent swelling), vaginal bleeding, preeclampsia (rise in blood pressure, sudden weight gain, water retention) and kidney infection, there remain other possible concerns in a multiple pregnancy and the following looks at some of these possibilities. The goal is to look at each topic and to familiarize yourself with some of the warning signs. An immediate call to your doctor enables early detection of any concerns and ensures timely and appropriate treatment. They are not listed in any particular order.

NOTE: This information is not intended to replace expert medical advice. If you have any concerns about any aspect of your pregnancy, PLEASE CONSULT YOUR DOCTOR IMMEDIATELY.

While some women may experience slight bleeding within the first few days after the fertilized eggs have implanted, it can be heavier with multiples. This bleeding is completely normal and is often mistaken for a light period before the pregnancy is confirmed. More serious bleeding later in the pregnancy may signal a miscarriage. With multiples, the risk of miscarriage before the 20th week of pregnancy is slightly higher than with a singleton. There is also a slight chance that one or more of the fetuses could miscarry (see Vanishing Twin) and the pregnancy continue with the healthy delivery of the remaining baby or babies.

As compared to a singleton pregnancy, many women report increased nausea and vomiting in the initial stages of the pregnancy, as well as feeling extreme fatigue. Much of this is due to the vast amount of hormones that are raging through Mom’s body as the babies are establishing themselves. Many women state that they generally begin feeling better after the fourth month. As in a singleton pregnancy, for some women nausea can last for the duration of the pregnancy. In the third trimester, fatigue is a common complaint as is the inability “to get comfortable” and “to get a good night’s sleep”. The increased baby load and the awkwardness of the size and shape of Mom’s abdomen, makes it a fatiguing load to carry.

Incompetent Cervix

A possible reason for bleeding early in the pregnancy is a condition in which the cervix spontaneously and painlessly opens early in the pregnancy. This is believed to be the cause of many second-trimester miscarriages. When detected early enough, an incompetent cervix can be sutured closed. For a mother pregnant with multiples, early detection is essential due to the increased pressure on the pelvic floor as her babies grow. Of course the higher the number of babies she is carrying, the earlier and greater the pressure on her cervix. It is not unusual for Mom to be put on bed rest and/or be required to spend some time in a tilted bed (tredelenburg position), with the lower body elevated above the head, relieving pressure on the pelvic floor.

Placental Problems

This is the most common reason for complications and bleeding after the 20th week of pregnancy. A condition called abruptio placenta occurs when the placenta partially detaches from the uterus before delivery. This may result in some bleeding and some abdominal pain.

With placenta previa, the placenta can implant low in the uterus, partially or completely covering the cervix. Placenta previa presents as painless bleeding and because the placenta is covering the cervix, a c-section may be necessary. This situation is more common in multiple pregnancies owing to the increased number and/or size of placentas present.

Iron-deficiency Anemia

The majority of women pregnant with multiples eventually develop iron-deficiency anemia, a condition characterized by low levels or iron in the red blood cells which carry oxygen to the tissues. The risk increases with each additional baby that is carried, particularly if you had low or borderline iron reserves before becoming pregnant. Symptoms include fatigue, light-headedness, pallor and shortness of breath. If untreated, anemia can adversely affect the babies’ growth, as well as increase your own risk for complications both during the pregnancy and after the birth. Because of the risk of iron and/or folic acid deficiency, the doctor may prescribe supplements in order to ensure that deficiency will not be a problem for Mom and her babies.

Gestational Diabetes

Common in women who are over the age of 30 years, overweight or have a family history of diabetes. Expectant mothers of multiples develop this kind of gestational diabetes two or three times more often than Moms carrying singletons. Gestational diabetes will clear up after birth.

Intrauterine Growth Restriction

Multiples usually grow slower than single babies while in utero and, additionally, do not always grow at the same rate as each other. This can be a result of unequal sharing of the available maternal nutrition. Depending upon nature’s distribution of the maternal nutrition available, the babies may therefore grow at different rates. Such a discrepancy can be revealed through ultrasound and may be evident quite early in the pregnancy.

Preeclampsia

Characterized by a rapid rise in blood pressure, the presence of protein in the urine, sudden and extreme weight gain and swelling of the hands and face from fluid retention. While this condition occurs in about one out of ten singleton pregnancies, it occurs in nearly one in three multiple gestations. It typically occurs in the second half of pregnancy. Bed rest is usually the recommended treatment. Severe cases may require hospitalization and medication will be given to lower your blood pressure.

