So I got a few twin/multiple pregnancy books out of the library and I now I'm feeling paranoid and questioning myself. I just read through the Barbara Luke book and she makes it seem that the only way one should deliver twins is by putting complete unquestioning faith in a specialized Ob. I was planning on delivering my twins with a midwife at a community hospital with only a level 2 NICU, is this foolhardy? However, I really don't want to deliver at a big university hospital and I think that I am more likely to be able to have the birth I want with a midwife I know and trust (assuming I don't develop complications earlier on). I am also worried that I will "over do it" and the Luke book made it seem like I should stop exercising working and just become a baby making machine for the next 5 months (I am currently 14 wks). I am healthy, I've had one full term baby (though I had to be induced as my water broke at 41wks and my body stubbornly refused to go into labor) and I haven't had any issues with weightloss etc during my first trimester. I think I just need some reassuring words and if any one recommend any more reassuring books on twins that would be great. I have had some reassurance simply by reading birth stories but if any of you could give me some background on your decision making process while choosing a provider and birth setting it would be great. My midwife is referring me to a perinatologist for a consult but that won't be for a few more weeks.
Luke book making me paranoid.
This Luke lady sounds crazy to me. Unfortunately you get a very medical opinion in a lot of birthing books. Trust yourself and your body. I think the less intervention the better (possibly especially with twins they seem to always want to cut them out of you early...) As long as everyone is healthy it shouldn't be an issue. I think keeping your work out should be fine. Just listen to your body.
I mainly was interested in her book for the nutrition information (which I found interesting - though I'm not sure if I can feasibly eat that much food.)
I just got back from the gym and I actually feel more energized and "normal" then I have all weekend. I guess it is a good idea for me to realize my limitations early and gear back the cardio - I just can't see stopping all lifting as I cart around my 25lb daughter daily (of course I will later on as needed.)
I think I am also nervous because financially I had planned to work until my due date (when I thought there was one) and now I realize that I will be going out at least a month earlier. It is hard to figure out the budget with so many unknowns.
One of the most difficult things about twin pregnancy for me was sorting through dubious and contradictory information. That's a chore for any pregnant mom, and for us twin moms the problem is so much harder because 1) there's a shortage of solid studies, 2) the studies out there often have small sample sizes, and 3) many twin studies lump together all twin types (di-di, mono-di, mono) although there are different risks specific to each.
In the end, you have to take the information you can glean, weigh one statement against another and against your instinct, and make up your mind.
Be ruthless about discarding information you know to be wrong!
I have very mixed feelings about the Luke book. I do think nutrition in the 2nd and 3rd trimesters is important, especially getting enough protein. Enough being the optimum term. No fixed number, and no need to force food on yourself. This may be extrapolating from her book, but I also believe maternal stress can bring on PTL or at least make things more difficult.
But, physical activity was very important to me. Never taking my good health for granted, and listened to my body, it responded really well to gentle activity in the 2nd and 3rd trimesters. A couple miles a day of walking, staying at my low stress job, turning down any unpleasant social occasions. That's what worked for me. Which meant I went into labor calm, strong and confident.
Do everything you know to take care of yourself: eat well, drink water, rest as much as you can, be as active as feels right, and be happy. Each of those things is important.
OK, birthing. It's been a while since I was deep into the research, but there's a lot of twin mis-information out there, even or especially among OBs. And few OBs have enough experience with natural twin birth. Which is not to say there aren't OBs who have been involved in natural twin births, but very few. There is plenty of evidence that suggests vaginal birth for twins can be safe, and of course has benefits to babies and mom. I hope to live long enough to see OBs recommend that women carry their twins 40 weeks, and truly believe the evidence will back me up one day. There are studies edging in that direction. My pediatrician was the only doctor who wished a full 40 weeks for me, and that meant a lot to me.
Having a perinatologist tell me all along that the twins and I were in excellent health gave me the confidence to ditch my OBs who told me my twins would die because I hadn't scheduled my 3-hr glucose test fast enough (no kidding, I was threatened with fetal death over and over). I did parallel care with a midwife from 30 weeks on, and had a great homebirth at 39 weeks.
It sounds like you're in a great position to have a good midwife birth too! Best wishes!
Here are some good things to read:
http://www.lookydaddy.com/weblog/2007/06/i_know_that_mos.html (great blog post, check out all the comments!)
Thankfully, I went with an OB and thankfully, had a C section. My B was 8 4 breech. They told me the monday before I delievered B was 6, OB said he could turn her. When I went into labor, I requested another ultrasound before deciding whether or not to section, and turns out B was 8 4. Ob said he wou ld try to turn her, but he couldnt promise anything, and that I could have gone with a natural for A and C sect for B which would have SUCKED. I think with twins, in my OPINION, it is best to deliver at a safe hospital, with someone who knows what they are doing. I do not regret the section AT ALL, and healed quite quickly from it.
I think when you read Dr. Luke's book you have to really thing about "who" she is writing too. A lot of the examples in the book are just common sense to most of us gals who are more intune with our bodies and its needs. My thoughts are her practice deals with women who are super concerned with gaining weight and/or keeping their life/job exactly the same as it was prepregnancy. A women who is used to working 18 hours a day and having coffee for breakfast is going to have to radically change her lifestyle. These are the type of women she sees in her practice in Ann Arbor.
I agree with the previous poster who said that you have learn what to take from each book and what to put aside. I have not eaten quite as much as she prescribed and I am having a birth with a midwife. I still think it is a good book to read for any mom pregnant with multiples,just with a great big grain of salt!
