Sunday, September 26, 2010

Surviving Pregnancy: Mood Swings... or Not

Week 20 - 167 Pounds
Measuring 28 Weeks
For as much stress as Mr. Geek (my DH) was under while we were finishing some home improvement projects, (he's about as handy as a swimsuit on a snowy day) he was still pretty much his cheerful, silly self most of the time. Though that wasn't really the case for our second pregnancy when we already had kids to care for and were too exhausted to be cheery. But one time, while he was reading a pregnancy book to the babies, (yes, we did the whole cheesy have dad talk to the babies to get used to hearing his voice thing). It instructed dad to try to be understanding of mom’s unpredictability and moodiness from pregnancy hormones. I asked him if that was really the case for me, and he said that I’m actually LESS  moody than before I was pregnant! I sometimes wonder if it had anything to do with the hormonal birth control I was on, but I think if I had mood swings, they were more noticeable in early pregnancy than later on. Or maybe I was just so full of excitement and anticipation for being a busy mom and leaving behind a stressful role in a family business that it adjusted my outlook on life.

Mr. Geek had a way of  making me smile with his silly antics while I was pregnant. Here are a few of my favorite Mr. Geek quotes:

In a frantic voice: Where’s the babies? (Then I would point to their last known ultrasound location and say 'right here & here!" He would respond :"I love all three of you!

With a blank look on his face, a distant stare and a melancholy tone: “*sigh* Twins. We’re gonna have two babies. *sigh* When asked how he feels about this, he never has a definite answer. Usually it was he didn't think he was ready for it.

Staring blankly at my belly: “Wow, your pregnant”. He claims that although he didn't find my belly sexy, he thought it was cute.

Staring at my recently-endowed chest and, uh, 'commenting' on it!  Pretty much every time he looked below my neck and above my belly, he felt the need to express his interest and pleasure with this change in my body. Yes, I noticed too dear, I didn't know we had to be so expressive about it though. (If I knew how to insert a rolling-eyes smiley I would do it here.)

Guys, if you are reading this far, note that expressing to your wife your continued love and undying affection is especially critical  and complimenting her physical appearance is generally very important during pregnancy! She needs your love and reassurance!

Surviving Pregnancy: Body Image, Hormones and Wildlife in the Bedroom

In the previous post about what to wear, I touched on pregnancy body image. Some people feel, ugly, fat, clumsy, or otherwise totally unattractive in their mom-bods. Others feel ultra-feminine, uninhibited, cute, voluptuous, totally proud of their natural beauty found in the amazing miracle their body is actively yet subconsciously nurturing.
Before pregnancy, my belly had been the part of my body I was most self-conscious about. One might expect that to be exacerbated by a growing pregnant belly…but actually the opposite is true. You see, for the first time in my life, I felt I could let it ‘hang out’ without shame. My growing belly was not just cute, it was a shining example of completely beautiful and exciting blessing.
For the first time, I felt completely at peace with my body. (Obvious note that this is in reference to body image and not the physical aches and pains of pregnancy!)  This gave me a feeling of freedom, and sexiness that I had not had before. Granted, my dear husband tells me that he thought I looked cute, but that my un-pregnant body was more attractive. But this wasn’t about his perception, it was about my own, and through my own skin, I felt like a goddess. And a woman who feels like a goddess wants to revel in it with her husband. And let’s face it ladies, the lucky guy married to a woman who is constantly pursuing her husband like a lioness seeks it’s prey is going to think she is super sexy – belly or not. Which of course gave our intimate life a touch of enthusiasm that it hadn’t had since early in our marriage.
It is interesting to note that it wasn’t just the improved body-image creating the spark. Pregnancy hormones are in fact KNOWN to fan the flames of libido for some expectant mothers. Increased sensation in some key nerve endings and increased natural lubrication are contributing factors. I found that arousal came much more easily and intensely and from things that wouldn’t even interest me previously. And the intensity and ease of climaxing was, ahem, very notable. There were even a few times that my entire pregnant belly contracted during climax, which was startling at first, but completely normal, and according to my doctor, nothing to be concerned about.
And yes, some women will feel just the opposite because of exhaustion, nausea, and the other physical discomforts and because generally having a four foot girth does not fit our cultural norms of sexy. No two people or pregnancies are alike. Guys (if Heaven forbid you are still reading this!) you should know that your wife might not appreciate the appearance of her mom-bod as much as I did. Know that your constant verbal and physical approval is necessary to help her feel good about herself. Be sure to point out whatever positive qualities you can see in her changing body - even if they are different than the things you appreciated before you installed that watermelon in her midsection. If you change the frequency or freeness with which you give her loving, touching and sexual affection, she will likely notice. Be sensitive and share any struggles you are having in a gentle way.

