Having Twins And More: A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood

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9780618138739: Having Twins And More: A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood

Now in a third edition, the best-selling guide on multiple births, Having Twins And More, covers everything from conception through childhood.

With ongoing advances in assisted reproduction, increasing numbers of women are having twins, triplets, and more, and they're having them later in life. Having Twins And More is the original source parents consult for guidance through the multiple birth experience.

For three decades Elizabeth Noble, a respected name in the field, has provided expectant parents with everything they need to make informed, safe choices and give birth to healthy babies. This comprehensive handbook emphasizes optimal health as well as physical and emotional adjustments to bearing and raising multiples, and it offers striking new insights into risks, complications, and treatments—candid information that is gathered only in this book.
 

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About the Author:

Elizabeth Noble is the author of seven books, including Essential Exercises for the Childbearing Year, Childbirth with Insight, and Having Your Baby by Donor Insemination. She is the founder of the Obstetrics and Gynecology Section of the American Physical Therapy Association, and of the Maternal and Child Health Center in Cambridge, Massachusetts.

Excerpt. © Reprinted by permission. All rights reserved.:

Introduction

Thanks to the ongoing interest and support of you, my readers, this book
has been published in multiple editions! Almost a quarter-century has passed
since I was first asked questions about twins I couldn"t answer, and I
promised I would research the topic for those couples. In the late 1970s, I
found not a single book for parents expecting multiples; and back then
triplets and higher-order multiples were infrequent. What a huge difference
today with a daunting array of resources, especially on the Internet!
The research I undertook in the 1970s for the first edition of this
book convinced me that many problems can be prevented or alleviated by
optimal prenatal care; that is, by the mother"s commitment to a vigilant
program of nutrition, hydration, exercise, rest, and education. In the
decades since the first edition, evidence has continued to mount in support of
this view. The focus of Having Twins — and More, then and now, is on the
physiological and psychological dimensions of the experience. Learning
how mothers successfully carried normal-birth-weight babies to term
empowers other women to do the same. Such mothers can still be found
despite the preoccupation with pathology that has occurred with the
medicalization of childbearing in general, and of multiple pregnancies in
particular.
This ever-increasing medicalization is a direct result of the focus
on potential problems in litigious societies and has undermined women"s
confidence in their ability to give birth. Blood plasma volume expansion
(causing low hemoglobin levels), hypertension (increasing arterial blood
flow), and altered glucose tolerance (making more carbohydrate available for
the babies) should be interpreted as signs of successful placental activity,
not disease processes! Yet expectant mothers (especially of multiples) are
aggressively treated for anemia, high blood pressure, and gestational
diabetes!

Prevention Is the Key: Health Care Is Self-Care

The privilege of working with childbearing couples for more than thirty years
has helped me to clarify what is important. In this book I tackle, rather than
avoid, controversies, without the usual suggestion that readers consult their
doctors. As an independent observer, I am not obliged to be politically
correct in order to obtain grant money or to keep an academic or clinical
position.
Being pregnant today, especially if "high risk," is full of challenges
that our grandmothers never considered. More than ever, parents need to be
thoroughly informed and empowered to make choices and take
responsibility for their decisions. They need guidance right from the start to
face confidently the months and years ahead.
One of the drawbacks of gaining knowledge and insight is that
feelings of reproach and guilt can emerge over prior events. "If only . . ." is a
natural, though not a constructive, reaction. When natural childbirth, breast-
feeding, and genital integrity, for example, are endorsed, mothers who did
otherwise may become regretful. Therefore, many health care professionals,
in the well-intentioned attempt to spare women such feelings, fail to
recommend unequivocally the practices that are clearly best for mother and
babies. I call this the "white bread" philosophy. To explain with an example:
whole grain bread is healthier than white bread, but it is not widely available.
Therefore, let us reassure the people who get the inevitable white bread in
the store, restaurant, hospital, airplane, and school that it is just as good.
This type of philosophy promotes mistaken ideas about pregnancy and birth:
bottle-feeding is the equivalent of breast-feeding, the "abdominal birth canal"
(Caesarean section) is just another way to give birth, and bed rest, like
white bread, must be acceptable if so many people partake of it! Such
reassurances have back-fired; outcomes have worsened as interventions in
pregnancies and births have increased, and breast-feeding remains a low
priority in our society. Mothers end up feeling guiltier than ever!
It helps to explore all possible facets of any health challenge and
to resist suggestions that a problem is "all in the mind," when the evidence
is clearly in the body! Such exploration may include the study of
complementary holistic therapies that address physical, mental, and
emotional aspects of childbearing. In her book Molecules of Emotion,
research scientist Candace Pert showed how a single thought can set off a
chain of reactions throughout the body. Evidence has convinced me of the
value of natural remedies such as homeopathy and herbal supplements
along with visualization and affirmations for treating both the emotional and
physical aspects of some medical problems.
According to the Food and Drug Administration (FDA), during the
five years spanning 1993 to 1998, federal, state, and local agencies
reported a total of only 184 deaths from using herbs and supplements (most
of which were associated with weight loss formulas). Contrast this with the
figures for pharmaceuticals, discussed below, which are responsible for
almost 100 times more deaths annually!
Nutrition remains paramount. A builder cannot construct a house
without all the supplies, right down to specific screws and nails. If extra
rooms are added, more supplies are needed. Amultiple pregnancy is the
same. A contractor hires subcontractors; parents of multiples need to
assemble a team of helpers who will optimize the outcome.

