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!

A Few Recipes for Eating Well

 Here are a few recipes that I used and enjoyed while I was pregnant. The flaxseed meal can be sprinkled into almost any casserole, soup, on sandwiches, or anything, to add some Omega 3.

Chicken salad sandwiches
1-    13oz Can Chunk chicken
½ Cup Kraft Parmesan Romano Salad Dressing (or your favorite dressing)
½ Cup frozen peas
¼ cup Flaxseed meal
Mix together serve as a sandwich on buttered bread with fixings as desired.
Broccoli Salad
2 heads broccoli, cleaned and cut
1 lb Fried crispy Bacon (I used the Hormel uncured with no Nitrates)
½ cup Sunflower seeds
½ cup Raisins
½ Cup Red onion, chopped
Dressing:
2 Cups Mayo or Miracle Whip
¼ - ½ Cup Rice Wine Vinegar
¼ - ½ Cup Sugar
¼ cup ground flaxseed meal
Mix Broccoli, Sunflower seeds, onion and raisins. Add the dressing. Mix to coat and add bacon before serving.

Super Duper homemade Power Bars
3 ½ cups oats
¾ cups raisins
2/3 cups sunflower seeds
½ Cups toasted sesame seeds
½ cups wheat germ
½ cup oat bran
3 tablespoons flax seeds
1 Tablespoon cinnamon
1 Teaspoon salt
1 cup coconut (organic, unsweetened if you desire)
1 + cups honey
5 cups butter (again, organic if desired) – melted
In a large bowl, combine first 11 ingredients. Stir in peanut butter, honey and butter. Press mixture into foil-lined 9x13 inch pan. Bake in oven preheated to 350 F for 15 minutes. Remove from oven, sprinkle chocolate chips over bars. Return to oven until its softened (about 2 minutes). Cool and keep refrigerated.

Hard Boiled Eggs
A great breakfast or snack on the go.
Place eggs in a saucepan covered by at least an inch of water. Heat to boiling. Remove from heat. Some recipes call to remove the saucepan from the heat and let sit in the heated water for 18 minutes, but I find that this consistently results in undercooked eggs (especially if you have jumbo size eggs!). I like to boil mine for several minutes, perhaps 5-10 and then remove from heat and let sit for another 10 minutes. I then strain the hot water from the saucepan and fill it with cool water and ice. This not only stops the cooking, but it also makes them easier to peel. Leave shell intact until ready to eat for better freshness.

Deviled Eggs
6 Hard boiled eggs
3 Tablespoons Mayonnaise, Salad dressing or half and half
½ teaspoon ground mustard (prepared mustard works in a pinch!)
Salt and pepper to taste
Paprika, olives or other garnish if desired
Peel eggs and cut in half lengthwise. Slip out yolks and mash them with a fork. Stir together remaining ingredients with yolks. Heap whites full with yolk mixture and garnish. Refrigerate in an airtight container.

Pregnancy: What to Eat?

26 Weeks, Weight - 178 Pounds, Measuring 36 Weeks

This is one of M.O.M.’s  most-pondered questions, and probably the least-answered. Most everything in the books is geared to singleton moms. And even then, the standard pregnancy book doesn’t include much detail about nutrition, even less how to manage getting all that low sodium, preservative free, fresh fruit and vegetable, lean protein baby fuel in your belly when you can hardly keep down Ramen Noodles and hardly stay awake late enough to brush your teeth before hitting the hay! But that’s why we’re all here, isn’t it!Rather than write a book on the subject (that's already been done), I’ll save you the trouble and do my best on what kinds of foods to eat, how much and how to do it without hiring a personal dietitian and chef.

