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Is the NY Times article on Twins scaremongering?

post #1 of 25
Thread Starter 
The NY Times just did an article on twins, IVF, and prematurity. Apparently, as an infertility patient who might be having twins, I'm part of the problem, and bringing down the medical system.

http://www.nytimes.com/2009/10/11/he...agewanted=1&hp

My gut feeling is they're playing with statistics to make things seem far worse than they actually are. For example, they point to low birthweight/prematurity as costing far more, and saying that twins are at much, much greater risk of both, but nowhere do they specify what "preterm" or "low birth weight" are - lumping all those 6 lb twins in with severely premature babies, I'm assuming. And what's premature for a twin? And, and.... and I'm too tired to figure this all out. Am I just being touchy? Anyone else want to take a stab at it?
post #2 of 25
I would say, yes and no.

Let's be real here--many people who use IVF (not saying that this is reflective of MDC people, just in general) are also going to high-risk management people with their OBs and may go straight into Maternal-Fetal Medicine specialists rather than regular OBs. I don't know of too many people, who had a highly medically managed TTC who don't jump into a highly medically managed pregnancy, even if they don't technically 'need' to be.

38 weeks is considered 'term' by the medical establishment for twins. Personally, with a few exceptions, I believe that means that essentially all highly managed twins will be premature because the doctors will not allow the mother to go past 36-38 weeks. IVF also seems to produce more MZ twins, who also will *tend* to be highly medically managed because of the risk of TTTS.

So no, I don't believe the *article* is scaremongering, I feel it accurately reflects the mainstream, sadly. However, one CAN find good doctors who are more flexible and less scared themselves. I'm going to guess they are fewer and farther between though.

I had a very medically managed pregnancy (we were always one u/s away from immediately flying across the country to have surgery to save my boys' lives--we never crossed that threshold thank goodness, but that was u/s every day or every other day, lots of talking about all the little things they found on there that were dire but then resolved themselves, ect.). Yet I was able to mitigate some things by refusing to sign myself completely over to the perinatologists and kept my original OB with the peris as consultants. Still, my boys were born at 36 weeks because I was becoming very ill. Because of the TTTS, there was a 2 lb discrepency, so despite my having MZ twins, one looked very much like a preemie (at 4 lbs) and one did not (at 6).

I was privledged to have an OB who was willing to do things a little unorthodox, or at least support me in having less specialists up in my grill all the time. It was also helpful that the TTTS specialist I saw was similarly supportive and did not fight me choosing to have my OB rather than him as my primary doctor.

But do most people have that? I don't know. And having spent almost every day in the MFM/perinatologist clinic for 6 months, I can tell you--after talking with couples who feel that they went through absolute hell to get pregnant in the first place I cannot say that I am unsympathetic to their feelings that they prefer to be as cautious as possible with the pregnancy and birth. And unfortunately if they ask the so called experts what the most conservative and cautious path is, they are going to be told a c-section at 36 weeks.

I don't agree with it, but again, I think that is many people's reality...accurately reported by that article.
post #3 of 25
I don't get the idea that they're playing with stats. Prematurity is always determined as anything before 37 weeks, singleton or multiple births. The truth is that there are higher chances of giving birth prematurely when you are carrying 2 or more. This does increase the amount of premature births when people do IVF/Fertility Treatments and get pregnant with multiples.

I had an OB who was very interested in getting me to term, has been in the NY Times as a doctor who delivers twins vaginally/naturally (no induction ever discussed) far more often than most and I gave birth prematurely at 30 weeks 5 days, having gone into preterm labor 12 days earlier. My doctor took good care of me, and I took good care of myself. One of the causes of prematurity is being pregnant with multiples. So naturally the numbers are going to go up. Esp. when you consider that many women who use ART are over 35 on top of that. FTR, I was 28 when I gave birth and my twins were conceived spontaneously.
post #4 of 25
Wow, I hated that article. Twins are bad, look at these horror stories! It helps me understand where most OBs are coming from, like Tigerchild says.

