Frustrated--friend's doctor routinely induces twins at 36weeks

[michellyn]

I have an acquaintance who is expecting twins, and she keeps talking about "preemies" this and that. When I asked her if she had some particular risk factors, she said that her doctor said she won't let her go past 36 weeks. I certainly don't expect that mainstream friends will go the home birth route I did, and I know that some twins will come very early, but not letting them go beyond that? It's just crazy to me!

I left a couple comments on her FB wall, but I doubt I have a chance of changing her mind (we're not close, it's her first pregnancy--she trusts the doctor completely, and she probably views anyone who had twins at home as crazy).

I posted the following to her: "Hmm. . . I wonder why that's her policy. An acquaintance who was induced at 37 weeks with twins (for no necessary reason) wishes she had waited since one of her twins hadn't developed his sucking instinct, which made things much more difficult early on--and it's crazy enough at that time without any developmental delays! Mine came at 38.5 weeks, which was really good for their health. Because they were tiny (6 lbs. 10 oz. and 6 lbs. 12 oz.), I had to work to get them awake enough to nurse sometimes (my singletons were bigger and never needed that), but they didn't have any developmental delays. Also, the longer they stay in, they were less susceptible to viruses (especially RSV, IIRC) which can be fatal throughout the first year to babies who were born really tiny."

I'm probably mostly just blowing off steam, but if anyone can think of anything else constructive that I can say to her (or how I might say it in a way that gets her to thinking rather than her just thinking I'm critical), I'd love the help! Thanks!

[stik]

Wow. Your twins were bigger than my singletons. And I didn't really think my girls were tiny. They were pretty alert - nursed like champs, regained birth weight in no time flat.

It's possible that your friend has some issues she doesn't want to discuss on her fb. Whether she does or not, there may not be anything constructive you can say. 36 weeks sounds early to me, but if she has signs of IUGR or some other problem, it might be really appropriate. Ultimately, it's her pregnancy and her decision.

[michellyn]

I doubt that is the case. She said that her pregnancy is completely normal. I know. I don't want to pressure her, but I also wish I could find a way to plant some questions to get her researching for herself. I don't want her to end up having unnecessary difficulty breastfeeding and end up regretting decisions later as she learns more.

[stik]

She might have difficulty breastfeeding, and she might have regrets. The same could be true if she waited for labor to start naturally. They're her decisions.

I think your instinct to not pressure her is right on.

[michellyn]

I don't have a problem with her making different decisions than I would. I just wish I could help her understand that she has decisons (rather than have her blindly trust her doctor). You think her chances of having problems breastfeeding twins are the same statistically regardless of when they arrive? It's my understanding that the sucking instinct is developed later in pregnancy. I hated that my doctor didn't inform me of half of the risks he chose to take on things (not with my twin pregnancy--my first two pregnancies, hospital deliveries). I didn't make choices and accept their accompanying risks--he did.

[stik]

I don't think the chances of nursing difficulties are statistically identical, but I do think that huge numbers of women in the US have difficulty breastfeeding for a ton of different reasons, and that therefore, she's unlikely to avoid all problems simply by scheduling a later delivery.

And, maybe she's not planning to breastfeed.

It sounds like you're projecting your feelings about your pregnancy and your OB onto your friend. She might come to feel the same way you do, but right now, it appears that she doesn't. Or, maybe these are her choices and she's happy with them.

[michellyn]

I'm not suggesting she will be able to avoid all problems. How early were your twins born? I've heard lots of twin stories where breastfeeding became impossible (or nearly impossible) because of how early the babies were born, so I think her chances of being really frustrated go up dramatically with a 36 week delivery. If that is medically necessary or indicated, you just take those chances, but the idea of taking those chances with a normal twin pregnancy boggles my mind.

I've always felt like Mothering was in favor of mothers making educated choices. How is wanting someone to be educated about her choices wrong? Certainly my former lack of education about options influences me--"projecting my feelings" sounds a little harsh. Don't all of our life experiences motivate us to help others avoid our pitfalls? There is definitely a line between informing and being pushy--I guess you think my first quote already crossed that line?

[stik]

I don't have twins. I am one. FWIW, I was born following an induction at 38 weeks, and was reportedly an extremely inefficient nurser.