Quantity
First of all, I think the most important thing is that it doesn’t matter if you are overweight, you need to eat a sensible diet of nutritious foods in amounts that roughly match your hunger. Being pregnant with two or more babies is NOT the time to ignore your hunger or worry about your waste line - manage your cravings, yes perhaps – but NOT your hunger. That is your body talking to you, and your body is very smart. Listen to it.  Learn to recognize what it is telling you. If you can learn to do this you will be well on your way to a healthy pregnancy and birth. I have not known a doctor to give any woman of any size a prescription on how much weight to gain when she is pregnant with multiples. I was overweight for a 5’ 3” person starting at almost 150 pounds, but my doctor never told me to slow down. She said the more I gain the better. If your doctor does advise you to limit weight gain, I would seek another opinion or input from another physician in the practice. Also consider requesting a consultation with a dietitian.
I gained 60-70 pounds during my first twin pregnancy, and lost all but 15 of it immediately (much of it was edema and swelling). I shed most of the rest off with the South Beach Diet, which lasted until my second pregnancy. Perhaps you don’t want to gain extra weight, but to me, it was well worth the peace of mind to know I was getting the needed nutrients to my babies. I  would do it again to have healthy babies again (and in fact I did)! An extra pant size is a much more pleasant prospect than premature or low birth-weight babies - and poor nutrition has been linked to.
Though I don’t encourage stressing over your weight, I think it is helpful to know where you are at on the continuum of average so you know what challenges you might have. According to the 'Mother of All Pregnancy Books' , twin moms should gain about 4-6 pounds during the first trimester and  1 ½ pounds per week on average after that. I have heard from several sources that gaining 24 pounds by 24 weeks is a goal for twin moms to strive for.
As you can see, I’ve attached photos to some of my posts of my pregnant belly with my first set of twins. I also noted my weight one each as well as my belly’s growth measurement! Hopefully this will help satisfy your curiosities about what your growing body might look like!

Nutrition
 My first pregnancy was really the beginning of my journey in nutrition. I grew up drinking Mountain Dew and eating Pop Tarts and sometimes worse for breakfast. Really. So I had no clue. I thought a slice of wonder bread with butter was pretty balanced. Now I see it as equal to eating a cup of sugar with butter on top. If even I can convert to somewhat-more-nutritious-eating habits without feeling like I am living a destitute life, you can too! Not that I eat great. But it’s certainly better than I did the first 20 years of my life!
Since it seems otherwise elusive, here is a chart of how many servings of various food types you should have if you are carrying 1,2 or more babies. I created this chart with information from ‘What to Eat While You are expecting’. Keep in mind that if you drink a glass of milk, that one serving would count both as a protein and a calcium serving, so adding up the number of servings of all the groups does not create a grand total of servings you are to eat daily.

Now this chart looks all scientific and such. But I really don’t think you must run out and buy a food scale or an iPhone app. Charting your intake is not a necessity to eating right during pregnancy! I think if you have an idea of what your body needs, and you occasionally count how many items you ate from a given category that day, you have done your babies a great service.
Note that white bread and empty carbohydrates do not even appear on this list! It is significant, and is consistent with the nutrition wisdom of the day that I have read elsewhere.  If you haven’t learned to find ways to enjoy eating whole grains, the time to experiment is now!  Whole grain breads needn’t scratch your throat on the way down. Whole grain crackers with a smear of cheese are a great snack. I think the best impact this chart should have on you is not what you choose out of your fridge, but what you choose at the supermarket. If your fridge is stocked with good choices, it makes it hard to mess up!
What I mean is that the more categories a food falls into, the more nutritious it is and the more of it you should aspire to eat. So plain ol’ applesauce counts only for 1 of your 2 daily ‘other fruit and vegetable’ servings. But if you shop for the vitamin C fortified version, then you’re doing better. Try whole grain pasta versus regular. To increase your likelihood of eating healthy snacks, search the grocery for some that are high in protein and low in sugar and salt. Find some all natural fruit leather
with no added sugar. Definitely get some protein bars. These were, ok ARE my favorite!
– the ones sold near the pharmacy section of the store. Keep them in your purse, desk and car glove box so that you never let your babies go hungry on account of your schedule! Keep hard boiled eggs handy in the fridge for a quick protein and Omega 3-packed snack. Try a pomegranate, star fruit or other fresh fruit or vegetable you haven’t before. Or try eating a food you didn’t like before with a new sauce or dip. One thing that changed my fresh fruit & veggie eating habit was buying Tupperware Fridgesmart storage containers that helped preserve freshness, and stack efficiently in my fridge. It was a lot easier to cut and keep melon, lettuce and veggies in a nice sleek and efficient rectangular boxes with lids instead of in the glass mixing bowls with plastic wrap on top that I once used! And it stayed fresh longer, so that it tasted better for more days. Previously, slicing a melon meant making a commitment to be sick of eating it in 2 days.