The only stat that jumped way out at me was "the average singleton pregnancy in the US lasts 39 weeks." Are you kidding? Is this true? What about the stat that I've heard lots of places suggesting a primipara goes an average of 41w1d with a singleton if not induced / sectioned earlier. I'm pretty sure the 41w1d is right. So are that many singletons early too in this country? Wow.

No IVF experience here, but I can sympathize to some degree. If I went through the heartbreak and hell of trying to conceive, I'd go for twins too. Not easy or risk free, but I wouldn't trade it for the world.
post #5 of 25
Thread Starter 
Quote:
Originally Posted by Tigerchild View Post
I would say, yes and no.

Let's be real here--many people who use IVF (not saying that this is reflective of MDC people, just in general) are also going to high-risk management people with their OBs and may go straight into Maternal-Fetal Medicine specialists rather than regular OBs. I don't know of too many people, who had a highly medically managed TTC who don't jump into a highly medically managed pregnancy, even if they don't technically 'need' to be.

This explained the wierdest thing that happened the other day! I have a homebirth-friendly doctor friend who said she'd be happy to see me for prenatal visits. So I call her office, and the minute the receptionist hears "IVF" she puts me on hold for a couple minutes. The receptionist comes back and says: "Dr. Friend does not want to see you. She thinks you should go to the OB/specialist department at...." This was a lie - she had not talked to my friend, who already had me on her list of pregnant ladies. I couldn't understand why someone would put their job on the line with a flat-out lie, but now it's making sense. And this is one of the biggest, best-regarded clinic/hospitals in the state!
post #6 of 25
I probably AM overly touchy, being one of those women who decided to implant three embryos (in hopes of being successful at all!). That said, I hated the tone of the article. I noticed this quote:

"Ms. Mastera said she was aware of the risk of prematurity with twins and had discussed the issue with Dr. Swanson before having the in-vitro procedure. Informed-consent documents given to patients by fertility doctors normally detail the increased risk of twins. But even with those increased risks, the actual number of serious outcomes like fetal death or brain damage is small. "

So, on the one hand they state that the risk of death or brain damage is small, but out of the 3 or 4 families mentioned in the article, one experienced the death of a twin and another had a twin with severe cerebral palsy!!! I admit I'm emotional about this, plus I have serious "baby brain" right now, but that does seem like a skewed presentation to me.
post #7 of 25
I had no idea that IVF increased the chance of MZ twins --- thought it would mean more DZ twins.


I was older (35) when I had my boys -- I only saw the MFM once, delivered vaginally, and the boys had no NICU time, went home with me in 3 days time. By price tag, my twin pregnancy/birth was cheap.


I don't know if they are monkeying around with stats, but I can tell you that anecdotally, in the local twins club, my boys being born at 37w/5 days is one of the longer pregnancies. I'm certainly one of the very very few vaginal births.

I'm a bit uncomfortable with putting a price cap on fertility treatments ..... to me, it's edging close to putting a price on life. Having never suffered from infertility, I cannot speak to the heartache involved, but I don't think you can put a family's desire to have a child into dollars.

I disagree with the statement in the article that IVF women are affluent --- the moms I know personally are far from it. They saved up years and years, put second mortgages on their houses, husbands worked 2nd jobs, etc. They certainly aren't Park Avenue.

On the flip side of that, as a health care professional, I cringe at statements like this:
Knowing that prospective parents can easily seek IVF elsewhere, doctors give them unusual autonomy in deciding how many embryos to transfer.
I honestly do not think our bodies are designed to carry huge numbers of babies. While I am sympathetic to women who want children, I think transferring large numbers of embryos is dangerous, both to the mother's health, as well as the health of the children.

What makes us, the mothers here at MDC different?? I'm going out on a limb here, and saying that the majority of us here carried our twinfants to term, and even post dates. Are we more educated? Take better care of ourselves? Have better health care providers?

There are some things you have completely no control of ..... TTTS, incompetent cervix, etc. But what's wrong with teaching women who have a multiple pregnancy how to take care of themselves, and maximize the pregnancy?? I lived by that Dr Barbara Luke book .... and I credit that, along with my husband, for a very healthy twin pregnancy. Why doesn't this article mention that clinic, who had wonderful rates of term pregnancies, low to no NICU time, and excellent birth weights for babies?

