Wednesday, November 30, 2011

Mid to Late Pregnancy Test for twins: Level II Ultrasound

Level II Ultrasound (also known as a fetal anatomy survey or scan)
This ultrasound is standard for all pregnancies (not just multiples) and is usually the 'big one' where you first get to learn your babies' genders. It is done when you are about 20 weeks along, but is usually repeated later in pregnancy if you are expecting multiples. My second level II ultrasounds were done around 30 weeks. This is done to assure that both babies are growing at a healthy rate and that intrauterine growth restriction, twin to twin transfusion syndrome (TTTS) or other complications are not affecting growth. With a singleton pregnancy, if mom’s belly is getting bigger, you can be quite assured that the baby is too. But with two inside, it is good to have more assurance that both babies are growing well and at a similar rate.
This ultrasound is essentially your babies’ first physical exam. The technician will take time to measure several different parts of baby’s body, including baby’s ‘crown to rump’ length (it’s hard to measure a baby’s total height when she’s all squished up in there!), head circumference, length of arms and legs and even of her little foot (which is a great measurement to keep track of and note or draw if you keep a pregnancy journal!) I actually asked the technician to simply print the screen on which she tracked all of my babies' measurements. Of course, you can learn the gender of your babies if you want, but be sure to let the technician know if you want to be surprised.
The technician (or sonographer) will also ‘examine’ some of babies’ major organs – kidneys, heart and brain. They do this to the extent that they examine each heart chamber, and identify the sections of her brain. They also view and measure the stomach. Suffice it to say that if they don’t find anything unusual, you probably have some very healthy babies in your big belly. Even if they do find something 'iffy' it is often resolved or more clearly normal at a later ultrasound.
If you see something you like, be sure to ask the technician to print a photo for you. Most technicians will give you a whole bunch of shots from the ultrasound, just be sure you check them before posting on your facebook profile, I found mine had my birth date, full name AND social security number embedded on them! So much for privacy…I wonder if they shred those when they are done?
Before your ultrasound, you may want to consider the following so you can be prepared. First, it takes about 45 minutes to do this detailed examination on just ONE baby. Add a second baby in there, and you could be in the ultrasound room for an hour and a half. Now consider that baby B will sometimes get in the way of a measurement they are trying to get on Baby A and now you could be in there for up to 2 hours! I recommend taking a potty break right before the exam (presuming you don’t need a full bladder as you do with earlier ultrasound exams). Also, you might bring a snack if it will be getting close to meal time.
This site "What to Expect", has some great info on ultrasounds and all pregnancy testing.

Wednesday, October 26, 2011

The Anxiety Cure for Kids - Book Review

The Anxiety Cure for Kids by Elizabeth DuPont
One Star

I read this book because one of my daughters has really been struggling with panic attacks and fits of crying over the tiniest infractions of personal discomfort ever since starting first grade.  She has struggled on and off with anxiety since, well since birth I guess, but I wanted to find out how I could help her and what I can do, what SHOULD I do. Well, the book is only mildly helpful for our situation. It did lay out just a few concepts and  fundamentals, but about 85% of the book is a list of exercises or mental (and sometimes physical) drills that will help give your child the skills needed to cope with anxiety. It may be useful to some, but it didn't help give me the big picture understanding of what my child is experiencing and how to parent her in light of it. Rather, if I had the time and understanding to do  as self-evaluation of he strengths and weaknesses that contribute to her struggle with anxiety, I could make a plan to use these drills to help her develop the skills she needs. While this may be helpful to some, it really wasn't for me because the causes of her anxiety seem so scattered and often related to sensory integration disorder. It may be helpful when combined with some other resources, but for me it gets 1 out of 4 stars.

Monday, September 19, 2011

I wish life had a speed limit

First, I apologize for the long absence. Now for an explanation. Sometimes, life stinks. No, really(see #6). I wish there were a limit on the rate at which things can break down and go wrong in life. Here is the short list of things my family has been juggling both mentally and physically (ya, there's more than I can even write about right now):
1. My husband's mother passed away unexpectedly in mid-August - besides our own grief, it also forced us to explain this all to our kids of course too. And besides grief, a death in the family brings about a number of 'administrative' duties like cancelling services and probate and making service arrangements and a myriad other things that no sane human can remotely consider pleasant.
2. This also caused more legal work and administrative work in coordinating guardianship for my husband's sister who is mentally handicapped. Not to mention that now we will need to arrange to make the 2 hour drive to occasionally visit and bring her to visit us for holidays.
3. Did I mention that we got a letter telling us our health insurance costs were more than doubling as of September 1st? That's fun too.
4. After we had all the funeral arrangements made as she had pre-arranged and pre-paid and the obituary had run, we got a call from the funeral home informing us that she actually cashed out her pre-arrangement plan and that we owed them a big fat sum of money (of course they waited until after the arrangements were a done that bait and switch or WHAT!?!?
5. As if one death were not enough, I got to sing at a funeral for a 3 day old baby. The tiny little girl was born to a dear friend of mine who was expecting twins on December 10th. She went into labor and gave birth at only 23 weeks - the cusp of survival. The other twin born to her is currently in the NICU and is totally a rock star. Thank God for that!
 6. My youngest twins who are now 2 suddenly begun having what I call TAPS (Toxic & Abundant Pooh Syndrome). It was causing diaper rash and general crankiness and separation anxiety (just what we needed to make the cherry on top, right?) Finally, on a hunch, I stopped giving them dairy products. The pooh suddenly stopped, but the diaper rash still persists.
7. School? Did someone say 1st Grade? Ooooooohhhhh, ya, I better find that supply list somewhere. Did you know that if you wait until the Friday before school, you don't actually get great deals, you get nothing. How Target can run out of glue sticks, pencils, erasers, pencil boxes, dry erase markers, and just about everything else before it has even gone on clearance mark downs and before school has even started, is way beyond my humble mental capacity.
8. A family reunion to boot. Because nothing enjoyable can ever just be left to enjoy - it has to be thrown into a furnace of chaos for deleterious affect. Enjoyed seeing my family - wish I had been in a better state of mind. They probably think I am not the same person I used to be (and I'm not, but I'm hoping to be her again in a few weeks!)
9. The mysterious bites. As if toxic pooh were not enough, my babies (I can call them babies until they're out of diapers, right?) have been getting mystery bug bites that just seem to appear regardless of what they wear, where we've been, and even whether or not we go outside at all! Their ped agreed they looked like bites, but couldn't find what on earth was biting them! We avoided going outside (which stinks with gorgeous fall weather!) We cleaned their room top to bottom looking for hiding spiders. We washed their bedding, we tried everything we could think of but the bites persisted - swelling up and getting itchy and adding to the general fussiness and malaise of our household mood. Finally a few days ago in a fit of frustration, we moved them into the room with their big sisters. It actually worked pretty well, and we haven't had any new bites since then. I guess the room sharing will be a permanent arrangement.
10. Neighborhood break ins. In the past 3 weeks, there have been 3 burglaries in my small niche neighborhood of only about 11 homes. The thieves hit when no one is home and take lots of stuff in a very short time. So we need to be uber religious about setting our alarms and locking our doors. We are at the end of a dead end street and there is a park before the main road that you must drive by to get in or out. It would be VERY easy for the thieves sit there and clock everyone watching and waiting for them to go. I am so nervous and I hate to let my one daughter do her favorite thing - which is to go outside and catch butterflies. Since we are always home I am nervous they will try to get in while we are here. I am totally and officially freaked out.
10. Just to make sure that every area of life has been affected, my husband got some disheartening test results back from the doctor. No - it isn't life threatening, thank God. But it definitely has been affecting his mood, his energy, even his ability to get all 3 things on the list he has for Walmart in one trip. Now we have to go through the drill and spend our time and money (not that we have any of either left) in specialists offices and laboratories figuring out what on earth is causing this. And hoping that he can return to his once happy-go-lucky, mentally focused, energetic self. Then again, after having 2 sets of twins do you ever get there? Time will tell I guess.