The Nocebo Effect: The "Evil Twin" of the Placebo Effect

The attitude of a health care provider that something is wrong and needs to
be fixed leads to anxiety and stress. Nocebo effects refer to symptoms that
occur when the suggestions, instructions, and expectations are negative, in
contrast with placebo effects that occur when intent and expectations are
positive.
Stress affects women in all walks of life, especially those who are
poor, hungry, beaten, or isolated, for example. However, anxieties about the
pregnancy, and especially an unplanned one, have been shown to be more
serious stressors for the unborn babies. We must realize the role of stress
as a cause as well as an effect in pregnancy complications.
Affluent expectant mothers may be exposed to more prenatal
anxiety because they can afford perinatologists and the latest fetal
surveillance technology. They receive a heavy dose of the nocebo effect
when maternity care providers anticipate problems. One woman felt as
though she had contracted a rare disease when her family doctor referred her
to an obstetrician.
Countless women can attest to the nocebo effect from the
disclosure of the multiple pregnancy or the genders of their multiples. For
example, triplets are seen on an ultrasound scan and the doctor enters the
room to talk about selective fetocide. Or the technician announces, "I"m
sorry to say, four boys." Many couples have felt their panic thermostat rise
because of an unclear test result, even when everything turns out to be fine.
New research in genetics has turned some of our theories around.
First, the Human Genome Project showed that we have only 34,000 genes
(experts had anticipated three times as many!). Also surprising was the
discovery that cells cannot program themselves: influences that switch
them on or off come from the environment. Ninety-five percent of us come into
the world with an intact genome permitting a healthy life. The causes of
disease in this majority have not been studied as intensely as have the
defective genes in the other 5 percent.
Furthermore, scientist Bruce Lipton"s research ("uncovering the
biology of belief") has shown that it is not just the environment that has an
impact on genes but a person"s perception of that environment that
determines the kind of change that unfolds. The mother is the mediator of
the world outside and transmits her perceptions to the unborn babies. Her
perceptions, of course, are learned behaviors due to perceptions and beliefs
programmed at the beginning of her life by her mother and others.
Perceptions experienced by unborn babies affect their
development and function. The babies are awash in the biochemical brew of
their mother"s emotions. These regulators cross the placenta and affect the
same target systems in each baby as in the mother. The development of
the fetal tissues and organs depends on the amount of blood received. A
mother experiencing chronic stress will impair her unborn babies" growth and
immunity. The hormone cortisol, secreted by the adrenal glands under
stress, is known to inhibit fetal growth.
Expectant parents of multiples need the facts on which to base
their decisions. By discussing complications and the associated medical
interventions to help parents make an informed decision, I do not
necessarily imply endorsement. I have played devil"s advocate wherever I
believe safety and efficacy are questionable. Evidence-based practice is the
standard today, but studies of pregnancy and birth are frequently retroactive.
In most cases, evidence-based practice is driven by the
pharmaceutical industry because of the ease of randomized controlled trials
(RCTs) with a pill versus a placebo. However, RCTs are often difficult,
practically and ethically, with pregnant women. For example, how could
adequate nourishment be deliberately withheld in order to show that
nutrition has important benefits for mothers and babies? (For that "data" one
looks to pregnancy outcomes during famine.)
There is an impressive amount of clinical experience on nutrition
from the work of Higgins, Brewer, and Luke, and it is on those grounds that
I base my recommendations, risking criticism of "insufficient data" by those
who accept only the stringent methodology of RCTs.
Another issue is quantitative versus qualitative obstetrics. The
medical profession and insurance industry are increasingly invested in
numbers — arduous paperwork documenting size, ratios, monitoring strips,
and other test results — further driven by evidence-based practice. This
preoccupation overlooks the effect of the "soft data" — psychosocial
influences — which can be measured quite well. However, while total life
stress score measures alone have been insufficient to differentiate increase
in obstetrical complications, preterm birth, or growth retardation, prediction
is possible using perceived life stress. Lewis Mehl-Madrona, M.D., published
a study in the Fall 2002 issue of the Journal of Prenatal and Perinatal
Psychology and Health. The research found that such factors do influence
birth complications and that complications could be reduced if attention
was paid to a woman"s fear of birth and lack of support from her partner.
Scrimshaw at the United Nations University Food and Nutrition
Program warns that psychological stressors cause metabolic responses
that are qualitatively similar to those observed with infections. Infections, no
matter how mild, increase catabolic nitrogen losses and divert protein for
the synthesis of immune proteins. Loss of appetite is an early characteristic
of acute infections, even before they are obvious. These issues are critical in
the outcome of multiple pregnancy.
Regrettably, it is the rare clinician who has the time to help
pregnant clients feel heard and respected as they describe their lives (which
is where midwives and doulas can play a critical role). Women who were
screened for psychological issues, once each trimester, were found to be
50 percent less likely to have a low-birth-weight or preterm baby.
A recent Japanese study found that one of the significant
indicators of high maternal attachment to the unborn child was the
statement by mothers who starting planning in pregnancy: "I plan the things I
will do with my baby." For mothers of multiples, it is hard to imagine life with
two or more babies, let alone plan for it, but this is a critical task discussed
in this book. Almost half of pregnancies are "unintended."
My focus is on strategies for prevention. For this book, I read
hundreds of studies and I quote from many of them, but I know that in a few
years any or all of them could be contradicted by other studies. (Such was
the case, for instance, with the controversial association between oral
contraceptives and twinning.)
Alternative health strategies are rarely acknowledged or used by
the medical establishment. Understandably, research into natural remedies
and one-on-one consultation are more time consuming than simply
prescribing one of the readily available products of the pharmaceutical
industry, even if the evidence fails to justify their use. In modern society, the
popular view is "better living through technology, drugs, chemicals" and
usually the conception, pregnancy, and birth of multiples reinforce this
position.