Ladies, on the days and weeks that you feel well, take advantage of them and give your body a chance to speak to you and tell you what it needs and wants. And maybe consider thanking your hubby in an intimate way for all the help he’s going to be giving you with these babies in a few months. After all – there won’t be as much time and energy to 'thank' him then! Just enjoy your free time while it lasts!

Thursday, September 23, 2010

Wednesday, September 22, 2010

Surviving Pregnancy: Stretch Marks - not just for your belly anymore!

So, having twins, I pretty much KNEW I would be getting stretch marks. I just never realized WHERE I would be getting them!  In my 7th week, we spent a weekend away from home. I generally felt pretty good, the cramping was finally going away, and morning sickness hadn’t totally kicked in yet. When I woke up on lazy morning, I felt good. The day was beautiful and the air fresh and crisp...and my husband and I didn't want to get out of bed just yet [insert winking smiley here]. Suddenly, a huge grin came across his face. (Yes, even more than otherwise expected.) Ahem - let's say he simply observed an amazing over- night growth spurt of my breast tissue. It was a serious growth spurt. Overnight, I grew at least a cup size. I voluptuously (and only somewhat uncomfortably) overflowed my bra for the remainder of the weekend.
And while the size may have been thoroughly a benefit, the quick growth brought with it stretch marks. That really didn’t bother me much though, as there is really only one adult that will regularly see them, and he’s too distracted with their other attributes to care. pregnancy thing could be fun after-all. Which leads me to my next post…

Surviving Pregnancy: Choosing a care provider

18 Weeks of Pregnancy - 164 Pounds
Measuring 23 Weeks
This is the one task that brought more stress to me during my pregnancy than any other single topic. At one point, the birth educator in a hospital class questioned the fact that I had a family practitioner for a high risk pregnancy and urged me to transfer care immediately. After calling around and learning I was too far in my pregnancy for any of them to willingly take my case, I consulted with one of specialists my doctor was working who completely laughed off the concern and said my doctor was certainly more than capable!

Choosing a Clinic
Early on, I chose a clinic and doctor because they had family practice physicians that would attend your birth and deliver your child. This was at Allina Clinics. I simply went to the Allina clinic website and read doctor profiles and philosophy and picked the one I liked.
The advantage of this was that unlike a standard OB/GYN practice, you could be assured that you would see the same individual for your prenatal visits as you would in the delivery room, ensuring as few surprises as possible. In other words, if you know your physician only performs episiotomy in urgent situations where the only other choice is C-section, then you won’t have to wonder about that when you are dilated to 10 and someone you’ve never seen before walks into your room covered in light green sterile clothes and only her eyeglasses peaking out as she says ‘hi, I’m doctor Smith and I’ll be delivering your baby today!”

Choosing a hospital
Another consideration is which hospitals your physician works with. In this respect, you might start your physician hunt by hospital shopping. You can start by going online and looking up the birthing centers or maternity wards of hospitals in your area. Often, their websites include basic information on rooms and policies. Most often however, if you want any specific information you will have to call. When you call, ask if they have a free tour or information session that you can attend. This is often the best way to lean more, and will give you an idea of how hospitals are different.
The hardest part is deciding what is important to you. Any good literature on multiples will recommend that you choose a hospital with a level II Neonatal Intensive Care Unit, as many multiples end up spending some time in a NICU. One consideration, especially for those who have high risk pregnancies (besides the fact you are having multiples) or are having  triplets or more is how easily accessible the hospital is from your home in case there is an extended stay there. The choices in this respect may be limited. Also, consider that if you are leaning toward a hospital without a level II NICU, that if your babies must be transferred there, you will still be recovering at the hospital you birthed at – making visiting your new babies complicated.
Aside from those factors, other items may be important to you, such as
*What are is the practice regarding fetal monitoring during labor? (see my birth stories to understand why this may be significant)
*In what situations are IVs are mandatory for laboring moms?
*Do I labor, deliver and recover in the same room?
*Where will you be delivering? (it is common for mothers of multiples to deliver on the operating table in an Operating room.)
*Is there a bathroom with a bathtub in the labor room?
*During recovery, may the baby(ies) remain with me, or are they required to be monitored in the nursery for certain periods of time?
*In what circumstances will the babies need to stay in the NICU? (based  on birthweight? Feeding needs? *Body temperature maintenance? Breathing assistance? etc.)
*Are laboring mothers able to eat, drink and eliminate on their own? (You may need to ask your physician this question also)
Be sure to preface these questions with the fact you are expecting multiples as the answer is often different.

