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MoonDragon's Pregnancy Information
TWINS & MULTIPLE PREGNANCIES






All human beings start as a single cell, the zygote. This cell divides into a clump of two cells, these two cells divide into a clump of four cells, and so on. Ultimately, a human being develops from the growing clump of cells.


  • Twins & Genetics
  • 9 Common Myths Exposed
  • Diagnosing Twins
  • Birthing Twins & Choics
  • Twins & Homebirths
  • Potential Risks & Concerns
  • Vaginal or Cesarean Birth For Twins In A Medical Setting
  • Parenting & Twins
  • Helpful Links For Twins & Multiple Births




  • TWINS AND GENETICS


    TYPES OF TWINS

    IDENTICAL, OR MONOZYGOTIC, TWINS

    This type of twinning occurs with one egg (ovum) and one sperm (spermatozoon). The inner cell mass that develops from a single fertilized ovum separates into two masses, each of which gives rise to a complete embryo. Because monozygotic twins are the result of the fertilization of a single ovum by a single spermatozoon, they are always the same sex and have identical genes and are considered identical. Among the general public, monozygotic twins are called identical twins, even though this is not completely accurate.

    It is commonly assumed, even by physicians, that monozygotic twins have the same DNA. This is usually correct, because both twins started with the zygote's DNA. The key word, however, is "started." DNA can become damaged or mutated at any time. If it happens early in development, it can affect most or all of the cells in the body. If it happens late in development, or after birth, the effect is not so widespread.

    Monozygotic triplets have been reported. This was quite rare before the advent of fertility treatments.

    Monozygotic twins may have separate placentas, depending on the stage of development at which the inner cell mass separates or they may share the same placenta and have separate amniotic sacs.

    FRATERNAL, OR DIZYGOTIC, TWINS

    This occurs when two ova are released during a single ovarian cycle and both are subsequently fertilized by separate spermatozoa. Fraternal twins, therefore, can be of the opposite sex and they can differ just as much as any siblings. Fraternal twins always have separate placentas.

    Does the genetic tendency to have twins run on the female line, or is there some male involvement?

    The husband and his family history would have no bearing on whether his wife released more than one egg and thus conceived fraternal twins. However I did read in Elizabeth Nobel's book (I think?) 'Having Twins' that there can be a genetic tendency for some sperm to predispose an egg, once fertilized, to divide. It could be an enzyme that certain sperm carry, who knows, but some fertility specialists are doing research into it after discovering a high number of monozygotic twins developing after early embryo transfer during IVF. So he may have an ever so slight influence, but on the whole no, the husbands family history has nothing to do with the wife's ability to conceive twins. So, fraternal twinning is influenced by heredity through the mother, since she would have to release two eggs in one cycle. And, the chances of releasing two eggs goes up with age and with the more children a mother already has.

    And just to confuse you even more, there is thought to be a third type of twinning, a blend of mono and dichorionic twinning, although it is very hard to prove. It is thought that the ovum goes through a third meiosis creating an original and daughter germ cell which are then fertilized by two different sperm. There is one animal, I think it is the hippopotumus or Rhino that always twins in this way. But like I said it is hard to prove in a human, but does explain why some fraternal twins are more alike than others.



    TWINS - EMBRYOIC DEVELOPMENT

    (A) The most common type of monozygotic twinning, with division of the inner cell mass of the blastocyst resulting in separate amnions but a single chorion and placenta.

    (B) A rare form of monozygotic twinning, with complete division of the embryonic disk resulting in two embryos in a single amniotic sac with a single placenta and chorionic sac.

    (C) Monozygotic twinning with division occurring between the two-cell and morula stages to produce identical blastocysts, resulting in separate amniotic and chorionic sacs and either separate (shown) or fused placentas.

    (D,E) Dizygotic twinning, with (D) or without (E) fusion of the placenta and chorion.





    LINKS ABOUT CONJOINED TWINS

    (When monozygotic twinning is not a complete division)

    Social History of Conjoined Twins
    Conjoined Twins: Effects of Environmental Factors & Twinning Biology







    9 COMMON TWIN MYTHS EXPOSED
    By Patricia Malmstrom





    The universal fascination with twins and triplets, and misunderstandings about the nature of twinning, perpetuate a mythology which has serious consequences for multiples and their families.

    MYTH #1: Twinning skips a generation.

    FACT: Dizygotic or two-egg twinning passes down the female line from generation to generation.(1)

    IMPACT: An expectant mother may disregard her symptoms of a multiple pregnancy, because she believes that she cannot have twins since her mother did.




    MYTH #2: Since multiple births are most often the result of costly infertility treatments, twinning is not a problem for middle- and low-income populations.

    FACT: Although twinning rates are influenced by infertility treatments the majority of multiple births occur naturally. The highest rates are in the African-American population, which is at additional high risk for poverty.(2)

    IMPACT: Policy makers and funders fail to provide resources to address the special needs of low-income families with multiples.




    MYTH #3: Every pregnant woman thinks she is having twins.

    FACT: Pregnant women have been found able to accurately identify the presence of multiples as much as three months ahead of the medical diagnosis. (3)

    IMPACT: Under the influence of this myth, obstetricians sometimes dismiss maternal suspicions of twin pregnancy and manage the pregnancy as if there is just one baby, such as limiting maternal weight gain to 20 pounds instead of the optimal 40 pounds for twins; inducing premature labor in the mistaken belief that a seven-month twin pregnancy is a post-mature singleton pregnancy.




    MYTH #4: You cannot breastfeed multiples, or if you breastfeed you must never use bottles.

    FACT: Mothers who breastfeed multiples report that the judicious use of formula as supplementation, in times of illness or extreme fatigue, can prolong the duration of the breastfeeding period. (4)

    IMPACT: Mothers of multiples who are willing to breastfeed are discouraged from attempting it. This can mean that low-birthweight infants, who are most in need of breast milk, are unnecessarily deprived of its benefits. In addition they may miss regular physical contact with their mother which the process of breastfeeding requires and which promotes the bonding process.




    MYTH #5: It is so much easier with twins. Everyone helps you; and you get lots of discounts.

    FACT: Child care and household management costs more, not less, with multiples. Subsidized child care and respite programs are inadequate to meet the pressing needs of families suffering the severe sleep deprivation which accompanies the 24-hour care of infant multiples. Unless the help of relatives and friends is organized and systematic, it may actually contribute to parental stress. Mothers of multiples benefit most from the help of their husbands/partners. Cultural biases may discourage fathers from participating. Lack of information and training in child development and care may reduce the effectiveness of any help fathers do provide. Although some purchasing discounts are available, the majority of the costs of medical care, equipment, clothing, diapers and food are double for twins and increase in proportion to the numbers of infants.

    IMPACT: When parents believe that the system will provide necessary help, they may fail to mobilize their own networks of support and be ill-prepared to cope with the extraordinary physical demands and financial impact of twin care.




    MYTH #6: There is a good twin and a bad twin in every pair.

    FACT: The relationship between co-twins is a dynamic interplay of personality variables which suffers from such potentially deterministic labels. Twins are children who get along more or less well with each other depending upon a host of variables such as temperamental compatibility and their relationships with the rest of the members of the family. Young twins experiment with the balance of their relationship - trading off being "leader and follower," or "bully and victim," as often as every hour. With good coaching and refereeing from their parents, multiples are capable of developing a mature, reciprocal relationship with lifelong benefits.

    IMPACT: Obstetricians, nurses and parents label co-twins "good" and "bad" or other positive/negative stereotypes, which damage their relationship.




    MYTH #7: There are all kinds of research to help parents understand the unique aspects of twin development.

    FACT: The majority of research known as "twin studies" employs twin subjects to examine the heritability of biomedical and personality variables. Most of the information available on twin development is a by-product of this work. Few longitudinal studies of twin development per se exist.

    IMPACT: Providers, funders and parents assume that comprehensive information about twin development is available for the asking and do not promote research on this neglected subject.




    MYTH #8: Twins and triplets share everything.

    FACT: Even though they have shared a womb, multiples learn to share their toys gradually, like all children do. First, each must develop a sense of ownership of their clothes and some toys. Once a child understands the concept of "mine," she or he can begin to lend and trade.

    IMPACT: Parents and care givers lump all the children's' clothes and toys together thereby retarding the development of self esteem and promote an endless round of competition between the children.




    MYTH #9: Twins should always be separated in school, so that they will learn to get along without each other.

    FACT: No one formula for school placement fits all twins at all times. The classroom placements for a set of multiples must be evaluated each year, just as classroom placement is evaluated annually for single born children. Young multiples who are still working out the balance of their relationship with each other benefit from starting school in the same class. There, in the comforting presence of their co-twin, they can learn to separate by participating in different activities with different groups of children. When multiples are separated before they have learned independence they will be overwhelmed with grief and anxiety and unable to concentrate on school work. See reference 5 below.

    IMPACT: Principals, parents and teachers place twins in separate classrooms before they are ready and thereby slow down the separation process they mean to promote.




    Please help demystify twinning! Share the facts above with your colleagues and friends. If you know of other myths or misconceptions about multiples to add to the list, we would like to be able to share them with others. The more people understand the facts about twins and triplets, the weaker the myths about them will become.





    REFERENCES

    1. Nobel, E. (1991) Having, Twins. Boston: Houghton Mifflin Co.
    2. U.S. Vital Statistics Reports
    3. Malmstrom, P. & Malmstrom, E. (1987) Maternal recognition of twin pregnancy. Acta Geni Med Gemellol, 37: 187-192.
    4. Sollid, D., Evans, B., McClowry, S., & Garrett, A. (1989) Breastfeeding Multiples. J. Perinat Neonatal Nurs 3(1): 46-65.
    5. LaTrobe Twin Study, Twins In School, Department of Psychology, Latrobe University, Melbourne.

    Reprinted with permission from Twin Services, Resource Series 500: #501, 1993. This article may be printed out for personal use but may not be reproduced in any other manner, including electronic, without prior written consent from Twin Services. For more information, call 510-524-0863.