The Dangers of Drugs

A 1998 article in the Journal of the American Medical Association
estimated that more than 2 million people require hospitalization per year
because of the adverse side effects of drugs. Deaths due to prescribed
pharmaceutical drugs total more than 100,000 annually. The number of
patients killed in hospitals because of "medical errors" adds up to another
100,000 or so, according to the American Medical Association. Burton
Goldberg points out that "the ordained guardians of our health kill as many
people every week (in hospitals alone) as died in the September 11 terrorist
attacks."
The Physicians" Desk Reference (PDR) — the "pharmaceutical
bible" used by physicians — is compiled from information submitted by the
drug manufacturers themselves! The FDA approves drugs by reviewing such
studies, not by actual testing. Only two studies showing satisfactory
results are required for FDA approval, despite the existence of other studies
in greater numbers showing adverse reactions. Goldberg warns that many of
the articles published in medical journals discuss the efficacy of a drug in
studies paid for by the drug manufacturer. Physicians, academics, and
scientists are often listed as lead authors to lend credibility to such papers.We must remember
that multiples were all born at home and breast-fed in the old days! Today
many women are confined to bed and pumped full of various drugs, only to
deliver a few days later babies who will spend weeks or months in the
neonatal intensive care unit (NICU). Some mothers eke out a few extra
days, or occasionally weeks, of pregnancy under great duress.
So much more needs to be available to parents who are strugg

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