As for blogging, will I ever get back to it? Maybe after we get my mother in laws apartment cleaned out. That is a big task for us and we are very overwhelmed with to-do lists right now. But I will get back to it, and just to prove it, I'll do another post yet tonight - I think.

Here's to remembering a wonderful Oma who took great joy in her children and grandchildren. We all miss her.

Sunday, July 31, 2011

I wish I had known...

I recently saw a post online from a first-time mom expecting twins who simply asked "What do you wish you would have known?" The question really hit home for me, and is really the reason I started this blog. Here's my response:

There are so many things...I don't know where to start. Maybe that my back and hips would start aching at only 3 months and go downhill from there - until I discovered the joy of the chiropractor and massage. Maybe that my boobs would grow a cup size overnight when I was only 10 weeks pregnant while I was out of town and had no correctly-sized bras with. And that that would be the only place I would have permanent, noticeable stretch marks! And how about the new-found hormones that kept my DH and I busy at night (in a good way!)

Might have been good to know that I would really have to work hard to find physicians who knew how, and had experience delivering twins without doing a c-section regardless the presentation of baby B. Or that I would have to call around to find out if the hospital will let a doula in the delivery room because hospital educator and  nurse and charge nurse told me 'no doulas, no way'  while former patients with twins told me 'I had a doula and they didn't say no'. Or maybe that spell check doesn't recognize the word 'doula' - "what crunchy planet are you from anyway!?" I hated knowing that I would be restricted to laboring on my back on an operating table.

Or maybe I should have known that I would NOT need to go on bed rest and I would NOT have preemies and NOT need to spend time in the NICU and NOT have any big medical scares and actually be induced at 39 weeks, deliver vaginally and be able to breastfeed exclusively even for a year. (Praise God for all of that!)

Or maybe that it would be possible to reach almost 220 pounds and a 4 foot girth because I had more than 14 pounds of baby in me and that my belly would get really cold hanging out of my jacket in the -20 Minnesota February.Or how about that dandelion root extract is a miracle cure for PUPPS (itchy belly rash) which perhaps was the worst of my week 36-39 misery....that would have been great to know because no physician could offer me help with that one. (would have been nice if I learned THAT before I delivered)

Or maybe that I should politely ask friends and family to not visit in the hospital or at their pleasure for the first few weeks b/c we were so exhausted and when they babies actually both slept, inevitably, someone had come to visit and was too busy chatting at us to realize we needed privacy and rest. (have a few hour 'open house' so whoever wants to come can get it out of their system).And also that if you ask for help, family and friends will graciously pitch in and save your mental health...providing you keep them moving in the right direction.

Or maybe to know that when babies cry all the time, that it isn't always just 'they way babies are'. And that there is actually a reason for it, but whether or not you can discover that reason and treat it is your job to discover because your pediatrician may not have the same ambition you do (after all, he isn't the one up all night) and brush you off as a freak-out new mom. (reflux, food sensitivities, sensory processing disorder, figured those out when they were older). Or that when they do cry and nursing them is the only way to get them to sleep, that if you take safety measures and let them sleep in your bed you won't have child protective services show up at your door, and in fact that you might get more sleep if you do this than stay up trying to rock/bounce/sooth a baby all night who just wants to nurse. Or that some babies are soooo stubborn and persistent that they will not go to sleep, no matter how long you let them scream.

And finally, would have been nice to know that even di/di girl twins could be identical, even if they look a little different. And even better to know that identical (mono-zygotic) twins may not just be a 'fluke' of nature, but there is actually research being done to determine if some moms and dads produce mono-zygotic offspring reliably. And even more so to know that when it happens all over again and you have yet another set of twins, it will be ok, everything you learned the first time will help you with every baby you welcome to your home and by the grace of God you might just survive it and might actually just love it.

Thursday, July 7, 2011

What to buy when you're expecting twins? Part 1

It starts for many of us as soon as you find out there’s more than one in there. What do I need to buy? Or maybe someone is throwing you a baby shower and you wonder what to register for.  Or maybe you need to pick a gift for a mommy expecting twins. 

Let’s face it, having two of EVERYTHING is both expensive and takes up a lot of space.  And if you are on a budget (or soon will be! ;) this should help you decide what you need most. It's a list of everything that I am glad I bought to manage my household with 2 little babies to care for. It is not a list of absolute necessities, but of items I thought were the best value and were worthwhile for me. It also tells you how I got by without some of the things many moms buy. Of course, all these items may not all be worthwhile for you, and if you talk to another twin mom, she will have a completely different list! So at the bottom, I have some links to other discussions of what twin moms found useful.

BTW - I tried to pick the items on Amazon that had the best quality, best prices and free or cheapest shipping, also, if you do put an item in your cart from my link and buy it, I'll get a small credit toward my purchases - so if you do patronize, my gratitude to you in advance. 

For Mama

Baby Be Mine Maternity Belly Band 2 Pack 1-Black & 1-White

Therse are absolutely awesome! Wear under your clothes so your belly doesn't show. Saves tons of money so you don't have to buy as many maternity shirts. And I'm no psychic, but with twins even maternity shirts won't cover the whole package at some point in your near future!
Don't waste money on expensive nursing shirts either. Wear these under any shirt and it is instantly a nursing top. Keeps your belly covered so you can lift your shirt and nurse discretely -worked better for me than any of the nursing tops I wasted money on and was always disappionted.  Beware, not all belly bands are wide enough like these - the ones you can get at target the fabric is only perhaps 8 inches wide. It won't be wide enough to stay up over your belly as you get twin size. These you may have to fold over at first, but when you are the size of a beach ball, there is enough fabric to pull over it to stay up! Plus, there is a black and a white band so one or the other will go with almost any outfit. If you want a cream colored one too, you can get the 3 pack:

Sony Alpha DSLRA300X 10.2MP Digital SLR Camera with Super SteadyShot Image Stabilization with DT 18-70mm f/3.5-5.6 & DT 55-200mm f/4-5.6 Zoom Lenses

Not a necessity, but I'm SO glad we upgraded to a DSLR. This camera snaps photos the instant I push the button AND focuses well on moving objects (2 features that are critical if you want a decent snapshot of your kids!) And that's still using the preview screen. It isn't a Rebel, but it works great for us, the batteries last and this one comes with a good basic lens and a telephoto lens. I wish I had had it about 3 years sooner!

 For maintaining your Sanity

Battery operated tap on light

Put this up by the changing table so you can avoid turning on the bright lights.  Turning on the bright light only interrupts your (and baby’s) circadian rhythms and makes it harder for you and baby to get back to sleep. Make sure you get some AA batteries!

