multiple gestation

Mamas on Bedrest: Your Twin Babies Will Always Remain Close

April 6th, 2015

Good Morning Mamas!

Twin FetusesLast week I had the great privilege to speak at the Austin Mothers of Multiples Meeting. Mothers of Multiples Meetings can be found nationwide throughout the United States and these non-profit organizations-comprised of mothers of multiples-provide support to families who have twins, triplets or higher order multiple births. At this particular meeting, in addition to me sharing about bedrest and how mothers of multiples are supported while on bed rest, there was a twin panel; a panel of adult twins who shared their twin experiences and shared what parents of twins could expect as their children grew up. The panelist shared everything from how they liked or disliked being dressed alike to how they have an inexplicable bond with one another.

I found the panel fascinating.  There was one set of male/female twins, one set of female twins, one set of male twins and a male identical twin who had a rare form of cancer that caused him to lose several of his limbs. His identical twin brother was not affected by the same disease. These twins generously shared what it’s like to be a twin and some things that parents of twins can look forward to (and not worry about) as their twins grow up.

Twins always share an unspoken (and inexplicable) bond. All the twin sets shared that they are connected to their twin in a way that they are connected to no one else on the planet. Each grouping said that they often know what the other is thinking, can sense when the other is upset or not feeling well (even if they are far apart as the sole identical twin said. His twin is back “home” in Australia!) and that they always feel best understood by their twin.

Built in Playmate/Confidant. The twins said that one of the best things about being a twin was that when they were little, they always had someone to play with. As adults, they always have someone with whom they can share their secrets or concerns that truly understands them.

Twins don’t always like the same things, but often do. Interestingly, the male/female twins were both dental students at the University of Texas and were currently sharing an apartment. They said that when they were younger, they had different interests in school and were not at all competitive about grades or friends. The male twins were both undergraduate students at the University of Texas and while not living together or studying the same major, they were in a couple of classes together and did live close enough that they were in a study group together. The female twins said they were very competitive all the way through high school and purposely chose to go to different undergraduate schools. The interesting thing about them is that once they got out of undergraduate school, one twin got married and had children here in Austin. When her twin later moved to Austin and then got married, they had 3 children born within days of each other. The twin who married first actually has 5 children and her first and last children she had solo while her 3 middle children are each born within days of a cousin-one of the other twin’s children!

Twins don’t always like being dressed alike. The panel was pretty unanimous in that they didn’t like being dressed alike-even if it was with the same outfit in a different color. The male twins shared how they would use being dressed alike to pull pranks on people-even their mama! The girl twins shared how as they moved through middle and high school they changed their hair and sought out other ways to distinguish themselves. They all, while realizing their similarities, sought to be individuals and preferred to be treated that way.

Most twins felt their parents loved them and treated them equally. With the exception of the male/female twin set, the twins felt that their parents treated them equally and as individuals, not favoring one or the other of them. With the male/female set, they admitted that he felt closer to his father and she to her mother, but they both felt that each parent loved them both and they both have great relationships with both parents.

Dating wasn’t an issue. The twins all said that dating wasn’t an issue and there was not an incident of both of them liking the same person. As the female twin set noted, and the other twins agreed, they tended to date (and in the case of the female twins marry) people who had the complimentary attributes of their twin.

Twin parents shouldn’t worry about…”emotional damage” they may cause from getting their twins confused. The parents seemed overly concerned that their twins may feel slighted but the twins on the panel assured them that they never felt slighted or that they weren’t individuals. They said it comes with the territory that they will be confused with their twin (even by their parents), even if they are not identical.

 

Are you expecting twins or higher order multiples? Has this panel review been helpful? Please share your comments or concerns below.

Do you have twins, triplets or higher order multiples? What has your experience been like? What is it like raising twins? Please share your experience with other mamas in the comments section below.

Are you a twin? Do you agree or disagree with what the twin panel had to say? Please add your voice to the discussion below.

Mamas on Bedrest: Is Being on Bedrest a (More) Common Occurence?

