How best to support a Mother with Twins Coming!

[DoulaAlicia]

Hello!  I am looking for any thoughts you doulas might have about supporting a Mama pregnant with twins.  As a doula I've been to over 50 births but none of them multiples.  And it looks as though I will have a Mama due with twins in April.  

I have a lot of ideas about this but I would like more information from you ladies who've supported a Mom/family like this....

To give some background she has some medical complications....  She is pregnant from IVF.  This will be her first birth and she is 41.  She has four different blood issues (which she is on lovenox blood thinner for) and had PCOS and is looking like she will have GD.  She has a thyroid problem (which I'm pretty sure is being handled with traditional meds).

She is something like 18-20 weeks pregnant (we have yet to meet so forgive me for not knowing exact details!).  And baby B does not have much amniotic fluid but all they can do is watch this.

This Mom was desperately hoping for a homebirth but is doing traditional hospital birth due to all of the medical complications.  She understands her risk of cesarean is higher than average and that Baby B might not make it although she has high hopes.

I'm thinking in our prenatals that this Mom will need a lot of emotional work no matter how healthy her babies I'm sure she's full of worry.  I plan to also prepare her emotionally for cesarean.  And prepare her emotionally for a beautiful vaginal birth!  She has concerns about the NICU if her babies are there and trying to breastfeed - concerns that she will not produce enough given her thyroid and insulin resistance...

So - if you can help me with these things...

1)  Emotional support.  Any ideas?  I do BFW so I have some good ways of approaching Cesarean, and fears.  But I am very unsure of how to support someone in a possible death of a child......

2)  Informational Support - I feel like she needs a lot of information about how to stand up for what she believes as far as nursing and Attachment Parenting in the event that babies are in the NICU and she has to deal with nurses who don't support these things.  I want to give her good info on infant jaundice, skin to skin, nursing a preemie etc...  What am I not thinking of here??

3)  Physical Support - She says she is very heavy - how best have you support the heavy Mom in labor....what are some ideas about keeping her comfortable if she is very big?

4)  Medical - anything besides the usual about keeping her the healthiest she can be?  Should I talk to her about Brewers to help her avoid Pre-E - I hear so many arguments for/against Brewers that I don't typically talk about it.  I usually talk to clients about probiotics, Vit D, preg Tea, Food Based Prenatals, and a couple others.  Anything else that could support her specific medical issues?  Should she be adding alfalfa to her preg tea for example to support the blood.....?

5)  Postpartum - Ok - this is where I really need help!  Life with twins!  Give me all you've got!  I told her she should really look into hiring a postpartum doula.  She says family is not that supportive of natural birth OR breastfeeding etc.... so it is important she has some support IMO.  But what about setting some expectations for her...how much sleep should she expect?  How easy is it to bond with two children at once?  Realistically what kind of help does she need?  Anything special she should know about nursing twins?  Schedules?  Co-Sleeping?  What else?

[momto9kidlets]

I don't have answers for all of your questions so will only address the ones I can speak on :)

2)  Informational Support - I feel like she needs a lot of information about how to stand up for what she believes as far as nursing and Attachment Parenting in the event that babies are in the NICU and she has to deal with nurses who don't support these things.  I want to give her good info on infant jaundice, skin to skin, nursing a preemie etc...  What am I not thinking of here?? Do you know for a fact that the NICU nurses won't be supportive of those things?  My experience have been just the opposite.  The NICU nurses were more helpful - promoted skin to skin more then labor and delivery or even postpartum nurses.  They are supportive of moms who want to spend time with their babies and want to breastfeed and will provide a semi private area for moms to spend that special time with their babies either in a separate room or behind curtains.  I would really suggest that she contact the hospital and see if she can get a tour of the NICU.  Some hospitals will allow this for moms who anticipate using that service.  Personally I had the best nurses ever when my son was in the NICU.  I even had a nurse go against doctor's orders when he said baby should stay in the isolet and she said "no this baby needs to be on his mama" and she had me disrobe and unwrapped my son and flipped him right onto my chest.  When I spent more hours then the average mom in the NICU they even felt bad for me and got me a comfy rocker/recliner and brought that in so I wouldn't have to sit in the hard chairs.  So before you assume they would be horrible it might be good for her to actually find out.

3)  Physical Support - She says she is very heavy - how best have you support the heavy Mom in labor....what are some ideas about keeping her comfortable if she is very big? Why would the heavy mother be treated any different from a thinner mother?  The only thing I could see would be if you normally hold up a mother you might not be able to do that with a heavier mother.  Also make sure if you use a birth ball that it will hold her weight.  Most professional balls hold a huge amount - I think up to 600 lbs (but please double check).  

