Glass Houses

Before I had children I was definitely the one rolling my eyes when people brought their kids into an “adult restaurant”. I was the one cringing when a family would board a plane with young kids. I never understood why anyone would care about someone else’s kids enough to stick their Christmas photo card on the fridge. In fact, I never understood why anyone would bother to send a Christmas card like that! I was quite the Scrooge when it came to kids.

And now? Now I do almost nothing that doesn’t have something to do with my children. Now, just about every one of my friends are “mom friends”. I’m one of those people who send those Christmas cards and I hang up every single one I get from others, marveling at every child’s changing features from year to year.  I can’t even see a movie in which a child might be hurt (or God forbid, die). I have become a complete softie.

The fact that I care so much about children, and pay so much attention to the effects our actions have on them, has made me sometimes very judgmental of others. But why do I do it I wondered? It’s kind of like when you’re in the supermarket checkout line and you look at the cart of the person in front of you and you think: “What the hell are you doing buying canned fruit??? Do you even know what a vegetable is? Why would you load up on Velveeta?” Somehow it makes you feel a tiny bit superior. What do you get out of that moment’s ego boost? Nothing really. It’s a bit like eating that Velveeta. Empty.

There are always those horror stories in the paper about people who leave their children in the car on a hot day and I often think to myself “how can you possibly forget your kid in the car?! What kind of parent would do that?”  Yep.  Judgment. Lots of judgments.

Sunday morning, after we took our kids to their baseball class we rushed to get back home (after dealing with children whining, dragging feet, and fighting in the car) to find ourselves late to meet friends waiting on our lawn for a play date we had scheduled. In the confusion, I got out and rushed to open the gate to our back yard, I thought my husband got both of our kids out of the car….he only got one out and thought I got the other. He headed upstairs to get something, I headed to the yard with our son and guests thinking he had taken our daughter upstairs. Only when he came back to the yard 20 minutes later did we realize our daughter was not with anyone. Complete panic set in as I rushed out to the front of the house. My first thought was that she had wandered off during the commotion when we first got home, but someone yelled out “Is she still in the car?” and as I opened the door to see her tear stained face and red eyes, I began to cry myself. She just whimpered to me “You took a long time!” and clung to me as I got her out.

My baby girl thankfully was just fine and hasn’t mentioned it since. So no psychological scars to deal with. But it really shook me up. And made me re-evaluate not only how caught up in my own stress I get sometimes, but how much I might judge someone who did what I did. We don’t always know the full story about why or how something happened. I like to think I am actually a very compassionate person (and I usually am), that I see the big picture, that I give people the benefit of the doubt. In that moment that I realized I had forgotten our precious daughter strapped in her car seat, I also realized that I would be judged; perhaps most harshly by myself.

my girlI think, perhaps, that scare has taught me a lot. For one, I need to slow down and focus on what really is important in the moment. Second, I need to slow down my reaction to what others do or say and remember that everyone is doing their best. As the old adage goes: People in glass houses shouldn’t throw stones. Most of all, Sunday morning taught me to be very, very grateful for every moment I have with my family. That one thought has helped me have less frustration and less impatience with our children. Our daughter wouldn’t let me leave after she was in bed last night: “I want you to stay and watch me dream”, she whispered. There are nights, believe it or not, where I am so tired and so over the long day that I tell her no, she has to go to bed. Last night, I sat beside her, rubbed her back and watched her dream. I am a very lucky mommy.

Making The Choice About Delivery Methods

I helped facilitate an Expectant Parents group the other night and there was a young mother, pregnant with identical boys, who had been told by her OB that she (the doctor) was uncomfortable delivering the babies vaginally. No discussion, this mother-to-be was just told that she would not be given the choice. I really felt for her. The choice of how you want to give birth can be complex, confusing and very, very intimate. There is so much that goes into this decision that for someone to simply take that choice away from you without considering what it might mean to you is cruel.

This particular mother has identical twins who are sharing a single sac, which may be why her doctor isn’t comfortable with trying. From NaturallyParentingTwins.com

“Certain situations that might affect your twin birth planning can include whether or not your twins share a sac or are at risk for TTTS [Twin-to-Twin Transfusion Syndrome]. Twins who share a sac (monoamniotic twins) are at significantly higher risk for cord entanglement, cord compression, TTTS, and preterm birth; they will require additional monitoring throughout the pregnancy and most experts recommend a scheduled cesarean for this kind of birth. Monoamniotic twins are extremely rare; however, even the most naturally-minded mothers expecting twins support having at least one ultrasound to determine the number of amniotic sacs and placentas. Identical (“monozygotic,” or MZ) twins can be at risk for twin-to-twin transfusion syndrome (TTTS), a situation in which the flow of blood to the babies becomes (for lack of a better description) rewired, causing one twin (the donor twin) to not get enough, and the other twin (the recipient) to get too much. Twins at risk for TTTS should be monitored throughout the pregnancy; if it is determined that the pregnancy has become too risky for the babies, an induction or Cesarean may be encouraged. It is important to note that there have been acute cases of TTTS that present during labor itself; ask your provider about this risk.”

pregnant bellyI wasn’t one of those women who dreamed about having babies or who was adamant about a natural childbirth. I, briefly, considered a water birth because I had always loved the idea of the baby leaving the warm, watery environment of the womb only to arrive into the warm, dimly lit, watery welcome of a bath, as opposed to the cold, brightly lit stark environment in a hospital. Once I learned we were having twins (that’s me to the left there, 9 months pregnant), I let the scary stories of possible complications scare me away from this idea. But I was adamant I wanted to have (or at least try my hardest to have) a vaginal delivery.

doctorsThere were a number of reasons for this; on a practical level, I knew that the recovery from a c-section was so much more difficult and the stay in the hospital was more than twice as long. On a medical level, I knew that the act of being pushed through the birth canal was extremely good for a newborn’s breathing and lung capacity. And on a spiritual level, there was something that spoke to me about allowing my children to successfully push their way through “adversity”; I didn’t want to take that away from them. My greatest fear in attempting this was that I would end up with one baby born vaginally and the other via c-section. Thankfully, my OB was very familiar with birthing twins, had thoughtful and respectful answers for all of my concerns and, even when our daughter took an hour and ten minutes to emerge after our son was born, never once gave up on my body to be able to give birth naturally. Thank you, Dr. Suzanne Gilberg-Lenz.

I was thinking about all of this as today there was an article in the Los Angeles Times about some recent scientific studies that suggest that cesarean births may expose newborns to specific bacteria that could play a role in their future health. 