Mesh Lingerie Wash Bag

No – this isn’t for your un-mentionables, as you will probably be washing those less often in the days to come!  Instead, hang a lingerie bag on the hamper for all those little sox and booties and mitts, etc.  It will pay for itself because you won't be paying to replace all the lost sox and bitty pieces!

Ocean Waves CD (no music)

White noise is soothing for babies...reminding them of the womb.  But white noise is annoying to most adults!  These pleasant ocean waves are familiar sound to baby who is used to hearing the ebb and flow of her mother's body sounds and is super relaxing - even for mom and dad!  This may be the one thing that I could absolutely have not gone without.

The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night by Elizabeth Pantley

Read this before babies arrive to help prevent sleep problems that are preventable,and it's easier to get reading done before babies arrive anyway and you'll have alot of time in waiting rooms for your prenatal appointments and non-stress tests!

Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate with Your Baby by Melinda Blau

Awesome book for first time parents.  I wish I had read it BEFORE my first set of twins, as I could have avoided many difficulties.  If you read it BEFORE your babies arrive, you will absorb it much better as you won't be half asleep!  There is not much twin-specific advice, but I consider it a must-read for all first time parents- twins or not.

For Breastfeeding Mamas:

Nursing Pillows

I had success tandem nursing with a Boppy as long as I was in my over-stuffed chair. It is also nice when baby is learning to sit up as she can sit in the middle and you don't need to worry about bonkin' her noggin' if she tips over! I used blankets with the boppy to add support where needed when tandem nursing.  Wait to see if boppy works for you, if not, then drop the money on an EZ 2 nurse twins pillow.

I actually tried the EZ 2 nurse pillow and had terrible luck with it. It was too bulky to fit in my easy chair, yet if I sat on the couch with it in my lap, it wasn't large enough to be the right height for the babies to latch on, so I needed a million pillows under it, which made it unstable and I couldn't bend over to lift the babies up on to it anyway. A total waste for me, though I know others who have loved theirs. Here's the link if you are interested:

The Nursing Mother's Companion: Revised Edition by Kathleen Huggins

This is a great general resource for breastfeeding! I referred to it while nursing both my older and younger set of twins.  As for nursing twins specifically, I guess I should write my own book about that...maybe someday. Still have to get that up as blog posts! Sorry I don't have any book recommendations on multiples in general. The books I did read on multiples were highly focused on medical phenomena and not practical life.

Soothies® by Lansinoh® Gel Pads

Do you really need it: Oh yes,you will want these if you are breastfeeding!

For Babies' Care:

A+D Original Ointment, Diaper Rash and All-Purpose Skincare Formula 4 oz (113 g) by A+D

You might as well buy in bulk...
This is great everyday ointment to prevent rashes.  Also, when baby is a bit chapped, I apply it underneath any zinc-oxide (white) cream as many of the white creams sting chaffed skin

Baby Bottle+Dish Liquid 16.90 Ounces by Dapple

Great soap for washing baby bottles!  They don't get clean enough in my dishwasher, so we wash by hand.  This soap helps get the grime off and it doesn't contain Sodium Laureth Sulfate and several other chemicals like most dish soaps! There is also a 34 oz refill for only about $16

Burt's Bees Baby Products

Burt's Bees has great brand promise that guarantees no harsh or potentially dangerous chemicals, "made from ingredients like buttermilk, apricot oil and cornstarch to cleanse, soften and protect baby's precious skin, safely and naturally. As always, they are SLS-, phthalate- and paraben-free." They are less expensive than organic products out there. I think it is the best value in natural baby products out there. This basket has samples of all the Burt's Bees Baby products, and free super saver shipping - woo hoo!

Folgers Brazilian Blend Ground Coffee, 27.8-Ounce Tubs (Pack of 2)

Sure you’ll you need some caffeine, but this container  tub is PERFECT for home made baby wipes!
Here'sthe recipe for how to make your own baby wipes:
Cut VIVA select a size paper towels in half (use a freshly-sharpened non-serrated knife)and put in empty coffee container (clean with baking soda to get out the smell).  Cut cardboard tube with scissors and pull it out.
In bowl, whisk 3 cups warm water, 1-2 Tablespoons aloe, 1-2 tablespoons of your favorite scented baby oil, and 10 drops of melaleuca oil (tea tree oil). (1 tablespoon baby wash is optional).
Whisk and pour over paper towels. Put cover on container and turn up-side-down for several minutes. Pull first wipe from the middle of the roll. You can try cutting and 'x' shape hole in the cover but I didn't try this because I didn't want to ruin my container if it didn't work. It will keep for about 5 days, which is usually just long enough to use it up with twins.

Viva Choose-A-Size Paper Towels - 15 Big Rolls

Monday, May 30, 2011

Mid Pregnancy Testing: Ultrasounds and Kick Counting

34 Weeks
193 pounds, Measuring 46 cm(Weeks)
Everyone looks forward to the big Ultrasound day, getting to see your baby for the first time is exciting, though if you know you are having twins, this probably isn't your first ultrasound, and won't be your last!

Level II Ultrasound (also known as a fetal anatomy survey or scan)
This ultrasound is standard for all pregnancies (not just multiples). It is done when you are about 20 weeks along, but is usually repeated later in pregnancy if you are expecting multiples. My second level II ultrasounds were done around 30 weeks. This is done to assure that both babies are growing at a healthy rate and that intrauterine growth restriction, twin to twin transfusion syndrome (TTTS) or other complications are not affecting growth. With a singleton pregnancy, if mom’s belly is getting bigger, you can be quite assured that the baby is too. But with two inside, it is good to have more assurance that both babies are growing well and at a similar rate.
This ultrasound is essentially your babies’ first physical exam. The technician will take time to measure several different parts of baby’s body, including baby’s ‘crown to rump’ length (it’s hard to measure a baby’s total height when she’s all squished up in there!), head circumference, length of arms and legs and even of her little foot (which is a great measurement to keep track of and note or draw if you keep a pregnancy journal!) I actually asked the technician to simply print the screen on which she tracked all of my babies' measurements. Of course, you can learn the gender of your babies if you want, but be sure to let the technician know if you want to be surprised.
The technician (or sonographer) will also ‘examine’ some of babies’ major organs – kidneys, heart and brain. They do this to the extent that they examine each heart chamber, and identify the sections of her brain. They also view and measure the stomach. Suffice it to say that if they don’t find anything unusual, you probably have some very healthy babies in your big belly.
If you see something you like, be sure to ask the technician to print a photo for you. Most technicians will give you a whole bunch of shots from the ultrasound, just be sure you check them before posting on your facebook profile as I found mine had my birth date, full name AND social security number embedded on them! So much for privacy…I wonder if they shred those when they are done?
Before your ultrasound, you may want to consider the following so you can be prepared. First, it takes about 45 minutes to do this detailed examination on just ONE baby. Add a second baby in there, and you could be in the ultrasound room for an hour and a half. Now consider that baby B will sometimes get in the way of a measurement they are trying to get on Baby A and now you could be in there for up to 2 hours! I recommend taking a potty break right before the exam (presuming you don’t need a full bladder as you do with earlier ultrasound exams). Also, you might bring a snack if it will be getting close to meal time.
This site "What to Expect", has some great info on ultrasounds and all pregnancy testing.
Kick Counts
Your physician should recommend that you begin kick counts some later point in your pregnancy. If your physician does not tell you when to start, you may do it on your own anyway, there are no risks...other than that you might freak yourself out and have trouble sleeping if you tend to worry alot! I started kick counts around 30 weeks, but you can start as soon as you can reliably and daily feel your babies move, perhaps around 25 weeks. It is a very simple way to give you peace of mind that your babies are doing well!
Here’s how to do it. The guideline I was given was that I should feel 10 movements from each baby, within two hours. It is easiest to do this during your babies’ most active time of day. The ACOG recommends simply keeping track of each and every baby movement you feel from each baby, and when you get to 10, note how long it has been since you began for that baby. If it takes longer than 2 hours, try again later in the day. If you still cannot detect 10 movements in a 2 hour window all day, you should let your physician know because it may be a sign that one of your babies is in distress. This is a great article about how to do kick counting.
The challenging part for us mothers of multiples of course, is deciding which baby kicked! I know with my first twins, I could tell with some movements that it was baby A or Baby B, but with others, I had no clue. Baby A was vertex (head down) with her feet up kicking my lungs. Baby B was transverse  across the top, or sometimes she was laying transverse the other direction along the top, or sometimes was breech. But every time I had an ultrasound she was different. So I never fully knew if baby A was kicking her feet against my lungs or baby B was turned that way and had one of her little arms or legs there and was kicking her sister back. (Unfortunately, it was habit forming as they are still exhibiting this back and forth banter at six years of age!)
Reduced fetal activity is an indication that baby might be in distress and potentially not getting enough nutrients or oxygen. So if you notice one of your baby’s activity dropped suddenly one day such that you cannot detect the 10 movements in 2 hours, try again later in the day and contact your physician if you still cannot detect 10 movements in a 2 hour window. 
Some women will say that they feel their babies move less as they get bigger. I agree that I felt less overall movement as the babies got bigger because there was probably less room to move in! But I personally think this is because the movements are just not as strong and pronounced and I just didn't notice them, even though they still happened about as often. I would say that you should pay really close attention to make sure you catch all the little flutters. But if you do notice a sudden change over a day or even a few days, you should probably call your physician - at least that is what I would have done. Bottom line is: if you don't count enough kicks in 2 hours, call your physician. She will be glad to put your mind at ease and you will feel better too.

