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!