Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women — including those who are carrying twins, according to guidelines released this week by The American College of Obstetricians and Gynecologists (ACOG).  This is great news for women expecting twins.  Previously, VBAC was not recommended for women carrying twins although there were no conclusive studies to suggest that twins posed a higher risk. 

In fact, VBAC was often not recommended for many women, and the rate of C-sections in the United States had risen significantly over the past four decades.  In the 1970’s, the C-section rate was about 5%, but by 2007, it was up at a whopping 31%.  One reason for the increased rate of C-sections was due to insurers, doctors, and hospitals opting for a repeat C-section rather than attempting a trial of labor after cesarean (TOLAC).

TOLAC and VBAC do present some added risk.  If uterine rupture occurs (between 0.5% and 0.9% of the time), it is an emergency situation that can cause serious harm to a mother and babies.  For this reason, TOLAC and VBAC should only be undertaken in a hospital where an emergency C-section can be performed in the event of complications.

Patients and doctors will need to work together on a case by case basis to determine if TOLAC and VBAC are appropriate.  New moms having twins should do their research and come prepared for a discussion with their OB/GYN about the possibility for VBAC with twins if that is their desire.  Patients who encounter doctors that won’t even consider VBAC for a twin pregnancy should consider moving to another doctor.  While there may be very valid reasons why a VBAC is not appropriate for your particular twin pregnancy, you should expect your doctor to cover those reasons with you in detail rather than rejecting the option out of hand.

These new guidelines will provide women expecting twins with more options than were readily available previously.  And when you’re having twins — your options are often limited and out of your control.  So bringing back options is always a good thing.  And reducing the number of “automatic” C-sections is a good thing.  Hopefully these guidelines will help to reduce the overall number of C-sections being performed in the United States.

Source:  The American College of Obstetricians and Gynecologists, “Ob-Gyns Issue Less Restrictive VBAC Guidelines“, July 21, 2010.

Copyright 2010 Kathryn Whiteley — TwinParenthood.com

Having twins and multiples means more of everything — including morning sickness. The majority of all pregnancies experience nausea to some degree, and that increases with each additional baby in the mix.  The severity of the nausea is also increased with each additional baby.

Pregnancy nausea is usually attributed to the increased hormones during pregnancy. Many of these hormones are produced by the placenta. So, when there is more than one placenta (as in many twin pregnancies), more of these pregnancy hormones are produced — causing increased nausea.

“Morning Sickness” can occur at any time of day, but is often associated with the morning because it can be more strongly felt with an empty stomach. In addition, a twin pregnancy can put more pressure on the tummy — increasing nausea.

One little trick to help with this is to keep crackers or a banana at your bedside. When you get up in the middle of the night to use the bathroom (as pregnant twin mamas often must do), eat a little bit. It is healthy for you and your babies — and will help reduce the morning nausea.

Increased nausea is one of many signs that you might be having twins.

Do:

• Eat small meals often
• Take a nap and get plenty of rest
• Learn your particular triggers and avoid those foods and smells that increase your nausea
• Dress in layers so you can peel off if you get too hot (feeling too warm increases nausea)
• Drink lemonade, eat watermelon, or something with ginger — as these help reduce nausea
• Exercise (but talk to your doctor about the amount and type that would be appropriate for your twin pregnancy)
• Eat salty potato chips
• Consult with your doctor — keep your doctor informed of your level of nausea (too much naseua can indicate a problem)
• Eat healthy with lots of protein

Don’t:

• Do not drink a large amount of fluids with meals
• Do not lie down after eating
• Do not skip meals
• Do not cook or eat spicy food

While morning sickness in a twin pregnancy can be more severe and can last longer into the pregnancy, it is survivable — as is just about everything twin related.  Take it one day at a time, and your little sweethearts will be here before you know it.

Did you or do you have morning sickness with your twin pregnancy? Any tips for coping?

Copyright 2010 Kathryn Whiteley — TwinParenthood.com

One fun aspect of parenting twins is choosing twin baby names. Some parents agonize over the decision — while some have no trouble at all. There are several philosophies to choosing twin baby names (or, as we we like to call them “twinfants” names). But, you need not worry, no matter your philosophy, you’ll eventually settle on something that will be perfect for your little sweethearts.