Cravings
When it comes to cravings, indulge with this caveat: Make yourself ‘pay’ for the right to indulge by first eating something from the healthy list. This will provide more needed nutrients for baby, and fill you up so you eat less of the indulgent food. Also, when you are at the store being tempted to buy that indulgent food – buy the most healthy version of it that still tastes like a treat to you! So instead of Ben and Jerry’s Ice Cream, pick one with perhaps less fat or less sugar and more calcium and protein compared to the others. If you start searching for nutritious foods at the store, you will find them in your cupboard when you are hungry!
I highly recommend The South Beach Diet book
AFTER babies are born if you want to take off some midnight ice cream! It is a diet book, but the ‘Stage III’ of the diet is no longer a weight loss diet. It is a recommendation for life-long heart-healthy eating and is quite educational about how our bodies work and process food. It is also somewhat consistent with other nutrition wisdom I’ve read…it just has the added benefit of explaining WHY it’s important. I also love the The Dr Sears Nutrition Deficit Disorder Book. It explores what a healthy diet is for children, and that is exactly the journey you are embarking on! It too, warns of nutrient poor carbs and spends lots of time on which additives and chemicals are of questionable safety. It also speaks in depth on the benefits of Omega 3 fatty acids. I began to take an Omega 3 supplement early on and make a conscious effort to eat Omega-rich foods because of the potential benefits it has for baby.

Eating and Morning Sickness
If there is one truth I found in both my pregnancies about morning sickness, it is that it is that nausea is much worse on an empty stomach! That may seem counter intuitive, but I’ve found it to be true both in pregnancy and other general nauseous situations (insert snide in-law remark here!).  I had nausea my first pregnancy, and it was generally worse in the morning than any other time of day. I did find a way to cope though! I did everything I could to keep myself from getting hungry because when I did get hungry, I also felt nauseous.
For me, this meant eating plain Ramen Noodles for breakfast the instant I woke up! It also meant keeping snacks and protein bars in my purse and at my desk so I could have them at any time. Though I did not have very severe morning sickness, early morning was the worst, and once I got some noodles or dry cereal in me, I felt a little better. After that, I still felt a little off most of the time through that first trimester, and even until 16 weeks, but there were only a handful of days that I was so miserable that eating even the most benign food wouldn’t help.
BTW – it is thought that keeping yourself full with high protein and fiber foods keeps nausea at bay. One idea to combat morning sickness is to munch on a high protein or high fiber snack during one of your late night/ early morning potty runs. Sure it may not be convenient to eat, but just a few handfuls of cereal or a cheese stick could help keep your blood sugar consistent and prevent that early-morning sick feeling. I kept a box of mini-wheats at my bedside for those early am hunger pangs.
And what about eating the ‘healthy foods’ when you can’t even keep crackers down? My advice is to eat whatever can make a truce with your stomach! Just make an extra effort to eat only A list foods when you aren’t feeling sick!
If you find that you are daily fighting the urge to ‘toss your cookies“ and loosing, try talking to your physician about treatments for morning sickness. There are a few drugs out there to help you, and they are vital for Mothers of multiples who need to keep nutrition going to their babies from early on. You don’t need to suffer helplessly.

Middle Pregnancy: Testing...Tesing,...1,2,3!

The positive pregnancy test is only the beginning. One thing that comes along with pregnancy - and especially twin pregnancy - are tests. Some tests you may need, and others you may want to forgo. This page is a good reference from the Mayo clinic. Here is our 'test' voyage.

