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Everything You Need to Know to Have a Healthy Twin Pregnancy




Excerpted from
Everything You Need to Know to Have a Healthy Twin Pregnancy
By Gila Leiter, Rachel Kranz

When I found myself pregnant with what I thought would be my second child, I was a practicing obstetrician/gynecologist at a busy private practice in New York City with a growing number of multiple births under our care. I've always enjoyed caring for pregnancies and deliveries of multiples, with their higher rate of prenatal problems and potentially difficult deliveries - there's always something unexpected to deal with. And I have always felt a special sympathy and awe for multiple moms. In any case, I always seemed to be the doctor on call when a set of twins was ready to deliver.

Imagine my surprise, then, when I found that I myself was pregnant with twins. Although as a doctor I was an expert in the field, as a woman I wanted the same comfort and reassurance that every expectant mother is looking for.

Of course, I had access to the latest in medical literature - but like any expectant mother, I wanted to read something more personal. As I did during my first pregnancy, I went looking tor a "regular" pregnancy book. Only this time I wanted a pregnancy book about twins.

I found so little to answer my needs! I am a doctor, so at least I had access to other information. But, I thought, what about all the mothers out there who aren't doctors? My patients wanted more information than I could give them in an office visit, more than the standard few pages that most pregnancy books devote to the special needs of the twin pregnancy. I vowed that someday I would write a book for them, to share my professional and personal experience. This book is the result of that promise.

The Special Needs of "Multiple Moms"

Any pregnancy, delivery, and motherhood is challenging. But multiple moms know that their experience is demanding in a way that no "singleton" mother could possibly imagine. As writer Betsy Israel put it in her 1998 article in The New York Times Magazine. "Mothers of twins, triplets, quadruplets, quintuplets . . . will suggest that I, a mere mother of 'singletons,' don't have a clue. We may all be moms but we do not belong to the same national chapter of motherhood."

What are some of the special needs of multiple moms? As the mother of twins, triplets, or quads, you'll be at far greater risk of preterm labor and premature delivery. You'll face a far higher incidence of prenatal complications, and you'll be more likely to have to take early leave from work or even to be treated with bed rest.You may face physical complications from the added strain of carrying additional weight for a longer period of time, and you might feel some extra psychological stress over wondering how you'll feed and care for two or more babies at the same time.

You also have special needs with regard to diet, nutrition, and exercise. You should have more testing and monitoring during pregnancy and delivery. You may face a more complicated delivery, with a greater chance of cesarean section. And you might face special challenges in involving your partner, other children, extended family, and friends in a physically and emotionally demanding experience. But what a great reward at the end of the road!

Coming to Terms with Multiples

If you've just found out that you're going to have twins, triplets, or quads - or if you're considering any form of fertility treatment or Assisted Reproductive Technology (ART) - you're likely to be wondering how you can handle the medical, physical, and psychological challenges. This book is geared to help you through.You might be a career woman in her 40s wondering about how you can balance the demands of your job with the very special needs of a multiple pregnancy. Or you might be the mother of two or three children concerned about caring for their needs as you gain 40 or so pounds and are instructed to avoid heavy lifting. Maybe you're in your early 20s, wondering how you and your partner will ever pay for two sets of baby clothes, two cribs, two sets of doctor bills. Perhaps you had ART after years of infertility, longing for one child - but were never prepared for the possibility that you might have two, three, or four at the same time.

Perhaps this is your first pregnancy, and you're wondering what to expect. Maybe this is your first multiple pregnancy, and you're asking yourself how this time will be different. Possibly you have a sister, aunt, mother, or girlfriend who's had twins, triplets, or quads, but maybe - even with the recent explosion in multiple births - you're the only multiple mom you know.

This book is your resource. In it, you'll hear not only my voice but also the voices of my patients, as we share with you both my medical knowledge and our personal experience of this very special kind of pregnancy and birth. (The stories here are composites, representing the concerns and experiences that I've observed in my years of private practice.)

We'll start at the beginning - how fertility treatments increase your chances of conceiving multiples (Chapter I), what you can do to ensure a safe pregnancy before getting pregnant (Chapter 2), and the basic biology of multiple conception (Chapter 3). We'll go on to help you explore the many feelings that often accompany a multiple pregnancy, offering you some concrete suggestions for working through the hopes, fears, and fantasies that might come up and some specific ideas for nurturing yourself (Chapter 4). We'll help you choose the doctor who is right for you, as we review the various options to an ob/gyn, a perinatologist, a twin clinic, and a midwife (Chapter 5).