How to Choose Baby Names for Twins

1. Family Names.  Some parents of multiples will use the opportunity to honor those special to the family (family members, ancestors, friends).  This is a great chance to do that as there are multiple children, and thus multiple names  – so that you do not have to choose which family member to honor first. 
2. Same Initials.  Another option is to name the babies so that all the names in the twins, triplets, or higher order multiples ”set” begin with the same letter.  Some examples:  Aiden & Addison, Brandon & Bryon, and Jacob & Joshua.  Thinking ahead, one pitfall to naming a set of multiples with the same initials is for labeling possessions such as clothing, sippy cups, etc. If they all have the same initials — you’ll have to do a bit more writing.  But, this is a minor inconvenience and may not deter you if you like the idea or the sound of the names together.
3. Birth Order.  Typically hospitals will assign a letter to your babies as they are born (A, B, C, etc.).  Multiples parents have been known to stick with the letter assigned to each.  Examples: A-Abigail, B-Brenden, C-Caleb, etc.
4. Sound Alike or Rhyming.  Many sets of twins are named based on similar sounding names.  Some popular examples: Jayden & Jordan, Ethan & Evan, and Taylor & Tyler, or rhyming names Zoe & Chloe.   Parents need to be aware, though, of a danger with rhyming names. Outside of the immediate family, it can already be difficult to distinguish between identical twins. Having rhyming names can add to the difficulty and be frustrating to teachers and other significant players in your twins lives.
5. Meaningful Names.  Twins are often named to reflect family values or are symbolic in some way to the family.  Examples: Faith & Hope, Jacob & Joseph, Austin & Denver.  Or, maybe you’ll want to choose names that have a similar or complimentary meaning in another ancient language.  Examples: Duke & Dean (which both mean “leader” in French).
6. Complimentary or Harmonious.  Sometimes we just like the way the names sound together. It is appealing the way the twins’ names roll off your tongue. For instance: Madison & Morgan, Olivia & Sophia, Ava & Emma.
7. Same Complexity.  Twin names often sound better together when they have the same number of syllables.  For example, Jessica & Samantha, and Tom & Jo.
8. Stand Alone. Probably the easiest method of all is to simply choose names that you like, and don’t worry about how they sound together. Some would even argue that this is the “best” way to do it because it promotes individuality.

Many resources can help with choosing names for your twins. Tons of books of baby names have been written over the years, and many baby related website have lists and pages of baby names.  One such resource that I think is especially helpful is the Social Security Administration’s list of Popular Baby Names and Popular Names of Twins.  These lists are updated annually, showing the most popular names for the prior year.

Try on names for a while. Write them out. Then, ask friends and family what they think.  But, if you’re like me, maybe you want to keep the names a secret among your friends and family.  If so, another great option is to ask for advice from online twins communities and/or twins support groups. Many great communities exist and typically, your friends and family are not members.

Finally, it is important to keep in mind that no matter what names you choose for your twins, triplets, or higher order multiples, there will always be those that think you should have chosen something else. Most people will be supportive, but there will be those that will be insistent in presenting their “perfect” names for your little ones.  Take it all in, mull it over, and above all, just have fun finding your perfect names.

Copyright 2010 Kathryn Whiteley — TwinParenthood.com

Expecting Twins?

Learning that you are expecting twins is both exciting, and a little frightening. Most parents expecting twins really have no idea what to expect. From the pregnancy onward, you’re in for some big changes.

So, here is the “critical, need-to-know information” about your twin pregnancy:

FACT 1:

Because twin pregnancies are classified as “high risk”, you will receive more ultrasounds and tests than an average singleton pregnancy to ensure the babies (and mom) are staying healthy.

• higher rate of miscarriage
• higher rate of maternal anemia
• higher rate of postpartum hemorrhage (bleeding) after delivery
• higher risk of developing gestational diabetes
• higher risk of preeclampsia (high blood pressure, protein in the urine, and sometimes swelling in feet, legs, and hands)
• higher risk of preterm labor and delivery

Advice:

1. Seek out an Obstetrician that specializes in high risk pregnancies, or see a perinatologist.
2. Visit your Obstetrician early in your pregnancy, be diligent about keeping all dr visits.

FACT 2:

Your twin pregnancy may leave you with more of the discomforts associated with pregnancy.

• – morning sickness may be stronger in the 1st trimester
• – back aches, heartburn, and sleepless nights might be worse and begin earlier than in singleton pregnancies
• – more spotting can occur
• – Moms pregnant with twins should expect to gain between 35 – 50 pounds

Advice:

1. Get regular exercise, but don’t overdo it — especially later in the pregnancy.
2. Do not underestimate the need for extra rest and sleep.
3. Get a body pillow to use between your knees for more support.
4. Be sure to eat enough to nourish the babies — there will be time to take off the weight later.
5. A small amount of spotting early in the pregnancy without cramping can be normal, but you should still inform your doctor. If spotting with cramping or heavier bleeding or clots happens — seek immediate medical advice.