Preterm Labour

A major concern in a multiple pregnancy. This is probably the most common concern that anyone pregnant with multiples might face. Approximately 50% of twins, 90% of triplets and virtually all quadruplets are either preterm or of a low birth weight. Among infants born prematurely, nearly one in ten do not survive. Although the majority of premature babies do very well, they are at a somewhat higher risk of a variety of medical problems, some of which are lifelong. These can include hearing loss, vision problems, developmental disabilities and delays. The more premature the babies are, the more severe the complication could be: e.g. cerebral palsy. Discuss with your doctor the signs and symptoms of premature labour. Both you and your partner need to be fully aware of the signs and symptoms of premature labour as well as the appropriate course of action to take should you feel that you are experiencing preterm labour.

Extended Bed Rest

It is common, but is not always the case, for Moms expecting multiples to have to spend some time on bed rest. This can be at home, with bathroom privileges and maybe going to the table for meals, or it can be on hospital bed rest with no privileges but to stay in bed. Bed rest at home may be helpful for those families with other young children at home, but those with young children, the doctor may insist on hospital bed rest so that Mom will actually rest. Bed rest can be prescribed when there is a danger that she may go into preterm labour or if she is showing some signs of physical stress. Bed rest and subsequent monitoring of Mom and the babies, may allow the situation to calm down and when (if) things are settled after a week or so, Mom may be permitted more activity.

For Moms expecting triplets, quadruplets or quintuplets there is an increased chance that some of the time will be spent on bed rest. When bed rest is prescribed, this takes pressure off of the cervix, helps to reduce strain on your heart, improves blood flow to the kidneys, which helps to eliminate excess fluids, increases circulation to the uterus thus providing additional oxygen and nutrients to your unborn babies. Further, it minimizes blood levels of catecholamines, the stress hormones that can trigger contractions and conserves your energy so that more of what you eat goes directly to promoting the babies’ growth.

The Disadvantages of Bed Rest

Bed rest may present an increased risk of blood clots. In some cases of extended bed rest, doctors may prescribe injections of heparin, a blood thinner, to lower the risk of blood clots. Prolonged inactivity may highlight or exacerbate heartburn, constipation, leg swelling or backache. Your doctor can provide some suggestions to alleviate some of your concerns. Inactivity may decrease your appetite and as you can appreciate, this will impact on your babies’ development. An extended period of bed rest could pose some financial difficulties with the loss of an income which you can ill afford. Bed rest can be boring and even very difficult for women who are used to being active and on the go.

An extended period of bed rest may affect your muscles. One mother had a massage therapist come to the hospital a couple of times in order to help keep her muscles in shape. It can be difficult to move about properly after the babies’ birth if your muscles are even somewhat atrophied.

It is important to keep in mind why bed rest has been recommended and that the longer your babies stay in utero, the healthier they will be at delivery and the sooner they can go home with you. Bed rest is a time to read, keep a journal, speak on the phone with family and friends, knit or crochet. See the time on bed rest as a “Count Up” to a healthy birth and healthy babies. Some parents may view bed rest as a time to worry, but keep in mind that the babies are growing and this time on bed rest is important to assist them in getting the best possible start to life. Bed rest requires giving up control and allowing others to do for you. Some women have difficulty with being dependent upon others. (See Web Site Page on Bedrest for more ideas.)

Depending upon how long the pregnancy continues and the number of babies Mom is carrying, there is a spectrum of outcomes that she might, to some degree, experience:

  • Foot size may change after the pregnancy. As the babies grow, the continued pressure on Mom’s feet may cause a change in foot size as the foot settles to accommodate the additional weight size. A foot size change will not reverse itself after the birth.
  • Change in body shape. Mom’s body will probably change, i.e. thighs and upper legs will thicken to better support her expanding abdomen. This may or may not right itself with exercise after pregnancy. There will be an expansion of the rib cage. As the babies slowly develop under the rib cage, it expands and after birth, does not always return to its original shape.
  • Due to increased hormone changes, it is not unusual for moles that were normally flush with the skin to appear to “grow” during the pregnancy. This apparent “growth” will disappear after the pregnancy.
  • Hair may be luxurious and healthy during the pregnancy and then, for sometime after the birth, fall out in handfuls and/or become limp and not hold any curl. This will rectify itself over time (3-4 months) after birth. This potential hair loss is attributed to hormonal changes and can occur with any pregnancy, not just with multiples.