“The finding is significant, scientists said, because the types of bacteria residing on newborns influence the development of their digestive and immune systems and may affect their health later….previous studies had suggested that babies delivered by caesarean section lacked the benefit of protective vaginal bacteria, making them more susceptible to certain pathogens, allergies and asthma…”

Sometimes with a twin birth you just don’t have a choice as to whether you will have a c-section or not. There is so much less room inside your body when you have two babies; even when baby A is head down, it is very common for baby B to be breech or transverse. We were lucky that our fraternal twins were both head down, but there are many qualified OBs who will attempt a vaginal birth regardless. The Berlin Wellness Group, where I do my coaching sessions, is a big supporter of mothers wishing to attempt a VBAC (Vaginal Birth After Cesarean) and it’s chief chiropractor, Dr. Elliot Berlin, along with his team, are well-known in LA for success in turning breech babies in utero.

new momAll this being said, don’t let your wish to have a vaginal birth cloud your judgment; your “birth plan” is less important than making sure both mother and babies are healthy and survive the birth. It is important to discuss your wishes and concerns as early on as you can. If your doctor isn’t on the same page as you or your partner, speak up and change doctors if you feel you need to. Just remember, your babies are really the ones with the plan; you ultimately will have to follow their lead.

What about you? Did your babies’ birth go as you had hoped or planned? What was your experience, emotionally and physically, if you did have a cesarean? If you had a choice, what factors went into deciding? I’d love to know your thoughts on the topic.

Health Scares, Vaccines and Recalls

I have posted previously about Dr. Jay Gordon and his views on vaccinations. I received an newsletter from him this morning regarding the current Pertussis scare, Tylenol recall as well as some of his political views. I thought it worth sharing here for those of you unaware of Dr. Gordon or his newsletters:

Dear Gina,

California declared a pertussis (whooping cough) epidemic this week. The California Department of Public Health reports 910 confirmed cases, including the death of five infants since the beginning of the year. The Department of Public Health is urging all families, especially those of Latino descent to vaccinate against this disease. The emphasis on families of Latino background apparently stems from Fresno County having the highest number of reported cases: 72 reported in the month of May.

Whooping cough, also known as pertussis, is a bacterial respiratory tract infection. It begins looking like most other upper respiratory illnesses:

There may be nothing more than a runny nose and sneezing, often with little or no fever. The first coughs can look like a common cold. After 1-2 weeks, this may progress to a stage characterized by bursts of numerous rapid coughs (paroxysms, a “machine gun” cough) followed by a loud “whooping” inhalation which givesBordetella Pertussis the alternative name of “whooping cough.” That “whoop,” however is not an invariable part of the illness. A final recovery stage with coughing may last weeks or months. It’s a nasty illness which the Chinese call the “100 day cough” and their number is not far off. In most cases, whooping cough is a truly miserable cough that can ruin a family’s summer plans and mean a lot of missed days of work and school. In very rare cases, it can lead to much more serious conditions. The risk is highest for infants in the first six weeks of life who can get very sick and even die from it.

At the present time I’m aware of two families in my practice who I believe have pertussis. I have no laboratory confirmation and in neither case has anyone in the family required hospital care.

The media and many official medical organizations get the discussion of “epidemics” wrong as often as they get it right and when they finally have something to talk about in the press it’s hard to sort out the truth. Before you read any further, have a look at this New York Times article about the whooping cough”epidemic that wasn’t.”

This time, unlike the H1N1 “pandemic” scare, the avian flu hype, the measles epidemic of 132 cases, the Jewish mumps scare and the West Nile Virus fear posters at every trail head, the pertussis outbreak information might be real and might be a reason to consider getting your child vaccinated. Whooping cough is not easy to diagnose with lab tests and doctors and parents often must rely on their clinical impression the cough and the pattern of disease spread. According to the official website of Children’s Hospital of Philadelphia, an article reviewed by Dr, Paul Offit estimates that there are between “600,000 to 900,000” cases of pertussis each year in adults and adolescents alone. This stands at odds with official data from the CDC which puts that number at 5000-10,000. This type of disparity makes the discussion of pertussis outbreaks and vaccination just a little more difficult.

I think the DTaP vaccine is the shot with the best risk/benefit ratio and it’s the vaccine I use the most often in my office week. The official schedule includes far too many shots for six-week-old babies. A lot of harm and confusion could be alleviated by vaccinating later and not giving five or six vaccines at the same time.

This “acellular” vaccine does not contain mercury (almost no vaccines still do) and has been in use for nearly fifteen years in the United States and for quite a few years before that in other countries.

DTaP vaccine prevents whooping cough and may even prevent illness or lessen the severity of illness after the first vaccine. The routine schedule includes three doses in the first six months of life, a fourth at eighteen months of age, a fifth at age five years and booster doses of a new adolescent/adult vaccine. I don’t think your babies under a year of age should be given any vaccines, including this one. The CDC and most doctors, including my colleagues in this office, disagree.

Erythromycin, Zithromax and similar antibiotics can shorten the contagious phase of pertussis and can stop the spread of the illness in a family or a school. Our office has DTaP vaccine for infants and young children and another for older children, adolescents and adults. I do not recommend this vaccine for infants unless there are unusual risk factors in a baby’s life. Again, the vast majority of experts disagree and I understand the need for public health considerations and preservation of herd immunity but still would rather vaccinate only after 12-24 months of age.

Ultimately this is a parents’ decision. Do not expect the media to let up on this issue in the near future.

*******************************************Tylenol Recall Update

Since the April recall, Children’s Tylenol, Benadryl, Motrin and other McNeil Pharmaceutical products are still unavailable for purchase. The latest report says we should not expect a return of these products until 2011. You can receive updates from the makers of Tylenol on their website. In the meantime, I recommend generic brands of diphenhydramine (Benadryl) for allergies and generic acetaminophen and ibuprofen for fever control when you need it.

Here is a resource to help you determine the proper amount of acetaminophen to give your child.

*******************************************

Some of you have expressed interest in Senator Barbara Boxer and my support for her advocacy for children. My wife and I are co-hosting an afternoon with Senator Boxer at a private home in Santa Monica this Sunday, June 27th and also will be co-hosting an event with Senator Boxer and Vice President Biden in July. If you are interested in either of these fund raising events, please email Sheila Creal at [email protected]

Jay Gordon, MD, FAAP

Home

The Super Hero and Princess Epidemic

in maskI’ve been having a fascinating discussion with some of my mom friends about the sudden outbreak of super heros and princesses that has invaded our homes. Having both a son and a daughter, all aspects of pretend play affect our family. After much thought, our preschool has recently decided to implement a dress code of sorts. Children will no longer be allowed to come to school with clothing or other items (lunch boxes, costumes and so forth) that have super heros, princesses or media characters and images (video games, Spiderman, Star Wars etc). Since we don’t really buy our children that sort of stuff, this doesn’t change a whole lot for me on the surface, however, it may change a greatdeal how my children feel about themselves and their world.