I'm jumping all over the place ..... I'm off to read your comments.
post #8 of 25
Quote:
Originally Posted by Gena 22 View Post

The only stat that jumped way out at me was "the average singleton pregnancy in the US lasts 39 weeks." Are you kidding? Is this true? What about the stat that I've heard lots of places suggesting a primipara goes an average of 41w1d with a singleton if not induced / sectioned earlier. I'm pretty sure the 41w1d is right. So are that many singletons early too in this country? Wow.

41w1d is the average time a first time mom will go into labor spontaneously. 39 weeks is the average singleton pregnancy because inductions and c-sections are included.
post #9 of 25
Quote:
Originally Posted by DiannaK View Post
What makes us, the mothers here at MDC different?? I'm going out on a limb here, and saying that the majority of us here carried our twinfants to term, and even post dates. Are we more educated? Take better care of ourselves? Have better health care providers?
Love you to death, but please tread lightly here. Speculating on this subject can be brutally painful for those of us who are educated, took great care, had excellent health care providers and still gave birth long before term.
post #10 of 25
Quote:
Originally Posted by OGirlieMama View Post
Love you to death, but please tread lightly here. Speculating on this subject can be brutally painful for those of us who are educated, took great care, had excellent health care providers and still gave birth long before term.
post #11 of 25
^^ all the protein i could scarf + bed rest and my guys still came tearing on through the cerclage at 32 wks
post #12 of 25
Quote:
Originally Posted by Altair View Post
41w1d is the average time a first time mom will go into labor spontaneously. 39 weeks is the average singleton pregnancy because inductions and c-sections are included.
and also because multiparas are included as well.
post #13 of 25
Quote:
Originally Posted by OGirlieMama View Post
Love you to death, but please tread lightly here. Speculating on this subject can be brutally painful for those of us who are educated, took great care, had excellent health care providers and still gave birth long before term.
trust me ... that's why I put my caveat in about 'things you have no control over'.

Definitely no offense meant to any momma ....
post #14 of 25
subbing to read article when I have time....
post #15 of 25
There are more articles in the series for anyone interested, including these:

http://roomfordebate.blogs.nytimes.c...h-twin-births/

I do think it's interesting to read the comments from parents saying they had no idea of the toll a multiple pregnancy could take on the mother's body and that multiples could take on parents once they arrived. I think there is a real perception out there that twins are so cute!! and not much thought is given beyond that.
post #16 of 25
I read the article more in light of the current health care debate, than being about scaremongering about twins. NICU time is extremely expensive and having twins increases the likelihood that the babies will have NICU time. Fertility treatments increases the odds of having twins. They talked about fertility patients as the "low lying fruit," meaning if they can get more women undergoing IVF to transfer, not "implant" as only nature/God/luck decides which embryos implant, one embryo, they will decrease the number of twin pregnancies and potentially save money.
post #17 of 25
Quote:
Originally Posted by f&p'smama View Post
I read the article more in light of the current health care debate, than being about scaremongering about twins. NICU time is extremely expensive and having twins increases the likelihood that the babies will have NICU time. Fertility treatments increases the odds of having twins. They talked about fertility patients as the "low lying fruit," meaning if they can get more women undergoing IVF to transfer, not "implant" as only nature/God/luck decides which embryos implant, one embryo, they will decrease the number of twin pregnancies and potentially save money.
I am trying to figure out the point of the article, and I think this is correct.

It's a tricky issue. My twin pregnancy was IVF, and I had additional risks. I did not see a peri though (that, in retrospect, was really dumb; I regret it; long story). I delivered vaginally, vbac, at 33 weeks and of course there was nicu time. After 5 failed IVF cycles, I'd do it all over again. (I wouldn't have needed IVF if my RE had listened to me, but that's a whole other story.) The amount the insurance paid for the hospital bill for them is less than what we've paid in premiums since they were born.

Then again, my father was a twin, born in 1933. I have no details of my grandmother's pregnancy since she passed away about 25 yrs ago. That reminds me, maybe my aunt, my father's twin who I don't see much, might know...
post #18 of 25
IVF mom here, with twins. Unmedicated vaginal birth at 41+ weeks. 6lb 9 oz, 8 lb 3 oz.