Early Pregnancy Tests

Because I conceived naturally, I did not have the hCG screenings that many do in early pregnancy. What I have seen from others is that hCG levels are not always consistent with what providers expect for M.O.M.s.  So don’t get your undies in a bunch if your levels aren’t rising ‘as expected’. Every woman, and every pregnancy are different!

Ultrasound

I always laugh when I see a fictional movie or TV show where a twin mom with no showing belly says ‘The doctor found two heartbeats! I’m having twins!’. Unless you are very far along in your pregnancy, AND your doctor is actively looking for two, AND your babies have the right positioning, AND your babies’ have very different heart rates – It WON’T HAPPEN THIS WAY. Even in my late pregnancy appointments when my doctor was searching for two heartbeats with a Doppler, we had trouble being certain that we were in fact finding two distinct heartbeats. But maybe there is someone out there who discovered she was having twins because they detected two heartbeats…if that’s you, I’d LOVE to hear your story!

My twins were diagnosed by ultrasound, as are the vast majority. But what if you don’t have an ultrasound right away? Many women wonder what they will find at their 20 week ultrasound. But if you just can’t wait, here are some reasons you should request your doctor send you for a ultrasound: You were taking fertility drugs, Your middle is growing more quickly than what is normal for gestational age (your doctor will monitor for this), twins tend to run in your family, and you’ve previously given birth to twins (yes, this means you too identical twin moms!). If any of these apply to you – you should ask your doctor about getting an ultrasound!

Although it isn’t the most exciting part of an ultrasound, there are a few important ‘other’ things that will be determined at your first ultrasound (well, your second one, after you know you are having multiples). They will attempt to determine whether your babies are sharing a sac or have each their own and also determine if they are sharing a placenta. Of course, ultrasound is also good because it can detect several abnormalities like heart problems thay may need treatment soon after birth. Later in pregnancy, ultrasound is used to make sure that the babies are growing at approximately the same rate and to monitor for intrauterine growth restriction or Twin to twin transfusion syndrome. 

Blood Glucose Test

This test is often done mid-way through your pregnancy to screen for gestational diabetes. There are some women who are normally healthy, but during pregnancy contract diabetes, and after pregnancy are healthy again. The test usually means drinking an orange-soda-like drink beverage and having blood drawn an hour later. If you do ‘fail’ this test..don’t worry. You will still pass the motherhood exam! Only a small percentage (about 15%) of people who fail it actually have gestational diabetes. But you will have to go back for another, more intensive test to find out. -one that involves drinking more orange soda over a longer period of time (if only it was GOOD orange soda!)

Blood Tests

No doubt your blood will be drawn at least a few times. Early on perhaps to test your immunity to certain diseases that can be dangerous to your babies if you contracted it while you were pregnant. They may occasionally monitor your levels of all kinds of things like platelet count, Strep B and blood glucose levels. I think someone could write a book on all the possibilities, so I’ll stop here in favor of providing a few links.

Urine Screening

I always promised myself I would write a stand-up comedy routine about being pregnant with twins. It would include a reference to the weekly attempts to make a ‘clean catch’ with a beach ball strapped to your belly! I had to do a pee test every time I had an appointment.  They generally screen for protein and sugar in your urine and other signs of preeclampsia or toxemia.

Amniocentesis

With this test, a needle is used to draw amniotic fluid (while monitoring via ultrasounds to make sure nothing gets unintentionally poked! Ikes!) from one or more of the babies’ amniotic sacs. It is basically a genetic test and is often done to further investigate results of a previous screening, especially chromosomal abnormalities or a whole slew of diseases or defects.

This test has a 1/200 chances of causing miscarriage or premature labor because it pierces the amniotic sac. Apparently the risk is greater earlier in pregnancy. If your physician recommends amniocentesis, make sure you understand the reasons for it and agree it is worth the risk. I once talked to a M.O.M. who had this test and had no clue why. It is SO important to be involved in your care and always know exactly what is being done and why.