    DIAGNOSING TWINS

    A fundal height (measurement between the mother's pubic bone, across the tummy, to the top of the uterus - called a fundus) above the gestational age in weeks should immediately lead the midwife and the mother to consider twins. But first, the midwife should rule out other possible causes of a uterus that is "large for dates" such as miscalculated dates, hydatidiform mole, gestational diabetes, polyhydramnios, maternal obesity, hereditary predisposition for big babies, fetal anomalies, baby high in fundus due to placenta previa or abdominal muscle tone, fibroids (internal or external) displacing the baby upwards or positioned atop the fundus, and postmaturity.

    normal fundal height


    For an average singleton baby of a normal mother, the fundal height should be approximately the same (measured in centimeters) as her weeks gestation (About 27 cm for 27 weeks gestation). After engagement of the fetus into the pelvis (just before or during labor), the fundal height will normally drop in measurement by a few centimeters. Until this happens, however, the fundal measurement and the weeks gestation should be relatively close to the same number.

    Next, the midwife should consider her clinical findings. This should include noticing an abundance of small body parts when palpating the tummy during prenatal visits and whether the head presenting at the inlet of the pelvis feels somewhat small relative to the fundal height. Twins are sometimes missed if one is tucked in behind the other's body.

    Unless a woman is subjected to serial sonography (which for many women choose not to have during pregnancy as a routine test), twins are usually discovered by 30 weeks, with clinical confirmation through the auscultation of two heart beats. But midwives, take care... what may appear to be two heartbeats may be just one, audible over a wide range. If the midwife notes a 10 to 15 point difference in rhythms with distinct patterns of variability, this is a possible sign of diagnosing a set of twins. When in doubt, a sonogram may be considered for confirmation.



    LISTENING FOR 2 FETAL HEARTBEATS


    listening for twin heart beats
    Listening for 2 heartbeats is not easy, but it is sometimes possible, especially in the last 2 months of pregnancy. You will need 2 good fetoscopes or stethoscopes, a helper and a quiet room. Here are 2 methods you can try:

    1. Find the heartbeat of what you think may be one baby. Then listen for other places where the heartbeat is easy to hear. If you can find such a place, have a helper listen to one place while you listen to the other. Each of you can tap the rhythm of the heartbeat with your hand. If the rhythm are the same, you may be listening to the same baby. If the rhythms are not exactly the same, you may be hearing 2 different babies.

    2. If you do not have a helper, but you have a watch with a second hand, try timing each heartbeat separately. If the heartbeats are not the same, you may be hearing 2 different babies. This method is helpful, but not as reliable as the first method.

    If you think there might be twins, get medical confirmation (even if you can find only one heartbeat). An ultrasound or x-ray can be done to see if there are twins.

    Since twin births are often more difficult or dangerous than single births, it is suggested that twin babies be born in a hospital or maternity center whenever possible. Since twins are more likely to be born early, the mother should have transportation ready at all times after the 6th month. If the hospital or maternity clinic is far away, the mother may wish to move closer in the last months of pregnancy.

    If the babies are to be born at home, it is best to have at least 2 very skilled midwives at the birth.


    It is important to identify twins as soon as possible because twin pregnancies carry extra risks and potential problems for the mother and her babies. Nutrition is a major concern since maternal anemia is much more common, as is the incidence of premature delivery. Women expecting twins need expert nutritional counseling from her midwife or a nutritionist so that she is able to provide all the necessary nutrients, including protein, that is needed to maintain a healthy pregnancy, to keep her babies healthy and have the needed weight they require before their delivery. Low birth weight is often a problem for twins as is a premature delivery. The midwife should provide recommendations for moderating the mother's activity and getting adequate rest. Guidelines for recognizing and reporting signs of premature labor should be provided immediately upon diagnosing twins.




    GIVING BIRTH TO TWINS - CHOICES

    Giving birth is always amazing. The process for giving birth to twins is doubly amazing. Here are some of the things that a twin mom will need to consider when giving birth to her twins.



    BABIES POSITIONS

    The position of the babies will largely determine how the twins are born - vaginally or by cesarean. About 40 percent of twins are both head down (vertex) at term, another approximately 30 percent see the first baby (Twin A) vertex and Twin B breech. Both of these positions are acceptable to consider a vaginal birth. Other positions of the babies like two breeches, two transverse or Twin A breech and Twin B vertex are usually delivered via cesarean surgery. This is usually known ahead of time with ultrasound technology. However, even twins can change positions late in the game and even into labor. This is particularly true of Twin B after the birth of Twin A.

    VAGINAL BIRTH

    More than half of twins will be born vaginally. Whether this option is the right one for you and your babies is a discussion that should be discussed with your health care provider or midwife. The good news is that even though you have two babies - you only have to labor once! Once the cervix is open, each baby will have it's own pushing stage (second stage). This means you will have to push twice, but the majority of the time the second twin is born much more easily than the first. This is because the first twin has paved the way, so to speak. The average time between the birth of the first and second baby is generally about 17 minutes. However, as long as the second baby is doing well (they will still be monitoring this baby), there isn't much need to speed things along. Sometimes during this phase of waiting, you will have an ultrasound to confirm the position of the second twin and your practitioner will decide how it is best to deliver him or her. Sometimes, the second twin simply comes down head first like Twin A, this is handled in exactly the same manner. If Twin B is breech, your practitioner may decide to allow the baby to deliver breech, to turn the baby externally or internally or even do something called a breech extraction (pulling baby out by the feet).

    CESAREAN BIRTH

    While having twins does increase the risk of you having a cesarean, fewer than half of twins are born this way. While positioning of your babies will play a large part in the decision as to what type of birth you will have, there are also all of the normal reasons for cesareans. These include, placenta previa, placental abruption, maternal indications like PIH, active herpes, and labor complications like fetal distress, etc. If you give birth by cesarean prior to labor, the date will most likely be set between 37 to 40 weeks. If you go into labor prior to the scheduled date, your cesarean will likely happen then. There is no real difference in the surgery or recovery from a cesarean with twins.

    COMBINED VAGINAL / CESAREAN BIRTH

    This is actually not as common as you might believe. One baby being born vaginally with the second twin being born via cesarean occurs in only about 3-4 percent of all twin births. Usually this is done for an emergency with Twin B, like a cord prolapse (This is where the cord comes out with or before the baby, thereby cutting off the baby's oxygen supply.), severe malpresentation (like a transverse baby that cannot be moved by internal or external forces), placental abruption (This is where the placenta tears away from the wall of the uterus prematurely.), etc.

    PREMATURITY

    More than half of twins will be born prior to 37 weeks. This can also impact how your babies are delivered. Talk to your practitioner about staying healthy and maintaining adequate hydration, rest and nutrition to care for your growing babies and body.

    HOSPITAL CONCERNS

    Some hospitals require that all twin mothers give birth in the operating room, even if they have a vaginal birth. You might also ask about the use of epidural anesthesia, as it is also sometimes a requirement, even if there are no medications placed inside the tubing. This allows immediate anesthesia should it become necessary. There may be other concerns you have like rooming-in or breastfeeding two babies. Be sure to talk to your hospital at length about issues you may be concerned about with your babies.





    TWINS & HOMEBIRTH

    For most homebirth midwives and their clients, a twin birth at home is usually contraindicated. This has more to do with political and legal reasons than with medical reasons for many midwives. Pressure from the medical community and the possibility of legal ramifications (regardless of the birthing outcome) prevent many homebirth midwives from handling homebirth clients expecting twins. Even within the medical community, there are few health care providers unwilling to allow a vaginal delivery of one or both of the babies and will automatically schedule a cesarean delivery for women expecting twins (or multiple births in general).

    There are and have been a few homebirth midwives that have taken expectant twin clients and delivered their babies at home, most without incidence, but most of us must refer them on to supportive medical care. However, some of us would consider homebirthing twins if it under just the right circumstance with just the right client and good back-up support and if the couple is really very insistent about having their babies born at home. If the decision needs to be made whether or not to have a twin birth at home, the midwife must fully inform the parents and make sure they understand the risks involved with this choice. Most likely, the midwife will have the parents sign an informed consent form, medical release form, and/or a refusal to transfer form before proceeding with a twin homebirth. This is to help cover her proverbial "backside" with the legal and medical communities in which she must work. She will need to make sure she has plenty of helping hands available at the birth and must be up on her skills (such as neonatal resuscitation and her ability to recognize potential complications associated with twin deliveries).

    MoonDragon's Birthing Guidelines: Unexpected Twins

    Whether or not the planned homebirth will end up being referred to other health care providers for the actual delivery, a midwife can provide special assistance to a woman carrying twins by focusing on the emotional, nutritional, and practical aspects of caring for two babies. Emphasis should be on the emotional aspects of the experience and the support the midwife can give to the expectant mother. And if the midwife can enable the mother to maintain her pregnancy to at least 37 weeks, a medically referred twin delivery will have a more positive outcome for both the mother and her babies and hospital management will be more relaxed with a possible early discharge.

    TWINS & HOMEBIRTH LINKS

  • Home Birth Reference Site - UK

  • Benjamin's & Montana's Birth - Childbirth.org

  • Psalm & Zoya's Unassisted Birth At Home

  • Sofia Fonesca's Home Birth Story of Twins

  • Miriam and her Twins


  • No matter how your twins come into the world, be prepared for a sudden change. Be willing to accept help when offered and take the time to get to know each of your new little bundles.





    POTENTIAL RISKS AND CONCERNS

    The reasons for hospital birth are numerous. One potential problem is cord prolapse. This is more likely to occur with the first baby if it is breech. In fact, most physicians will do an automatic cesarean if the breech is footling or kneeling. The second baby is at even greater risk for cord prolapse, especially if it remains high in the uterus after the first has been born. It may also become hypoxic, as reduced uterine volume may cause constriction of vessels leading into the placenta. For the same reason, there is risk of placental abruption. Finally, there is considerable risk of postpartum hemorrhage from an over-distended and tired uterus.

  • Giving Birth To Multiples






  • WHY ARE TWINS OFTEN BORN EARLY?
    By Peg Plumbo, CNM
    (Peg Plumbo has been a Certified Nurse Midwife (CNM)
    since 1976 and has assisted at over 1,000 births.)





    CONCERN: I am pregnant with twins. I have carried my two other babies past term and they were good-sized babies and very healthy. I attribute this to my excellent diet. My doctor told me not to expect a full-term birth this time and that twins were often born early. Is this always true, and if so, why?

    A twin, or any other higher order multi-fetal gestation, is by its nature a higher risk pregnancy. The most frequently encountered problem with a twin gestation is prematurity. Growth restriction is another difficulty that may be experienced by one or both of the fetuses. Some labors need to be induced before term if one or both of the babies is in jeopardy.

    Because we do not precisely know why labor starts in singleton pregnancies, it is hard to accurately theorize what influences pre-term labor in twin gestations.