BUT.. because I needed IVF I assumed that I was somehow reproductively flawed and must also be flawed in other ways pertaining to carrying babies to term. (And I already had two full term singletons, with comfortable vaginal births.) But I bought into the fear that my body wasn't capable because I wasn't capable of conceiving on my own.

If I had been a first time mom I would have totally bought into the fact it was a high risk pregnancy and can't imagine I would have had a MW instead of an ob. I would have been one of the stats of moving from a highly medicalized (is that a word?) conception to a highly monitored pg to a medicalized birth.

**Off to save article to read more thoroughly. The twins are 28 months and don't nurse as much so I'm rapidly losing computer time!
post #19 of 25
So insurance does not cover IVF in most cases, so people who have to fork out all this money (often going broke in the process) are of course going to do what they can to be successful - risk of multiples be damned. (I know, because I WAS one.) So the insurance companies instead pay a million dollars for a premature twin or HOM birth. How's this for a plan? Cover IVF by insurance, limit it to one embryo transfer.
post #20 of 25
Quote:
Originally Posted by Tigerchild View Post

38 weeks is considered 'term' by the medical establishment for twins. Personally, with a few exceptions, I believe that means that essentially all highly managed twins will be premature because the doctors will not allow the mother to go past 36-38 weeks.

I agree with this. I am a member on another board, specifically for IVF, and the vast majority of ladies preggo with multiples immediately post from their 1st ob appt that the doc has already scheduled their c-sec somewhere from 36-37 weeks. At the first ob appt! I was referred to a peri because my dd has some issues, and the first question from their nurse was "when do you want to schedule your c-sec?" I kept saying, "I'm NOT having a c-sec", but was proven wrong when baby A's cord prolapsed and baby B's placenta partially abrupted during labor. I made them wait until I was 38 weeks to induce, and would have gone longer had my dd not had major medical issues we needed to deal with.

But, this is not the case with a lot of people. I feel that a lot of twin moms don't get the info that might help them carry longer. A few of us on my twin board all read the Dr. Luke book, and I'm the only one who actually followed the diet. One gal told me that there was no way she would gain that much weight, and another's ob told her it was just a bunch of crap and not to eat that much protein as it wasn't good for her. Two others said, "oh, I tried, but it's too unrealistic to follow such a diet." And, a lot are told by their doctors that there is no point in staying pregnant longer than 36-37 weeks (based on what I've read elsewhere).

The fact is, though, that there ARE certain risks associated with multiple pregnancies. No matter what you do, there are going to be instances where babies are born prematurely, with NICU stays and with problems. The risks are there with singletons, too, just not as much. My ds1 was born at 37w because of my high blood pressure. Developmentally, though, he was a 35 weeker, and had a NICU stay.

As a former IVF patient, I can tell you that after having gone through all the shots, the retrieval, the hormones, the emotional upheaval and all the things that come with it, I would be really angry if my doctor told me he was only transferring one embryo. At least when I was ttc my ds1. My second cycle (the one that gave us twins), I wanted to transfer only 1 embryo, but the doc was insistent on 2, given my previous history with IVF (we had transferred 3 embryos the first cycle, with a chemical pg, then 3 embryos and got my ds1). He tries very hard to keep the multiple rates as low as possible, and does only transfer one embryo pretty regularly to those he feels are good candidates for it (again, anecdotal evidence from the other forum, where many patients from my clinic come for support during their cycles). I do remember reading, though, that there is evidence emerging that suggests the success rates between transferring one and two embryos isn't that different, but the rate of multiples is pretty significant. I just wish I remember where that was.......

At any rate, we did end up with a NICU stay for one that would have happened whether she was a singleton or a twin. She actually was moved out of the NICU on her 2nd day, as she was mainly just being observed for a few days.

Okay, sorry, I'm rambly. I have a lot of opinions on this subject, and think that it's hard to tell someone who's laid their life savings on the line for IVF that "nope, sorry, you can only transfer one embryo on your one shot at getting pregnant." At the same time, I know and recognize the risks of multiple pregnancies, so it's a hard line to walk.
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