Chorionic Villus Sampling

This test is actually kind of similar to Amniocenteses. The main difference is that instead of removing fluid from inside the baby’s amniotic sac, it is removed from outside the chorionic sac of tissue. It can diagnose a multitude of fetal diseases.

Our choice in which tests to do was quite simple. If the test could reveal a problem we could actually seek treatment for, we would do it. We knew that we could never bring ourselves to terminate, no matter the problem, and didn’t see any reason to do tests that would cause anxiety over something we can do nothing about. If there was some sort of problem, I would rather go on enjoying my pregnancy and basking in the joy of it rather than stressing over what may or may not be wrong. My doctor didn’t wrestle me on the decision and said that with the many ultrasounds done on twins they would probably pick up on most problems anyway. We forwent the genetic testing and only had ultrasounds and standard maternal urine and blood glucose and screening test.

One thing to be aware of is that your insurance may not cover some of the genetic tests. Make sure you call your insurance company and get pre-approved for genetic tests so you don’t get stuck with an unexpected bill!

Middle Pregnancy: Oh My Aching Back!

24 Weeks, 175 Pounds, Measuring 32 Weeks

For me, this was quite possibly the most miserable aspect of my first pregnancy. It began already when I was only 12 weeks along. I could feel a little ‘twinge’ right on my tailbone. That soon spread to my hips. I was gaining weight and just the weight of my growing pregnant body on my hips at night was enough to roll the muscles into painful knots as they tried to hold my hips together! I prayed to never have to go on bedrest, because the pain of laying in bed for me was sheer torture! And if peeing every 3 hours in the night wasn’t enough, I couldn’t sleep for more than 2 consecutive hours waking in pain in the hip I was sleeping on! It was like sleep training preparing me for life with two newborn babies!

I would wake up with the hip of whichever side I was laying on just throbbing with tension.  I would get up, stretch it, and roll over and try to sleep again. Finally after tossing and turning for a few hours, I’d head for the couch, hoping it would help. On the couch I usually used pillows to make a reclining lounger for myself since we didn’t have a lazy boy chair! This way, at least there was no weight on my hips so they got a break for a bit. Somehow there is still only so long it is comfy to sleep reclining on pillows and I was up, again, looking for a new way to sleep.

So what helped? Different things at different times I guess. But here’s a complete list to give you some ideas of what might help you! 

Massage

Most often what I wanted was a massage. While I could have spent my future kids’ college tuition on massages during my pregnancy, instead I found it worked great for my dear husband (bless his heart for all the massages!) to actually sit in front/behind me while I layed on my side and he would use his elbow to knead the muscles in my hips and buttocks. This way his hands didn’t get so tired, and the bluntness of his elbow was just about perfect. When he wasn't available (ie – I was awake in the middle of the night!) I would use a rubber 'bouncy' ball between me and the wall to knead the muscles. I would just lean and roll against it.

Of course, nothing beats a professional massage from someone with strong hands. I got to know the massage therapist really well at a massage center down the street! I think I went in about monthly until the last month (which for me went to 39 weeks!) I rewarded (or is 'consoled' a better word?) myself for staying pregnant so long by getting a massage just about every week!  Erika soon knew EXACTLY where my rough spots were and exactly how to make them better! Also, if you can get your physician to ‘write a prescription’ for massage, you can pay for it with Flexible spending account or Health Savings account funds.

Heat

Of course heat and massage often go together. I really liked my 'bean bag' heat pack to help loosen the tension in my muscles. I don't remember where I got it though. My chiropractor has some that are filled with some sort of bean and my massage studio had ones that were filled with corn. Either is great! It is basically a heating pad but you just put it in the microwave. It is also GREAT for postpartum cramping and keeps you from having to take so much meds.  Here is one on Amazon that appears to fit the bill - complete with aromatherapy built-in! If you are more practical and not into fragrance, this heat wrap fastens around your waist. I highly recommend bringing one with you to the hospital!