Multiples: an automatic 'high risk pregnancy'
Most hospital and physician protocols go into ‘hyper-over-protective’ mode because you are having twins. And yes, they have some good reason to, as multiples are often born earlier, or smaller, and have complications such as Twin to Twin transfusion that singletons are not at risk for. However, there is a tendancy for protocol to be over-restrictive or overly-intervening even when there is no true benefit to the action in YOUR particular case.
I personally believe this is due both to lack of adequate research regarding risk in multiple pregnancy as well as a subconscious tendency to practice ‘defensive’ medicine. There is often not enough research to know for sure what things really are more risky for expectant M.O.M.s because there are just not enough multiple moms out there and not enough studies being done on them to provide reliable risk information. The tendency to practice medicine defensively stems from an emotional reaction (rather than a logical one) which inappropriately favors a known risk over an uncertain risk. This happens because we all have an innate desire to avoid liability and potentially poor outcomes, but as a result we may minimize or ignore the known and unknown side effects and risks of the intervention or restriction being proposed. (More on this in a future post).
This means it is critical for you to know and understand what conditions and risks are pertinent to YOUR pregnancy, and not just multiple pregnancy in statistics. Statistics often don't account for factors like previous poor pregnancy outcomes, socioeconomic status, access to health care and education. All of these are factors in general in pregnancy outcomes, and all should be considered when making decisions about YOUR pregnancy - not JUST a raw statistic. It is also very important to understand every procedure, test and intervention your provider recommends, why it is being done, what it's risks and side effects are, whether you and your physician has reason to think those same statistics would apply to you, and what the risks are of NOT doing it.

 So for instance, a doctor may recommend that you do not do any regular exercise because it is a risk that in their mind is not worth taking, but there is not data to show how risky it is - or even that it is correlated with complications at all. My question would be, what is at risk? They probably think the extra stress on your body could cause early labor. But are the chances of that really significant? Especially if you have had previous non-complicated pregnancies in which you DID exercize? Are there studies that show complications arising due to M.O.M.s exercising? Or is it just an 'extra' precaution? Is there is an intuitive reason that exercise will cause complications? If not, what are the potential side effects and risks of just remaining sedentary during multiple pregnancy?  You can see there is nothing clear cut, it all requires reliance on your doctor's knowledge and communicating your own risk tolerance and preference to her, and finally, using your intuition when logic is not available.

Natural Birth hopefuls: Critical Question for your physicians!
In the end, I worked with the same doctor both times – but the important part, which is critical here, is that she worked in coordination with a group of perinatologists who were on call during my birth, and actually attended them. In fact, because of a slight complication with thrombocytopenia, I was transferred totally into the care of the perinatology clinic for my second birth. Because of my experience, I highly recommend that all M.O.M.s (mothers of multiples) seek a highly trained perinatologist either for primary care, or that will coordinate with  your physician to attend the birth. The reason for this is that many physicians (even OB/GYNs) and midwives are not trained or experienced in breech birthing, especially the younger ones who were not practicing decades ago when it was more common.

Most OBs and physicians will advise you that as long as baby A (the first baby to be born) is head-down, you will be able to attempt vaginal birth. If vaginal birth is important to you to avoid C-section, you should pay careful attention to this subject. Some physicians will have a low personal risk tolerance, and may advise you that unless both babies are both vertex (head down) you should really consider having C-section. This is code speak for “I certainly wouldn’t try vaginal birth, but I guess I would put up with it if you did”. Do you really want to work with a doctor with that attitude? If you are like me, this won’t be the only issue you struggle about with him or her. And in reality, the advice is extremely short-sighted, as even if baby B is in a vertex  position, she is likely to present differently after baby A is born and will either need to be turned or birthed breech. (in both my pregnancies, after A was birthed, B had changed positions from where she was even during pushing of A) It is important to know if your doctor (and the other doctors in the practice) are able and willing to do a breech extraction on Baby B if the conditions are right (they may not do it if baby B is significantly larger) or to do an internal inversion of baby B after the birth of A. If they are not able or willing to perform either of those procedures, you will very likely be one of those mothers who had the ill fortune of delivering one child vaginally and the other via C-section.
In my personal experience, and from listening and knowing the experiences of those in the mothers-of-multiples group I am in, it seems that perinatologists are much more well-trained and experienced in these procedures than your average OB or midwife. Not to say that an OB practice would not be appropriate for you, but be sure to ask the important questions, and that you are comfortable with the answers.