We didn’t offer television as an option to our kids until they were over three years old. I am not judging anyone because I totally understand why it can be helpful to turn on the TV to be able to get anything done (especially with twins)! We also purposely tried not to introduce Disney princesses or “commercial” toys for as long as possible. My own feeling about this is that it allows children to develop their creativity and their minds more extensively when you don’t present them with characters whose roles are already determined. Our kids had no concept of who Batman or Cinderella was, and so would play dress up or pretend in a very different way than they did once those characters were introduced to them. It’s not necessarily a terrible thing that this has now happened, but I have noticed the difference in their behavior since this type of play became more prevalent (and more important to them because their friends were doing it).

I adore both our preschool and its director. She has a very progressive, very child-centered way of approaching things. One of the aspects of the school that we loved most when we first toured was the lack of Disney or Dora or Elmo on the walls; everything there was something that sprang from the children’s own imaginations. There are a lot of great parents at our school too, some of whom are totally comfortable with allowing their children to watch movies, television and videos that I wouldn’t choose to let my kids see just yet. Some of these parents have been quite upset by this new rule and feel there is nothing wrong with their children wearing their favorite Tinkerbell shirt or carrying a Spiderman lunch box. I take a deep breath, sigh and am amazed at the resistance to this. One of my friends said it best: “A few hours without Super Heros and princesses will not affect these kids with all the paraphernalia. A few hours WITH them IS, however, having a huge impact on your home life”.

superman outfitI have noticed that in the past few months our son has come home more than once talking about “bad guys” and having to “protect himself” or “kill” things.  I do know that he will eventually know what these words really mean and I will have to discuss them with him, but it would be my preference that at this age he wasn’t asked to understand those concepts. I think that, perhaps, what parents who feel comfortable exposing their children to various types of movies/stories/videos don’t consider is how it much it affects the other children who interact with their kids. Some children are just much more sensitive than others and may not be able to handle knowing about the bad guys these Super Heros fight or even why they are fighting. I have tried, instead, allowing my kids to create their own heros with whatever powers they might imagine and they come up with the wildest things and it is from THEIR imagination so there is no scary imagery I have to combat; Picasso the Super Rabbit was one the other day….he painted the world bright colors and made everyone happy. Not too deep, but the kids had fun.  

Our preschool director wrote:

“…Banning guns and Super Heroes all together is not meeting the children’s needs. Whether at home at or at school, if telling the children “no guns”, they will continue to build them with Lego or to turn any object into a shooting device. We live in a violent society and a world filled with images driven by the media that are scary for young children to process. Even if children have not seen a Super Hero movie or seen anything  comparable to it on TV, they are constantly surrounded by it.  In an ideal world, we would want to shield our children completely from these images, yet this is impossible as it’s everywhere and even built into, I believe, our collective unconscious. This is a phrase Carl Jung coined and I feel fitting to draw attention to when discussing the behavior towards weapons and the biological “need” for boys to play with them. Jung discussed that we have an inherited part of the unconscious that occurs in and is shared by all members of people or race. It is a reservoir of experiences of the human species. Could this be what boys are experiencing? 

We want to figure out what the children need to process by playing like this. One way is through observations and careful conversations filled with questions of what the child is creating with this play. Questions like, “I see you are playing with your friend, what game is this? What kind of powers does your Super Hero have?” Through observations and conversations, we can learn so much about how the children’s needs are being met. Telling a child “not to play” a certain game or with something could be a missed opportunity to look deeper into the feelings and the psyche of the child.  This is the deeper understanding we want to promote. After we have an understanding of this, THEN we can challenge them to a different type of play by redirecting them into something else that can still help them process their feelings and channel their emotions without the shame of making them feel that what they are playing is wrong.

…So we ask; how can we be creative with the children in creating Super Heroes, if the topic arises, and how can we help them to create their own imaginative play outside of the limited,  close ended, and developmentally inappropriate characters that the media have created?  Do we create our own Super Heroes? Do we allow the children creative license to play within the context of processing these emotions without having all the boys being Spiderman or Superman? We do think Super Heroes and the idea of “heroes” in our society is important. That is not what we are trying to avoid. We want to promote imaginative and creative play in which the children can learn and develop rather than imitative play…” 

in fairy outfitAlthough the Super Hero stuff hasn’t taken a turn for the worse in our house yet, I am DEEPLY disturbed by the princess problem that has begun. Our daughter, who is not quite 3 1/2, has been telling me she “looks ugly” in some outfit, or that she won’t “look pretty” if she can’t dress like a princess. It absolutely breaks my heart and I know, in part, that it comes from school. It’s not the only place of course, but when she tells me that girls at school have prettier clothes, it makes me wonder what’s going on. I know that at this stage she is not really feeling that she, herself, is not pretty; it is more about not having the language to express that she may think a dress she has on is not fancy enough or her clothes are too sporty for the mood she is in….but, for me, the princess issue has a more far-reaching problem than even super heros do. I don’t want my daughter feeling that her looks are all that matters, or that growing up to have no goals other than to meet a prince is OK. And yet, it is so hard to avoid. She is a pretty girl and people comment on her looks all the time. Well-meaning friends buy her princess things for her birthday and it’s so easy to give in; princess stuff is pretty and not letting her play with it brings on the tantrums!

Again, our preschool director writes:

“…In presenting all of these topics, let us not just imagine that this is a boy issue. The media presents itself to girls in a way that is far too mature for them to grasp as well. Girls are developmentally more emotionally mature than boys and process feelings of powerlessness in a different way. Girls are presented with images of women in the media, dolls, fashion; they feel they have to imitate to feel worthy. We comment on their outfits and outward appearances as a way of connection and compliment harmlessly while forgetting to connect with them in a way that is boosting their self esteem on the inside. Instead of gun play, we often see girls being emotionally mean to one another in attempt to appear powerful or in control of their friends. We can hear phrases like: “You can’t play with us.” Again, the root of these behaviors comes from the same place of a child’s perception of being small in a big, huge world and feeling overwhelmed by images in the media targeted at young girls. We want our boys and girls to feel good and strong from the inside”.

cute girl

Like everything else about parenting, the easy way out is only good in the short term. It’s a bit like making the choice between fast food and a well-balanced, home cooked meal; one is so much easier and it tastes so good, what’s the harm? The other is a pain in the ass to prepare, takes so much time, tastes good, but maybe not as yummy as greasy fries and a burger. Why bother? In the long run, making the hard choices and doing the hard work is how I see us being able to raise the compassionate, bright, self-assured well-adjusted children we know our children are capable of becoming.