    The distended uterus may put out signals or respond to hormones triggering premature contractions. The amniotic membranes may rupture too early. We know that the fetus has a role in the initiation of labor, so if two or more fetuses are present, perhaps they secrete a higher level of a stimulus substance. We just do not know the answer or answers.

    Some twins share the same placenta and the same amniotic membranes (monoamniotic). These twins are at higher risk of cord entanglement and of twin to twin transfusion. Such a pregnancy is considered "full term" at 34 weeks and should be delivered this early because of the significantly higher risks associated with longer gestation.

    All twin gestations are considered full term at 38 weeks by most obstetricians and it is not unusual for mothers to be induced at this time. Risks of going to term with twins are: the potential for cord prolapse, intrauterine fetal death of one baby and twin to twin transfusion. Mothers too may be at higher risk of placental abruption, hemorrhage and hypertension.

    A report was published recently by the Health Resources and Services Administration's Maternal and Child Health Bureau (The Journal of the American Medical Association, 2000;283). Lead author, Dr. Michael D. Kogan, reported that results demonstrated that mothers who received more frequent prenatal visits had the highest risk of pre-term birth, but these babies were more likely to survive.

    Might it be that women who seek prenatal care earlier and are more adherent to a schedule of regular visits are higher risk, or are the interventions and antepartal fetal testing creating the need to deliver these babies earlier?

    The number of twin gestations has increased as maternal age has advanced and assisted reproductive therapies are utilized more frequently. Such women are seeking care from, and are being referred more often to, higher level specialists. Such practitioners rely on technology to ascertain fetal well-being. The results may be earlier and earlier delivery. Fear of litigation may also be driving such pre-term interventions and deliveries.

    The message is clear that women need to regain some of the faith in their own ability to birth their babies. Mothers and fathers should interview potential care providers to see if philosophies match. Trust in one's health care practitioner or midwife is critical as is the ability and freedom to ask questions and even disagree with the plan of care. Such a dialogue is in the best interests of the woman, her baby and the family.





    TWINS & UMBILICAL CORD ANOMALIES

    CONCERN: I am 32 weeks pregnant with twins. I was told that one of the babies has only has two vessels in his cord. Should I be concerned?

    Umbilical-cord anomalies such as a two-vessel phenomenon have been implicated in an increased risk of having a baby small for its gestational age. In general, twins are at risk for this anyway.

    But whether or not a smaller-than-average baby is also at an increased risk for birth hypoxia (low oxygen levels) is still debated.

    Twins who share the same chorion (fetal membrane) are at higher-than-average risk for hypoxia and growth discrepancies. Usually, the smaller baby is at increased risk for lower hemoglobin and, therefore, for hypoxia.

    Two-vessel cords sometimes alert care providers to look for kidney problems in the baby. But remember, this is an association, not an absolute. If the baby were having difficulty excreting urine, an ultrasound would reveal an enlarged bladder or an abnormal amount of amniotic fluid in the uterus. You may wish to ask about fetal kidney function.

    ADDITIONAL CONCERNS TO ASK ABOUT INCLUDE:
    • Appropriate size for dates.
    • Discrepant size between the babies.
    • When sharing the same membrane/placenta, do both babies have approximately the same placental mass?
    • Amount of amniotic fluid.
    • Fetal kidney appearance/function.
    • Ask your provider if there are any indications of a twin-to-twin transfusion. In this condition, one baby gets most of the blood at the expense of the other.

    Be aware that some health care providers get annoyed when clients ask well-studied questions. They prefer to have the clients feel that they (the health care provider) has everything under control and will let you know what you need to know. Some clients like this approach best as well. However, I am one of those people that will research an issue and bring my concerns and comments up in discussion with my health care provider before making a decision about any approach or therapy. I firmly believe in "question everything" and "be informed", especially when it comes to health care issues. If the health care provider does not like that I ask questions and make up my own mind, I find another health care provider that expects me to take an active part in my decision making process regarding my health and my body.






    RISKS OF TWIN GESTATION: MONOAMNIOTIC TWINS
    By Peg Plumbo, CNM
    Peg Plumbo has been a Certified Nurse Midwife (CNM) since 1976
    and has assisted at over 1,000 births.





    CONCERN: My wife and I are having twins, and the doctor said they might be "monoamniotic." He also said there was only a 50 percent chance of both of the twins making it. Please tell us more about this condition.

    Twins are either mono-zygotic or di-zygotic. In your case, mono-zygotic, a single fertilized ovum splits into two distinct individuals. These babies will be "identical twins" - of same sex and genetically identical.

    The incidence of this type of twinning is approximately four per 1,000 births. Unlike the fraternal type of twinning (di-zygotic), this type does not seem to vary depending on mother's age or how many children she has.

    Some twins share the same amniotic sac and the same placenta (monochorionic and monoamniotic - 1 in 25,000 to 1 in 60,000 pregnancies) - and because of this, cord entanglement and compression become a very high risk. This can lead to an interruption in the blood flow to one or both babies where they may not receive enough nutrients or oxygen.

    When there is no membrane between the babies - a monoamniotic twin pregnancy - there is a very high risk of cord entanglement and also twin to twin transfusion syndrome. This represents a very high risk pregnancy and intensive monitoring and testing of the babies is required. At times, it is safer to deliver such babies early, some as early as they are viable (24 to 28 weeks). A good NICU is essential when considering the birth. 34 weeks is often considered "full term" for monoamniotic twins because of the cord risks outweigh the prematurity risks.

    I would recommend that you seek out the care of an perinatologist, an obstetrician who specializes in the care of high risk mothers and pregnancies and concentrate on excellent nutrition during this pregnancy.

    If you have been diagnosed with monoamniotic twins, you may find a support group helpful to answer your questions and listen to the stories of others in a similar situation. You may want to visit the Monoamniotic.org: Monoamniotic Monochorionic Support Site





    RISKS OF TWIN GESTATION: A FOLLOW-UP


    I understand completely the concern that you must be feeling about your twins. As I discussed before, these babies are at higher risk than fraternal twins. I also understand what delivering outside your community and away from the comfort of a physician and care facility that you have come to rely upon.

    The fact that your care provider admits to having little experience with monoamniotic twins should cause you to investigate alternative options for the birth of your babies. Monoamniotic twins are often delivered prior to 34 weeks because of cord entanglement and compression problems.

    My recommendation is that you make an appointment with a perinatologist (an obstetrician specially trained in managing higher risk pregnancies). Such doctors can be found in larger metro area or in University centers or the local chapter of the American Medical Association should be able to help you find one.

    Bring all your data, charts, doctor reports, lab reports, ultrasounds with you. Tour the unit that physician works with and ask the staff questions about past experience and care with high risk twin births.

    Yes, I would recommend that you deliver at such a center, one equipped with a neonatal intensive care unit. The likelihood of getting transferred to such a site anyway is great and this way you already know the doctor and the layout.

    The local United Way or March of Dimes or the newborn intensive care unit staff may know of a place where families can stay during a high risk pregnancy, especially toward the end.






    TWIN BIOLOGY: CHORIONICITY OF THE PLACENTA
    By Geoffrey Machin





    During a twin pregnancy, the main business is to make sure the mother and her babies are well nourished; that the pregnancy goes as near to term as possible; that common complications are anticipated (increased risk of hypertension and hemorrhage); and, that support systems are in place when the twins come home. Chorionicity of the placenta is the most important prenatal issue.

    Although it is well known that twin pregnancies carry higher risks than single pregnancies, it is not always realized that some types of twins are more likely to have very high risks; this is the group who have both twins connected to a single (monochorionic or MC) placenta. For MC twins, the risks of serious, life-threatening complications are up to 10 times higher than for those twins who have one placenta each (dichorionic or DC). The distinction between MC and DC twins can be made by ultrasound exam in the first and early second trimester. The dangers in MC twins are caused by the fact that the circulations of the twin pair are usually connected with each other via the placenta. The dangers include: twin-twin transfusion (TTF); twin reversed arterial peffusion (TRAP); unequal sharing of the placenta by the twins, leading to growth discordance; brain damage to one twin if the other should die during fetal life; monoamniotic (MA) twins sharing a single gestational sac with danger of umbilical cord entwinement; conjoined twins. In addition, the rate of major malformation is higher in these twins than in other twins or singletons. Usually, one twin is malformed and the other is not. The malformed twin fetus may threaten the life of the co-twin, and consideration is sometimes given to selective termination; this is highly dangerous in MC twins because of the shared circulations.

    Although the distinction between MC and DC twins can be made early in pregnancy, in practice this is not always done. And, if the first ultrasound exam is not done until 16 weeks, some of these disorders will already be in an advanced stage, and it may be too late to plan proper management. There are particular risks in MC twins that are over and above the risks of twin pregnancies in general. The great majority of adverse outcomes in twin pregnancy occur in the MC group. They can be anticipated and diagnosed if there is sufficiently intense prenatal care. Outcomes can be improved, although some of the problems are very challenging and are presently the subject of intense debate among obstetricians.

    Zygosity becomes the most important issue after birth. There are two major causes of confusion about zygosity:

    There is no simple relationship between zygosity and placental status. All MC twins are MZ, but some MZ twins are DC, so not all DC twins are DZ. Many parents are misinformed and believe that their twins are DZ because there were two placentas. I have found that many parents continue in this belief even when their twins look so much alike that everyone else assumes they are MZ, and even after this has been proved by the best genetic testing available. What this tells me is that zygosity is deeply important to twins and their parents, that it is an issue that they want settled in their minds, and that they will stick to what they have been told even when the information is clearly wrong.

    I have never met a pair of "identical" twins and I do not believe that they exist. The use of so-called "identical" and "fraternal" (for girls?) is inaccurate and sometimes disastrously misleading; I would stop it today if I could. The use of "identical" to describe MZ twins is a major cause of confusion. Parents distinguish between their MZ babies by identifying their differences. Once they have found these differences, however slight, parents may believe that, since their twins are not "identical" in the strict sense of the word, they are not MZ. Sometimes parents who are able see differences between their MZ twins which are not apparent to others invoke the theory of "polar body" twins (PBT) to explain the differences between their twins. The theory of PBT is based on the hypothesis that the polar body of a fertilized egg can be fertilized by a different sperm, thus creating twins which are "half identical". This theory is extremely doubtful and is not needed to account for differences in MZ twins. In fact MZ twins are never absolutely "identical", as this misleading label suggests. Some common differences in MZ twins include variations in the shape of their faces, their height, and/or weight They may have different birthmarks; and be discordant for illnesses such as downs syndrome and cerebral palsy.