Questions to ask when choosing your physician:
*Are you (and those in your practice) able and willing to do a breech extraction on Baby B if the conditions are right (they may not do it if baby B is significantly larger) or to do an internal inversion of baby B after the birth of A?
*In what situations would I be required to have a C section?
*For what reasons do you recommend bed rest?
*If all is healthy, is there a reason I would need to be induced?
*Can I have a doula present at my birth?

These are not all-inclusive by any means, but they are the most likely to bring up topics that can vary widely between providers and their experiences.
In reality, and in today’s medical care economy, it is extremely rare that you would actually be able to meet with doctors from various clinics, though sometimes they will make such appointments or have office hours. More often than not, they expect you to just schedule a regular exam or checkup and become a patient first, and ask questions later. For that reason, I would choose to start by taking hospital tours very early in pregnancy to choose a hospital first. Then I would find clinics and physicians that can practice at that hospital and call their offices to find out what resources are available to answer your questions. Don’t rule out a doctor or clinic because they are too busy to take your questions – it is probably a good sign. Join a local Mothers of Twins club or Mothers club and ask what hospitals/clinics/physicians other M.O.M.s had for their pregnancies. Pick a clinic or physician and ask lots of questions your first few visits. If you are not happy with the answers, make your next appointment with someone else. Choosing the right care provider is definitely an art and not a science!

Tuesday, September 21, 2010

Surviving Pregnancy: Staying Active

16 Weeks Pregnant - 159 Pounds
Measuring 21 Weeks

Pregnancy may be littered with ailments. Fatigue, nausea, aches and pains, bed rest. Try not to let these ailments wear on your general mood. Take advantage of the days and weeks when you feel good and do something good for yourself and your baby, or babies!
I began doing Yoga in my first trimester. I didn’t do it every week, but I did go to a class with a friend, which helped motivate me and keep me honest about showing up! I highly recommend finding a workout buddy. We both traveled over 20 minutes to meet to work out, but since we didn’t have kids, it worked out.  In fact, it was a nice way to spend time together even though we were at different stages in our lives. I was pregnant; she was unexpectedly single only a few years ago.
After the yoga series was over, we continued to meet up and do elliptical machine and stretching together. I really treasured the connection that working out gave us, and blessing of all blessings, she found her future husband during that time! But if you don’t have a workout buddy, or can’t get out of the house, you can surely at least find a prenatal workout video and even prenatal yoga on DVD.
Note though, that I did NOT overdo it. While I didn’t check my heart rate, I was easily able to keep conversation with my friend the entire time, which is an important indication that I was not over-exerting myself. Note that I did this with the blessing of my doctor who advised me only to take pre-natal yoga, and do non-jarring machines like bikes or ellipticals. I will admit however, that I never asked when I should stop though! And I kept it up well into my 7th month!
Finally my belly was too big to be comfortable lugging it around a gym and I had such a blood volume within me that I was too easily fatigued. When this happened, I’ll admit I spent a lot of time lounging on my couch like a beached whale, or soaking in the tub. But rather than become completely sedentary, I began swimming.  This really was beneficial not only for the exercise and circulation, but it was a heavenly way to get the weight of my babies off of my belly! I remember swimming in the water just dreaming that I could take a nap there!  I actually went swimming every few days, and even the day before I delivered at 39 weeks!
Of course, you should check with your care provider about exercising during a multiple pregnancy, but if he or she completely discourages you from any activity ‘just to be cautious’, I would question that recommendation or seek a second opinion. I don't believe a healthy mom should not be discouraged from physical activity simply because she is pregnant with more than one baby. There it no research to show it is detrimental, and unless you have other risks, and especially if you were active before pregnancy, there is nothing to be cautious about until much later in pregnancy.