So maybe letting my daughter have that Ariel costume wasn’t the end of the world, but if I don’t balance it out with showing her that there is so much more to life than pining away for a prince to kiss you, I will have failed my job as mom. If my son wants to be Superman at Halloween, I can live with it; but I also have to show him that there are many ways to feel powerful in this world and that he doesn’t have to worry about battling bad guys all the time. Being a parent is hard. Sometimes I think being a kid is a lot harder than we may remember.

How do you feel about your children playing Super Heros or Princess? I’d love to hear your thoughts on this topic.

Coping When Your Twins Are Premature

twin pregnancyBecause 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.

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’re Put on Bed Rest:

  • 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.

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 Diapers.com and/or Drugstore.com. Both will deliver just about anything you need that is baby related. Diapers.com 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!
  • 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.

The Babies Arrive Early. Now What?

  • newborn twinsExpect 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. 

Creating Family Rituals And Traditions

I was talking the other day with some fellow twin moms about the idea of creating rituals in our families. Not necessarily ones revolving around religion or holidays, but every day, little, family rituals that your children can think back on when they are grown, and smile about. Sometimes having twins means that you are so overwhelmed and stretched so thin that holidays and events just sneak up on you (Father’s Day anyone?)! I’m an only child, with almost no extended family and my parents are not the most traditional of folks. I honestly can’t think of any real traditions we had. I have great memories of wonderful things we did together, yet I can’t think of anything that I can point to and say “in our family we always did that”! No famous recipes passed down. No yearly trips to the cabin by the lake. No “traditions”. 

My husband, on the other hand, is one of seven children. Somehow in the midst of that chaos, his mother managed to create rituals and traditions that the children now carry on. The oldest of my husband’s sisters cooks many of the family’s favorite dishes when we all get together for the holidays; all gleaned from watching their mom cook, or from pouring over their mother’s massive cookbook collection. This same sister-in-law told me once about when she first started school how her mother helped her get over her fears by drawing a heart on her wrist each morning so that every time she felt scared, she could look down and know mom was thinking of her. This ritual continued as she grew older; although it was no longer every day, if my sister in law went through a tough period in high school, had stressful days in college, took exams, had interviews, there was the heart. When their mother passed away, my sister-in-law had a hand-drawn heart tattooed on the inside of her wrist to always remind her that her mother was thinking of her.

One of the things that will help your twins bond with each other is shared experiences. We all want our twins to look back and reminisce about a childhood filled with things they did and experienced together. So here I am, mother of two, creator of memories. I want to give our kids all of these great traditions and do all of these wonderful things and then I just sit here, overwhelmed and paralyzed. Maybe it’s because I want our traditions to be so fantastic or so well thought-out that I can’t even begin. Or maybe it’s that I want them to be so full of meaning and a character-building experience that I get stopped before I start. But deep down, I realize that this isn’t necessary. A family tradition just has to be something you do on a somewhat regular basis that your family enjoys. It can be something so simple that you create meaning and memory out of. 

I think one of the best places to start is to think about what you enjoy. No matter if it’s nature, charity work, sports, the arts, cooking, travel or being together as a family, there is a family tradition waiting to be created. Here are some ideas based on things we do (or would like to do) in our family:

Back to Nature

I’ve written previously about the nature walks we do around our neighborhood and the idea of making a keepsake box of some sort to keep your collections in. This can be done on any trip you take or on any type of outing, whether it’s a family vacation or a trip to your local park. this is a lovely way to teach your kids about the beauty of the world around them as well as cherishing memories of time spent together.

  • From “The Book of New Family Traditions“: In the early Spring, birds returning home after the winter need materials to build their nests. This variation on a bird feeder called a “bird’s nest basket”  helps attract birds to your yard by supplying them with things they can use to make their new homes. Use a small, lightweight basket (like the plastic kind blueberries come in) and fill it with short pieces of string or ribbon, feathers in muted colors (birds won’t take anything in a bright color that might attract predators’ attention), twigs and leaves. Arrange materials in the basket, tie the basket from it’s four corners with string and hang from a tree branch you can view from the inside of your house. Wait, and watch. In the mean time, you can take advantage of your children’s interest in the process to teach them about birds and why they build nests. You can also pass the time by making these decadent Bird’s Nest Cookies. Just make sure to have a toothbrush handy afterwards!
  • A great combination of appreciating nature and taking care of the world we live in is to volunteer with an organization like Heal The Bay. One of the great things to do with kids is to get involved in their Nothin’ But Sand beach clean ups. Children are welcome, although if they are under 18 they must either be with an adult or have a waiver signed by a legal guardian. Heal The Bay does these clean ups every month so this can easily become a ritual you do all the time. 

Giving Back

  • kid walkingWe have begun to introduce to our children the idea that not everyone is as fortunate as we are. It’s very easy to get carried away and to spoil our children particularly when their birthday or Christmas/Hanukkah rolls around. One way to balance this out is to teach the kids that we must make room for any new gifts by clearing out old ones we no longer need and giving them to a family who has less than we do. It’s not always easy for them, and each forgotten toy that is unearthed suddenly becomes a new “favorite”, but each time you do it they will get better at it. You can also suggest that they collect old clothes that no longer fit. Let them come with you to make the donation drop off. 
  • The multiples club I belong to, WLAPOM, has a terrific philanthropy called Multiple Helpings which helps new mothers of multiples who may not have the financial resources to cope. Last Christmas, our family “adopted” one of the MH families; Our children shopped for, wrapped and brought gifts, clothes and baby items to bring to a very appreciative family. 6 months later, the thought that some families don’t have as much as us is something that our kids bring up from time to time. One twin mom I know does this as well, but added the wonderful idea of creating a photo album with pictures of the process so the memory is really strong for her girls.  
  • There aren’t many opportunities to volunteer with children, but one of the few that does welcome them is SOVA which has three locations in Los Angeles. Among many wonderful resources offered, they run a food pantry that provides free groceries and personal hygiene products (when needed) for every member of the families who seek help there. You and your children can help stock and sort the pantry, distribute completed orders to clients, or sort donations that come into the center through food drives. Please note that SOVA allows children as young as 8 to volunteer when accompanied by an adult, or on their own once they turn 12. However, if you have younger children, as I do, you can organize a food or book collection with your children and bring the items to one of their pantries so the kids can see where it’s all going.