Based on the HUGE number of women in the US who become frustrated with breastfeeding and quit early on, I don't think that a later delivery saves that many people from complications. Yes, it helps if the baby is older because the sucking reflex develops later in pregnancy, but clearly, that alone is not enough.

Nothing is wrong with wanting someone to be educated about her choices. However, *your* desire to educate people is really not what's at issue here. What's at issue is your friend's desire, since she is the one making the decisions or allowing them to be made for her. It's great to be motivated to help others avoid our own pitfalls. It's very altruistic. But it's also sort of patronizing. Your friend is capable of making her own decisions, including, if she wants, the decision to blindly trust her OB.

It doesn't matter if you think she's making mistakes. She has to walk her own path and experience her own journey. You've offered some thoughts, and if she is interested, she will follow up on them - maybe with you, maybe with her OB, maybe by doing a ton of research on the internet in the dark of night, you may never know.

I don't speak for Mothering magazine. I am in favor of women making educated decisions, but I also recognize that I can't educate people against their will and ultimately, their decisions are their own. I have no objections to your first quote, but I really don't think there's much more you can say and remain constructive.

[rainbow_mandala]

Originally Posted by stik

I don't speak for Mothering magazine. I am in favor of women making educated decisions, but I also recognize that I can't educate people against their will and ultimately, their decisions are their own. I have no objections to your first quote, but I really don't think there's much more you can say and remain constructive.

I think it has more to do with a person's personality when it comes to this sort of thing. Some people are more open to other people's ideas and point of views, other people just want to be left alone to do their own thing.

michellyn--since you don't know her that well, if I were you I would wait and see how she responds to the first thing you wrote and use that as a guidepost for possibly sending her more information.

While it may be true that a lot of women give up on breastfeeding for one reason or another, I don't feel that premature twins who haven't fully developed their sucking reflex is a minor thing. If this woman plans on breastfeeding then this could very well be a huge stumbling block, especially given the fact that she's going to be new at this and it's twins, for heaven's sake. This person could definitely use different sources of wisdom. That's not to say she's open to it, but it doesn't hurt to try.

I've found that often the best approach for people is simply directing them to different sources of information. A website, for example, or a book. If we're just coming at them with our own opinion or the facts we've picked up along the way then their less likely to be receptive to it since it sounds/feels more like an attack than a "hey, here's something you might want to look at." It might still be coming from the same place inside yourself, but the way they'll receive it will probably be a lot different. Most people don't like direct confrontation, especially if you don't have a close relationship with them.

[ariatrance]

If I had a friend or acquaintance who had directed me to an informative website during my first pregnancy, the chances of me acquiring the information I needed to make informed choices would have exponentially increased. I may not have made different choices but I would have actually known I had a choice to make. Perhaps in owning my choices, I could have avoided a preterm cesearean delivery, breastfeeding difficulties, formula feeding, severe post partum depression, difficulty bonding and lingering guilt. I completely understand the desire to 'save' someone from that path by passive ignorance.

I think gently directing her, even through facebook, to a website or two (even Mothering) would be helpful without being overbearing or pushy or whatever. I would also acknowledge to her that there might be information she finds unhelpful or offensive and she has every right to ignore it but that there is also information she could find enlightening as well as other mothers who have been there/done that, so she can be ready for whatever comes.

[Spring Lily]

The sucking reflex starts around 33 or 34 weeks. Mine were born at 34 weeks (in an emergency situation) and sucked just fine--DD even latched perfectly when she was a few days old. The problem was that they didn't have the strength or energy to take a full meal by sucking for several weeks. And it took a couple of months for them to nurse. So that's more likely to be the problem. Also, it's funny to me to hear you call your 6.5 lb babies tiny! Mine were half that, so our perspectives are quite different.

Anyway, at 36 weeks many babies can do just fine. My friend's twins were born at 36 weeks, had no NICU time, went straight home and breastfed great from day one. And then other babies are born at 39 or 40 weeks and end up in the NICU and have trouble breastfeeding. I think it's harder to predict than you're thinking, although it's great you are trying to help her see that she has options.

If you really want to support her, telling her about fatal diseases is probably going to be off-putting or even make her mad that you're overstepping. I'd suggest giving her a link to the Kellymom site, like this article on breastfeeding preemies, and see how she reacts to more positive support from you:
http://www.kellymom.com/bf/preemie/preemie-links.html

Also, you can't assume that she's telling you all the details of her pregnancy, and she may not want to do that publicly. She could have mo-mo twins with no other issues, and in that case giving birth at 36 weeks is for good reasons. You just can't make any assumptions.