Chiropractic

Another date I could hardly wait for – the chiropractor. I can't say enough good things about my chiropractor. I didn’t go to the chiropractor in my first pregnancy until I was past my first trimester and my back was already my worst pregnancy ailment. I had been to him before for a back problem right out of college and he fixed it in just a few visits, whereas another chiropractor at that time had told me I was in for almost a few years of treatments. The point is I knew I could trust him. Find a chiropractor you can trust. Either with a referral from a trusted friend, or an online search that gives good feedback.

When I found out early on that I was having my second set of twins, I started going to him right away and my back worked 100% better for my second pregnancy compared to my first. There were times I would walk into his office, not even being able to stand up straight, and when I walked out and hour later, I was completely normal. Beyond back care, he gave me tips on vitamins that helped my energy level (B vitamins and vit D3) – something I would expect to hear from my doctor, but never did (outside of making sure I was taking a prenatal vitamin).

 Also, my doctor diagnosed me with Carpal Tunnel late in my first pregnancy – which is actually listed as a pregnancy ailment because of the extra fluid in your body that can temporarily create this complication. So when I showed up at the chiropractor to have my back adjusted and he saw the braces on my wrists, he asked about it and examined them. He told me I did NOT have carpal tunnel, and in fact I had tendonitis. He taped my arms to take the pressure off the tendons that were bothering me and it worked wonders! I was symptom free in a few days and ditched the braces!

He even fixed my jaw once when the dentist leaned on it too much during a long visit. My adventures in pregnancy have really led me into a relationship of trust and gratitude for my chiropractor! I now run to him for many ailments of my own and my kids’ because where a doctor has a treatment, a chiropractor has a solution. And it happens to be faster and easier and cheaper that a doctor visit every time. I guess there are some things a chiropractor can’t fix though!

Getting in Water

Swimming was a great relief for my hips and back. Taking a bath in a nice deep tub helps too. Anything that takes the weight off for even a short time is such ecstasy! I added 40% to my bodyweight by the end of my pregnancy! IKES! So I really needed that kind of relief to make it through with some cognitive ability left! Now in the Midwest in February, you can’t exactly just go jump in a lake. But I bought a YMCA punch card, which was relatively inexpensive compared to a monthly membership, so I could still go swim in the pool there once or twice a week. In those final days of my pregnancy, rotating days where I got a massage, visited the chiropractor and went swimming was the only way I made it day to day!

Sleep Positioning

As for sleep, I found that the couch was a comfy alternative in the middle of the night. - I think it distributed the weight better and kept it off my hips. Plus I would stack up pillows so I could sleep on my back in a reclining position, which kept the weight off either side of my hips. What I really wish I would have done in my first pregnancy is to buy a recliner so I could actually get some sleep at night. Back sleeping isn't 'allowed' but in a recliner should fine because you can control how far back you lay (check with your doctor to find out how far is ok for sleeping at night). A mess of pillows on your bed including some body pillows is also helpful to try and distribute all of your weight evenly. I found a nice squishy one to always put under my belly to help distribute that helped too!

Stretching

Being very active in dance growing up, I am addicted to stretching. It really helps flexibility and that comes in very handy when trying to find comfy positions to sleep in. Not to mention for labor and juggling two babies while trying to breastfeed and feed yourself simultaneously! Here are two of my favorites!

-Stand next to the wall with your right side near the wall and right hand on it for support. Bend your right knee and stick out your left hip (you will feel it in the left hip).
-lay on your back (just for a minute – it’s ok!) and cross your right ankle onto your left knee. Use your left knee to push your right leg close to your belly while using your hands to push your right knee away from your belly. You will feel it in your right buttock/hip.

And...

One other thing you should know is that you can request your doctor refer you for physical therapy treatment and it may be covered by your insurance. If you are on bedrest – the therapists might even come to you! It’s definitely worth a try if you are in pain and miserable.

Of course I don’t have all the answers, so please share what worked for you in the comments!!!