As the pregnancy progresses and the babies grow, keeping your balance can be a cause for concern. Mom’s enlarged and extended abdomen changes her centre of gravity and it is important to be very careful about maintaining your balance, especially when going down the stairs or when it is slippery outside. Late in my own pregnancy, on a wonderful Summer day, I turned quickly and my tummy kept going, while I did not. I landed flat on my face but did manage to get my arms around by stomach before I fell. The fact that I was laying on my arms didn’t permit me to push myself upright. Luckily it was the weekend and my husband was home. He heard my yell as I went over and rushed to help. Another Mom reported falling down the stairs at 16 weeks pregnancy as her twins were both lying to one side of her abdomen and therefore her balance centre was off. Always hold the railing when descending the stairs.

Some Moms have reported that due to positioning within the womb, a baby may lie on arteries or nerves to her lower extremities. This can be quite uncomfortable and limit Mom’s mobility until the baby moves and then the discomfort usually corrects itself.

Knowing ahead of time what might occur permits us to take quick, timely appropriate action in order to rectify the situation. While many of the above possibilities may not happen to you, it is wise to be informed and able to make the best possible decision based on your individual situation. Knowledge is power.

Bibliography

  • Twins, Triplets and More: Their Nature, Development and Care, by Elizabeth Bryan, London, Multiple Birth Foundation, 1995
  • When You’re Expecting Twins, Triplets or Quads by Dr. Barbara Luke and Tamara Eberlein, Harper Perennial, 1999
  • Double Duty, by Christina Baglivi Tinglof, Contemporary Books, 1998
  • The Art of Parenting Twins by Patricia Maxwell Malmstrom and Janet Poland, Ballantyne Books, 1999
  • Multiple Blessings, by Betty Rothbart, Hearst Books, 1994

Additional Resources

If you have further questions about risks during pregnancy, please visit askanob.com.

  • Expectant Mom Tips, Multiple Births Canada Fact Sheet
  • You’re Having Multiples, Multiple Births Canada Fact Sheet
  • Twin Care: Prenatal to Six Months, Multiple Births Canada
  • Finding our Way, by Triplets, Quads, Quints Association, 2001
  • This article was written with grateful input and assistance from:
    – Dr. Elizabeth Bryan, Multiple Births Foundation, London, England
    – Dr. Karen Fung Kee Fung, Ottawa, Ontario, Canada

Suggested Reading List for Parents Expecting Twins, Triplets and More!

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Forever Linked: A Mother’s Journey Through Twin to Twin Transfusion Syndrome, Erin Bruch, Philatory Ink, 299 pages, $14.95US, ISBN 13: 978-1-936519-02-6

Twin-to-twin transfusion syndrome (TTTS) is a disease of the placenta and can affect monozygotic (identical) babies, including within triplets or more when there are monozygotics. It has a spectrum from mild to severe and if left untreated, can result in death for one or both babies, or put in jeopardy the complete pregnancy for triplets or more.

Erin Bruch explains what TTTS is, how it can happen, the need to have the diagnosis as early as possible in a multiple-birth pregnancy, about managing it and what it feels like for the parents and families to go through, sometimes with the loss of one or both babies. In addition, 21 mothers’ stories of their twin pregnancies are followed from finding out their babies had TTTS, the worry that knowledge carried, through their births and outcomes. Bruch has included a drawing of what a TTTS placenta might look like. It is a helpful visual in understanding what is happening with the babies and why their struggle with TTTS can be a life and death matter. I also find both the cover pictures to be important visuals of what the babies go through with their unequal sharing within the womb.

If your babies have or had TTTS and if you like first hand accounts, this is definitely a must-read book.

Twice the Love, compiled and edited by Susan H. Heim, in collaboration with TWINS Magazine, 2007, ISBN 1-891846-31-0, 208 pages, $13.95 US

Includes 82 stories from families with twins and more, and in some cases singletons as well. It is well worth the read. Pick it up and open it anywhere to enjoy entertaining stories, tales, joys, challenges, and adventures that belong to families with multiples. Or if you prefer, Heim has chosen to group the stories by subject, e.g. Becoming a Family, Trials and Triumphs, Mischievous Multiples (no kidding!). You are not alone in your journey and the bonding that goes on with other families with multiples in this delightful book proves it!