Tuesday, September 7, 2010

Surviving Pregnancy: The Ever-Shrinking Wardrobe

14 Weeks of Pregnancy - 157 Pounds
Measuring 18 weeks
As I have already alluded to, there is this terrible in-between time for all pregnancies when regular clothing becomes too small, and maternity clothing is still fits too much like a tent. This mis-fit period is shorter for M.O.M.’s thank goodness, but it also hits sooner for them, before most people know you are expecting, which presents it’s own challenge: What on earth do I wear? My jeans were already getting noticeably snugger before I was 5 weeks along! By the time I was 7 weeks jeans were out of the question and I was in elastic waistbands only. I literally wore through the seat of the 2 pairs of ‘normal’ pants that I could still fit into. I didn’t feel confident going to buy lots of maternity clothes yet because, well, nobody really knew I was pregnant, and most maternity clothes are pretty obvious, or at least have a big stretchy waistband that is a dead giveaway.
I did go shopping and found a few nifty new pairs of ‘regular’ pants with elastic waistlines that got me through, and actually they worked well for postpartum as well. Dresses would be a good option, except I didn’t have many. My favorite maternity clothing item was a pair of bib overalls. Buy large – you’ll need the room! They were the only item that actually covered my girth and stayed up in my final week!
Another great  item that I wish I would have discovered sooner was  belly bands. They are simply stretchy rings of fabric that go around your midsection. So as your cute ‘lil baby bump (or for us M.O.M.s perhaps ‘voluptuous belly bulge’ is more appropriate) starts to pop out under your regular shirt, you’re not baring your skin. The belly band shows beneath your shirt, which I think is so cute, and it saves you from having to buy a bunch of in-between-size maternity shirts…and save up for the tent-size ones you’ll need later on.
I recommend getting several belly bands that coordinate with your current (non-maternity) wardrobe because not only are they good during mid-pregnancy, but they are also EXCELLENT for nursing moms, because they allow you to nurse in public without baring your belly or buying expensive nursing shirts or futzing with a nursing cover or blanket. I used them under my clothing everyday after the babies arrived so I could nurse easily when needed. Also, be sure to buy the extra tall or wide belly bands, because some are rather ‘skimpy’ in that the fabric is only about 8” wide, and let’s face it twin mamas, 8 inches isn’t going to cover your ‘buns in the oven’ very far into this pregnancy!
It was such a relief when the cat was out of the bag, and I could proudly display my midsection because, let’s face it, at 10 weeks it was getting tuff to hide! At 15 weeks, there was not a single pair of pre-pregnancy pants I could squeeze into. I’ve always been so self conscience about my belly, and have always been very conscious of my posture, so being able to let it all ‘hang out’ was a very freeing experience. Never before did I have a reason to be proud of my figure, and now I did. Actually, it was during middle pregnancy that I felt more proud and confident in my body than I had since, well, ever in my life. And it was only about to get better…

Saturday, September 4, 2010

Surviving Pregnancy: SLEEP PLEASE

12 Weeks of Pregnancy - 155 Pounds
Of course, another plague of early pregnancy is exhaustion. Your body is working hard, to build and nourish not one, but two (or more) other little bodies. You have nutrients to process, cells to divide, and blood volume to build. If you think you would be this tired if you ran a marathon, you are right. Your metabolic rate is increased. And to add to it, your body is producing more progesterone, which has a sedative effect.

I think for me, week 8 was the worst for feeling exhausted. I pretty much fell asleep right after dinner, if I made it that far! And I often wanted a nap in the afternoon when I could sneak one in. Any mom will tell you that the only thing worse than having a full time job and being that exhausted is having young kids and being that exhausted - even worse all of the above! Just do whatever you can to get some rest. Go to bed early, sneak a nap, make your hubby drive and catnap in the car, call a friend in for help. Don't feel bad about it, your body does need sleep for you to function well and give your best to your family and your job.

It was at this time during my second pregnancy that I started the habit of putting in a longer movie in the afternoon to let my older kids watch while I snoozed for 45 minutes. If your kids are younger and you can’t let them roam around the house while you snooze, try putting him/her/them in a crib with their favorite baby-safe toys. Or even buckling ‘em in a car seat in the living room in front of a Baby Einstein movie. Of course, I don’t condone this as a regular habit, but when your body id desperate for rest, it is important listen.

I still felt pretty fatigued at 10 weeks, but after that, the worst of it was over. In general I needed more sleep, but it wasn’t overwhelming. Also, remember to take your B vitamins! I was taking a B supplement of some sort but can’t recall which…so ask your doctor if it would benefit you. If your doctor gives you a blank stare in return, ask to see a nutritionist or dietitian.