FACT 3:

Your pregnancy will require “more” of your body’s resources.

• And, you’ll need to eat more, too. You’ll need to eat an additional 500 – 1000 calories per day.  And protein is critical, you’ll need an additional 35-50 grams beginning around week 20. In total, you’ll need about 150 – 170 grams.
• You definitely will need a good prenatal vitamin with iron. Some vitamins/minerals/supplements will require a higher dosage — including folic acid. Talk to your doctor about the proper vitamins and dosage for you.
• The babies will draw calcium out of your bones & teeth if you are not taking enough in to support the twin pregnancy.

Advice:

1. Be sure to ask your doctor about the need for vitamins and supplements.
2. Make a note on your daily calendar when you have taken your vitamins, so that you will not forget.
3. Drink more milk, and eat yogurt, peanut butter, and fish. These provide more protein, and the milk & yogurt add much needed calcium.  Do be careful, though, about the types of seafood you eat, as you’ll want to avoid those species that have been found to be high in mercury. Learn more about the FDA and EPA’s recommendations for pregnant women: http://www.epa.gov/fishadvisories/advice/
4. Eat small meals, but much more often. You might find that you are not hungry — either due to morning sickness, heartburn, or just feeling full because of the babies pressing on your stomach. But, getting enough calories to support the babies is crucial. Eating protein rich foods is helpful.

FACT 4:

Chances are greater than not that you will be put on bed rest at some time during your pregnancy. And, labor/delivery are more likely to come early.

• Most moms of twins go into labor at 36 to 37 weeks (40 is the norm for singletons).
• Bed rest comes in various degrees. It can range from a modified bed rest (where the doctor simply instructs you to get off your feet whenever possible), to strict at home bed rest where you can only get up to use the toilet, to hospital bed rest.

Advice:

1. Have all your baby preparations completed no later than the 30th week of pregnancy (nursery set up, etc.). Even if you are not placed on bed rest, you will likely be too tired to complete preparations much later than 30 weeks.
2. Discuss with your doctor his/her thoughts about working during your pregnancy and if or when you should stop.
3. Drink a lot of water. Then drink some more.  More water is needed to support the increase in volume of blood. Dehydration is one cause of preterm labor.
4. For tips on how to survive bed rest, read TwinParenthood.com’s article, “Surviving Bed Rest in your Twin Pregnancy.”

FACT 5:

You are more likely to have a C-section.

• There is a higher rate of babies in the breech position.
• There is more incidence of “failure to progress” during labor, as the uterus muscles are often too stretched out to muster a coordinated effort.

Advice:

Think about your wishes for your birth plan before you are admitted to the hospital, but plan to be flexible. Don’t go into it saying, “I’ll be so upset if I have to have a C-section.”

FACT 6:

People (even strangers) are more likely to ask you personal, probing questions about your pregnancy. People are just very interested in multiples.

Advice:

Join a Twins or Multiples Support Group or “Club”. No one can relate to a mom pregnant with twins better than a mom who has “been there, done that”.   Also, you’ll be needing to get a lot of “stuff”, but most of it doesn’t need to be new. These groups often have huge sales where you can stock up.  Still unsure? Check out TwinParenthood.com’s article, “Top Ten Reasons to Join a Twins / Multiples Support Group or Club

Try to keep in mind that people are just interested in multiples, decide how much you want to reveal, and always answer with a smile. To see the humorous side of this, read our article, “Out and About with Twins — when does the carnival end?“.

A twins or higher order multiples pregnancy can be a challenge.  But, by seeking advice early, and following the doctor’s instructions, you can ensure the healthiest outcome possible. There is much you can do to prepare for the coming changes in your life. Research at TwinParenthood.com is a great start.

Copyright 2010 Kathryn Whiteley — TwinParenthood.com

What have I missed? I’d love to hear more facts and advice about twin pregnancies from all you twin moms & dads. Please leave a comment.

Expecting Twins? Have Questions?

Today, TwinParenthood.com is very excited to announce a new service available to new parents of twins and those expecting twins.  Starting today, parents expecting twins, or those with twin infants (or as we like to call them, “twinfants”), can submit up to five questions to TwinParenthood.com, and receive a personalized answer.  This new service is free for a limited time.