It’s Twins: Parent-to-Parent Advice from Infancy Through Adolescence, Susan M. Heim, Hampton Road Publishing Co. Inc., 2007, ISBN 13: 978-1-57174-531-6, 306 Pages, $17.95 US

From the first few weeks through to 17 years, Heim covers many of the bases parents could expect to face and she doesn’t shy away from the tough discussion such as when bottle feeding is best for you and your twins. Two of my favorite Chapters addressed the advantages and disadvantages of being twins when the kids have reached adolescence. Even if you haven’t reached that stage yet, here are some thoughts for you to prepare yourselves. Another nice touch is each section has Points to Ponder with writing space for the reader to address those topics which are pertinent to them.

I liked that this book addresses the whole spectrum of raising multiples and did not just focus on the early weeks, months and years. Birthday party planning is important as is encouraging them to play with others, but so is dominancy, disabilities, when they mature at different rates, college – together or separate? and my favorite certainly as expressed to me by other parents with monozygotic (identical) multiples, the Old “Switcheroo.”

I found this book uplifting, informative, thoughtful and I wasn’t beyond laughing out loud at some points from understanding and having “been there, done that.”

Emotionally Healthy Twins: A new philosophy for parenting two unique children, by Joan A. Friedman, Ph.D., 2008, Da Capo Press Books, soft cover, 245 pages.

I am SO excited about this book! There, that’s off my chest. For anyone expecting or raising multiples, this book needs to be on their recommended reading list! There are several very good books which focus on the early (and intense) years of raising multiples. Friedman’s book addresses the early years’ challenges and explores the parenting scenario beyond, into the multiples’ young adult years and does so with insight and personal knowledge.

As someone working with multiples and their families for over 2 decades, I was pleased to note that Friedman encourages parents to look beyond their multiples’ unique bond and to focus as well on what makes them individuals. Every child, even if they arrive more than one at a time, needs and deserves the chance to discover his or her unique potential, and have ample opportunities to nourish and develop their individualities. Parents set the tone in their multiples’ development and Friedman asks them to honestly evaluate their contribution to encouraging their twins to become self-sufficient. Friedman provides several examples of twins whom have flourished within their “twinship” but floundered or were impeded when they needed to separate from each other. Her messages are some that every parent raising multiples needs to hear.

Friedman is a twin herself and has twin sons and 3 singletons, so she has many support bases covered. This book is an important addition to the reading resources for anyone raising their multiples.

Womb Mates: A Modern Guide to Fertility and Twinning, by Gary D. Steinman, and Christina Verni, 2007, Baffin Books Publishing, 121 pages, soft cover

Any couple looking into infertility treatments to assist them in getting pregnant would benefit from reading this book before they begin their treatments. It thoroughly sets the stage for such families to understand the chances of them conceiving at least twins, how that might happen and the many possible ramifications. Dr. Steinman describes, in easy to understand language, how twinning occurs (the controllable and uncontrollable factors) and explores such topics as the risks of a multiple-birth pregnancy for the mother and babies and the different types of infertility assistance. Important issues for prospective parents to consider.

Healthcare and related professionals, researchers as well as some parents could get a lot out of this book. In other words, this book is very technical. I don’t think that it would be as valuable to parents who desire to learn how to get their babies on the same schedule or how to deal with sleep deprivation, for example. For most parents looking for ideas and answers in handling their new families, this is not a book I would recommend.

Nevertheless, this book belongs on the shelf of anyone involved with teaching multiple-birth prenatal classes, doulas, midwives, lactation consultants and those wanting to better understand how to better meet the needs of their clientele.

One and the Same: My Life as an Identical Twin and What I’ve Learned About Everyone’s Struggle to Be Singular, by Abigail Pogrebin, Double Day, 2009, hardcover, 275 pages, $26.95 US; $33.00 Cdn.