    I strongly advocate that parents be given technically correct information about the zygosity of their multiples.

    Apart from the fact that parents have the right to know such a basic piece of information about their twins - as do the twins about themselves - there are other important medical and biological reasons which support routine determination of zygosity:

    MZ twins may well have more difficulty in individuating, and require special social and educational considerations.

    There are high concordance rates in MZ twins for many chronic disorders with a genetic background, e.g., allergies, asthma, heart disease, Alzheimer's, schizophrenia, diabetes, neuroses, cancer. These disorders may not actually happen simultaneously, but they can be anticipated in the second twin if they occur in the first twin.

    MZ twins can serve as rejection-free organ transplant donors for their co-twins.

    Medical research needs MZ and DZ twins to sort out the relative importance of environmental and genetic factors in the development of normal people as well as their disorders and diseases. Many twins are eager to participate in these studies for the good of all as well as to learn more about twinning. Not everybody wants to participate, but the studies are non-harmful and non-interventional. They contribute greatly to the cause of disease prevention.

    Zygosity can be determined as follows:

  • Monochorionic (MC) twins are all monozygotic (MZ).

  • Unlike-sexed twins are dichorionic (DC) and dizygotic (DZ).

  • Not all dichorionic (DC) twins are dizygotic (DZ).

  • Like-sexed dichorionic (DC) twins need testing for zygosity.


  • The zygosity test of choice is DNA fingerprinting, a non-invasive procedure which currently costs about $100. This is not at present considered a standard part of the care of twins. I believe that it should be and that parents and twins and others should lobby for it.




    For more information on twin biology, refer to Twin Services' Parenting Education Handout #125, "Twin Beginnings". Geoffrey Machin is the fetal pathologist for the Northern California region of Kaiser Permanente Medical Centers. His book, Biology and Pathology of Twins, is forthcoming in July 1997.

    Reprinted with permission from Twin Services Reporter, Spring 1997. The Alphabet Soup of Twin Biology article may be printed out for personal use but may not be reproduced in any other manner, including electronic, without prior written consent from Twin Services. For more information, email us at twinservices@juno.com or call us at 510-524-0863.

  • TwinServices.org: Free Articles


  • Twin Services Consulting
    P.O. Box 10066, Berkley, CA 94709
    510.524.0863
    www.twinservices.org





    VAGINAL OR CESAREAN BIRTH FOR TWINS IN A MEDICAL SETTING





    HOPING FOR VAGINAL BIRTH WITH TWINS
    By Peg Plumbo, CNM
    Peg Plumbo has been a Certified Nurse Midwife (CNM) since 1976
    and has assisted at over 1,000 births.





    CONCERN: I am nine weeks pregnant with twins. I was hoping to use a birthing center, but because I'm carrying twins no one will accept me. I am currently under my fertility specialist's care, but I have to transfer to a high risk specialist in a few weeks. Since a birthing center is not an option in my area, do you have any recommendations of how I can find an Ob/Gyn that is not "knife-happy"? I would really like to have a vaginal birth, preferably without an episiotomy.

    Twins are not automatically indicative of a high risk pregnancy, although there are risks inherent that are not necessarily shared by singleton pregnancies.

    Nurse midwives do co-manage multiple gestation pregnancies. They might see the client with the obstetrician or take turns with the visits. CNMs may deliver the babies if all is going well with the obstetrician in attendance.

    If both babies are vertex and the labor is progressing smoothly, there would be no need for a cesarean. Most obstetricians would agree with this. The difficulty of course comes when there are signs of pre-term labor, premature rupture of the membranes, growth discrepancies or abnormal presentation of one or both babies. In these circumstances, your risk of a cesarean is much higher.



    CESAREANS: ARE THEY REALLY A SAFE OPTION?
    By Henci Goer


    Henci Goer, award-winning medical writer, is the author of The Thinking Woman's Guide to a Better Birth. Her previous book, Obstetric Myths versus Research Realities, is a highly acclaimed resource for childbirth professionals, and she is an acknowledged expert on evidence-based maternity care. Goer has written consumer education pamphlets and numerous articles for magazines as diverse as Reader's Digest and Childbirth Instructor. For twenty years, Goer has been a Lamaze-certified childbirth educator and labor support professional (doula).




    "The trouble with people is not that they don't know, but that they know so much that ain't so." Josh Billings.

    Lately, prominent obstetricians, including Dr. Benson Harer, the president of the American College of Obstetricians and Gynecologists, have been waging a campaign intended to increase our already outrageous cesarean rate. They are trying to convince the public that cesarean section is so safe, and vaginal birth so injurious to mothers and babies, that women should not be deprived of cesareans on demand. An article in the December 4, 2000 Newsweek and Harer's appearance last summer on Good Morning America are cases in point. Without access to the obstetric research, their arguments for the benefits of c-sections seem reasonable. In my opinion, this is on a par with tobacco company spokes-people of yore claiming that cigarette smoking improved lung function.


    DOES VAGINAL BIRTH INJURE THE MOTHER?

    The belief that vaginal birth harms women has come largely from the observation that women tend to have weaker pelvic floors shortly after vaginal birth than women having planned cesareans. In addition, many older women experience uterine prolapse (the uterus sags into the vagina) or urinary or anal continence problems (incontinence of gas, urgency, or fecal incontinence) related to weakness or injury. This has led some obstetricians like Dr. Harer to leap to the conclusion that planned cesarean is protective.

    To begin with, vaginal birth probably has some adverse effects, as does pregnancy, in that some women develop urinary incontinence during pregnancy. However, the main source of problems is obstetric management, principally the largely unnecessary, but still common, practice of episiotomy. None of the justifications for its routine or frequent use are supported by the medical research(9,12,14,37,42), and women with no episiotomy have the strongest pelvic floors after childbirth (23). This should not come as a surprise. Logic dictates that cutting muscles would weaken them. Moreover, episiotomies can extend, tearing into, or through, the anal sphincter. Anyone who has ever snipped a piece of cloth in order to tear off a length will readily understand why. Anal sphincter injury almost never occurs except as an episiotomy extension (22), and anal tears permanently weaken the sphincter. Even without extending, episiotomy can cause hidden injury to the anal sphincter (35). Forceps delivery can also do considerable genital damage and anal sphincter injury, as, to a lesser degree, can vacuum extraction (6,19-20,38,41).

    That older women have problems due to weak pelvic floor muscles and injury is a moot point. They all had large episiotomies with each birth, and many had routine forceps deliveries as well. In addition, the command to begin prolonged straining at full dilation, in defiance of any natural urge, would seem to be a recipe for overstressing pelvic floor muscles and connective tissue. So would pushing while lying flat or nearly flat on one's back, which means pushing the baby uphill. As with episiotomy, no evidence supports either practice, yet they were universal until recently, and are still the norm in most hospitals today.


    DOES CESAREAN SECTION PREVENT MATERNAL INJURY?

    In any case, cesareans are not protective. The studies comparing pelvic floor strength between women having vaginal births and women having cesarean deliveries have all been done within a few months after birth. In point of fact, the pelvic floor recovers (7,11). Studies doing long-term followup fail to find differences in muscle strength or urinary incontinence between women birthing vaginally and women having cesareans (13,21,27,40). What's more, a program of pelvic floor exercises can strengthen the pelvic floor and relieve symptoms in many women (4,32). In other words, weakness can often be remedied without risk or expense.

    ARE CESAREAN SECTIONS SAFER THAN VAGINAL BIRTH?

    As someone whose life work is evaluating and synthesizing the obstetric research, I can attest that NO data support the contention that cesareans are as safe as vaginal birth for mother or baby. A cesarean section is major abdominal surgery, with all that entails. Compared with vaginal birth, cesarean section causes pain and debility, sometimes for weeks (26). The surgery itself, as opposed to medical problems that might lead to a cesarean, increases the risk of maternal death, hysterectomy, hemorrhage, surgical injury to other organs, infection, blood clots, and re-hospitalization for complications (16,24,33-34,39). Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs and the risk of chronic problems from adhesions. The surgery itself also increases the risk of the baby being born in poor condition or having trouble breathing after planned cesarean or cesareans done for reasons other than the baby's condition (2,8,18). Also, because of scar tissue, the incidence of placenta previa (the placenta overlays the cervix) and placenta accreta (the placenta grows into or through the uterine muscular wall), complications that kill babies and mothers, soars with each successive cesarean (1,3,10,17,28,36). Infertility and ectopic pregnancy (the embryo implants outside the uterus) associate with previous cesarean section as well (17). Finally, the uterine scar raises the specter of uterine rupture during a subsequent pregnancy or birth, a danger not removed by planned repeat cesarean (15,30).

    The Newsweek article stated that vaginal birth caused cerebral palsy, implying that elective cesarean section was the solution. Studies show that few cases of CP arise from events in labor, which is one of the main reasons why electronic fetal monitoring has had no effect on the CP rate (5,25,29,31). Even the fact that some babies develop cerebral palsy after vaginal birth without an obvious explanation does not necessarily mean vaginal birth was the cause. As with pelvic floor weakness, obstetric management plays a role. For example, Pitocin, used to induce labor and stimulate stronger contractions, can cause overly strong contractions that deprive the baby of oxygen, and instrumental delivery can cause bleeding in the brain. Also, while a policy of routine cesarean might prevent a few cases of CP, the benefit would be vastly outweighed by the harm done to many thousands of other mothers and babies.


    WHY DO OBSTETRICIANS THINK THE WAY THEY DO?

    How can obstetricians hold beliefs so contrary to the facts? Primarily because "If all you have is a hammer, everything looks like a nail." Despite rhetoric about being "women's health physicians," obstetricians are surgical specialists in the pathology of women's reproductive organs. The belief that birth is difficult, dangerous, and damaging and that major surgery is preferable validates and reinforces their sense of professional worth.

    Other motives also come into play. Obstetricians are hardly disinterested parties when it comes to cesarean versus vaginal birth. Cesarean section offers them protection from malpractice suits (they think), convenience and efficient use of their time, and in some cases, more money. Given this, you can readily understand why many obstetricians are willing to deny or rationalize the risks of cesareans and to delude themselves and their patients on these points.

    Don't be deceived by the issue being framed as denying a woman's right to choose. This has nothing to do with making an informed decision based on an objective understanding of the pros and cons of the various options. The "right" to a cesarean is the sole instance where obstetricians have ever championed a woman's right to determine any aspect of her care other than, perhaps, her right to refuse an epidural. The fact that so many women believe cesarean section to be a safe, easy, and less painful way to have a baby and have exaggerated ideas of the dangers of normal birth is proof positive that obstetricians have been derelict in their duty both to help their patients make informed choices and to practice evidence-based care.