Friday, May 6, 2011

Ready, Set, Breastfeed

Getting ready to breastfeed two or more...

With all the benefits of breastfeeding, the majority of moms strive to nurse their babies at least for a few weeks, and some for much longer. While breastfeeding one baby has a steep learning curve and struggles, breastfeeding two or more rates just below Navy Seal training for intensity. The most common challenges of breastfeeding twins is related to the fact that many twins are slightly premature.  Even a birth date at 35 weeks – which is only 1 week shy of what is considered ‘full term’ for twins - can affect a baby’s ability to nurse efficiently. And even breastfeeding healthy full-term twins brings a set of challenges that most moms and lactation consultants have never encountered.
Honestly, I want to warn you that the greatest challenges of breastfeeding for me were not logistic, nor physical. They were mental – either self-imposed, or imposed under the pressure of a well-meaning but short-sighted lactation consultant or nurse.
If you want to maximize your chances of success, and make the whole experience a lot easier on yourself, I recommend you invest some time researching and learning before babies arrive…finding time to read and comprehend a book while playing ‘Hot Potato’ with 2 crying newborns is simply not enjoyable or effective!
If you can manage, put these on your to-do list:
1. Read (ok, at least skim) a good comprehensive book on breastfeeding like this one, The Complete Book of Breastfeeding.

2. Find a breastfeeding 101 course at your hospital or Le Leche League. Nothing beats the getting the 411 in person from someone who knows what they are talking about!

3. Get the phone number of a lactation consultant from other moms you trust – make sure she doesn’t charge double for twins! (yes, this has happened to a poor twin mom whose insurance didn’t cover the visit. You really should not have to pay for 2 visits when they truly only have one house call to make!) Then, if you have difficulties, the hardest part is done - finding an expert to call - and all that’s left to do is pick up the phone!
(If you want to be truly prepared, you should also call your insurance To find out if L.C. is covered. - Note sometimes it is only covered, or has less of a co-pay during your postpartum hospital stay, but not thereafter.)

4. Create a ‘nursing nest’. You will be spending a LOT of time nursing your little, uhhhh, nurslings. You might as well do it as comfortably as possible! If you have a rocking chair, glider or other comfy chair you plan to use, create an area that has everything you need to stay comfy. This means putting it in a place that makes the most sense for your lifestyle and schedule. Yes, instinctively you may want to place it in the babies’ room, but that may not be the best option depending on your family and preferences. For instance, since I had two older 3-year-olds, I put my nursing nest in the living room so I could watch and interact with my other kids and make sure they weren’t getting into trouble! Next to my chair, I put a TV tray that can house my laptop computer or a book or magazine. On the window sill of the other side of the chair, I put a small basket in which I could store all sorts of essentials – nipple cream, TV remote, an extra burp cloth, tissues, my breastfeeding reference book and my big kid’s favorite finger puppet. I also kept the Boppy leaning right next to the chair as well as my breast pump.

5. Buy 1 Nursing bra in advance. Get one that fits even while you are pregnant, but err on the large side as your bosom will soon have superhuman elastic capabilities ala Elastigirl!

6. Get the gel pad ‘Soothies’ and a good nipple cream. I recommend this all natural cocoa butter nipple cream. It is not sticky like the lanolin and it goes on gently even if you’re a bit chaffed.

7. Invest in a breast pump or plan to rent or borrow one. If you do borrow one, consider buying all new tubing for it online or at a baby superstore.

8. Get connected with a good twins club/ moms club in your area. You will no doubt have questions or need input that is best found from other mothers of twins who have recently been in your shoes. If you can’t find a local club, join an online social network for twin moms. Some examples are Twinversity  or the Got Twins? group at They are usually free of charge and full of compassionate women who have some wisdom to share.

I break for Highschool Musicals

Sorry for the long absence! I had a blast doing choreography for a High School Showing of "Guys 'n Dolls". When I get it up on youtube, I'll post a link here. Working with kids who don't have to be reminded to use the potty is such an appreciated change of pace!

Now for catching up on here!

Friday, March 25, 2011

Twin Sleeping Arrangements

32 Weeks
187 Pounds. Measuring 38cm (weeks).
Some parents ask if they need to get 2 cribs. The surprising answer is ‘no’. There are several alternative possibilities. One is that you could use Pack N Plays as cribs instead. In fact, it has several advantages. They are smaller and hence fit more easily into a small room. Also, they are portable! Making it easy to move one crib to a separate room, which is very good if they wake each other up at night. If you travel pack and plays fold up nicely and many even have a carrying handle making it easy to throw in your trunk or back seat or even check on the airline.
Another option for some parents is co-sleeping. I once heard a mom comment that when she had her twins (a surprise pregnancy after several other children) that she wasn’t even going to buy cribs because they would sleep in her bed like her other children did. If that’s your thing, I say go for it. But as a mom who co-slept with my second set of twins whenever they needed it, I have just a few words of experience. First, sleeping with one baby is nice. You know right where she is (which in our case was between me and the mesh bed rail). When she wakes to nurse, you are right there for her and can snooze a little yourself. And she doesn’t take up much space even in a smaller bed.
The whole game changes a little when you are sleeping with 2 babies. You have to decide where the 2 will sleep…both between mom and the bed rail, or one between mom and dad. When they wake up, you can nurse one, and when the other one wakes too, you can sit up and make a pillow fort to tandem nurse them, but you certainly can’t snooze while nursing 2 babies at once in bed (if you can, please explain it to me in the comments because I’ve been trying to figure this out for 5 years and 2 sets of twins!) Also, they take up space, and when both my babies were in bed with me, I had trouble finding the space to roll over to nurse when the other awoke, much less had space to sleep comfortably as the babies’ tendency is to squirm closer and closer to you throughout the night! Those were the mornings that my back ached from sleeping on my back or on the same side all night.
That said, if you are a sleep-with-your-baby all the time mom, you might consider at least getting a pack and play or co-sleeper to keep in your room. As a side note, there is a weight limit on most pack and plays, but note that the weight limit for them using the bassinet inserts is much less than the weight limit using them as cribs. I separated both my twins during nap time and the oldest slept in a pack and play at naptime until she was almost 3 years old, and I’m guessing about 40 pounds, which I think is probably above the official weight limit.