Middle Pregnancy: Measurements and what they Mean

At your average prenatal visit, your doctor will take a tape measure starting at your sternum, pull it over your belly to your pelvic bone (while you are laying down) and announce a resulting number as ‘you’re measuring 18 weeks). What she is actually announcing is the number of centimeters that measurement it – which just happens to roughly coincide with the number of weeks gestation a normal singleton pregnancy is. The purpose is to make sure that there is consistent growth – consider it your baby’s first growth chart for all practical purposes.
This method obviously has some limitations though! For instance, if your baby happens to have a generously filled amniotic sac, you might think you are having the Goliath of babies, only to find that instead, you have been growing more Olympic swimming pool inside you than baby mass. Let’s hope that means he’ll be a good swimmer!
With twins, the technique is only mildly useful. Obviously, you’ll be measuring larger than a singleton mom. So when you’re in for your 20 week appointment and your doctor announces ‘You’re measuring 24 weeks’, that simply means, ‘You’re belly is about as big as a singleton mom’s is at 24 weeks’.  So yes, if you stay pregnant long enough, you too will have the joy of measuring 42 weeks, 45 weeks, or maybe even 50 weeks!
The challenge with using measurements as a growth indicator for M.O.M.s is this. As long as you are growing, you know that at least one of your babies must be growing, but you don’t know if they are BOTH growing. For that reason, there are typically more ultrasounds done for mothers of multiples than for singleton mothers.
Below are some of my measurements at various times in my first pregnancy. FYI – my babies were both 7 pounds when they were born, so this is approximately what one would measure with 2 very average-sized babies inside of her!
At 17 weeks, measuring 21 cm
At 19 weeks, measuring 23 cm
At 21 weeks, measuring 28 cm
At 23 weeks measuring 32 cm
At 26 weeks measuring 36 cm
At 27 weeks, measuring 37cm
At 30 weeks, measuring 41 cm
At 32 weeks measuring 40 cm (must have been off on one of these, or babies changed position)
At 34 weeks, measuring 46 cm
At 36 weeks, measuring 47 cm
At 37 weeks, measuring 49 cm
At 38 weeks, measuring 50 cm
That was the last measurement taken! I actually measured my girth...I have to double check the exact figure - but if memory serves, I think it was 50 inches! IKES!

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!

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.

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.

Surviving Twin Pregnancy: Morning (and afternoon, and evening and nighttime) sickness

10 Weeks of Pregnancy - 153 Pounds

So one thing that *almost* every expectant mom gets to participate in is the dreaded morning sickness. I believe mine started around 8 weeks. It seemed worse if I got hungry, so the best thing I could do to help it, ironically, was eat. Mostly I craved comfort food: Macaroni and cheese, Ramen Noodles (beware the MSG in the seasoning!), soda, or anything with lots of carbs. When I felt sick, I ate anything of the above to keep myself sane. And when I felt well, I tried to eat extra healthily to make up for it. The worst time for me definitely was in the morning. I got into the habit of waking up and immediately boiling water to make ramen noodles. It was the only thing I could stomach, but after I ate them I felt much better. Most of the day I still felt slightly off. I think this is really the worst time of pregnancy because you are so miserable and just want to keel over on the couch and watch old episodes of Friends from the season Phoebe is pregnant with triplets while sucking on preggie pops, but you can’t because most people probably don’t even know you are pregnant yet! (Or maybe because you have several little ones running around already trying to play in the toilet water and your long-abandoned maxi pad drawer). But nevertheless, you are stuck trying to live your day to day life in an honorable fashion.
Usually, for me, it got better as the day went on, though there were a handful of days that I was quite miserable and just threw up the white flag claiming illness and sympathy from my hubby. I never actually ‘tossed my cookies’, because I HATE throwing up, and resist it with my whole being. But I probably would have felt better if I did! My heart goes out to those women who can’t quit the vomiting. But especially for you twin and multiple moms, it is VERY IMPORTANT to keep food down and get lots of nutrition and weight gain a little earlier in pregnancy because twin, triplet + buns generally don’t get as much time in the oven. Talk to your doctor if you have a hard time keeping food down on a regular basis because they can prescribe drugs to help.
Also, one thing I did find helpful was this device that I already owned because I frequently get motion sick. It’s called a ‘Reliefband’ and works on the principle of emitting a small electric pulse through a pressure point in your wrist. It worked miracles for my motion sickness when flying. Unfortunately, it was removed from over the counter sale around 2005 or so and was subject to FDA approval. There is now a new version on the market called 'ReliefBand Voyeger' that seems the same, except it is considered disposable because you cannot replace the batteries. I only once replaced the batteries in my original Reliefband in years of use, so if the new ReliefBand Voyager is as high quality, you should get many good months/years of use before it is kaput.
The Seaband works on the same premise, so you could try that too, but knowing how much pressure I had to apply to my wrist when I forgot my relief band, I’m guessing the Seaband isn’t as effective, but it's cheaper and may be worth a try for the desperate. As for my second pregnancy, I did have morning sickness, but not nearly as often, nor as intense. On the other hand, I just had a constant sense of being slightly ‘off’ that could usually be controlled with eating consistently. So I got in the habit of keeping a granola bar or healthy snack in my purse every day, which seemed to help.
Do take heart that nausea is a continued sign that you are still healthy and still pregnant! In fact, if you had a very sudden drop the severity or frequency of nausea, I would give the doc a call, just to make sure everything is ok. The dreaded morning sickness did finally dissipate and get milder for me around 15 weeks, and milder and less frequent yet around 16 and 17 weeks until it was a mere memory! Good luck getting there! Be sure to post a comment if you have any tips or tricks that worked for you!