Then I'll proceed to the many medical decisions you'll be making: the hard choices that often come with a twin diagnosis and a thorough review of the tests you might have (Chapter 6), along with a comprehensive look at your diet (Chapter 7), use of medications (Chapter 8), and relationship to work, bed rest, and exercise (Chapter 9). We'll go through your pregnancy trimester by trimester (Chapters 10, 11 and 12), as I review what is happening to your body, what you and your doctor will be discussing, and how your babies are developing. My patients and I will be sharing our own experiences and suggestions throughout.

I'll also talk you through some of the common and uncommon complications of a multiple pregnancy, including a look at how diabetes might affect you and your babies (Chapter 13). We'll take a long look at the possibility of preterm labor and premature delivery (Chapters 14 and 15), which pose the greatest risk to the life and health to multiple babies and which you and your doctor will be making every effort to avoid.

Finally, I'll talk you through the birthing process, explaining the kinds of decisions you and your doctor might have to make (Chapter 16) and giving you a blow-by-blow description of what you might expect in the delivery room, including the possibility of a breech birth or C-section (Chapter 17). You'll hear about those first few days in the hospital (Chapter 18) and find out what it's like to bring your multiples home (Chapter 19). At the end of this book, there's a list of resources - Web sites, books, and organizations - that might help you through your pregnancy and early years as the parents of twins.

As I review this chapter, I'm sitting on the labor floor at Mt. Sinai Hospital, taking a welcome break after finishing my morning rounds. I've got two sets of twins on the postpartum floor: one that was delivered very early, at 27 weeks, due to the mother's complication of placenta previa (a condition in which the placenta covers part of the cervix); another that stayed in the womb for a full 37-week term. Thanks to the miracles of modern science, all four babies are doing well, and both mothers are recovering nicely. I continue to marvel at how bravely and gracefully my patients manage the many challenges and surprises of a multiple pregnancy - and at the joy and excitement that a multiple birth can bring.

Preventing Prematurity: Your Number-One Goal

One of the most important objectives of your multiple pregnancy can be expressed very simply: to carry your babies to term.

This is not as simple as it may sound. A multiple pregnancy is far more likely than a singleton to end in preterm labor and premature delivery - with consequent risks to your babies. As a pregnant multiple mom, you need to do everything you can to prolong your pregnancy - eat right, avoid certain types of exertion, follow your doctor's orders with regard to lifestyle, work life, and bed rest.

If your babies are bom prematurely, you want them to come into the world as big and strong as possible, to compensate for the problems caused by early delivery. So you also need to eat right from the very beginning of your pregnancy to ensure early, adequate weight gain.

Much of what I discuss in this book is geared toward helping you have the healthiest babies you can by making the very most of their time in the womb. As I'll be repeating many times before the book is done: Knowledge is power. While you can't have complete control over when your babies "decide" to come out, you can do a great deal to promote their health and safety.

Exploring the Mystery of Twins

"Everyone is interested in twins - or they should be," wrote Horatio H. Newman, an early student of twins, and certainly most societies that we know of have shown a remarkable fascination with twins and other multiples. Twin lore goes back to ancient times. In the Bible, for example, Jacob and Esau were twins, as were Zarah and Pharez, the father of King David, while Greek mythology features such twins as Apollo the sun god and Artemis the moon goddess.

It's not only Western mythology that reveals this fascination with twins, in most cultures, pregnancy and birth are themselves seen as mysterious and thrilling - and multiple births seem even more so. In some societies, twins are viewed as a kind ot punishment; in others, they are seen as a divine reward bestowed upon the parents. Most of the multiple moms I know, myself included, feel that both are true.

Twins are frequently the subjects in scientific studies that seek to establish the boundaries between "nature" and "nurture," especially with monozygotic (popularly called "identical") twins separated at birth. Certainly, in my own experience as a New York City ob/gyn, I've seen that multiple moms enjoy a certain honor, a special kind of respect and wonder. When a woman pregnant with twins walks into our waiting room, there's a kind of hush that falls over the room. Even other pregnant women are a bit in awe. And whenever we deliver twins or triplets, even in a delivery room where everyone is more or less used to "the miracle ot birth," there's a way that the whole labor floor holds its breath and then bursts into applause when the multiples arrive.

A Growing Number of "Multiple Moms"

In the ten years since I had my own twin daughters, the number ot multiple moms has risen at an extraordinary rate, and 1 in 40 births in the United States is twins. This statistical increase is being reflected more and more often in popular culture. The New York Times Sunday Magazine, The New Yorker, and numerous other journals have published articles on twins, triplets, quads, and other multiple births. TV news programs focus on famous quints, sextuplets, or octuplets; TV movies explore the joys and sorrows of multiple parenthood. A casual walk through the streets of your own neighborhood will reveal more double strollers and identically dressed babies than ever before.

The New Generation of Multiple Moms

Gone are the days when a doctor can respond to a patient's queries by saying dismissively, "Don't worry, dearie, it's just doctor talk" - and I say, good riddance!



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