Monday, March 14, 2011

Preparing your Home for Babies

This is one of the really fun aspects of becoming a mommy and daddy. Preparing your home is a fun way to anticipate your coming bundles of joy. But rather than just glancing through the latest Pottery Barn Baby catalog and needing your jaw re-aligned after seeing the price tags, here are some other things to think about.
You probably have already scoped out a room or space in your home for babies. We had two bedrooms in addition to our own and chose the one that shared a common wall with us, ensuring that we would hear any beckoning calls, even if our bedroom doors got shut. It also faced west, so it would be getting evening sun, instead of morning sun – which as night owls, was a significant factor for us! You might also consider other environmental factors like noise - the sump pump right below a room that runs 3 times a day in spring, or the neighbor's loud motorcycle that he revs at 6 am every nice summer morning, or how that corner room doesn't stay very warm in winter.
The problem we faced is that the best location was the smallest room and we weren’t sure how everything was going to fit! Two cribs, a dresser, changing table, nursing chair, clothes hamper, diaper pail, lamp, and toys…all in 10 x 13 foot room!  For that, Mr. Geek (DH) made a diagram on graph paper and actually cut out little models of all the furniture we had to fit! It actually worked out quite well.
We decided that though we would have 2 cribs, we would only set one up at first; it gave the room a little more ‘breathing space’.  For our younger twins, we did use a crib separator (essentially 6 inch square strip of foam covered in cloth) which helped keep them from kicking one another for a little longer, maybe an extra month is all. They slept together in the one crib until around 5 or 6 months before they began to roll all over one another despite my best efforts.
We forwent a changing table in favor of a dresser, because we needed the clothing storage space and because the dresser doubles as a changing table by just putting the contoured changing pad on top of it. We hung wall-mounted baskets above it to house diapers, wipes, creams and other supplies. Instead of a diaper Genie or similar expensive diaper disposal system, we opted for a plain foot-pedal operated can. I found that the diaper disposal systems often required 2 hands to operate (something I don't usually have - especially while changing a diaper) and that they required specially-designed refill bags that are not cheap. And with 2 babies, we figured we would be emptying the can often enough to keep the smell at bay. Sure it smells when you open it, but only for a millisecond, not enough to permeate the room!
We also hung a battery-operated ‘tap light’ next to the changing area. This was great because it cut down the need to turn on the bright lamp in the middle of the night, which can of course signal to an infant is that it is morning and time to wake up! I recommend putting the light to the right of the changing tale (if you are right handed) so that it shines toward babies’ bottom and not in her eyes!
Also handy were a set of TV trays which were small enough to fit in most any cranny and provide flat space for wipes and supplies, Kleenex and reading material next to my nursing chair.
We bought a clothing hamper for the room and a nice floor lamp (since there were no overhead lights in the room, it needed that anyway). I also got a mesh lingerie wash bag to hang on a corner of the hamper for baby sox and mitts. It helps keep all the pairs together!
In the closet, we assembled a cube storage system of metal mesh panels that I had from my college days. It was perfect for tucking boxes and baskets of toys, books, shoes, socks and other clothing and supplies. You could also use something like this – which would be useful outside the closet when baby gets older.
Though our living room and hall floors were laminate, the bedroom was carpeted, so baby would have plenty of soft, snugly area for playtime. But if your home is wall-to-wall hard wood floor or tile, you might consider ‘softening’ it up a bit. These large foam floor tiles
can be arranged wall to wall for a pretty reasonable price. You can either leave them visible (these have a nice natural wood appearance), or buy a carpet remnant from your local home improvement store to lie on top. Just line the remnant up with one wall and cut it to size along the walls or edge of furniture and it will look just like wall to wall carpeting!
For seating, we had a stuffed chair which was not too large and the perfect height for my short legs. The pattern was outdated and overbearing for a nursery, so I picked out some fabric and asked a friend make a cover for it. This was also great because the cover can easily be removed and thrown in the washing machine - which is priceless when your kid has the stomach flu! I also got a nursing stool, which was really helpful because having it under my feet raised up my knees so they were about the right height for supporting the babies’ heads on a boppy, enabling me to tandem nurse in football hold. Without the nursing stool, tandem nursing would have been quite difficult. Making a cover for the chair and buying a nursing stool was much less expensive than buying a rocker or glider…especially a Pottery Barn one!
For the one window in the room, we bought a blackout roller shade. Anything to help babies sleep during daylight hours.
Some people choose to get a co-sleeper or bassinet to place in their own bedroom. I did debate on doing this, but the babies’ room was so close to our own I decided it wasn’t necessary and that they could sleep in the pack ‘n play in our room any time I wanted. For our second set of twins though, I did end up buying a guard rail for the edge of my bed, deciding that if I wanted them close to me, I would just bring them to bed with me – which worked very well for us, in fact I wish I had done it with my first set of twins as we would have gotten much more sleep! For more on sleeping arrangements, check out this post.
I think in total, we spent less than $1000 for furniture and everything in the nursery, which we thought was pretty good for a nicely furnished room. We did have help though because the bedding and several decorations were given as gifts and we were really fortunate to find matching cribs being sold as floor models at a local children’s furnishing store that was going out of business.
You could always buy used and find other ways of saving money too. Mothers of multiples clubs often have huge sales of their members’ baby items that can be tremendously helpful (and are very helpful even if you don't plan on buying used!). If you are interested in saving money, do your best to find similar bargains locally and online with websites like Craigslist or ebay local.

Monday, February 28, 2011

Life in the Sick Lane

Just wanted to throw out a feeble excuse and half-hearted apology for taking the last few weeks off as 'sick time'. This certainly has been a bummer of a winter in our house! I was at the pediatrician's door 3 times last week for 2 different ear infections and again for a really bad cough and congestion. And that was just the kids! I've shaken the flu and was hardly able to stay awake long enough to brush my teeth before crashing for over a week! (and I am obsessive about brushing my teeth). Did I mention that my youngest are getting their two-year molars too? Yes the last few weeks have been one big um-ya-ya cough, cry, sneeze and sniffle fest on the couch while watching Wiggles Jungle Safari with Steve Earl for the 100th time. It's a good think I love that show and love the Croc Hunter. It does bring a tear to my eye seeing him with his wife and little girl on that show.