Celebrating Your Familyfamily-tree

  • One ritual I love that we do in our home is “kind brother/kind sister day”. I created a “Kindness Tree” out of construction paper that we hung in our dining room. Each time one of the kids does something kind towards the other, they get a leaf on one of the branches with the act of kindness written on it. We periodically read the leaves and show it off to anyone who comes to our house (that’s our daughter checking it out when it first went up). Once the branches are full of leaves, we do something special to celebrate their kindness towards each other. We actually had a kind brother/kind sister day Friday; the kids’ best friend came over for a back yard play date and we made ice cream sundaes together. It was great fun….and a little insane (three 3 and a half year olds hopped up on sugar. Yikes!).
  • Father’s Day (or Mother’s Day) is a tradition in pretty much every family’s house. One of my favorite blogs, My Submarine To The Future”, had a great post yesterday about a very cool Father’s Day Surprise Lucky Dip Gift Box. It’s an easy way to make gift giving fun and personalized while still being able to get the kids involved. Plus, it works for any birthday, Christmas, Hanukkah etc.
  • book 1Family Meetings are both a ritual and a great way to work through issues that are plaguing the family as a whole. What better thing to teach your kids than the idea that coming together as a family to talk things through will result in a happier and more closely-knit family. What is a family meeting you may ask? From the fantastic book “Positive Discipline For Preschoolers“: “…children gather on a regular basis to help each other, encourage each other, learn communication skills, focus on solutions, and develop their judgment and wisdom. By far the most powerful effect of [family] meetings, though, whatever the age of the child, is to create a sense of belonging.” You can start these meetings when your children are as young as two or three, but by three and a half they should definitely be ready to participate. Begin your meetings with compliments and appreciation (ie: “I want to thank david for setting the table this morning. It was so helpful to Mommy that you did that”). If there is a conflict that needs resolving, you may prefer to end the meeting with compliments and get to the pressing matters right away (ie: “I want to compliment Lisa because she brought up that she was feeling jealous about the new baby. I appreciated hearing your ideas on what would make you feel happier”). At the meeting: allow each family member to be heard, take notes about each person’s feelings and concerns, read them aloud to make sure everyone understands, allow each child time for rebuttal, invite everyone to offer as many solutions as they wish without evaluating them (children go first), decide on which solutions you can live with. Most importantly: make a date to follow up. Family Meetings, especially when dealing with conflicts, are outlined very well in “Siblings Without Rivalry“. From the final chapter of that book: “You wouldn’t expect your car to run without periodic refueling and maintenance, yet we expect our family unit to run without regular checkups…it’s a great way to make sure tensions never build up. We sit around and talk about family activities, chores, who wants to do what, who wants to trade off what, who’s bothered by what…It’s a time for all of us to think creatively about what we need for ourselves and how we can be supportive of each other.” 

sitting on grassI was recently asked to make a list of 10 attributes I would want my children to possess as young adults. This was a lot harder to do than I thought; just ten??? But when I really thought about it, I realized that every single attribute I would want them to have has to come from somewhere: from something we teach them, something they learn in school, something they figure out based on the character they build growing up in our home. If I want children who are expressive, self-assured, resilient, and compassionate (and 6 other things), I have to do more than just love them; I have to teach them, expand their horizons, and give them a sense that their family is secure base from which to explore. For me, the idea of creating family rituals is all of that. I’d better get my butt in gear!

What about you? What are some of the rituals and traditions you have in your family? I would love to hear about them!

Nurturing Individuality – A Conversation With Dr. Joan Friedman

friedmanbookAbout a year and a half ago I discovered a book called “Emotionally Healthy Twins” which radically changed my parenting style and the way I looked at my then 2-year old twins. The author, Dr. Joan Friedman, is a psychotherapist and prominent twin expert who specializes in the emotional well being of twins. As an identical twin herself, as well as a mother of 5, including adult twin boys, she understands the specific dynamics inherent in raising twins as well as growing up as a twin. Her book begins with seven keys to parenting, some of which include:

  1. Think of your twins as two unique individuals.
  2. Expect to have different feelings for each child.
  3. Give each child consistent “alone time” with you. They need it in order to adequately bond with you.
  4. Don’t attempt to “provide a fair and equal” childhood for your twins.
What??? Only a few “keys” into it and my head was already reeling. I really hadn’t considered most of this. Being an only child I never really considered the idea that siblings needed time away from each other. More to the point, I noticed that I had a lot of preconceived notions about twins that were keeping me from truly getting to know my children and that were going to keep my children from learning who they were, apart from their co-twin. 
 
When our children were born, I quickly realized that the more you do with your babies as a set, the more validation you get as a mom. The average person would look on as I tandem breast fed and would marvel at my accomplishment. Merely navigating the aisles of Whole Foods with one baby in the cart and the other in a sling was enough to garner looks of approval and a brief adult conversation or two. All this was so needed early on that I actually feared taking out one baby and no longer being “special”. On top of all of this, there are all of these accepted ideas about how twins have been together in the womb for 9 months and they need to stay together in order to adjust. 
 
JoanFriedman-202x296Last week I had the great pleasure of sitting down with Dr. Friedman (that’s her in the picture to the left) to talk about both this first book and the new one she is writing about adult twins. In the new book, she shows how families who give their multiples permission to express their ambivalence about being a twin, and who nurture the children’s individuality, allow them to develop healthier and happier relationships with their siblings, parents, and significant others.
 

We began by talking about Dr. Friedman’s own experience raising her twins and it was so interesting to hear that she had separated her boys immediately and never saw any reason not to. In part, she said, it might be because she already had three other children before her boys were born, but also she instinctively knew that doing so helped relieve some of the guilt she was feeling over not always being able to give each her full attention and that separating them was so helpful in being able to get to know each of them. She was so shocked that, even to this day, people have so much resistance to this concept that twins need and want to have experiences apart from each other. Where does that resistance come from we wonder as we talk. How can we help people see that giving each child time to themselves where they don’t have to share everything can be nothing but good for them.

Perhaps this resistance stems from the “twin mystique” that Dr. Friedman speaks of often in her book. This concept is the assumption most of the world holds that all twins feel intensely connected to each other, feel lost without their “other half,” and enjoy being part of a matched set. Many of us who had never intimately known twins before becoming parents to them, have this romanticized notion of what being a twin is supposed to be like and it can be a major road block to being able to look at our twins as individuals. There is an excellent short newsletter on Dr. Friedman’s website entitled Beware The Myth as well as her own description of why twins need alone time

JoJo smells something stinkyAccording to Dr. Friedman, the earlier you begin the individuation process the better. Like anything else (transition to sippy cups, elimination of the pacifier etc.), the longer you wait, the harder it can be. But don’t mistake the protests of your two-year old when you try to take him out without his brother, a two-year old will complain about just about anything that is foreign to him; it doesn’t mean that what you’re attempting is bad for him! However, she does point out that this way of parenting must resonate for you. Just as well-meaning friends can recommend sleep training as the way to go when you are sleep deprived, if you’re not ready to hear it, separating and individuating your children won’t be something you’re going to try.