February 6th, 2013

I was speaking with my mom the other day and we were chit chatting away about my work. My mom is really interested in “this bed rest stuff” as it was not really common when she was having us in the late 50’s and early 60’s. My mom asked me, “Is bed rest really that common?”

Bed rest is certainly more common now than when my mom was having kids and there are a myriad of reasons. Just to bring folks up to speed, according to the CDC the numbers are still holding at some 750,000 women going on bed rest annually in the United States. But my mom’s question is one that hounds me. Why are so many women going on bed rest? I tried to find a specific answer and while the literature is not specific, here is what I have been able to gleen.

1. Bed rest is more common right now because we have more diagnostic tools to diagnose conditions for which bed rest is recommended. When my mom was having my sisters and I, many of the ultrasound machines and fetal monitors that are used today to evaluate a mama and her unborn child simply didn’t exist. If a woman had a short cervix, she simply had a short cervix. Now I can hear the collective cyber gasp at that statement. But at the same time it makes you wonder, “How many women over the centuries had a shortened cervix during pregnancy and had a completely healthy baby?” One could give the opposing view, “Well how many women lost babies due to shortened cervix?” We don’t know the answers to these questions, but it does make for interesting mental gymnastics.

I am currently researching the life and career of my great grandmother, a “granny midwife” in the south from the late 1910’s to the early 1950’s. I hear tell that she had an uncanny way of knowing which women were going to have problems and which women were going to be “good breeders”. I also am learning that she had phenomenal clinical skills. I wonder if she was able to examine a woman and note if her cervix was shortened? Or if she would have preterm labor? I do know that she saw a lot of women through their pregnancies and advised them when to stop working (most were farm women) and to rest. It’s an interesting historical perspective and as I learn more, I will certainly share with you all.

2. Bed rest is more common because we have more women having children later in life. I don’t know if I completely agree with this. My grandmother gave birth to my dad at age 43 and he was her 15th child, 13th pregnancy (2 sets of twins, yikes!!) Now one could argue that her body was accustomed to having kids (one about every 18 months!).  But one could also argue that her body was “worn out”. As far as I know, she had no problems during pregnancy, no bed rest and no still births. She did lose the twin boys to infant illnesses.

One thing that my reproductive endocrinologist told me when I was in the “height of my childbearing years” is that ovarian age can be uncertain. By that he meant that some women may be 20 yet have the ovarian age of a 40 year old, and some 40 year old women will have more youthful ovarian tissue and function than their much younger counterparts. There is no way to predict which women will have “youthful” ovarian function and which women will not. Likewise, there is no way to predict when a woman will cease to have ovarian function. When we speak of advanced maternal age, we know that in general, as a woman ages, her ovarian function decreases as well as the quality of her eggs. However, we all know of older women who have had completely healthy, unassisted pregnancies, labors and deliveries, and young 30 somethings who have struggled.  The best that we can say for now is, relatively speaking, as a woman ages, her chances of having difficulty conceiving and having complications during her pregnancy are increased and continue to increase as she ages.

3. Assisted Reproductive Technologies (ART). Today there are thousands of women who become pregnant as a result of assisted reproductive technologies (IVF, GIFT, ZIFT, IUI, ICI, Surrogacy/gestational carrier).  The use of ARTs is a relative risk factor for a woman being prescribed bed rest because women who use ART are often older and often have pre-existing reproductive issues that would predispose them to complications any way. Additionally, women who conceive via ART are at greater risk for having a multiple pregnancy which increases the risk of going on bed rest.

3. Stress. I have written extensively in previous blogs about the role that stress plays on a woman’s ability not only to become pregnant but to maintain that pregnancy. Today more than ever women are balancing the demands of a career, a family that they have created, caring for family members from family of origin (parents or even grand parents) or have other pressing responsibilities not common to women 30 or more years ago. The work of Kathleen Kendall-Tackett PhD and others shows that the stress response has a direct effect on the cervix and preterm labor. Women who are under stress are releasing neurochemicals that soften the cervix and “ripen” it in preparation for labor and delivery-even if it isn’t time.  Stress also increases a mama’s blood pressure and may cause her not to eat or take optimum care of herself so her baby may experience Intrauterine growth retardation (IUGR).  It is critical that pregnant women avoid stress as much as possible not only for their own health but also for the health of their unborn babies.