So here's to our health and yours, and hopefully to some more blog posts in the coming weeks!
PS – more belly photos are forthcoming…we’re having some technical difficulty (yes, even with Mr. Geek on the job). He’s been so busy helping me with runny noses that even keeping up on technology has been a challenge lately!

When the time is right: Getting ready for Babies!

One question that some couples ponder is whether they should set up the nursery and buy all the furnishings sooner or later in pregnancy. Some are tentative to do so early in pregnancy for fear that something should go terribly wrong and they would have to face a fully furnished nursery where such is no longer needed. On the other hand, if you wait until late in the pregnancy, you are more likely to be on bed rest or simply too tired and uncomfortable to help in putting everything together. There is also the possibility that you wait so long that you will be trying to get everything put together in time for the babies to come home from the hospital! Another less-than-ideal situation.
It is a personal decision. But for us, it was a no-brainer – only partly because we never dwelt on the things that could go wrong nor anticipated them. We bought our cribs early on simply because it was opportune to find them at a going-out-of-business sale. We had no choice in much of the matter because a friend of mine was staying in the room until I was about 30 weeks. We had a lot of fun, and she helped me paint the room while she was living there. As soon as she moved out we were working full-bore to put up cribs and furniture and wash bedding and clothing and get it ready. Being 30-34 weeks at the time, that was no fun task and thankfully I was never put on bed rest. If we had the opportunity, I think we would have started much sooner, perhaps around 25 weeks. I think this is a good time because once in the 27-30 week range, it is a common time to be put on bed rest.
The same principle applies when considering baby shower dates – early is good! Don’t plan a baby shower for when you are 34 weeks along! You won’t be comfortable and there is a good chance you won’t be able to attend your own shower because you’ll be on bed rest, or already have babies!
If you are like me, packing your bag for the hospital is another event that you will probably procrastinate on until the day you are flying down the freeway to the Birth Center! Packing for the hospital was a process for me. I think I started haphazardly packing things that I wouldn’t want to live without in a bag around 28 weeks. These were only items I would likely otherwise forget if I were packing in a hurry though. As the weeks went on, my packing became more thorough as I added items to the bag and finally considered it complete around week 34. Then, when my induction was finally scheduled I went and threw in a bunch more items! Of course, for my second pregnancy – after having one full-term twin pregnancy that was induced at 39 weeks – I don’t think I started packing anything until 34 weeks! Despite my own habits, I again urge you that sooner is better though!
That said, do what is best for your own sanity. I’m simply giving you food for thought.

Saturday, February 5, 2011

Preparing for Birth: Birthing Classes

30 Weeks with Twins
184 pounds - Measuring 41.5 Weeks
I remember enjoying the drive ‘downtown’ and eagerly anticipating what we would be learning that night in our ‘Multiples’ birthing class. Somehow, each night, I was disappointed – yes, about having to pay for parking – but more so because I was hoping that we would cover more in class the next time. Not that the class was terrible, it covered the basics – options for pain relief, the basic stages of labor, a few laboring positions, maybe more, but I certainly can’t recall much more, except for what was thinly-veiled propaganda to make you an easier-to-manage patient.
What I do recall is being shown the operating room where even M.O.M.s delivering vaginally were to give birth - and then quickly realizing any notions I had about stretching, changing positions and choosing a productive pushing position flew quickly out the door. I remember being told by the instructor that I should find a new physician because my family practitioner would never be competent enough to manage a twin pregnancy. (When I asked one of the Perinatologists she coordinated with about this, he laughed and said my doc could hold her own! Too bad I lost about 2 weeks-worth of sleep before I had that  appointment!)
I also remember being told I could not have a doula because the delivery room 'would already be too crowded' – another falsehood.
But, I still recommend you take a hospital birthing class, for all the wrong reasons! If nothing else, you learn the basics and what to expect from the hospital and its staff. It gives you a hint on what you want to be clear about in your birth plan, what to ask your doctor special permission for and what you should prepare to accept if you must.
If you are the woman that wants to get an epidural the minute you get your hospital gown on, the woman who doesn’t care how it happens but just wants the baby out, then read no further. Take the hospital class, and follow doctor’s orders.
But if you are looking for ideas and methods on how to manage labor pain without drugs, how to increase the possibility of vaginal delivery, how to help your labor progressing and avoid failure to progress, you should take a birthing class in addition to the hospital class that provides more focus on this. There are many types of these methods, I’m sure you’ve heard of some of them like the Bradley method, HypnoBirthing, or Lamaze or ANYTHING that you think will help you. I’ve put links on the names to help your research.
I did not take any of these classes – mostly because I was largely ignorant of them going in to this whole experience. But I was fortunate enough to take maternity yoga classes from an instructor who was our doula. Please understand, the only yoga class I had ever taken previous to my pregnancy was once on vacation. I did it because appreciated the stretching and strength training it provided, just as I enjoyed dancing and theater in a former life!
I met our doula through an organization called 'The Childbirth Collective’ which is basically an group of doulas, lactation consultants and other birth & baby-related service providers in my area. The organization offers free info sessions on various topics surrounding pregnancy, childbirth and infant care. That is where our more comprehensive birthing education took place. After our first twins’ birth, our doula started an awesome business which I am totally going to plug here called Blooma. They offer a huge variety of, yoga classes, birthing technique classes, services, and ‘therapeutic services’ (ie.-massage) for expectant mothers. Look for such an organization in your area.
The yoga classes really helped me – especially with the yoga instructor there talking me through what we learned in class. I honestly cannot remember specific techniques anymore, but I do remember focusing on what she was saying seemed to take me away from the agony of the moment…even if I did end up asking for an epidural while hyperventilating in a bathtub! It got me through a completely induced, horrifically painful labor to 7cm - far enough to be assured that I wasn’t going to have a C section for failure to progress – which is a high risk for induced mamas!
You would think that I took a great birthing class in some technique for my second pregnancy, but sadly, no. My baby A had been breech until 36 weeks, so I was too afraid, and frankly, depressed that I would be having a surgical birth. Finally, when baby flipped, I flipped too! Mr. Geek and I immediately went in to Blooma for an emergency last-minute birthing basics refresher course!
Should we ever come across the need for anticipating giving birth again, I will do a better job of researching and taking a birthing class ahead of time, breech or vertex!

Friday, January 28, 2011

What you need to know about Premature Labor

If there is one thing I remember about my prenatal visits, it is the little blurb my doctor had memorized verbatim about preterm labor. “Ok remember lots of rest, lots of water, stay off your feet, take a half hour break every day lay on your left side and if you feel cramping, tightening, pressure or have any bleeding or other unusual symptoms give me a call.”
That about sums it up folks…see you next week! 

Seriously though, the question is, how important is each of these things and how do  I implement them into my life? After all, when my left hip gets all knotted up from laying on my left side, all night, am I going to smush my baby by turning onto my right? Or, heaven forbid, my back?