Your questions can be about anything twin related. 

• Equipment to buy
• Nursery set up
• Bringing twins home
• Sibling Issues
• Pregnancy Questions
• Managing the Nights (or the days!)
• You name it

To submit your questions, please visit our Expecting Twins page.  Hope to hear from you soon!

Bed rest in a multiples pregnancy is very common. Don’t be alarmed.

When you are on bed rest, it is very important to follow your doctor’s instructions. You’ll want to do everything possible to keep those babies in utero as long as possible.

In most cases, your doctor will want you to stop many “normal, everyday” activities.  Some things you’ll want to ask about:

• Picking up older children
• Driving
• Walking
• Stairs
• Shower (or Bath)
• Cooking
• Sitting upright
• Light Chores
• Sexual Intercourse
• Exercise

Make “Bed Rest Buddies”

After gaining an understanding from your doctor about what you can or should not do, you’ll want to connect with other multiples moms also on bed rest. There are some great website communities for women on bed rest. A fantastic resource is sidelines.org. Connecting with others on bed rest can be an emotional lifesaver. Also, often times these bed rest buddies develop into lasting friendships as you and your pals raise your multiples.

Prepare for Bed rest

Set up a bed rest station in your main living area.  Some things you’ll want within arms reach:

• laptop with internet connection
• snacks
• water and other drinks
• pencil / paper
• books and magazines
• TV remotes

What else can you do? 

• Reconnect with friends
• Get Ready for Babies (Pick names, update your financial records – wills, etc.)
• Read Parenting Books
• Craft Projects
• Work (discuss with your employer options for working from home using your laptop or a telephone)

Being on bed rest can be challenging, but it can also be fun. Like many things in life — it is what you make of it. So take a sunny approach and see what you can get accomplished.

Copyright 2009 Kathryn Whiteley — TwinParenthood.com

Many twin and multiples parents worry that they’ll have trouble telling their newborn twins, triplets, or higher order multiples apart.  Often times, even fraternal twins are hard to distinguish. 

And yet, “identical twins” are not completely identical. There are many differences in appearance.  Typically, one twin will be narrower in the face — the other rounder. Some identicals are even “mirror image” of each other. 

The good news is that most parents quickly learn the subtle physical differences between their twins / multiples, and it is mostly friends and outside family that have difficulty.

Still, there are techniques to make it easier for everyone in your multiples’ lives to tell them apart. Having some of these techniques in place will be especially helpful when part-time caregivers come to your aid.

1. Hospital wrist bands. Keep the hospital wrist bands on for a couple of days after returning home.
2. Assigned colors. Assign a color to each of your twins, triplets, or higher order multiples.
3. Dressing in assigned colors. Purchase clothing in the assigned colors and dress each accordingly. It can be fun to dress twins in matching outfits, differing by assigned color.
4. Paint a toenail. An age old, tried and true method to tell newborn twins / multiples apart is to paint a toenail on one or more of the babies (in your chosen assigned color for each, of course). Why a toenail and not a fingernail? When the babies begin to suck their fingers, you can avoid ingestion of the polish.
5. Color code your charts. If you keep charts for tracking feedings and sleep schedules, highlight each infant’s chart with their assigned color. (Check back for a future article on the subject of charting your infants’ schedules.)
6. Color code your cribs. Choose bedding in the matching assigned colors, and place colored labels with their names over the cribs. If they share a crib, always place each infant under their name on either the left or right.

When our babies were young, we soon were easily able to tell them apart. We tried to take a lot of pictures, but didn’t always have time to go in and label the photos to identify who was who.  Big mistake.  Now that they are older, we look back at early pictures and often can’t tell them apart!  At the time, we were easily able to key in on the differences, but looking back is more difficult. Often times, it is the color coding of the outfits in the pictures that lets us know.

Even with techniques in place, mix-ups can (and do!) happen. The trick is to be extra careful to check your charts and schedules and double-check which baby you’re holding. This can be critical in the case of food allergies, for example.  One of our identical girls had a severe allergy to milk, the other not.  A mix up did happen once, which resulted in our little sweetie vomiting after her feeding. Fortunately it worked out fine, but was pretty scary for a few hours.

How about you… what have you done to tell your newborn twins apart? Have you ever mixed them up?