I’ve read a lot of books about multiples, and this one I could not put down.  It is one thing to raise multiples and address the unique challenges, joys and pleasures of doing same, but quite another to be a multiple.  In her research, Pogrebin has not only drawn on her experiences and journey with her monozygotic sister, but interviewed a plethora of well-known experts in the field of multiples (many of them being multiples themselves) as well as speaking with many sets of multiples across the U.S.  In addition she attended the International Society of Twins Studies Conference in Belgium to gather more data and attended the annual Conference of Twins held in Twinsburg, Ohio.  As most of us in-the-know are aware, this Conference is a melting pot for multiples from all over the world.
What follows is a riveting, entertaining, informative, insightful and educational journey which is MUST read not only for multiples themselves, but also for the parents who love them.  Pogrebin presents the many nuances of being a multiple, some complicated, some simple, how multiples are “entangled” and how both parties will usually attempt to seek individuality within their multipleship and when (e.g. marriage).  And some can’t see themselves apart, even for a moment.  In addition, she explores the unique circumstances around when one dies and what that event can mean for the survivor.

I could not put this book down, really.  For anyone involved with multiples in any form, this book is definitely the crème de la crème!

Blender Baby Food, Nicole Young and Nadine Day, 2005, Robert Rose Inc., 189 Pages, $19.95 Cdn., $18.95 US, softcover

For parents wishing to make their own baby foods or wishing to have some fun choices to offer toddlers, this book is a must have! It is broken down from when babies need to begin solid foods through 12 months and older and includes suggested meal plans for each age. There are 125 delicious recipes included for babies beginning solids, with hints and tips in the margins on how to “upgrade” each recipe for older children.

The authors begin with steps on how to recognize when your babies are ready to begin solids, address food consistency at each age and stage, answer safety with food issues (such as with eggs), choking hazards, storing, freezing and thawing prepared foods and offer a list of the equipment you can expect to use when preparing your own baby food. There is even a section covering salt, sugars and The Picky Eater. It couldn’t be easier.
Another great point – it’s a Canadian book!

The no-cry potty training solution: gentle ways to help your child say good-bye to diapers, Elizabeth Pantley, McGraw Hill, 2007, 174 pages, softcover, $12.95 US, $16.95 Cdn.

Here are two goals which can bring joy to a parent’s heart: “sleeping through the night” and “toilet trained.” For the latter, Elizbeth Pantley has scored again with her newest book on potty training. It isn’t unheard of for parents to find themselves in unpleasant, close enocunters of the potty-training kind when trying to train their toddlers. It doesn’t have to be so and Pantley gives us suggestions, not the least of which is to recognize the signs of each child’s readiness to be trained. If they are not physically ready and able, training can quickly move to a battle of wills, with no winners insight.

Right at the beginning, Pantley sets out a Readiness Quizz so that we know what signs of readiness to look for in our children. She addresses topics such as keeping it natural, making it a game, getting to the bathroom quickly (kids tend to leave it to the last second and when they say they “need to go,” time is of the essence), bathroom safety, how to teach your child to wipe properly and wash their hands afterwards.

There is a chapter on bed-wetting which is extremely helpful. Bed-wetting is more common with boys and during the night, the kidneys may not be sending appropriate messages to the brain to signal the need to go and/or the bladder is not fully developed enough to go through the night. Bed-wetting can sporadically last for years, or not. She provides constructive ways to handle bed-wetting and to help keep your child dry, without them losing their self-esteem in the process. Pantley even includes some suggestions for toilet training children with special needs.

While her book focuses on training singleton toddlers, there reference about training twins and more. She gives us notice that our children may not be ready to train at the same time – and haven’t we heard that before in other contexts! – and reminds us not to compare them regarding successes and failures – yet another common theme for parents with multiples. Each child having their own potty ensures that when the time is right, there will be no waiting in line for a turn and perhaps subsequent accidents.

While toilet training is long-past with my own children, I really appreciated Pantley’s easy writing style, identifying the challenges and offering suggestions, and positive approach to a topic which can be a challenge for parents as well as toddlers. She takes the pain out of it all for everyone and if your children are nearly ready to toilet train, this is one book you don’t want to miss reading.

Your Premature Baby: the first five years, by Nikki Bradford, 2003, Firefly Books, 208 pages, $19.95

An excellent Canadian book offering detailed information regarding your premature baby. Why does premature birth happen?; What can you do?; how a premature baby may behave (looking at the body language of a premature baby), how the hospital can help, bringing them home, and feeding a premature baby are some of the topics covered in detail. The photographs of these special babies are simply fabulous. This book would be a great resource for those with a premature baby.