I think you can stick with your plan as long as you have a backup plan in case things go wrong. My plan was to have my babies at our community hospital, which has a special care nursery but can't handle babies who require mechanical ventilation for more than 24 hours. Basically, my OB was optimistic, but also said if I went into labor before 32 weeks, he'd have to transfer me to a colleague at the university hospital 20 minutes away. That did end up happening to me at 27 weeks, and I spent two weeks in the hospital before giving birth, which gave me time to get to know the doctors there. It wasn't ideal, but not everything is.
Hope for the best, and have a contingency plan!
I liked the luke book. I really appreciated the nutrition advice, and even shared it with my doctors, who followed it, when I was admitted for weeks 28-30. She does present a cautionary tale, but the truth is not everything goes beautifully all the time, and being aware is a good thing. By all means, look for a book that feels right for you, but don't ignore the reality of the situation, either.
Thanks so much for all the advice. I think I have general plan worked out - I am going to stick with my midwife at the community hospital (which has a level 2/special care nursery) and see a perinatologist at a hospital with a level 3 NICU for consultation. Hopefully they will agree to follow me if complications develop and I will plan to go there if I go into preterm labor before 32 wks. I will have to talk more to my midwife about the what ifs after 32 wks and weigh my best options (I'm hoping the perinatologist will still be willing to follow me even if I'm considering delivering at another hospital.)
I would recommend the Elizabeth Noble book - "Having Twins something something". It also has a lot of emphasis on nutrition but is also strong on natural childbirth. I found it very helpful.
I think a lot of the risk factors in having twins comes from the increased likelihood of premature labour. If you can hang on to them for long enough (nutrition being crucial here) you are really upping your chances for a natural delivery. And of course the bigger they are the less likely they are to need help. Mine came on their own at 37 weeks, born vaginally but with about a million people in the room (it seemed) and needed a bit of a warm up in an incubator and that was it. They were quite small too, 5 lb 2 and 5 lb 8 (? something like that anyway...)
But then, as other posters have said, and as with all childbirth, you kind of have to go with the flow. I would not have chosen my labour to be exactly as it turned out, but I am not heart broken over it. It sounds like you are covering your options which is sensible. Best of luck with it all!
I wasn't a big fan of Dr. Luke, and I agree you have to consider her in the context of what she sees at her clinic. I do think the nutrition aspect is important, though somewhat unattainable - but getting enough protein, and working to make those babies as big and healthy as possible (especially since chances are higher they'll come early) are really important points.
Regarding OBs, it also totally depends on the type of twin pregnancy you have and therefore what the risks are. If, for example, you have an uncomplicated pregnancy at say, 37-41 weeks, I personally wouldn't hesitate to follow your plan. I think it's great to consult with the peri - more or less depending on your level of risk - and "go with the flow" as your pregnancy progresses.
I had a mono-di pregnancy that was initially labeled mono-mono and so I started seeing a high-risk OB and seeing a peri for an ultrasound every two weeks after 16w. Around that time I switched to a regular OB, continuing to see the peri. When I started to see there could be an issue at the 22w ultrasound, I switched back to my very good high-risk OB who saw me through to the end. But if I had had an uncomplicated di-di pregnancy I would have seen the regular OB and had a vaginal delivery in hospital unless Baby A was breech.
One simple piece of advice that will serve you well no matter what: anytime anyone tells you that there is only ONE way to do a thing (which is their way of course) KNOW that this cannot be true. Esp when it comes to being a parent. I think OPs gave you great advice, so I won't be redundant. LOL
I grew up in Ann Arbor and I assure you it is the crunchy/hippie dippie center of Michigan. So its a little funny seeing Ann Arbor women described as being like NYC girls!
My doctor was not very hot to trot on Dr. Luke, though I came into the pregnancy already a bit overweight. I was at a very high-tech University hospital myself, and I think for that reason my very run of the mill twin pregnancy was handled in a fairly relaxed manner (since they see so many more exciting/unusual/rare pregnancies than plain ole twins).
What I appreciated from the Dr. Luke book was some of the nutritional advice and her advice on exercise! My husband really wanted me to be doing a lot more walking while I was pregnant, but I had sciatica and pelvic pain (from the babies weight on the nerves running through the pelvis) which started at about 4 months. I figured that was my body telling me to put my feet up, and it was nice to have a resource to reassure my husband that not exercising was fine.
great - Thanks for all the advice! I have an appointment with an Ob group that delivers a lot of twins and while I have heard less than great things about the hospital as far c-sec rate (for singletons) and encouraged interventions - though this particular doc is supposed to be encouraging of vaginal delivery in twins (I'll find out more with my appointment) and delivers most of his own patients - they have a great nicu and they have highly recommended specialists. I still have my appointment with the midwife (I feel a little a dishonest making appointments with other providers "behind her back" but I owe it to myself to explore all my options) as well as a perinatologist appt.
I was doing okay with the protein until this week (well I was getting close to 140 I think) - I think the heat and working late has decreased my hunger. I am drinking protein shakes to supplement.
16 wk Ultrasound looks good - It looks like a boy and a girl! And they move around like crazy
I returned the Luke book to the library :)
Now to battle sciatica (already?really?)
All the best! I hope you don't have the pelvic pain I had. In any event, never feel bad or disloyal about getting a second opinion. A good provider should appreciate you seeking as much input as you need. As one of my doctors said -- a care provider who is discouraging or makes you feel bad about getting a second opinion is not a care provider you want to have.