    REFERENCES

  • Ananth CV, Smulian JC, and Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 1997;177(5):1071-8.
  • Annibale DJ et al. Comparative neonatal morbidity of abdominal and vaginal deliveries after uncomplicated pregnancies. Arch Pediatr Adolesc Med 1995;149(8):862-7.
  • Asakura H and Myers SA. More than one previous cesarean delivery: a 5-year experience with 435 patients. Obstet Gynecol 1995;85(6):924-9.
  • Berghmans LC et al. Conservative treatment of stress incontinence in women: a systematic review of randomized clinical trials. Br J Urol 1998;82(2):181-91.
  • Blair E and Stanley FJ. Intrapartum asphyxia: a rare cause of cerebral palsy. J Pediatr 1988;112(4):515-519.
  • Bofill JA et al. A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor. Am J Obstet Gynecol 1996;175:1325-30.
  • Bump RC and Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 1998;25(4):723-46.
  • Burt RD, Vaughan TL, and Daling JR. Evaluating the risks of cesarean section: low Apgar score in repeat c-section and vaginal deliveries. Am J Public Health 1988;78:1312-4.
  • Carroli G and Belizan J. Episiotomy for vaginal birth. In: The Cochrane Library, 1999. Oxford: Update Software.
  • Clark SL, Koonings PP, and Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985;66(1):89-92.
  • Cosner KR, Dougherty MC, and Bishop KR. Dynamic characteristics of the circumvaginal muscles during pregnancy and the postpartum. J Nurse Midwifery 1991;36(4):221-5.
  • Eason E et al. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 2000;95(3):464-71.
  • Gordon H and Logue M. Perineal muscle function after childbirth. Lancet 1985;2:123-5.
  • Graham ID. Episiotomy: Challenging Obstetric Interventions. Oxford: Blackwell Science Ltd., 1997.
  • Gregory KD et al. Vaginal birth after cesarean and uterine rupture rates in California. Obstet Gynecol 1999;94(6):985-9.
  • Hall MH. Commentary: confidential enquiry into maternal death. Br J Obstet Gynaecol 1990;97:752-3.
  • Hemminki E and Merilainen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996;174(5):1569-74.
  • Hook B et al. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 1997;100(3):348-53.
  • Johanson R et al. North Staffordshire/Wigan assisted delivery trial. Br J Obstet Gynaecol 1989;96:537-44.
  • Johanson RB et al. A randomized prospective study comparing the new vacuum extractor policy with forceps delivery. Br J Obstet Gynaecol 1993;100(6):524-30.
  • Jolleys JV. Reported prevalence of urinary incontinence in women in a general practice. Br Med J 1988;296:1300-2.
  • Klein MC et al. Does episiotomy prevent perineal trauma and pelvic floor relaxation? Online J Curr Clin Trials 1992;1(Document 10).
  • Klein MC et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol 1994;171(3):591-8.
  • Lydon-Rochelle M et al. Association between method of delivery and maternal rehospitalization. JAMA 2000;283(18):2411-6.
  • MacDonald D. Cerebral palsy and intrapartum fetal monitoring. N Engl J Med 1996;334(10):659-60.
  • Miovich SM et al. Major concerns of women after cesarean delivery. J Obstet Gynecol Neonatal Nurs 1994;23(1):53-9.
  • Nygaard IE, Rao SSC, and Dawson JD. Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol 1997;89(6):896-901.
  • O'Brien JM, Barton JR, and Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 1996;175(6):1632-8.
  • Phelan JP and Ock Ahn M. Perinatal observations in forty-eight neurologically impaired term infants. Am J Obstet Gynecol 1994;171(2):424-31.
  • Rageth JC, Juzi C, and Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions. Obstet Gynecol 1999;93(3):332-7.
  • Richmond S et al. The obstetric management of fetal distress and its association with cerebral palsy. Obstet Gynecol 1994;83(5 Pt 1):643-6.
  • Sampselle CM. behavioral intervention for urinary incontinence in women: evidence for practice. J Nurse Midwifery 2000;45(2):94-103.
  • Schuitemaker N et al. Maternal mortality after cesarean in The Netherlands. Acta Obstet Gynecol Scand 1997;76(4):332-4.
  • Shearer EL. Cesarean section: medical benefits and costs. Soc Sci Med 1993;37(10):1223-31.
  • Signorello LB et al. Midline episiotomy and incontinence. BMJ 320(7227):86-90.
  • Taylor VM et al. Placenta previa and prior cesarean delivery: how strong is the association? Obstet Gynecol 1994;84(1):55-7.
  • Thacker SB and Banta HD. Benefits and risks of episiotomy: an interpretive review of the English language literature. 1860-1980. Obstet Gynecol Surv 1983;38(6):322-38.
  • Vacca A et al. Portsmouth operative delivery trial: a comparison vacuum extraction and forceps delivery. Br J Obstet Gynaecol 1983;90(12):1107-12.
  • Van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of cesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997;74(1):1-6.
  • Viktrup L et al. The symptom of stress incontinence caused by pregnancy or delivery in primiparas. Obstet Gynecol 1992;79(6):945-9.
  • Williams MC et al. A randomized comparison of assisted vaginal delivery by obstetric forceps and polyethylene vacuum cup. Obstet Gynecol 1991;78(5 Pt 1):789-94.
  • Woolley RJ. Benefits and risks of episiotomy: a review of the English-language literature since 1980. Part I. Obstet Gynecol Surv 1995;50(11):806-20.





  • twins, twice the work


    PARENTING & TWINS


    Parenting can be a stressful challenge at any given time, even with just one new baby in the household. However, parents of twins or multiple births have even a greater challenge, emotionally, physically, financially, and mentally. I have gathered some helpful articles to help parents in surviving parenthood and parenting twins with some sanity still left intact.

    twins, double trouble






    TWINS: 8 SURVIVAL STRATEGIES FOR NEW PARENTS
    By Patricia Malmstrom, M.A. and Catherine Phegan





    1. GET HELP

    Most families need regular outside help with twins during the first year. Set this up ahead of time if you can. You can get help from people you trust and get along with, such as:
    • Relatives-older children, parents, sisters, brothers
    • Friends
    • Neighborhood children 10- to 12-year olds
    • Teenagers
    • College students
    • Housekeeper or live-in help

    And you might be able to trade services with friends. Remember outside help does not always have to cost money. Call your county health and social services departments and ask what in-home services are available for families with new babies. (Programs differ from county to county.)





    2. GET REST

    The first months can seem very long because the babies' schedule will not let you get enough sleep. Rest whenever you can. You can use earplugs to sleep while someone else takes care of the babies. This may mean your house is not as clean as it was before twins. But remember, the more rest you get, the better you will be able to take care of your babies-and yourself.




    3. ORGANIZE YOUR HOUSE

    Before the babies arrive, get your house ready for them:
    • Put the baby clothes and equipment where you plan to use them. You may want to have more than one changing area in the house.


    • Set up a place where the babies can be left safely alone, in portacribs or playpens, on the rug in a circle of pillows, on a blanket on the floor or in an area closed off by a gate.


    • Make the care of your house and your clothes as simple as possible.




    4. MAKE A SCHEDULE

    It is easier for people to help if you have a schedule they can see. Make a list of the things you do at (somewhat) regular times each day and put it on the wall. Work toward getting the babies on the same sleeping and feeding schedule. When friends offer to help, suggest they:
    • Come at bath time to bathe one of the babies.
    • Help out at feeding time - feeding one of the babies.
    • Clean the kitchen.
    • Bring dinner or a frozen casserole to be heated up later.
    • Go shopping for you or run errands.
    • Take the babies' brother(s) or sister(s) out for an outing.
    • Care for the babies while you sleep.
    • And if your day isn't going right, drop everything and take the babies out for a walk. Fresh air can make everyone feel better.




    5. HELP EACH OTHER

    If you have a parenting partner, help each other. Having twins is hard on relationships. Talking about your feelings can help you and your partner to understand it is hard work caring for twins. You may be tired or in need of time alone. It helps to tell each other what you need.




    6. GET TIME ALONE OR TIME TOGETHER

    Plan a regular time for you and your parenting partner to be together without the babies. Go for a walk, out for breakfast, to the park. Go dancing, to a movie, or listen to music. Make a permanent baby-sitting arrangement for this and go even if you are too tired. If you have older children, do something with them alone once a month or so. They need time off from the babies too.

    And make time for you alone. Get a friend, neighbor, or relative to watch the babies for an hour or two and:
    • Take a walk.
    • Take a long bath.
    • Make that call you never have time for.
    • Go shopping.
    • Do something that makes you feel cared for.




    7. ESTABLISH BOUNDARIES

    You can expect your family to be just as excited and fascinated by your twins as outsiders will be. This can be helpful when grandmothers, aunts, brothers, etc. offer to help with the work. But it can also be a hindrance if they offer unwanted advice and criticism at the same time.

    Welcome the help of your family if you enjoy their support. But set limits when and where you need it. Start this early so things do not get out of hand, and keep in mind that it is your right to raise your family the way you want to. What worked for them may not work for you.





    8. SMILE

    People are fascinated by twins. They also have some strange ideas about twins. They may stop you on the street and ask, "Which one is the smart one?" You can get worn out trying to respond to everything that is said. Smile, and push on! Their comments do not have anything to do with you.




    This information is based on Twinline's work and discussion with hundreds of parents of twins and from our understanding of current research on the twin relationship. Reprinted with permission from Twin Services, Parent Education Series 200: #215, 1983. This article may be printed out for personal use but may not be reproduced in any other manner, including electronic, without prior written consent from Twin Services. For more information, call 510-524-0863.








    PROTECTING YOUR TWINS FROM "GAWKERS"
    By Gayle Peterson
    Gayle Peterson, MSSW, PhD is a family therapist
    specializing in prenatal and family development.





    CONCERN: I am a mother of toddler twins. I am upset with the way strangers gawk, ask questions and in general, intrude on my children as if they are "freaks." What can I do to stop the intrusion?

    The fascination with twins is rooted in our psychological fantasy of having more than one of ourselves in the world. The experience of seeing a real set of twins may even stimulate a wish for our own imaginary clone. Naturally, this is not what real twins are about. And so, reality and fantasy collide.