Expecting, twins, triplets, and more: a doctor’s guide to a healthy and happy multiple pregnancy, by Rachel Franklin, M.D., M.O.M.* (*Mother of Multiples), 2005, St. Martin’s Griffin, N.Y., 221 pages, $14.95 U.S.; $21.95 Canadian, ISBN 0-312-32823-0

Read my full review of this book

Dr. Franklin has a light-hearted, easy to understand writing style, generously laced with humour. Her book takes you through each stage of the pregnancy. She includes Chapters on learning the news “…and What To Do About It”, she addresses issues you might expect to face in each trimester of your pregnancy, focusing on nutrition, exercise, and preparing for the babies. .

Mothering Multiples: Breastfeeding Twins, Triplets or More by Karen Kerkhoff Gromada from La Leche League

Covers every possible breastfeeding topic, with good photos and is very encouraging to breastfeeding mothers. Lots of other topics of interest to multiple birth parents.

Raising Multiple Birth Children – A Parent’s Survival Guide, by William and Sheila Laut, 1999

I haven’t yet read this book by parents of triplets but it has come highly recommended to me. Includes practical tips for getting organized, baby gear you will need, coping with sleep deprivation (I like it already!), gift ideas, funny stories (we can always use those) and more!

When You’re Expecting Twins, Triplets or Quads by Dr. Barbara Luke and Tamara Eberlein, 1999, Harper Perennial

Twins From Conception to Five Years by Averil Clegg and Anne Woolett, 1983, First Ballantine Books

Multiple Blessings by Betty Rothbart, 1994, Hearst Books

The Art of Parenting Twins by Patricia Maxwell Malmstrom and Janet Poland, 1999, Ballantine Books

Finding our Way: life with triplets, quadruplets and quintuplets, Web Com Canada 2001

Double Duty, by Christina Baglivi Tinglof, 1998, Contemporary Books

The Joy of Twins and other multiple births by Pamela Patrick Novotny, 1994, Crown Trade Paperbacks

Twins: Pregnancy, Birth and the First Year of Life by Connie L. Agnew, Alan H. Klein and Jill Alison Ganon, 1997, Harper Perennial

Twins, Triplets and More, by Elizabeth M. Bryan, St. Martin’s Press, N.Y.

New Father Book by Wade F. Horn and Jeffrey Rosenberg, 1998, Better Homes and Gardens Books

Feeding Your Baby the Healthiest Foods by Louise Lambert-Lagace, 2000, Stoddart Publishing

The No-Cry Discipline Solution, Elizabeth Pantley, due for release: June, 2007, McGraw Hill, softcover, 235 pages, Expected price $16.95US

Elizabeth Pantley has, thankfully, added another book to her “No-Cry” series. This latest one offers discipline solutions for toddlers and children, aged 2 to 8 years. All types of potentially difficult situatons are covered such as bedtimes, tantrums, not brushing teeth, hitting, bitting, meal times, inappropriate language use and more. She covers not only what the child might be feeling but also the parent’s feelings. A very helpful section looks at anger, what it means, possible triggers and how our own anger can affect the situation and sometimes make things worse. Pantley offers useful suggestions on keeping one’s own emotions in check, turning the situation around with distracting methods (make a song out of what you want done, use humour) and offers appropriate consequences when or if necessary.

My favorite section has to be Part 4: Specific Solutions for Everyday Problems.

When my girls were small (twins and a singleton 22 months their elder), I just didn’t have time to read psycyologically-based, drawn-out solutions for situations which generally had one child, one adult and the general message “follow this advice and all will be well.” Yeah right! Not in my house where the parents were outnumbered by little ones feeding off of each other’s behaviour. I needed quick, helpful, supportive feedback with several possible suggestions to consider in turning things around. Flying by the seat of your pants and/or “learning as you go” doesn’t always equal good parenting skills.

Pantley clearly and concisely states a situation, for example Sibling Fights. Each begins with a story from a frustrated parent. Pantley asks us to Think About It (in this case Sibling Fights) and addresses what such fights can mean for the child. She then offers step by step ideas on What to Do and, perhaps more importantly,What Not to Do. Pantley cross-references to other areas of the book for additional suggestions. In this case, Biting Other Children; Bossiness, Hitting, Kicking and Hair Pulling; Playtime Behaviour. Most topics are covered in two pages, making it quick and simple to grab the book (topics are alphabetically listed), peruse the appropriate area, absorb some techniques and get back to the home situation, all in a timely fashion. That’s my kinda guide!