4)  Medical - anything besides the usual about keeping her the healthiest she can be?  Should I talk to her about Brewers to help her avoid Pre-E - I hear so many arguments for/against Brewers that I don't typically talk about it.  I usually talk to clients about probiotics, Vit D, preg Tea, Food Based Prenatals, and a couple others.  Anything else that could support her specific medical issues?  Should she be adding alfalfa to her preg tea for example to support the blood.....? I am not sure about this, but why is she concerned about not being able to breastfeed due to thyroid issues and diabetes.  I have known women with both who breastfeed successfully.  I have had a thyroid issue for over 17 yrs and have successfully breastfed all kids since my diagnosis (there have been six of them since I was diagnosed).  

5)  Postpartum - Ok - this is where I really need help!  Life with twins!  Give me all you've got!  I told her she should really look into hiring a postpartum doula.  She says family is not that supportive of natural birth OR breastfeeding etc.... so it is important she has some support IMO.  But what about setting some expectations for her...how much sleep should she expect?  How easy is it to bond with two children at once?  Realistically what kind of help does she need?  Anything special she should know about nursing twins?  Schedules?  Co-Sleeping?  What else? As far as postpartum - yes a doula can be a really good idea especially if her partner isn't going to be around or won't be available to help.  As for bonding - it isn't any different then bonding with one.  I haven't had a single twins mama struggle with this, and I have mainly done postpartum care for twins families.  The whole sleep thing - make sure she is sleeping when the babies are sleeping because she could potentially be up a lot.  Most of the families I have worked with will try to get the babies on the same schedule or a similar one.  The way they do this is to wake the second baby when the first wakes up.  I am torn on this one, but have never fought a very tired twins mama who wants to do it because while it would be great for the babies to be able to follow their own rhythms I totally understand exhaustion too.  As far as nursing goes - I have heard nursing both at the same time can be helpful, but I have not have one single client do it yet.  They have tried, but found it just didn't work.

Good luck.

[courtenay_e]

Don't have time to answer all the points right now, but if she plans to breastfeed, glucophage DURING PREGNANCY has a good rate of regulating milk supply in PCOS mothers (just researched this today), and might also help to regulate her blood sugar enough to avoid GD issues... please ask her to research that if she wants to breastfeed her twins...talking to an IBCLCmay help.

[DoulaAlicia]

I don't know for sure about NICU nurses.  ;)  Just haven't had the best experiences and want to make sure my client is in a place of knowledge before going in so she doesn't get pushed around if that situation comes up.  The tour is an excellent idea!!  I should tell her to do this and ask all those good questions about whether their environment is supportive of breastfeeding and family or mother camping out there a bit while babies are there.

The reason I asked about physical ideas for the heavy mother is because this Mom said she is "very large".  I'm not sure what that means....but I know that my husband is "big" and seems to get uncomfortable much quicker than me.  For example being on his knees kills him if he is there for a couple of minutes.  H & K is a very common labor position.  Even sitting on his butt for too long really kills him.  So I just want to be as supportive as I can in positioning help.  And yes, I likely will not be able to hold her in some ways I do for thinner clients.  So just looking for tips in this area...

I also didn't understand why she was so concerned about thyroid/GD.  I myself have thyroid issues and breastfed my last baby fine (he was the only one I had a hypothyroid problem for) - and we are still BF now.  Anyway I wasn't sure if there was something I was missing, if her doctor had told her something that I had just missed along the way in my experiences!!  I've also had clients with GD no problems BF.....  Maybe she read about the hypothyroid and risks of low milk supply but to my knowledge this is only if the thyroid isn't being treated.

Courtenay - thanks for the med rec.  I will definitely tell her to look into this and research a bit more myself.  So PCOS is a problem that might cause supply issues?  

[momto9kidlets]

Honestly as far as positioning I would simply discuss it with  her and maybe try out the positions that you would use with any other client.  Assuming that something might hurt her because of size or might be uncomfortable may not even apply to her.  I am not saying this to be mean, and I totally understand where you are coming from, but on the flip side I have seen some very skinny people who can't get into some of the positions I suggest that some of the heavier clients I have had can.  In all honestly I would experiment with positions when you meet with her (after you are hired / at a prenatal). I have always found this to be the most helpful regardless of who the client is because then you can discuss what they liked, didn't, whether they might want to try it or whether it makes them so uncomfortable (physically or even emotionally) that they never want to do that again (had an abused client once who felt so vulnerable in knee chest and trying it out before labor was so helpful for me to find this out - never would have known had we not "practiced" and I let her express her feelings openly).  

As for breastfeeding - I missed the PCOS part and I think that can impact breastfeeding (hopefully someone else here can give advice on that).

Good luck :)