Drinking Enough Water
There is debate whether ample hydration can actually prevent pre-term labor or not. However, I think your body works better when it is well-hydrated, and it also seems (and this just from my personal experience and that of other M.O.M.s) that you are more likely to have contractions in the latter half of pregnancy when you are dehydrated. In fact, the common wisdom to stop recurring contractions is to drink a big cup of water, go pee, and lay down on your left side to relax. I did this only once or twice but it worked!
In general, your body functions optimally when it is well-hydrated, and keeping your body in tip-top shape (operationally) should be your prime directive. Of course, water is the obvious choice for hydration. While low in salt, sugar, fat and just about everything else it does a great job of quenching thirst. For some, the water supply is not palatable. I know from experience that I would fill 2 huge bottles from my home to bring to work because I didn’t like the taste of the water at my work and would not drink as much as I needed, even though I was thirsty. So I started filling up at home. Do what you need to keep yourself drinking enough fluid. If it means finding a bubbly, flavored or otherwise enhanced beverage, go ahead. Just try to stay away from caffeine and artificial sweeteners in large quantities! Translation – 8 glasses of diet Coke a day is not a wise choice for fulfilling your babies’ fluid needs!
Keep a bottle with you at all times so that you don’t have to excuse yourself from any situation to take a swig. Realize the importance of stopping for a moment and listening to your body. If you don’t take a moment here and there to notice if your mouth is a bit dry, you won’t drink enough because you’ll be too busy to realize you are thirsty.
Take note how many times a day you refill your bottle. That should give you a rough estimate. I’m not a proponent of giving you a number of glasses you MUST consume because I think you should follow your thirst as a guide. But, eight 16-ounce glasses a day is probably the minimum amount of fluid you need – and probably more. Be assured that milk and other beverages and even fluid from foods count toward your total too.
I know it is tempting to cut back because of fear of all the bathroom trips, but consider this: Especially early in pregnancy, the trips to the bathroom are more a factor of pregnancy hormones and other adjutants like caffeine. Think of all the water that won’t be coming out…water that is needed to build blood, cells and amniotic fluid for your unborn babies!

Get Off Your Feet
This is a high order for many. So many people have jobs that require standing on your feet for several hours a day. Retail workers, teachers, manual labor jobs and especially you work-at-home mums. Truth is, you need to find a way to at least reduce the number of hours you spend on your feet per day. Why? Because standing puts the most weight and pressure directly on your cervix and because research has shown that those who spend more time on their feet are more likely to go into preterm labor than those who do not.
There is good news. Most ‘standing’ jobs are actually able to be performed sitting down on a high stool. And if you live or work in the good ol’ U.S. of A., your employer is required to accommodate you in a reasonable way under the Americans with Disabilities Act. I know, you are not disabled, but you have special health needs, which counts. A reasonable accommodation would be to allow you to sit on a stool while ringing customers or teaching. If they cannot accommodate that, another option would be to temporarily re-assign you to a sitting task until after the babies arrive. Or even to assign your to a ‘sitting’ task for a few hours each day.
For those who already sit long hours on the job, I recommend getting a nursing stool or other small box you can rest your feet on. This will keep you more comfortable and keep circulation at its prime because it takes the pressure off the blood vessels on the underside of your knees. It will also help prevent those pesky varicose veins that often show up during pregnancy. I’m glad to say I have none even after both my pregnancies! (All of the strain went to creating gray hairs in my case!)
As for resting on your left side, because of the way your arteries lie, it is beneficial to your circulation, but not necessary. Laying on your right side is good too. And though some pregnancy literature warns of laying on your back, I was told at my doctor visits that it is only a problem if you start to have noticeable circulation trouble - dizziness, or light-headedness etc. Still, if I did lie on my back,but I did so slightly inclined on pillows.

For us work-at-home moms, there simply is no ADA law telling your toddler that you will only feed and diaper her on a pre-determined schedule.  But there are plenty of ways you can short cut your load to promote the health and well being of those siblings on the way! The down side, is that you will need to either get other recruits to make up for your well-justified slacker status, or just deal with having a sub-standard cleanliness rating in your home. I recommend wearing slippers because the crumbs at least will not stick to your feet, and the Legos won’t hurt so much. Ten years from now, nobody will remember or care if your windows were washed or if the floor had streaks or if you had an entire basement full of 80’s memorabilia that needed sorting and labeling for your cool bar display or even if your toddler ate crackers off the un-mopped floor.
Instead, lay back on the couch with your kids and read them a story, tell them about the babies growing inside your belly, watch a movie, start telling them about how you will be spending a lot of time with the babies when they come out because they are so little and need so much help. During my second pregnancy, I had a ritual. We would get through lunch time and I was just exhausted, so I would stick a movie in the DVD (yes, usually a full length one!) and just plop on the couch and snooze while my 3-year-olds watched. My doctor gave me full permission. And my children are not dumber for it, nor do they have vision problems or anything else – at least nothing different from before they got to watch a movie every day! Ladies, you need to give yourselves and your unborn children a break for their health. Recruit your husband or neighbors or family or the Jehovah's Witness folks who keep knocking at your door! Just find a way to do it, and don’t feel guilty about it.

Recognizing Labor
My doctor consistently asked if I’d been having any contractions yet. I had no clue what a contraction even was or felt like, I didn’t know what I was looking (or feeling) for, so how would I know? The main point to remember is that contractions can be felt as a variety of sensations from tightening, to menstrual-like cramping, intestinal distress, dull aches, pain, pressure, heaviness, nausea or other unusual sensation. And it is not always felt in the abdomen, but could also be in your lower back, or in your pelvis or vagina. It may be rhythmic or persistent. Some women feel no pain or unusual sensations at all. It may just come to you as a panicky feeling, or a sense of unrest, or a gut feeling that something isn’t the same. Another hint could be a change in discharge, especially what is referred to as ‘bloody show’ (no this isn’t the newest U.K. reality show!) that may appear brown or blood streaked. If you are having unusually heavy watery-discharge, there is a chance that your membranes have ruptured and you are leaking amniotic fluid. In all of these situations, it is necessary to call your physician right away!
Ladies, if you are carrying multiples and you have any of these symptoms – including an inexplicable feeling of unrest or panic, or more than 5-6 contractions in an hour, please don’t worry about whether or not you should call someone. JUST CALL. Call your doctor, call a nurse line, call the labor and delivery ward –whichever you feel the most comfortable with - the chance of premature labor is NOTHING to mess around with. I know you may feel really silly calling the nurse line and saying you are having an inexplicable panicky feeling, but your instinct is usually right. Even if it isn’t, I guarantee the doctor or nurse won’t mind, and will just be relieved that it wasn’t a problem.
The bottom line is that there is no way to ‘undo’ premature labor - defined as the softening, shortening and opening of your cervix in preparation for birth. And the longer you delay making the call, the shorter your cervix may get, the more likely you are to go past the point of no return.
On the other hand it is completely normal to have occasional (read: irregular, not several occurring one after the other) contractions that feel like someone wrapped a wide elastic band around your middle section. They are commonly called 'Braxton Hicks' contractions. Yet, the only other difference between Braxton Hicks contraction and the real thing is that Braxton Hicks do not efface or dilate your cervix...and you wouldn't know that unless you CALL YOUR DOCTOR! (OK, you probably think I'm some sort of 'hyper-spaz' over this, but really, I've just seen too many forum posts from M.O.M.s who are almost in active labor because they totally ignored the contractions they were having for the last 2 days.)
For a really great article on the symptoms of preterm labor, click here.