It is important to understand that allowing your children their own individual time and experiences does not undermine their bond as twins and siblings. In fact, it allows them to miss each other and to reconnect with great joy when seeing each other again. Nor is Dr. Friedman suggesting that you never do things as a family or with both children together, just that you allow for this expanded way of seeing your children. So…if you are still reading and, like me when I first read Dr. Friedman’s book, you’re intrigued, consider this: Nurturing individuality 

  • helps with the bonding process for both parents.
  • helps form strong attachments.
  • helps the father/partner feel both needed and included. 
  • allows both mother and father time where they are not pulled in multiple directions and can truly enjoy being a parent.

If that’s not enough to convince you to consider it, think about what benefits your children will reap:

  • Children are allowed to get out of the presence of the other child to whom they are constantly measuring themselves against and competing with.
  • Your twins will each experience the confidence boost that singletons are accustomed to: no sharing, not having to wait, time just for themselves where they are the focus of their parent’s full attention.
  • Each child gets a chance to really be seen and known for who they are, not just in comparison to their co-twin. This allows for your children to fully develop their own, unique personalities. 
If you have boy/girl twins, as I do, this process is probably easiest because eventually your children will probably separate into typical “boy” and “girl” activities. If you have same sex twins you, as a parent, have to work so much harder to point out and notice your children’s differences, really focusing in to “get” their individual personalities. This is so much harder to do if you rarely have them alone. 

What happens when twins don’t separate?

Dr. Friedman and I continued to talk about what happens when children are not separated or allowed to individuate. She pointed out that, as a parent, one has to be conscious of the fact that you are bound to have preferences when it comes to your children. One’s temperament is going to “fit” with one child’s more easily than another’s at times. It is particularly hard if one child is sweet and easy and the other is moody and disconnected. If you always have those children together, they will constantly be compared (by you, by others, and even by themselves). Not being conscious of this reaction to their personalities affects how you treat each child and ultimately how they think of themselves. You must work twice as hard to accentuate the strengths of each child and take extra steps to connect to the twin who you feel most at odds with.
twins_dressed_alike_blueflys_blog_flypaperPerhaps the most difficult part about convincing parents to try these methods is that there are rarely instant benefits to doing this. Unlike sleep training, where you see results after a few tough nights, the process of nurturing a child’s individuality takes shape over decades and you never really know what might have been had you not done it this way. What happens when twins don’t individuate? This question intrigued Dr. Friedman as she began to write her second book (tentatively titled “The Greatest Story Never Told: Twins’ Struggle For Intimacy”). As we discussed the book, Dr. Friedman reminded me that many, many twins have wonderful relationships with their families and with each other. She is passionate about helping parents understand what twins need in order to individuate so that they mature without difficult developmental dilemmas. It’s cute when they’re infants, but as far as I know, no one wants their twins to end up in their 70’s and still dressing alike!

The Parents’ Role

In this new book, Dr. Friedman discusses how parents who have the idea that their twins have to be best friends, don’t allow them to fight or dislike each other or have any kind of ambivalence towards each other. Singletons have the freedom to work out their anger, competitive feelings, and general sibling rivalry. They have lots of permission to express their negative emotions. Twins are sometimes robbed of this privilege and are, instead, encouraged to always include and be friends with their co-twin. Dr. Friedman believes that many parents feel that if twins appear as if they are not getting along then they will be seen as terrible parents. This can lead to a conscious or unconscious vested interest in presenting to the world twins who are best friends; if not, it is some sort of terrible parental failure. So how do some twins end up so enmeshed?
  • Their parents are too exhausted and overwhelmed and see it is a relief if the children take care of each other.
  • Parents don’t buy in to the concept of alone time.
  • If there is insufficient attachment to the parents, children bond to each other and have to get along with each other as no one else is there. In an extreme case like this, the adult twins can’t afford to delve into their co-dependence, conflict or anger; there is too much at risk.

Adolescence and Young Adulthood

Adolescence is often a time of experimentation and trying to understand who you are really are. Often twins, who up until this time have enjoyed their sameness will decide, sometimes abruptly, that they need their own identity; someone will cut their hair, separate friends will be made, divergent interests may take hold. Most adolescents have the need to break away and be separate. According to Dr. Friedman, if parents don’t allow their twins to differentiate themselves from each other and to form their own identity, there will be guilt, anger and perhaps a greater chance of high risk behavior. For female twins, sometimes this dynamic results in anorexia. Twins will compete to see who can become “the thin twin” and this can result in one becoming so ill that her identity now becomes “the sick twin”. In this twisted way of thinking, the sick twin is saying “I may be destroying myself, but at least I’m different than my sister”.
 
College attendance is another rite of passage where we, as parents, can take a stand for our children’s individuality. For parents it can be so much easier to just send our kids to one school, and have them on the same sports teams, and hang out with the same group of friends; but is this really helping our children? Dr. Friedman told me the story of twin girls who had always been in the same classes their whole lives and when time for college came their mother encouraged them to attend the same school once again. This scenario worked well for one daughter, but the other was so angry about it that the two girls didn’t speak until, by chance, they were separated for a year by the way the school happened to run it’s junior year. This time apart allowed them to miss each other, have their own lives and then re-define their adult relationship based on being two individual women who happen to be sisters. They had never been given a chance to know each other that way and it was just what they needed to cement their sisterly bond.

Who Do You Love Most?

One of the hardest things that twins who have never had separate lives have to deal with is the introduction of a boyfriend/girlfriend/spouse into the picture. This is particularly difficult when one twin is involved with someone and the other is not. Often the unattached twin is angry, jealous, and can’t tolerate feeling left out so they either consciously or unconsciously try to sabotage the other’s relationship. The twin who has the relationship is torn between feeling entitled to her own experience, yet guilty because she knows it is devastating to her co-twin. Different age siblings don’t have this exact experience; they may have some jealousy, but they don’t have the “why are you choosing him over me?” feeling. The twin who marries has an extreme loyalty conflict and has to work overtime to prepare their spouse for this. This is why we often hear of twins marrying twins; they already understand and accept not being the preferred person and confidant!
 
Dr. Friedman writes at the end of “Emotionally Healthy Twins”:
“As I came to understand that a childhood connection is different from an adult connection, I realized that my relationship with Jane [her identical twin sister] had to be redefined. Adults are more capable of self reflection, more able to articulate their own experiences, more capable of taking responsibility for their feelings and actions, and more perceptive about themselves and others. And all of these skills require an increasing sense of self-confidence and self-awareness. Young adults who aren’t twins have a tough enough time with all of this, and for twins the challenge is considerably greater. For twins who grew up with an unhealthy enmeshed connection, like Jane and me, developing those skills is more daunting still.”
 
Growing up a twin can be both difficult and an extraordinary experience. As a parent to twins, it is entirely possible to nurture their individuality yet cherish their twinship. The word “twin” has so many connotations, we often forget that it also is simply just being a brother or sister to someone else. By allowing your children to be both twins and siblings, and you will have children who relish their bond and celebrate their uniqueness.