    Families come in all shapes and sizes, but we sometimes forget to respect children's boundaries in the same way we would an adult. Children are people, too. They deserve respect and consideration equal, not less, than any adult. We could all use greater consciousness about our affect on children, when taking license to comment, gawk, touch or in any other way force our interaction upon them.

    Stop intrusive touching when it occurs. Ask strangers to maintain appropriate distance, even if you have to say, "Please do not touch my child."

    Set limits. Let others know when you feel uncomfortable. Remember, they are the ones being intrusive!

    Talk with your children. Help your children learn about boundaries and how to maintain their privacy, as they grow.

    Multiple children pose their own unique challenges to parents. Everything from financial to emotional resources are tapped at a compounded rate. The early years of parenting multiples are particularly stressful. But as with all things, the years have a way of teaching lessons of cooperation and balance is achieved over time. Parents of multiples quickly learn to recognize the differences in their children and are well aware that looks are only skin deep. No wonder they tire of repeated commentary by strangers, which becomes intrusive rather than friendly.

    Parents of multiples are not alone in their frustration. Families with adopted children of different races or any parent with a bi-racial child, for example, go through the same recurrent commentary when out in public. Are these your children? Are they adopted or biological? Anyone who falls a bit out of the "norm" in our culture is fair game.






    ENCOURAGING TWINS WITH DIFFERENT ABILITIES
    By Erlyne Osburn


    The first years of school are critical in forming good work habits and attitudes. Erlyne Osburn, an elementary teacher with a background in both public and private schools, is here to help you do everything you can to enhance your child's education.




    CONCERN: My nine-year-old twins are on a travel baseball team. Our coach will be splitting the team into two and has indicated that one of the boys will be moved to the top group. How might this affect them?

    It is difficult to predict how this scenario will manifest itself in your children. There is a potential for rivalry, but it really depends on the relationship that your youngsters have with each other. It is also dependent on how you handle the situation with them.

    Participation in these kinds of programs can be challenging for parents and children alike. When the competition heats up, the learning aspect of the sport can be overshadowed by the desire to win. Parents have to be prepared to deal with their child's emotions, as well as their own in this situation.

    Your particular scenario is further complicated by the fact that you have two children on the same team, which does not happen often in competitive sports where children are grouped by age.

    Before the boys are reassigned to different groups, sit down with each of them and discuss the impending change. Let them know that it is probable that they will be in different groups. Watch closely how they react, and proceed from there. Perhaps they already realize that this is going to happen. Then again, it could be quite a surprise, especially to the child who will not be in the "top group." Remind them that they are both part of a team and that each of them needs to do his part to help. Explain to them that the coach is doing what he thinks is best for the team as a whole.

    Parents usually have a special way of encouraging their children and making them feel better even when they are down. You have the capability to ease the children through this transition as smoothly as possible because you know them both so well and because you want to see them happy and successful in their lives.






    ENCOURAGING TWINS WITH DIFFERENT INTERESTS
    By Pattie Greenbergy Wollman


    Patti Greenberg Wollman has been a teacher for twenty years. She lives in New York City with her husband and two children.




    CONCERN: I have six-year-old identical twin boys. One is eager to learn the alphabet, colors and shapes, while the other only cares about playing ball, riding bikes and other physical activity. They never seem to be enjoying the same activities at the same time. Any suggestions?

    Often children very close in age will do the opposite of what their sibling is doing. It is as if they take the area where there will be least competition and the most chance for individuality. If you think about it, this is a normal and healthy way for a child to establish a clear sense of identity.

    Perhaps your sons are doing the opposite of each other precisely because it is that - the opposite. If this is the case, you probably should try to support all of their activities. What are they each doing that they are good at? Running or jumping or throwing a ball? Give each credit for it. Both children need to feel worthwhile.

    Meanwhile, you might try to involve them in games which involve fine motor coordination. Try playing board games such as Colorama and Cootie, which require manual dexterity as well as hand-eye coordination. The boys can have fun together while you strengthen their abilities.

    I assume your sons are in the same class at school. If you continue to see a great polarization in the boys' interests as the year progresses, you should probably think about putting them in different classes this coming school year. This way it will be easier for them to work on all areas of their development, without looking over their shoulders to see what the other one is doing.






    ENCOURAGING INDIVIDUALITY IN TWINS
    By Patricia Malmstrom, M.A. and Elinor Davis





    CONCERN: Many parents of new multiples wonder how their children will be able to develop individual identities when their early experiences and environment are so similar, especially if they look alike. Most parents have seen media accounts of adult twins who still live together and dress alike, who seem never to have become separate people with separate lives. These parents wonder what they can do to prevent this from happening to their children. We assure concerned parents that individuation is not something that parents do to twins.

    Twins, triplets or more are individuals already, by virtue of the fact that they have physically separate bodies and brains. Families can either enhance or obscure their multiple-birth children's individuality, but they need not create it. That has been taken care of already. (Incidentally, parents report that fingernail polish on one twin's big toe helps them tell their babies apart.)

    Parents sometimes tell us they feel guilty that in the chaotic and exhausting early months, they are unable to give each baby much individual attention. Again, we reassure them that every time they change a diaper, feed or talk to the babies, they are giving "individual attention." Each child experiences these simple acts with his or her own sensory equipment, storing them away in each one's personal memory bank as feedback from the external world.

    For the first year or so, then, it is not necessary to be concerned about providing separate experiences or otherwise promoting "individuation" for twins. Parents have their hands full just attending to the physical care of their babies. But what about the period between 18 months and three years when children are forming concepts of their individual identity, and beginning the two-decade process of separating from their parents? Is there anything parents can do during this stage to increase their twins' ability to establish individuality and develop separate lives as adults? YES!

    Here are some simple yet very helpful and important things parents and other family members can do to promote healthy identity formation in their multiples.

    Give them distinctly different names. If they do have very similar sounding names, you may want to use a nickname or middle name for one or both to lessen confusion.

    Give them each their own clothes and avoid dressing twins alike on a regular basis past infancy. Few families can resist the adorable image of identically dressed babies, and there is no harm in this during the first year or two. However, since identical outfits emphasize the twin "unit," and make it harder for other people to tell them apart, you should refrain from dressing older twins alike. If they are given matching outfits, just don't use them both on the same day.

    Separate their clothes. You might even want to label them. Keep them in different drawers or sections of the closet so that the children know which belong to each when they start choosing their own clothes and dressing themselves. If your twins want to dress alike, don't prevent them. Just provide a varied wardrobe and casually remind them that other people may have trouble knowing which of them is which. Sometimes older identicals experimentally dress alike to force their friends to respond to their individual personalities instead of differences in their clothing. Twins who wear school uniforms report this benefit.

    Give them each their own toys. As a wise preschool teacher once said, "Children cannot share until they have had." Before they can understand the concepts of sharing, taking turns and trading, they have to have some notion of ownership. If everything belongs to both of them together, it is harder for twins to think of themselves as separate people.

    Try to refer to each by names, not as "the twins," and make it easy for others to do so. When they start school, give them name tags, if necessary, or color-code their wardrobes so that teachers and other children know that "Jenny always wears something red and Sarah always wears something blue."

    For birthdays, you might make two small cakes and sing "Happy Birthday" twice. Give them separate gifts and encourage family and friends to, also. Few things are more frustrating to young twins than being given one present to "share."


    SEPARATE EXPERIENCES

    While trying to carry out the above suggestions (do not worry if you cannot manage all of them all of the time), you may still be wondering if you should be providing separate experiences for your multiples as a way of helping them develop individuality. There may be some benefit in arranged separations, but they need not be forced before the twins are ready to accept them. If providing outings for one at a time imposes a great financial or logistical hardship on the family, try something simpler, like a five minute special talk-time with each child every morning or at bedtime.

    In some families, each parent takes one twin on brief separate outings at the same time. Sometimes it works for one parent to take one out while the other twin stays home with the other parent. Few young twins understand this, however. They think the one staying home is being deprived or punished. A single parent who has a close relative or friend whom the children know well and are comfortable with might ask this person to babysit one child at a time to provide each one with some special private time with the parent.

    Short periods away from a co-twin give each twin the opportunity to interact directly with an adult or other children, without help, interference or competition from each other. Especially in situations where one twin is more verbal and assertive and routinely expresses needs for the quieter twin, separate times call on a shy child to learn to "speak for yourself." Such experiences can be helpful for the development of language and a sense of individual social competence.

    If arranging separate experiences for your toddlers is difficult for you or upsetting to the twins, do not do it. Physical separation is not what makes people individuals. The important thing is to establish individual relationships with each child, however you can work this out. Acknowledge each one's interests and achievements with smiles and praise, attend to their needs as presented. If they sense that you see them as two separate, different beings, they will learn to see themselves that way, too.


    SEPARATION IN SCHOOL

    The subject of separate experiences and individuation inevitably leads to the issue of placement in school. It may seem logical from what we have said so far that twins are better off in separate classrooms. Indeed, many school administrators still follow a policy of routinely separating twins in kindergarten, regardless of parental wishes, in the mistaken belief that this will promote individuality and decrease behavior problems for the teacher.

    However, the fact is that all twin development research in the past twenty years plus the experiences of thousands of twin families support the opposite conclusion. Twins who are allowed to be together in preschool and as long as they want to be in the early elementary years seem to make a much better adjustment both academically and socially than those who are arbitrarily separated. Four and five year olds are simply not ready to make the transition from home and parents to school and achieve separation from their lifelong companion simultaneously. Twins who are separated too soon become so anxious about each other's whereabouts and welfare that they cannot concentrate on learning and socializing. Once the adjustment to school is accomplished, separation in later grades happens naturally and easily. We have found that the development of individuality in twins is delayed, not enhanced, by too early school separation.


    LET THEM BE THEMSELVES

    In their desire to promote individuality in their twins, parents may encourage or impose differences between the children which do not exist. Identical twins and even some fraternals may have very similar interests and abilities. They should not be deprived of the opportunity to pursue the same hobbies, sports or lessons if that is really what they are inclined to do. Try to support and respect each child's true inclinations as much as possible, however alike or different they may be.

    It is important to realize that attitudes about the value of individuality vary widely across different cultures and that the United States is probably at the extreme in glorifying "rugged individualism." For example, African customs regarding twins celebrate and call attention to twinship in a variety of ways, and Black Americans often continue these traditions by dressing fraternal twins alike for many years and giving them similar names.