What Happens Next?
What happens after preterm labor begins depends on a variety of factors. At 37 weeks, twins are considered full term because they actually mature sooner than singletons. (For triplets, 34 weeks is the goal, and about 30 weeks for quads.) If you are between 34 and 36 weeks with twins when labor sets in, an admission to the birthing center and a congratulations are probably in order. Prior to that, you may be admitted for various drug therapies to stop the contractions. If they are successful in stopping the contractions, you may be able to go home and back to business as usual, or you may be asked to remain on bed rest. If you dilated significantly and are early in your pregnancy, you may be asked to remain on bed rest in the hospital. For a thorough article on what course of treatment may be selected for preterm labor, click here.
Whether or not you experience contractions there is a possibility your water could break prematurely (Premature Rupture of the Membranes or PROM). In this case, it is more likely that your babies’ deliveries are imminent, though it is possible to delay labor by days or weeks. At around 34 weeks, the risks of uterine infection outweigh the risks from preterm birth, so beyond this time, it is likely physicians will not try to hinder your labor.
But if you are not yet 34 weeks along, it is possible that your physician will use drug therapies to stop or delay labor and delivery long enough to administer corticosteroid therapy (steroid shots for mom). The steroid shots speed the development of babies’ lungs, greatly reducing breathing problems when they are born (assuming that birth can be delayed for 1-2 days so the steroids can take effect).  
If in fact you succeed in halting labor after your membranes have ruptured, the greatest risk in this scenario (besides pre-term delivery) is the risk of uterine infection. You would probably remain hospitalized under close monitoring during this time and may have antibiotic therapies.

Now, take a moment to step back into reality, take a swig of water and maybe a bite of chocolate, look down at your burgeoning belly and take a big sigh of relief that this is probably not going to happen to you. And even if it does, you now know what to expect and/or request of your medical care team!

Sunday, January 16, 2011

Preparing for Birth: Doulas

28 Weeks Pregnant with Twins
180 Pounds - Measuring 37 1/2 cm
What do doulas do?
I don’t think that most parenting literature and books do justice to describing what a doula does.  And further why do you need a doula when you have 1 or 2, or more labor nurses, midwifes and doctors? I certainly didn’t fully understand until I had one at my side! There are actually two roles doulas fill. Birth doulas attend your birth and support you through it. Post partum doulas help and support you and your baby after birth. In this post, I focus on birth doulas.
A labor nurse has many jobs in managing your labor, measuring your progress, ensuring that there are no complications, monitoring yours and your babies’ vital signs, filling in paperwork and following other hospital protocol, communicating with your doctor and to some extent managing and directing your labor if you are being induced or have pitocin.
A doula is not pre-occupied with those things. She is there to attend to you. To help keep you comfortable, to get you a blanket, to massage your back when it hurts, to help you to the restroom, to give you ideas for positions and techniques  for pain management to keep you company while your hubby runs to grab a snack, to help you progress your labor using every tool available, to encourage you and give you feedback on how you are doing, to give you ideas and options about your labor that may not have known existed (did you know that you CAN get out of bed? Your labor nurse may have forgotten to tell you), and finally to advocate on your behalf, and last, but not least, to catch your husband if he faints.
And doulas are not simply a paid friend for the day. I have plenty of friends who would come to my child’s birth if I asked, but they are not trained in childbirth comfort measures, massage, and lactation assistance or certified by Doulas of North America as so many doulas are. Your best friend may not know to encourage you to try a new position if you’ve been laboring for a few hours without much progress; nor how to help you decide if you are debating between Demerol or an epidural or to trying to stick it out for another centimeter.
I asked Mr. Geek, “As a twin daddy, what do you have to say about doulas?” He responded “Priceless. [Long pause and queue for more info here] They know all the tricks, and it’s nice to have an extra set of hands.”

Doula Resistance
When I asked my hospital birthing instructor if I could have a doula she said absolutely not. I was told only one person may accompany me into the birthing room. Though other ‘normal’ patients could have a doula, since I was having twins, I was to deliver in an operating room instead of a regular birthing room – even if I was having a vaginal birth. Oh the frustrations of having a completely natural and healthy pregnancy, yet being automatically assigned to a statistical category which subjects you to a whole new lineup of protocol that may or may not be justified by actual research. To say the least, I was frustrated.
 Yet, when I talked to a family who had given birth to twins with a doula at this same hospital a few months prior, they let her in. (Mothers of Twins club are a great recourse!)  I don’t see how they couldn’t. We ended up choosing a doula who had formerly been a labor nurse there, and were sure the hospital would agree to allow attend when the time came.
One of the reasons the nurse gave us is that the operating room is small and there are already so many nurses and  personnel that need to be there, physical space is restrictive. But with so many people in there anyway, does one more really change a darned thing? Twelve’s a party but thirteen’s a crowd? I’m sure they don’t want you bringing five of your closest friends if you know what I mean! I eventually found it was all talk and no action, so be persistent in your request and be sure to talk to the charge nurse or other manager of the birth center, and not just someone in a peripheral role (like a birth class instructor!).
Many traditional doctors, providers and nurses seem to be offended by the notion of doulas, as if they aren’t doing their job well enough so we need to get someone else involved. Yet, while some midwives or family doctors will come close to fulfilling the role a doula fills, the vast majority do not.
It is a fact supported by research that births attended by doulas result in fewer C- sections, fewer episiotomies, less anesthesia, shorter labor (9 hours vs. 19!), fewer babies admitted to the ICU and babies more likely to be breastfeeding at 6 weeks, as well as moms who are more satisfied with their birth experience! In fact, after being told years before that I could not have a doula, the perinatologist that handled my second birth highly recommended I have a doula. At the time it looked as though I would be having a vaginal birth without the option for an epidural because of my low platelet count. So hopefully, the medical community is becoming more accepting of doulas as a positive addition to birth support.
I was blessed enough to have two vaginal deliveries of twins, even when both were induced (inductions have a higher chance of Cesarean delivery than spontaneous deliveries). I don’t have reliable statistics, but somewhere between 1/2 and 2/3 of twins are born by Cesarean section. And besides good luck, and physicians experienced in breech presentation, I credit having a doula to help me birth, change positions and aid the natural process. I also waited as long as I could to get an epidural and made sure to move be active and vertical (I was rarely in the hospital bed!) to get those babies moving down and out!

Paying for it
One thing you will notice if you are searching for a doula is that they are not usually covered by insurance. Insurance companies should want to minimize surgery, expensive interventions and NICU stays as well as maternal bleeding complications (which are more common with Cesarean section). So I urge you to call or write your insurance company and urge them to cover doula services. Cite the research that supports the positive implications of doula-attended births.

When you consider if you can come up with the cash to pay for one yourself, think about how much it would cost in hospital co-insurance for a Cesarean birth versus a Vaginal delivery, or a NICU stay or even just an epidural. Also, many doulas are willing to work with you on their fees and newer doulas who have less experience are more willing to be flexible. Less experienced doulas often want to gain experience with twins, so twin mamas in a tight financial situation can take advantage of that and ask if they would be willing to work for a reduced fee or even for free.
The other thing to note is that most birth doulas not only attend your birth, but also visit with you before hand to help create a birth plan and get an idea of what your preferences are before labor begins. They also will meet with you after birth to check on you and baby and offer lactation advice. DONA certified doulas all have some training in lactation.
Finally, some hospitals will provide doulas as part of their birthing package, and some hospitals have an organization of volunteer doulas on call, so be sure to ask about that at any hospitals you are considering. Meanwhile, I say, ‘Just doula it!’. [Insert rolling eye smiley here!]