Surviving Twin Pregnancy - I'm HUNGRY!

Sixth week of pregnancy
pre-prego weight: 148 pounds
Weight now: 149

 Hunger? Yes, hunger
At first I thought it was subconscious. That irresistible urge to give in to relentless eating. Binging on mac 'n cheese, ice cream, chips and salsa, cookies, Ramen noodles, Peanut Butter Captain Crunch, chewy tortillas and queso dip. Anything full of carbs and starch! I tried to balance it by eating a fruit or vegetable before I indulged, but try as I did to resist the urge,  my tummy was not lying. I was hungry. I was hungry before I even got morning sickness. In fact, when I thought back on it, I think I had a bigger appetite before I even knew I was pregnant! While that sounds unreasonable, I once heard a lady say that she figured out she was pregnant after her mom watched her eat 3 taco Bell chalupas and commented to her how unusual that was! So perhaps it is true. I ate, and ate, and ate. I tried to be healthful, but if only junk food was available, even better! I told myself that I shouldn’t be eating so much! That baby didn’t really need calories to speak of until the 3rd trimester! But it didn’t work. My belly told me otherwise, and I went with it. Finally when my pants began to get too tight at only about 8 weeks, I thought “oh no, I HAVE to quite eating so much! I’m getting fat!” I even consulted friends to find out how far along they were when their belly outgrew their clothes. 3 months at least was the earliest for any of them in their first pregnancy.
Of course I thought I was eating too much. The thought of having twins never even really crossed my mind. After all, some of my friends had already taken their turns playing the ‘I think I’m having twins’ card and then being disappointed. I even skipped the ‘multiples’ chapters in the pregnancy books I read. So I was NOT going to mention the ‘T’ word. Once we did find out though, I felt much better about my ever-expanding waistline. My doctor also verified what my stomach was telling me, and she said to listen to my body and eat whenever it said. She said that there is no reason to be concerned about weight gain, and that with multiples, more is better!
Be wary of any health care provider that instructs you to limit calories or limit weight gain with a multiple pregnancy. For many multiples, pregnancy doesn’t last as long and weight gain in the early weeks is more important than with a singleton. If you’re not sure how much to eat of the various food groups, ask to consult with a dietitian. Get pregnancy nutrition book from the library. If nothing else, focus on eating proteins which your growing babies will need the most of, and proteins are not efficiently stored in the body, so you need a constant supply of them. Eggs, deli meat (but nuke it first to avoid listeria), cheese, milk, peanut butter. Keep a protein bar in your purse so that whenever your belly starts growling for food, you don’t have to keep your little ones waiting!