If you have kids aged 2-8 years, this book is a must have. I hope that Pantley will soon add a “No-Cry Discipline” focused on preteens and teens.

NOTE: Don’t just limit yourself to books on multiples. There are some wonderful books on babies out there and here are a few examples:

  • What to Expect When you are Expecting
  • Dr. Spock’s Book – describes childhood diseases and incubation periods
  • The Mother of All Pregnancy Books, by Ann Douglas – an all-Canadian guide
  • Secrets of the Baby Whisperer, by Tracy Hogg with Melinda Blau

DVD Reviews

Fascinating DVD regarding conception and gestational journey of Twins, Triplets and Quads. A must view for parents, grandparents, researchers, healthcare professionals and any one else with an interest in multiples.

Check it out at:  http://www.rocketrights.tv/womb/multiples.php?
PHPSESSID=15b23a92713177aa2c4be1065cfc2eb4

Your Babies’ Journey: Twins, Triplets, Quads, approx. 100 minutes

This amazing DVD out of the UK will no doubt be very well received not only by parents (and grandparents) expecting multiples but also by the healthcare professionals who look after them. The photography, graphics and sonagrams lets the viewer into the womb to watch the babies’ growth, development and interactions. It’s breathtaking and I was glued to the screen throughout. I found myself jettisoned back to my own pregnancy and was thrilled to observe what our girls were doing prior to their delivery. This fascintating documentary is an important and enlightened resource for anyone with an interest in multiple-births.

If I were to comment on anything, two little things stood out: l) Society often refers to vaginal birth as “natural birth.” Does that make a necessary c-section an “unnatural birth?” I think not. A “natural birth” is, in truth, any birth that ensures a healthy Mom and baby(ies), and that includes a c-section. Many families whom need to have a c-section feel guilty about having to do so and by changing our vernacular, we could make a positive difference. And 2) I would have liked to have heard more direct references to the fathers and their roles. Two parents are ideal in any parenting situation and this is partiacularly true in the case of multiples. Dad, an important part of the parenting equation, is almost completely absent from this otherwise stunning DVD.

Vanishing Twin and Multifetal Pregnancy Reduction: New Reproductive Technologies, New Losses

Posted by on in Lynda Weighs In, Pregnancy, Prenatal EducationLeave a comment

There are two types of losses which, in my opinion, are often overlooked, not only by family and friends, but also by many professionals, including medical practitioners, therapists and grief counsellors. Those two losses are Vanishing Twin and Multifetal Pregnancy Reduction.

For reasons which can be understood, although debated, one can see why they might be marginalized (it’s an early loss…, “you hadn’t yet had time to bond with your child(ren)” or “at least you still have one [two]”). However judging by the number of e-mails I receive from families with questions, disbelief, concerns and aching hearts, I think, as a society, we need to take a hard and long look at how we are supporting (or seemingly not supporting) families experiencing such losses.

Vanishing Twin (VT) is a surprisingly common situation, certainly judging by how many questions I receive (it’s the most hit-on article on my site). Even as a young girl, I can remember a couple of my Mom’s women friends saying something like, “It’s the strangest thing;  I’ve been bleeding but the doctor tells me I’m still pregnant.”  In hindsight and prior to the advent of ultrasound, I bet some of these women experienced VT.  Not knowing that they did might indeed be their story, and they continued on with their lives, thankful for their healthy baby.

In the messages I receive, parents narrate their stories, desperately looking for hope regarding the empty sac and asking “over time will there be a baby in it?”  Then there is the worry about the effect of VT on the health of the remaining embryo(s). Because ultrasounds are regularly performed at 5-8 weeks, we learn very early that we are pregnant and with how many.  Hence, to learn by 10-12 weeks the situation has changed dramatically is devastating to many families.  Doctors, ultrasound technicians, grief counsellors, friends, family all need to realize that the loss of these much-wanted children is two-fold:  first there is the loss of a baby, and then there is the loss of unique parenting experience. Passing off an early loss as “at least you still have one” is not the way to comfort anyone and only adds to the confusion and disappointment these parents feel while also depriving them of a right to safely talk about their feelings.