[babygirlie]

My SINGLEton was born at 34weeks. Granted 2 weeks earlier and was induced. She is delayed, couldn't breathe on her own, could not suckle despite using every trick the consultant had, I couldn't produce milk anyway despite every device used on me. btw the inducing took 3 days.. not fun. I regret not waiting despite the demanding dr. I knew she would not breathe on her own as her recent ultrasound they couldn't get her to take practice breathes. but the doctor assured me up and down it was no problem. Ended up being a big problem when you see a breathing machine breathing FOR your kid and the insertions of feeding tubes. Hold onto your baby as long as you can!

[babygirlie]

more than likely the same guy is going to force a cesarean on her anyway so it doesn't matter how big they get.

[OGirlieMama]

You may have some good points, but you lost me at calling your almost-7-pound twins "tiny" and implying that their size at 38.5 weeks was the sole reason for nursing difficulties.

[Gena 22]

You could share this link with your friend, arguing that unless there's a medical contra-indication, doctors should let twins come spontaneously up to 40 weeks:

http://www.uptodate.com/home/content...=labordel/5122

[michellyn]

Originally Posted by OGirlieMama

You may have some good points, but you lost me at calling your almost-7-pound twins "tiny" and implying that their size at 38.5 weeks was the sole reason for nursing difficulties.

I really didn't have nursing difficulties with my twins (some supply issues, but not that early on), but I'd heard that tiny babies are often very sleepy and hard to keep awake for nursing (and my twins were the only babies I'd had that took some work to waken for nursing--once I got them awake, they latched fine, but they didn't seem to stay awake for a full feeding for a couple of weeks). That was anecdotally passed on to me, so that may be wrong.

I know 6 lbs. 10 oz. doesn't seem tiny to many people for a baby, but I'm from a tall family. That weight at 21" long is sooo skinny! Both my sons (singletons) were within a half inch of that, and one was a pound bigger and the other was two pounds bigger, so after the two of them, the twins seemed tiny. And I'm certainly not complaining to have had twins that size--I was blessed that they were able to stay in and grow that long. I know that medical necessities force many twins to be born earlier.

[michellyn]

Originally Posted by Spring Lily

If you really want to support her, telling her about fatal diseases is probably going to be off-putting or even make her mad that you're overstepping. I'd suggest giving her a link to the Kellymom site, like this article on breastfeeding preemies, and see how she reacts to more positive support from you:
http://www.kellymom.com/bf/preemie/preemie-links.html

Also, you can't assume that she's telling you all the details of her pregnancy, and she may not want to do that publicly. She could have mo-mo twins with no other issues, and in that case giving birth at 36 weeks is for good reasons. You just can't make any assumptions.

Good point. Thanks for the link. She has said that they're di-di.

[michellyn]

Originally Posted by Gena 22

You could share this link with your friend, arguing that unless there's a medical contra-indication, doctors should let twins come spontaneously up to 40 weeks:

http://www.uptodate.com/home/content...=labordel/5122

Thanks--I'll wait a little while and see if I have a good chance to share that. Thanks, everyone else for your suggestions as well. I'm sorry I was a little combative at first. I haven't been on here much in a few years, and I came because I needed to vent to someone who would understand. So I overreacted a little when I felt like most of my points were dismissed.

[JenChaffee]

I have no particularly good advice. Here is my experience. Mine were born at 41 weeks. I was in fine health. My first doctors (I switched to a M/W) had informed me at 9 weeks that they did induction no later than 37 weeks, and that it was standard to have c/s with twins. My little baby was 6lbs 5oz. I wonder what she would have been if I had been forced to get her out of my belly a month earlier?

[titania8]

Fwiw, I agree with you (OP) that the information needs to be made available to her. Hearing that (inducing at 36 weeks as standard procedure) would eat at me, knowing it was most likely unnecessary and could lead to any number of difficulties.

Could you start a private convo with her, just ask her how she feels about the induction, worries or concerns she may have? Might be a good way of introducing the idea that she does in fact have options, and why it might benefit her and her babies to at least look into it a bit.