Interview with Carol Braun, Doula

carol1I have mentioned before that my husband and I decided to hire a doula when I was pregnant with our twins. We decided on hiring a doula team so that we could have 24 hour help. At first, we thought we would just have them postpartum, but ultimately chose to include them in the birth as well. Hiring our doulas was a decision I hesitated about at first, but ultimately have never regretted. 
Carol and I are still good friends; she has been an enormous support as I start this venture and has graciously agreed to let me interview her as I think there are so many expectant parents of multiples that have never heard of hiring a doula and may not know how much it can help!

The Twin Coach: The first question many people have is “what is a doula?” Can you give me a little background information?

Carol Braun: I think the best description of what a doula is comes from the DONA (Doulas of North America) website:

“The word ‘doula’ comes from the ancient Greek meaning ‘a woman who serves’ and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.”
carol 2There are birth doulas and postpartum doulas. A birth doula primarily works with a woman and her partner before the birth of the child, offering research-based information, reviewing comfort measures and developing a birth plan. The birth doula also provides physical and emotional support to the woman and her partner during the labor at home and/or at the birth center or hospital.
Postpartum doulas essentially “Mother the Mother”. They help ease families as they transition while caring for their newborn. Doulas offer support with breastfeeding, newborn care and infant soothing techniques. In an effort to help keep the family household in balance, the doula may also “tidy up” or do some light cooking or laundry if appropriate. I like to explain our services as “preventative education” as well. Hiring a doula can help prevent postpartum depression or problems with breastfeeding. Ultimately, the objective of the doula is to give the parents enough knowledge and confidence and in their parenting skills that the doula is no longer needed!

TTC: I hear many people talking about hiring a “baby nurse” or a “night nurse”; what is the difference between that type of postpartum care and what a doula offers?

CB: The difference is quite large! It is my experience that a baby nurse, or newborn care specialist (as many states do not allow such a title unless the person is actually a certified nurse) only encompasses the need of the baby. A postpartum doula works hard at understanding the dynamic of the family within their household and weaves her services according to the needs of the mother, baby and other family members.

A newborn specialist is similar to a doula in that she provides newborn care and instruction, but generally will not “tidy up” or do “light cooking”. She may also be capable to help with breastfeeding, but her knowledge tends to come from her own experience nursing her children- which can be helpful, but every baby is different when it comes to nursing and there is so much to know about breast feeding! Newborn specialists also tend to have more experience with “sleep training” or putting a baby on a feeding or sleeping schedule.

Typically a newborn care specialist will work with a family until the baby is sleeping through the night, but will also work with families  for the first four weeks or so, to help the parents adjust to the “sleepless” nights. Doulas also are known to work at night, but again, focus on supporting the mother as she tends to her baby in the middle of the night…breastfeeding doesn’t only happen during the daytime hours!

TTC: Yes! I totally agree. Because we had 24 hour help when you worked with us, you partnered with another doula, Julie Skehan, who helped us at night. My lower extremities were terribly swollen after the birth, and since Julie was formerly a licensed massage therapist, she would massage my legs and feet as I nursed, in order to get the blood flowing again. Talk about support!

TTC: So, now that we know what a doula is, can you tell me about your own background and why you became a doula?

CB: Well, I’m married to Steven and mom to Beckett. I have a Bachelor’s Degree in Social Work, which gives me a strong foundation for doula work. I’ve always been fascinated with pregnancy and birth since I was a little girl. I grew up in a large, Italian family,so it seemed like a baby cousin was born left and right.  I have fond memories of wanting to touch my Aunt’s pregnant, round belly all the time (they lived next door and she had 5 children). The idea of feeling a baby move inside her was thrilling to me!

That same aunt was the person responsible for introducing me to what a doula was.  I had just moved to California (2002) and I wasn’t “feeling it” when working for the State Health Department.  After alot of self reflection, I found myself eager to unearth my passion for birth. I thought about going back to school to become a Labor and Delivery Nurse, or a Midwife, but I didn’t fancy the idea of going back to school. Once I found out that you could have a career in doula work, I couldn’t sign up for the certification course fast enough! I got certified (by DONA International) as a birth doula in 2004 and haven’t looked back. I’ve served over 60 birth families and probably about 30 or more postpartum families.

TTC: Do you have any have special training?

CB: As doulas, either birth or postpartum, it is essential to stay up with all of the research based information out there. Much of my income goes toward paying for workshops or lectures just to keep me informed. There are specific methods of birthing which I have studied,(ie: Hypnobirthing, Lamaze, Birthing From Within) and I’ve found it quite helpful to remain versed on breastfeeding and the challenges women are faced with while learning to nurse within the first few weeks after delivery.

I’ve also attended workshops and lectures on more sensitive issues which can present themselves during a woman’s most vulnerable time, in labor or just postpartum (ie: past sexual abuse/trauma, postpartum depression/anxiety, fetal demise). In addition, I’ve served on the Board of Directors for the Doulas Association of Southern California (DASC). DASC is responsible for many of the educational opportunities that have been offered to me as a doula. We learn from each other, do quite a bit of outreach, and bring in many fascinating and highly educated researchers to update us in an effort to keep our clients informed and empowered.

In general, although one is neither required to be certified, nor attend any specific training, it is highly recommended that one attend a certification training workshop to become familiar with childbirth education and the role of a doula. There are several well known organizations who offer such training. These organizations also practice a strict code of ethics and scope of practice as well.

Again, it is strongly encouraged that if one were to provide doula services, whether for birth or postpartum care, that one remain updated and active within the doula community. I’m a firm believer in attending at least 1-2 major trainings per year, just to keep me fresh. I would encourage clients who are interviewing doulas to inquire as to how many or what types of trainings they have attended.  This will tell them a lot about the quality of services they will be paying for.