    Twins are born into a uniquely close and complex relationship, more intimate, even, than marriage. They probably know more about how to conduct and maintain a long-term relationship than those of us who came into this world alone. On the other hand, the challenge of becoming an independent adult is more complicated for twins than for the rest of us. As we have discussed, parents can help the process along in subtle ways without violating the close bond between their children.

    Reprinted with permission from Twin Services, Parent Education Series 300: #310, 1987. This article may be printed out for personal use but may not be reproduced in any other manner, including electronic, without prior written consent from Twin Services. For more information, call 510-524-0863.






    17 TIPS FOR STAYING SANE UNDER TWIN STRESS
    By Paula Wagner, B.A. and Marilyn Wedge, Ph.D.





    CONCERN: "Sometimes I feel like screaming!" "Some days I feel like throwing my babies away."

    Comments like these are distress signals from frantic mothers of twins. While they may not always feel this way, these mothers have something in common: they are suffering from stress.

    Although the heavy demands of caring for multiples makes parents especially susceptible to stress, there are measures that can help to reduce the strains of double duty. Following are some suggestions that may help you recognize and cope with the physical, emotional, environmental and financial pressures of raising multiples.

    First, just what is stress? The physical, mental and emotional strain or tension that we call stress is the body and mind's way of telling us that we are overloading our coping mechanisms. The mothers quoted above all feel overwhelmed. They may have enough energy and nurturing love to give to one baby, but splitting it among two, three, four or more is more than they can cope with, and they react with a fairly typical "fight or flight" response-they get angry, or they want to escape from the source of stress, their babies.

    They love their babies, but at the times they hate them, too, and these conflicting emotions contribute further to the stress they are feeling. For instance, the mother who unintentionally hits her child too hard because of her anger and frustration then feels intense guilt. And the mother who "feels like throwing her babies away" may really be longing for release from the overwhelming demands of caring for the babies and feeling resentful that her efforts are unappreciated. So, in addition to being physically exhausted, these women may be emotionally drained from feelings of anger, frustration, sadness, guilt, depression or self-pity.

    Though fathers may not express their emotions as readily as mothers, they too may be suffering from stress. It is common for fathers of multiples to feel neglected, somewhat jealous of the attention showered on the babies, and pressured by the extra financial demands. They may, however, be able to escape these stresses in a way their wives cannot-by spending extra hours at their workplace. Unfortunately, this places even more demands on their wives, who need their cooperation and help at home more than ever.

    Whatever the specific cause or response to stress, both parents often experience sinking energy and lowered self-esteem, which make stress doubly difficult to dispel. But as negative as all these reactions may seem, it is very important to realize that they are normal responses to the stress of caring for twins and other multiples. And it is equally important to develop positive coping skills to lighten your double load.





    PHYSICAL STRESS

    In the early weeks and months, a major cause of physical stress among parents of multiples may be lack of sleep and exercise, and irregular meals. Even with sufficient time to rest, handling an around-the-clock cycle of feeding and diapering babies and doing laundry is hard enough, especially if there are other siblings to care for. But trying to do all this while you're deprived of your own physical needs is like losing the oil-drain plug on your car at 60 m.p.h. everything comes-to a screeching halt! While there are no magic remedies for the physical stress of caring for multiples, especially newborns, a first necessity is finding help. Do not be afraid to ask relatives and friends or regular baby-sitters to provide relief. If you are a single parent, you might discover some resources by reaching out to your community services. Remember that it will be easier for anyone to help you if you suggest specific tasks, such as feeding or bathing one of the babies, taking them out for a stroll, shopping, cleaning the kitchen, or preparing a meal.

    Other helpful coping techniques include taking naps when getting a full night's sleep seems impossible, or eating small, more frequent meals when there's no time to prepare a full meal. Although resting when the children are napping may mean sacrificing the satisfaction of "getting things done" you'll be rewarded with renewed energy. And it is possible to maintain good nutrition with frequent snacks of cheese, raw vegetables and fruits, whole grain sandwiches, eggs or soup.

    Just do not fall into the trap of relying on coffee, cola and junk foods high in sugar and fat to keep yourself going. Adequate vitamin intake, especially of the B-complex vitamins, has been linked to stress reduction, but beware of substituting supplements for balanced nutrition.

    Physical exercise may not appeal to you when you are exhausted, but regular activities such as a walking, jogging, stretching, yoga, swimming, bicycling and aerobics can actually be energizing. Meditation also can reduce stress and increase your energy level. Whatever you choose, make it something you enjoy, rather than just one more obligation, and try to keep the emphasis on relaxation and realistic expectations. Then make a "sacred" time for that activity on a daily or weekly basis. With appropriate exercise, you may find your sleep and appetite improving as well as your energy level.





    EMOTIONAL ISSUES

    Physical exhaustion often translates into emotional stress. When parents feel depleted but children's demands are on-going, depression, irritability, and a sense of inadequacy are common responses. The mother of twins who says, "I would feel great if only I could get out or get some sleep," will probably feel the emotional doldrums lifting when her physical needs are met. But sometimes the stress of caring for multiples can call into question emotional issues that run deeper. If parents assume they should always feel boundless "natural" or "instinctive" love, they may experience self-doubt when the demands of young children exceed their emotional supply, according to a counselor who works with mothers of twins. She says it is not unusual for parents of multiples in this situation to experience a guilt-laden secret wish for a single child instead.

    The mother whose self-image is modeled on Superwoman may also be a high-stress candidate. The Supermom of television advertising may be able to handle all crises perfectly at all times, but such expectations in real life are usually a recipe for disaster, especially with multiples. When the demands of twins upset fixed schedules and efficiency, a "Supermom" may find herself resenting her children for "sabotaging" her best-laid plans. If her idea of being a good mother means always being well-organized and in control, loosening her grip may seem like losing a precious part of herself.

    Adjusting unrealistic expectations to fit reality can help ease such emotional stresses as the ones just described. While to acknowledge one's own limits may at first seem like admitting failure, reaming this skill is a key to coping with twins and other multiples. However, if you are experiencing persistent problems, you might want to talk to a counselor about how to handle the stress of parenting multiples.

    Finding time to be alone-to rediscover oneself apart from the roles of mother, father, wife, husband, provider, cook or housekeeper-is essential in reducing emotional stress of any kind. As soon as parents and children feel comfortable being away from each other, it is wise to arrange periods of separate time. Perhaps parents can relieve one another, or exchange services with friends or family to get some respite time. If you can afford it, paying for childcare is well worth the cost.

    Allowing someone else to care for you is a well-deserved way to alleviate the stress of constant nurturing. One mother of twins found that the relaxation of a regular massage and trip to the hairdresser made her feel "mothered." Being waited on at home or in a restaurant can have a similar effect. Whatever the activity, you do not need to justify such self-nurturing when you are meeting the double demands of multiples!

    Many parents of multiples say their greatest resources are flexibility, humor, endurance and, again, the ability to ask for help. The support of friends, family, playgroups, sitters or community services can be an emotional lifeline as well as a source of physical relief. Often, just talking with other parents of twins, either informally or in a support group, provides emotional release and a chance to exchange useful tips. Even if problems differ from family to family, it is comforting to know you are not alone.





    ENVIRONMENTAL PRESSURES

    Although the environmental stress of parenting multiples may be less obvious than the physical drain, it too takes its toll. The arrival of any new baby often results in more cramped living space, increased noise and constant interruptions. Even rural serenity can close in on new parents when their nearest neighbor is 20 miles away. But magnify these common parenting stresses by the arrival of twins or more, especially if there are other young siblings close in age, and you can see how parents can quickly feel trapped. Fortunately, many of these stressors are controllable. You can cut down interruptions by unplugging the phone or using an answering machine during mealtimes and naps. Limit TV time or move the tube to another room if you find it irritating - do not overexpose yourself to the world's crises when you are in the middle of your own. But do choose your own time to keep up on outside events so you will not feel entirely isolated.

    Some simple checks of your home can avert disasters-waiting-to happen. When toddlers are around, that dangling phone cord, an iron left on, sharp objects and spillables are invitations to accidents and their resulting stress. One way to minimize such hazards is to make a habit of finishing one task before starting another. In short, by controlling some of the potential stressors, you will increase your sense of well-being and your confidence for other challenges.





    FINANCIAL BURDENS

    Financial pressures further complicate life for parents of multiples- two or more babies simply cannot live as cheaply as one! Parents can economize, however, by having twins share such big items as cribs during early infancy, buying quality used equipment and clothing, and swapping outgrown items with other families. The financial burden cannot be completely solved by efforts to economize, however. Parents must still buy multiples of many things. In addition, child care costs more and is hard to find. This presents a special dilemma for the woman who would like to continue a career. Although the family may desperately need a second paycheck, her potential income may barely justify the costs, and she is needed just as desperately at home. In such a situation, women experience tremendous conflict. Fathers need to be sensitive to these issues when the double load of mothering makes their wives feel as if they are losing out on both worlds.

    Practical options in this Catch-22 are difficult to come by, but realistic financial planning can sometimes reveal solutions that relieve worry. A first step before deciding to return to work is to weigh the dollars-and-cents gain against all expenses, including the hidden cost of stress on family members.

    Whether or not mothers hold paid jobs, the sharing of housework and childcare seems to be the greatest point of contention in most households. One way to make your endless unpaid labor more visible is to make up a daily list of all the household chores, from shopping to vacuuming, to feeding the babies and running the dog. Then either assign chores to each able family member or let them choose their own. The checklist provides a sense of accomplishment for everyone as well as a more equal distribution of labor.

    One vital stress reducer is getting recognition for one's work, regardless of its nature or whether the family roles are traditional or nontraditional. A simple "thanks for trying" to the parent on night duty goes further and accomplishes more than criticism, even when your babies are still wailing at 3 am.

    In fact, showing appreciation for each other's efforts and sensitivity to each other's needs helps make all the other stress more bearable. At times, of course, even the best stress-control techniques may seem of little use. As one harried mother remarked, "It is hard work to relax!" Much as we might wish, there are simply no instant formulas for perfect peace of mind. But the process of discovering what works for you and your family can transform stress into strength and trauma into triumph.





    STAYING SANE - 17 DO'S & DON'T'S

    DO

  • Schedule a consultation with a counselor experienced with twins and multiples.

  • Ask for help from friends, relatives, sitters, community services and other families with multiples.

  • Sleep whenever you can.

  • Eat well.

  • Get regular exercise. Try walking, jogging, swimming, yoga, aerobics, dancing, or anything else you enjoy.

  • Take "sacred" time for yourself, on a daily or weekly basis.