Saint Bev. That’s what my mother-in-law used to call my mom. She saved us. She gave of herself so unselfishly in those first few months. And she still does — at age 80, she still comes to be with us and help for a few hours a couple of days a week. She is amazing.

But not everyone can have a Saint Bev. In fact, many expectant parents of twins, triplets, or even higher order multiples don’t have a support system in place and don’t realize how much they’ll need one.

That’s where you come in. You don’t have to be a Saint Bev, but you can choose a twin baby shower gift that will contribute to a support system that can save the sanity of new twin parents. And you can still give something darling, soft, and cuddly that they’ll use everyday, too.

Whether you’re throwing the twin baby shower, attending, or are the guest of honor, bringing forward these ideas can make for a twin baby shower that sends the parents-to-be off with some concrete ways they’ll be receiving direct help for facing one of the most difficult seasons of their life.

The Diaper Party. Diaper parties have been around for twin showers for a while. At this shower, every attendee brings a case of newborn diapers. As a fun activity, one of the cases is opened, and attendees write inspiring and supportive messages to mom on the diapers using rainbow colored permanent markers. When mom changes a diaper, she gets an instant (virtual) hug. Make your own “diaper” cake to add to your shower’s theme. (Note: you don’t EAT a diaper cake… they’re made out of diapers!) Some of these are a real work of art!

Twin Help Signups. Create signup sheets for bringing meals, running errands (e.g. groceries), and for being a mother of multiple’s helper.

There are many great online tools available to make signing up to help easy. On Carecalendar.org, a coordinator inputs needs on a calendar, and guests can sign up for tasks and shifts that work for their schedule. If you create one, have a laptop at the shower so guests can signup on the spot. Still, old fashioned pen and paper work just fine.

Guests can signup to bring meals for several weeks after the babies are born. These signup slots should be no more frequent than every other day – as you don’t want the family inundated with leftovers.

Mother’s helper signups are particularly useful after the first couple of weeks. Often times, family and close friends come to help in the first few weeks, and something is needed to fill the gap when initial help drops off. Some don’t have family nearby, so you will want to plan the signups according to the need for this particular twin family. Usually, you can begin scheduling these helper shifts based on the twins’ due date. Since twins are usually early, the timing often works out just right. These can be scheduled out for several months with some guests wanting a regular weekly shift.

If you’re not able to participate in a group signup, make your own coupons to give to mom-to-be, detailing what help you can give (babysitting, errands, mother’s helper, household chores, etc.).

Families of Multiples are in real need of real help. Helpers need to keep in mind that this is not a time to just visit and hold a baby or change a diaper (or two!). It is helpful if the family has a list of tasks that can be performed. And most often, what mom really needs is a nap. Encourage her to do so, but don’t push too hard. She needs to know that you are willing to do what she most wants to get accomplished. If she doesn’t have a list, you can offer to do the dishes, run the vacuum, or even clean a bathroom.

Darling, soft, and cuddly, too. Dillyhearts product review. While giving help to mom is most frequently cited as the “best shower gift” by parents of multiples, we all like to give and receive something darling, soft and cuddly, too. My personal favorites are handmade by dillyhearts. “Personalized super-soft cuddle blankets are a popular twins gift”, says Vickie Erlandsen, mompreneur of Dillyhearts, delightful gifts for babies on the go. “I’ve found that most of my customers prefer to order fun color combos that compliment each other, but are not necessarily an identical match.”

With so many options available, it’s easy to create a one-of-a-kind twins gift set that is ideal for mom-to-be, and will be a huge hit at the baby shower.

Dillyhearts’ personalized minkee toddler pillows have also become a top-selling twins gift. “After participating in celebrity twins First Birthday Gift Baskets for Patrick Dempsey’s boys and Marcia Cross’ girls last year, requests for double-pillow orders started rolling in,” Vickie says. “They’ve become by far my best seller.

Although intended for ages 2 and up, toddler pillow sets also make a fabulous baby shower gift since they can be used by mom as comfy nursing pillows, and are adorable additions to nursery decor until the babies transition safely from crib to toddler bed.”

Other hot sellers for twins are themed bib duos and themed bib & burp sets. To give a twins gift with impact, get creative! What style is the mom-to-be?
– Is she a modern rock ‘n roll mama?
– A trendy mom with funky retro taste?
– An active mom with a passion for baseball?
Find out the little details and your selection will not only stand out among the sea of generic baby gifts, but will be extra-meaningful for the mom-to-be.

Check out all the fun and unique hand-made gifts at www.dillyhearts.com.