Wednesday, June 2, 2010

Coping When Your Twins Are Premature

8 months pregnant on our last "babymoon"
Because my husband and I were going though fertility treatments, we learned we were expecting twins very early on. It wasn't shocking really, as one in four IVF procedures lead to a multiple pregnancy. It was, however, complete naivete that let us simply be excited about the fact that we were at last pregnant, instead of being overly concerned that at 38 years old I was about to embark on a "high risk" pregnancy.

High Risk. Those words didn't mean a hell of a lot to me as I didn't know anyone who'd had a truly difficult pregnancy or birth. Difficulty getting pregnant? Yes, I knew tons. So I could really relate when someone brought that up.  But the truth is, around 30 percent of twin pregnancies go into premature labor, and around half of all women expecting twins give birth before 37 weeks. That's a LOT of premature babies.

From Baby Center:
"Premature labor is more common in identical (monozygotic) twins, particularly if the babies are sharing the same placenta, membranes, or amniotic sac. Premature babies born between 34 and 37 weeks generally do very well. Extremely premature babies born before 28 weeks may survive, but they'll need intensive medical care and a little luck. However, advances in neonatal care mean the outlook for premature babies is improving all the time."

Had my children been born prematurely I don't think I would have been in the least prepared. Somehow, I had convinced myself that I would carry to term but, as the statistics show, I was lucky. Being a mother of twins has shown me how important it is to be prepared for the unexpected. I spent some time in the last few weeks speaking to friends of mine who delivered their babies prematurely and asked them what they would want to share with expectant parents in case their twins come earlier than expected.

One way to keep your mood up when on bed rest is to
make sure you stay connected with a good support system. 
If You're Put on Bed Rest:
  • Sometimes it will be at home, and sometimes your will be in the hospital so you can be monitored 24/7. For many, the hospital is a blessing and a curse. It takes some pressure off of you and your partner because there is no guessing involved; the hospital staff is watching so closely and you will know if anything at all is wrong. But it can be quite hard to have week after week in the hospital, away from your other children if you have any, away from your life. 
  • If you do end up on bed rest to try and keep in mind that any discomfort (mentally or emotionally) is temporary and is to ensure that your babies will have the best chance at a good start in life. Take it one day at a time and focus on staying pregnant, not on having a premature birth. 
  • Set little goals like: "get to 26 weeks, 28 weeks, until my friend get back from her  trip etc." Have a schedule whether at home or in the hospital. Set your clock for a specific time to wake up, have breakfast and watch your partner get ready for work. Perhaps there are TV shows you watch in the morning, have lunch...always have something to do.
  • Stay hydrated and empty your bladder; both are really important and a great help in avoiding preterm labor. 
  • Join an online support group. There are many specifically made up of other mothers on bed rest. While not all are expectant mothers of twins, they are all going through many of the same roller coaster of emotions you are. It is beyond helpful to connect with people who share your experience and be able to talk about everything you're going through. Some of the support groups include: Baby Center's Bedrest Club and if you've gone through fertility treatments the support groups at Resolve are amazing. Another fantastic place for support and information is Sidelines
  • Although you will be online a lot, DON'T search the internet about your condition. It will only make you crazy. Trust your doctors and concentrate on staying pregnant.
  • Remember that supermarkets like Vons and Bristol Farms deliver. If you do this, have food delivered on a day when a housekeeper/nanny or another set of hands is around to help unload and put away.
  • Doctor Jenn Berman, a Licensed therapist here in LA who has twins herself, wrote an article on bedrest a few years that will give you some additional insight and tips. You can read her article here
What To Do Before The Babies Arrive:
  • If you are considering hiring a nanny, do it before your babies arrive. You can have her set up your nursery, get groceries, run errands etc. The last thing you will want is to be interviewing someone if you are also caring for two premature babies. Obviously, if you are facing the fact that your babies may come early, discuss this with the potential caregiver and assess her background/familiarity/comfort level.
  • Hire a night nurse or doula. You will need the extra rest and help. If you have been on bed rest for an extended period, or have had a c-section, your body will not bounce right back to where it was before. You and your partner will appreciate the night time support and you will not miss the money.
  • Collect take-out menus from your area. You will not want to be cooking. If you are a member of your local MOMS Club they always have a "Welcome Baby Dinner" program where members drop off food for families with newborns.
  • Sign up for and/or Both will deliver just about anything you need that is baby related. does it overnight! It's just one less thing to worry about running out to do. One thing to consider with twins is that one child may need different sized diapers from the other!
  • Call your birth hospital to ask about any information the consultants at their NICU (Neonatal Intensive Care Unit) may be able to share with you in how to care for the babies should they come early. Forewarned is forearmed.
  • Look into Mommy and Me classes. These are classes you will do with your children. Sue Darrison gives a terrific (and perhaps the only) class that is specifically on parenting twins. The Pump Station also gives very highly recommended classes on bringing home baby and although you may likely be the only one with twins, it will still give you good information.
  • Take an expectant parents class with someone realistic who had a good pregnancy. You will be bombarded with so much negativity and scary statistics, it's also good to know that twin births can go smoothly and babies born early can thrive! WLAPOM (West LA Parents of Multiples) has a great one.
  • Talk about all of this with your partner. Communicating and allowing him/her to express their own anxiety and fears is crucial to surviving this phase. Let your partner offer support, and be prepared to offer some back. Get on the same page as to how you will cope with all of the stages that lay ahead. Doing this early on will allow you both to make it through the tough times in tact.
My daughter and son...not preemies
but still so very small!
The Babies Arrive Early. Now What?
  • Expect your babies to be in the NICU until their due date. If they do come home earlier, great! 
  • There is a lot of lactation help at most hospitals. Take advantage of having all that knowledge at your disposal. Depending on just how early you deliver, the goal of your NICU nurses is just to make sure the babies get to the stage where they can suck, swallow and breathe on their own. If breast feeding is important to you, make this known as clearly and often as possible. But be aware that very tiny babies may have to have feeding tubes, or have extra calories added to your pumped breast milk; try to breast feed when and if possible. Don't be discouraged if you can't do it right away or as often as you'd like. 
  • Since you won't be able to take your babies home, use the time to take care of yourself. This may be the last time in a while that it will be somewhat simple to get a haircut or get a manicure. Do it! Pump often to keep your milk supply up. Remember, your babies do best when they sleep, because they are not burning calories, so visit them often, but don't be afraid to go to lunch with a friend or get out a little bit. Take the opportunity to learn infant CPR at the hospital and learn all you can from the NICU nurses. 
  • Get emotional support. I can't stress this enough. Whether it's seeing a therapist trained in twin issues like Dr. Pamela Varady, or joining an online group for parents of multiples like WLAPOM (if you live in Los Angeles) or SFVMOMC (if you live in the Valley). You will need someone outside of your immediate family to talk to and friends who have singletons or children of different ages will not fully understand.
  • There is the possibility that one child will come home earlier than the other. There is, perhaps, no way to prepare yourself for how you will react to this, as everyone has different responses. You may feel guilt over which child you should be with: the one in the hospital or the one at home. You may feel conflicted over bonding: are you bonding more easily with the "sick" baby in the hospital who needs you so much, or bonding more easily with the "healthy" baby who is so easy to care for at home. Give yourself a break and know that there is no "right way" to respond. You are doing the very best you can and you have to trust that each baby is getting what they need.
  • One idea that I loved was that if your children do leave the NICU on separate days, is that you mark that day as their "coming home day". You can then celebrate their birthday together and additionally be able to give them each their own, individual, parties on their "coming home day". Talk about making lemonade out of lemons!
  • Set your email on "Auto-respond" and do not feel pressure to write "Thank You" notes. Your email can be programmed with a note to say something like: "I'm taking some time away from the computer and cell phone so I can bond with and care for my little ones. I will be in touch soon. Thanks for thinking of me". The pressure to adhere to social convention and send a note quickly after a gift is given should be thrown out the window when you have twins. And especially so if you have preemie twins! Your friends will understand.
  • Be prepared for the fact that one or both of your children may need PT (Physical Therapy)/OT (Occupational Therapy)/Speech Therapy or any number of other services depending on their development after birth. If you suspect your child needs some type of developmental assessment you don't have to wait for your pediatrician or the NICU to refer you, you can call The Regional Center closest to you for a free assessment.
One of the more difficult aspects of having premature twins is the inevitable comparison you will make to friends' and acquaintances' children. There can be so much guilt and stress surrounding your children's premature birth. Be gentle with yourself, know that every stage is just that: a stage. Reach out for help and remember that at a certain point whatever developmental hurdles they may be struggling with may be because they were premature, but they may have these struggles regardless. With early intervention, knowledge and their parents' love, your children will have the lives they were meant to have. 
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3 Great Comments Made By Clicking Here!:

The Twin Coach said...

More great suggestions from a reader:

"At Cedar's [in Los Angeles] they have special programs for long term patients. I had a woman come play the harp for me a couple times a week and a woman who brought her dog for me to see. This was all through the hospital and was free. The harp was SO cool. The kids would kick [inside my belly] to the music. I LOVED it.

The nurses had numbers for massage therapists (but this actually made me contract more) and nail places to come give me a mani/pedi in the hospital. It was really nice to be able to pamper myself while I was there."

Sharon said...

You are amazing!! Thank you for the time and effort that you invest in your wonderful and extremely informative blog!!

Gina Osher said...

In case you wind up on bed rest, this was a private comment from a reader that I thought was an excellent suggestion:

"I wanted to share my find with the group. I have been on bed rest for about 17 weeks and counting and for the last couple of months had severe leg pain (especially in my lower legs) from lack of movement in my legs.

I think massage might have helped but it would have to be in home, which would be logistically challenging at times and very expensive.

Last week I found a leg massager that has practically cured all my pain in 3 days. It is called the "Ucomfy Leg and Feet Massager". I got it from Bed Bath and Beyond. Here is the link:

It costs $200 but Bed Bath and Beyond always has 20% off coupons. It was the best almost $200 that I've ever spent. Anyone on long term bed rest probably understands the level of severe pain.

This machine is great because it only takes about 15 minutes of use per day. It really helps increase the circulation and likely reduces the risk for blood clots. I was in the ER for some issues and this machine could have helped reduce my blood clot risk in advance.

I can't say enough great things about this machine and how it has helped me so quickly. I hope this helps other people too."

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