  • Keep expectations realistic and flexible.

  • Finish one task before starting others.

  • Trust yourself.


  • DON'TS

  • Isolate yourself at home.

  • Depend on drugs or alcohol.

  • Blame yourself or your partner for feelings of stress.

  • Try to be a Supermom, striving to cope with everything all alone.

  • Sacrifice fun and enjoyment for the sake of perfect efficiency.

  • Use your "sacred time" to do chores, errands or grocery shopping.

  • Expect your needs to be magically met without asking.

  • And DON'T GIVE UP!





  • Reprinted with permission from Twin Services, Parent Education Series 200: #230, 1986. This article may be printed out for personal use but may not be reproduced in any other manner, including electronic, without prior written consent from Twin Services. For more information, call 510-524-0863.






    TWIN FATHERS NEED HELP TOO
    By Jean-Marie Knudsen, MSW and Catherine Girardeau





    CONCERN: Most calls from parents to the Twinline are from expectant and new mothers of young twins. They speak of feeling isolated, overwhelmed, and exhausted from lack of sleep because of giving the constant care their multiples demand. All these are serious difficulties - caring for twins is often too much for one person.

    Fathers call less often than mothers, but they too need someone to turn to with their feelings of inadequacy as parents or providers, their exhaustion from long hours and little sleep, and possibly their own mixed feelings about being parents of twins.


    Fathers' reactions to the event of twin birth range from ecstasy to depression. Some fathers learn gradually to adjust to life with their young twins, but have a rough time coping in the beginning. A number of physical, psychological, and sociological factors affect their ability to adjust.

    According to Fathering Multiples, "The sheer number of hours necessary to care for two or three babies interrupts the couple relationship for first-time parents, and astonishes fathers who have had only single baby experience. As one father put it, I gained two children but lost my wife, and I did not particularly like this zombie who looked like her but had no time for me or our marriage. It took me about three weeks to realize that if we were to keep our marriage intact, I had better pitch in and be a partner. Once that brilliant thought was turned into action, I became a zombie too, but at least now we were a matched set again!"

    This change in the couple's relationship may be one of the most difficult adjustments for first-time parents. According to one mother of one-month-old twins, who was interviewed by Canadian researchers Beverly and Arnette Anderson, "My husband and I are looking at each other in a completely different light as we adjust to our new roles as parents. Now I see him as a father first, and my husband second, and I am sure he is seeing me in much the same way."

    When both parents are under the extreme stress of meeting the demands of two or more infants, even those who felt a very supportive relationship with their partner may begin to feel that support system breaking down from the wear and tear of caring for two babies. Peter, now the proud father of ten-year-old twins, says, "I cannot believe we all made it. I thought my wife and I had a few problems before the babies, but when the twins hit, so did everything else. Suddenly we had no time for each other or anything but babies - and neither of us slept more than two hours a night. It was incredible."

    The stress of having twins can exacerbate any difficulties that already exist between the parents. In addition, "Fatigue, and the imminent possibility of a baby or two crying, often leads to a reduction in sexual activity after twins. It took time, patience, communication, and a sense of humor to get most couples through this period" (Double Feature: 8:1).

    In addition to pressures at home social pressures can contribute to fathers "twinshock." For one thing, extended families are not around as they were forty years ago. Without grandparents, uncles and aunts on hand to help with childcare and household duties, it's up to the father alone to hold up half the sky at home. Sometimes the father is the only one available to help with the babies, and it is often his help that means the most to the babies' mother. Eight out of ten mothers of month-old twins interviewed in the Anderson study said that they appreciated their husbands' help with baby care more than any other help they received.

    But in most families the father's time and energy are divided between home and work. Add to the sudden tightening of finances that two, three, or more new babies bring, the fact that most employed mothers need a-long maternity leave (which is often unpaid), and you can imagine the kinds of financial pressures dads might feel. To further increase the burden, the high cost of childcare for twins often makes the mother's return to work economically impractical. So the father is often caught in a double bind: feeling that he needs to be fully involved at home and, at the same time, that he needs to work more to make money to support the family.

    There are few societal supports for new parents: Paternity leave is rare, if it exists at all, and maternity leave is usually unpaid. People in general and employers in particular do not tend to be sympathetic to the needs of fathers or of multiple birth families. Both parents are under extreme stress for the first months: The mother spends all day and evening caring for the babies; the father works at his job all day and helps with the babies in the evening, and neither parent gets much sleep. Says one well-rested father of five-year-olds, "l could fall asleep anywhere during the first three months - unfortunately even at work, standing up in a meeting!"

    Even experienced fathers with other singleton children undergo twinshock. Adjustment to multiples may be especially stressful for this group, because they have been parents before and are stunned by how much harder it is with twins, especially during the infant stage. The need for the couple to be co-parents is acute in the first months with newborn multiples, the father may find himself deluged with much more responsibility for infant care, household chores, care of siblings, and finances than he had with his singleton(s).

    The most critical time in the early months with multiples is when the father realizes he must become an equal co-parent; if he is not able to accept this challenge, he often bows out of the family picture emotionally or physically (although there are cases in which the father is the one abandoned). Unfortunately, in so doing he overlooks the fact that his partner may also be overwhelmed; but does not have the choice of "running" from the situation (Double Feature, 8:1).

    A typical scenario is this: New babies arrive, both parents feel overwhelmed, father responds by working longer hours and/or neglecting mother and babies, and feels guilty about it. This initial guilt reaction can set the stage for either the father's further involvement with, or disassociation from, his family as a co-parent. "I felt like I was going crazy," says George, a father of undiagnosed twins, who experienced severe twinshock. "I would come home from work every night to find the house a mess and my wife in tears, and have two screaming babies thrust into my arms. I started working later and later, and tried to stay out of the house on weekends."

    While this kind of situation is a temporary stage for most families that experience it, the father who can't find a way to cope effectively with his stress runs the risk of losing an opportunity for connecting with his children, as father, and his partner, as co-parent.

    Twinline continues to encourage and welcome fathers of multiples to use all our services and to let us know about their experiences.

    "Being a father of twins is not easy, but it has its rewards," said one dad. "There is nothing like coming home from work to have two chubby faces and two sets of chubby arms held up to me, pleading, 'Daddy, hold you! Daddy, hold you!"

    In the words of a Nigerian father, "Twins are a hard happiness."





    Reprinted with permission from Twin Services, Parent Education Series 200: #240, 1985. This article may be printed out for personal use but may not be reproduced in any other manner, including electronic, without prior written consent from Twin Services. For more information, call 510-524-0863.






    TWIN BIRTHS RISING: SO IS PARENTAL STRESS
    By Jennifer Steinhauer
    "When Babies Come in Twos" The New York Times, November 29, 1999, A25





    A significant rise in the use of fertility treatments has largely contributed to a 55 percent overall increase in the births of twins since 1980, according to figures from the National Center for Health Statistics.

    Women who become pregnant with twins are automatically put into a high risk classification by their doctors and require more monitoring and appointments. They often have more emergencies. It is not uncommon for women pregnant with twins to require bed rest or very curtailed activity.

    Many parents of twins have gone through years of fertility treatments and there is a slightly higher incidence of twins among older mothers.

    Parents, usually mothers, tend to seek out parents of other twins for support, especially in the early months. Equipment is traded and stories shared. Everyone in the same boat has felt the painful pull of one child's cry while the other one is nursed, bathed or diapered. Many parents of twins say they feel out of sync with parents who have single children and say they often feel unwelcome at play dates because twins can be too overwhelming for other families.

    Parents of twins do say that things get easier, especially when their children develop a symbiotic relationship. While raising twins can be stressful, parents say that it is also a wonderful experience.





    HELPFUL LINKS

  • Twin Birth: UK Midwifery Archives

  • Twin Homebirth Story

  • Cope: Support For Mothers of Twins & Multiples, Natick, MA

  • Twinstuff.com: Twin Store With Personalized Items For Twins


  • HELPFUL BOOKS FOR FURTHER READING:

    Having Twins: A parent's guide to pregnancy, birth, and early childhood"
    The Art of Parenting Twins: The Unique Joys & Challenges of Raising Twins & Other Multiples
    Mothering Twins: From Hearing the News to Beyond the Terrible Twos
    Raising Twins: What Parent Want to Know (And What Twins Want to Tell Them)




    MoonDragon's Pregnancy Information: Chance of Having Twins
    MoonDragon's Birthing Guidelines: Unexpected Twins





    PREGNANCY RELATED LINKS

    MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
    MoonDragon's Pregnancy Index
    MoonDragon's Womens Health Information: Pregnancy Index
    MoonDragon's Pediatric Information Index
    MoonDragon's Parenting Information Index
    MoonDragon's Nutrition Information Index





    HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS

  • MoonDragon's Nutrition Basics Index
  • MoonDragon's Nutrition Basics: Amino Acids Index
  • MoonDragon's Nutrition Basics: Antioxidants Index
  • MoonDragon's Nutrition Basics: Enzymes Information
  • MoonDragon's Nutrition Basics: Herbs Index
  • MoonDragon's Nutrition Basics: Homeopathics Index
  • MoonDragon's Nutrition Basics: Hydrosols Index
  • MoonDragon's Nutrition Basics: Minerals Index
  • MoonDragon's Nutrition Basics: Mineral Introduction
  • MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index
  • MoonDragon's Nutrition Basics: Dietary Supplements Introduction
  • MoonDragon's Nutrition Basics: Specialty Supplements
  • MoonDragon's Nutrition Basics: Vitamins Index
  • MoonDragon's Nutrition Basics: Vitamins Introduction


  • NUTRITION BASICS ARTICLES

  • MoonDragon's Nutrition Basics: 4 Basic Nutrients
  • MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients
  • MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute?
  • MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods
  • MoonDragon's Nutrition Basics: Foods That Destroy
  • MoonDragon's Nutrition Basics: Foods That Heal
  • MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals
  • MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods
  • MoonDragon's Nutrition Basics: Phytochemicals
  • MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce
  • MoonDragon's Nutrition Basics: Limit Your Use of Salt
  • MoonDragon's Nutrition Basics: Use Proper Cooking Utensils
  • MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water




  • RELATED MOONDRAGON HEALTH LINKS & INFORMATION

  • MoonDragon's Nutrition Information Index
  • MoonDragon's Nutritional Therapy Index
  • MoonDragon's Nutritional Analysis Index
  • MoonDragon's Nutritional Diet Index
  • MoonDragon's Nutritional Recipe Index
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