4. Litigation. I hate bringing this topic into the argument, but in our current culture, litigation is probably closer to the top as opposed to the bottom of the list of reasons some OB’s put patients on bed rest. Currently, there is not scientific or medical evidence that bed rest is beneficial in preventing preterm labor or preterm birth. In a review article published just over a year ago, I reviewed the current medical literature regarding the efficacy of bed rest and again found no solid medical or scientific evidence for the use of bed rest as a treatment to prevent preterm birth. But as a former clinician, I also understand why OB’s prescribe bedrest. If on the off chance an OB discovered an anomaly with the pregnancy, yet did not prescribe bed rest and the pregnancy had an unhappy ending, that OB can count on being sued and would likely lose his or her ability to practice as an obstetrician. At the current time, medicine in the United States (or globally) has not discovered any other, more effective ways to deal with the complications of pregnancy that often result in the bed rest prescription. Until that occurs, bed rest, effective or not, will remain a “standard of care” in the management of pregnancy complications.
Now whether or not a woman should be put on bed rest is still a heated debate. Given that there is no scientific or medical evidence that bed rest is effective in the treatment of preterm labor, one could argue that we are potentially creating more problems for mamas and babies than solving. But to mamas who have been on bed rest and now have healthy babies, there is no other route to go and no talking her out of the fact that bedrest saved her baby’s life.

I pass no judgement because I know that when I was having my kids, if my OB had told me to spin on my head and shoot marbles out of my nose, I would have done it. I think that high risk pregnancy is an emerging field and one in which there is still much to learn. I am very excited to watch what is emerging in the medicine and science, and I am very excited to be a part of the public health solution of supporting mamas on bed rest.

Mamas on Bedrest: Meet April’s Mama of the Month, Jennifer Breedlove

April 4th, 2012

I love hearing how mamas cope with bed rest. Each story, while strikingly similar is also uniquely different. Each mama finds a way to cope, stay strong and do what she must to “keep her little bun (s) in the oven.”

April’s Mama of the Month is Jennifer Breedlove. Jennifer is a mama of 4 and endured 11 weeks of bed rest while pregnant with her now 15 month old twin boys. Here is Jennifer’s story.

I was put on bed rest at 25 weeks for preterm labor with cervical shortening.  I was hospitalized and got magnesium and sent home three days later.  Four weeks afterward, I went back for a check up (I had been seen at two week check up, with no cervical changes) and I was dilated to 5 cm in preterm labor again!  My first twin was breech so at 29 weeks, they kept me in the hospital for preterm labor and advanced cervical dilation.  I stayed at 5 cm for the next seven weeks and ultimately got induced!  My ob said he’d never seen anyone stay dilated for so long without complications.  I was on bed rest with our twin boys for eleven weeks…56 of those days on hospital bed rest!

I had a goal each day and became a creature of habit.  I am very active so I was shocked when I was put on bed rest!  I immediately started a bed rest exercise program and when I became inpatient, a physical therapist designed a program for me that I would do every day (most times twice daily).  Like most moms on bed rest, I felt alone, afraid for my babies and angry that my body was going into labor too soon.  I Just prayed for each day to stay pregnant and at 36 weeks, I was induced and gave birth to two healthy boys!  Praise God!

To mamas on bed rest I say stay positive, take help from whomever offers and have a daily goal.  I got reacquainted on Facebook and looked forward to my two other children and husband to visit.  Thankfully, my mom was able to visit me ever night and eventually, I got wheelchair privileges  to get some fresh air.  It’s been a rough year but we’re finally adjusted to our new life and I ran my first marathon within eight months after their birth to celebrate our health.

Andrew and Joseph were born on January 30, 2011.  Drew was 5 lbs, 6oz.  Joseph was 6 lbs, 2 oz.  Perfect little men who walk now!