Multifetal Pregnancy Reduction (MFPR) is very complicated and in a recent 10-day period, I was contacted by six families facing reduction or who had just gone through it and were comfortable with their decision, and one who deeply regretted the decision and felt pressured to reduce or chance losing the whole pregnancy.  Here too, anyone coming in contact with families facing reduction needs to be in tune with the emotional strain, possibly lasting a life time, of having to decide to reduce.  Yes, a reduction offers a better chance to having healthy survivors; yes, a reduction improves the physical stress on the mother, and yes the brain tells us a reduction makes rational sense in so many instances.  None of this can be repudiated, but it isn’t just the brain making this decision; the heart is very much involved too and will not be ignored.  The heart is already in love with the babies within and wants desperately to believe that the pregnancy will continue to deliver healthy 3, 4 or 5 infants.

In some cases, it will and things work out, and sometimes things don’t work out so well for one or more of the babies.  There is the emotional strain of the decision:  Am I a killer of my baby(ies)? How will I ever tell the others?  When do I tell them?  Do I tell them?  My babies are already bonded in utero, how will a reduction affect the survivors?  All difficult questions and parents need informed guidance and support in finding solutions which will work for them.

MFPR is not a topic that can be easily discussed with family or friends.  The decision is usually made by the parents in conjunction with professionals and peer strangers who are located on the internet (e.g. other families experiencing or looking at reduction, caring support people and organizations who guide them along the rocky path).  Parents can feel very isolated, frightened and alone in making a decision which bears such significant and life altering impact.  If the discussion to reduce does include family members or friends, then it is no longer a “secret” and telling the kiddies of their origins takes on a new urgency so that parents have control over how and when the children are told.

There are no easy answers but one thing is for sure and that is these grieving families need society’s support, comfort, and understanding in a non-judgmental way.  They are mourning their losses and like any grieving individual, deserve a safe place to do so, with caring people all around them who do not minimize or de-legitimize their loss.  It is the least we can do.

By Lynda P. Haddon, Article copyrighted.

Multiple Births Canada
www.multiplebirthscanada.org

Twin To Twin Transfusion Syndrome (TTTS) Survivor

Posted by on in Pregnancy, Stories From Parents, Twin To Twin Transfusion SyndromeLeave a comment

My name is Nancy Reyes. I have beautiful 5 year old twin girls who survived twin to twin transfusion syndrome (TTTS). I was 20 when my doctor called me letting me know there was something wrong with my pregnancy. I was around three months and had blood drawn and an ultrasound showed only one baby. The results from the blood were so high that I went to see a specialist.

I remember as if it was yesterday being told I was going to have a baby with down syndrome (they didn’t know I was carrying twins) and having counseling that day.  Our options were to keep the baby with its special needs or to have an abortion.

It was such a hard time for my husband and me, we already had a three-year old boy. We were taken that day for another ultrasound to get an actual look to see what was wrong to our baby. Soon enough the blood results changed.  We were carrying twin girls. Everything was suddenly so different. From being told we had a down syndrome baby to having twins! Shocking! that is all I can say. We learned that our twins had TTTS.  Being young and Hispanic, I didn’t really realize what twin to twin syndrome meant. I just knew that I had two precious babies inside me and they needed me to be strong. I had to take care of myself and them.

At four months I stopped working to be on complete bed rest. My doctor and nurses were wonderful. They explained a lot to me but it was so hard to understand at that time and to be honest, almost six years later I am realizing how lucky I am to have my girls by my side. Not everything was all beautiful. My pregnancy was very difficult. I had excess amnio fluid removed twice from the receiver, making the possibility of a miscarriage even higher. Their heartbeats at times would be real great, but there was the possibility of having them early. I thank God for letting me carry them for nine months.

I was really lucky. My girls were due on January 1st, but they were born December 24, 2000, Ruby 5lbs11oz and Melissa 4lbs2oz, Ruby’s heartbeat was dropping so my delivery was induced, all the pain and suffering was worth it. I can honestly say I would do it again to have my girls with me like I do now.

Weeks after birth their birth they contracted RSV virus, not once but twice. It has been a rough journey, but I am enjoying every single day. I never realized how lucky I was, especially not knowing what TTTS was and how severely the girls had it. I thank God and I am so glad we are survivors of this disease. I wish the best to everyone who is carrying this disease, take it easy and pray that everything should be okay.

Nancy, Ruby & Melissa