TTC: You have a lot of experience both as a labor doula and postpartum doula for parents of multiples; for expectant twin parents reading this, what would be the most important reasons why they should consider hiring a doula?

carol 3CB: Particularly for a family welcoming multiples, it would be to help the transition into parenthood go more smoothly and be less shocking. In addition, to help nurture the mother, who’s in an extremely vulnerable state for the first few months after birthing twins.
Since twin moms are more susceptible to postpartum depression (PPD) it’s critical to help maintain her wellbeing through this time. A postpartum doula can help ward off circumstances which can lead to PPD. She should have the experience to recognize the signs of PPD and guide the family to get help when appropriate. 
Another important reason to hire a doula for postpartum care of twins is to help identify a routine which will work for their family dynamic/household so things are not so overwhelming. Lastly, to help with breastfeeding if that’s how the parents decide to nourish their children. On average, by breastfeeding twins for the first year of life, a family can save close to $3500.00. However, it’s also a huge commitment and a mother will need to allow herself the time and patience to learn how to nurse her twins as efficiently as possible. This is where an experienced doula can be invaluable.
TTC: Having worked with so many multiples what are the most common areas that new parents are surprised they need help with?carol 4

CB: The 3 B’s, and they all tie into one another:

  • Budgeting: There are so many things people can do to limit their spending on things they won’t really need before the babies are born. In my opinion,and from what I’ve experienced with all of my multiples clients, budgeting for postpartum help for the first 3-6wks after leaving the hospital is by FAR the most important thing for the family to do. Getting a strong foundation from the beginning is key.
  • Breastfeeding: There is so much to learn from an experienced lactation support person. The goal will be to as efficient while nursing as possible, so mom can get back to catching up on rest. Tandem nursing (feeding both babies at a breast at the same time) will be one of the most important things to learn.
  • Banking on as much time to catch up with sleep and nutrition.

TTC: Often people who already have children think they won’t need help with their newborn twins since they have been through it all before. What has been your experience in those cases? Has having twins been as easy as they expect, or did it turn out to be much different and how were you able to help in either case?

CB: The one thing I’ve noticed is that when parents expecting twins already have other children, both parents tend to have a very strong sense of their parenting roles and routines. I think their consistancy is what gets them through the young years. Perhaps this time around they have learned to accept that their lives will revolve around the care of their young children, at least until things fall into a new routine that works for them.

I often help clients to remember that acceptance of this new way of life is really half the battle. It won’t ALWAYS be about the babies…eventually they will access the elements which shaped their identity. But, as with everything, change takes time to feel “normal”, so I ask many of my clients to just allow themselves the time and to always remain fluid.

When Superman Wants A Fairy Wand

boy-dress-in-fairyOur son is sweet and funny and charming. He is currently obsessed with dressing like his soccer coach, builds jails for his dinosaurs and is often, as I once saw a boy described, “noise with some dirt on it”. I don’t quite know where this boy came from because as recently as 3 months ago he threw a tantrum over the fact that he did not receive “Fancy Nancy” dress up clothes like his twin sister did at birthday time. Poor boy.
Some well-meaning mother had bought him “boring” doctor and train conductor outfits while our daughter was decked out in ribbons and pearls and high heeled princess shoes. Anyone would be jealous! I handled this one by rushing off to Target to buy Tinkerbell and Ariel costumes so he wouldn’t feel left out. This meltdown wasn’t really a surprise since he had coveted her silver, sparkly princess slippers at Christmas time (again, I bought him a matching pair)

At Halloween, he had thrown an enormous tantrum when she was a fairy princess and he was Superman. This one I managed to figure out, was actually about the fabulous fairy wand that she had and luckily I happened to have a spare, although different, wand in the closet.  When he was really young, he was obsessed with bracelets and rings. He wore them all the time, even to sleep. 

I think everyone who has a daughter expects her to go through a princess stage. I didn’t really expect my son to be quite as enamored of them as he was. Part of it, I think, is because he really likes his sister. And he wants what she has. Plus, girl’s stuff is just so much more festive/sparkly/pretty! At age 3, this is all developmentally appropriate. Most children don’t differentiate between “boy’s things” and “girl’s things” until they are a bit older. It’s often hard for the parents to deal with because, as I said, we have our expectations about what our children will be like and we usually expect the standard: boys play with trucks and trains. Girls like dolls and dress up and if your child is “different” you don’t know what to do!

For us, it actually seemed harder for strangers to handle our son’s predilection for being fancy. We didn’t really care that he liked this “girly” stuff or that pink was his favorite color. But strangers would comment or older children would say things, and I would begin to wonder if my comfort with his self-expression was going to end up having him feel bad about himself.

I ended up allowing him to do whatever he wanted at home or at play dates. We didn’t bring tutus or bracelets to the park and I told him pink UGG boots would get too dirty, so we bought brown ones (for both of them). I never made him feel as though he “shouldn’t” like those things or that he “should” play with other toys. But I found myself secretly thinking these things. Before the kids were born I always felt that I wasn’t sexist and that I held no rigid stereotypes when it came to boys and girls, but once our son’s love of all things pink and girly began to take hold, I realized this wasn’t entirely true!

I recently read a review in Newsweek Magazine of a book called Pink Brain, Blue Brain: How Small Differences Grow Into Troublesome Gaps — And What We Can Do About It”. This book, by Lise Eliot, a neuroscientist at Rosalind Franklin University of Medicine and Science, works hard to show that our accepted thinking that male and female brains are different from birth is actually false. 

We, as adults, no matter how liberal thinking we may be, have notions of how boys act (aggressive, less able to express emotions) and how girls act (emotional, less physical). From the Newsweek review of Eliot’s book:

“how we perceive children—sociable or remote, physically bold or reticent—shapes how we treat them and therefore what experiences we give them. Since life leaves footprints on the very structure and function of the brain, these various experiences produce sex differences in adult behavior and brains—the result not of innate and inborn nature but of nurture…The belief in blue brains and pink brains has real-world consequences, which is why Eliot goes after them with such vigor (and rigor). It encourages parents to treat children in ways that make the claims come true, denying boys and girls their full potential.”
I notice how much more at ease I am with my son’s love of his basketball shorts than I was with his tutu wearing. And that makes me sad. In very little time I am sure my son will no longer be asking for my daughter’s hair clips or for me to paint his nails. I’m glad I indulged him while the love of color and sparkle lasted. Now that it’s almost passed, I already miss it.

Skirball Parenting Lecture on Secure Attachments – A Summary

I spent the day on Saturday at The Skirball Cultural Center at a very interesting lecture entitled “Secure Attachment: Helping Your Child Get the Best Start in Life”. The first keynote speaker was Sir Richard Bowlby who spoke on Attachment Theory which was originated by his father, John Bowlby. Attachment Theory, as Sir Bowlby described it, is “the science of family bonds”. That is, adults form a bond to babies and children form attachments to adults. I described the central theme of Attachment Theory in an earlier post as “primary caregivers who are available and responsive to their infant’s needs establish a sense of security. The infant knows that the caregiver is dependable, which creates a secure base for the child to then explore the world”. One point Bowlby made early on in his speech was that the term “caregiver” is actually inaccurate as it does not describe the bond. Instead, attachment theorists prefer the term “Primary Attachment Figure” (as well as secondary and tertiary).

It is generally, but not always, the mother who is the child’s primary attachment figure. Sometimes it’s the father, the grandmother, a nanny and so on. It comes down to, apparently, “who comes when I cry most often? Who comes most and responds most intensely when I smile?” A child’s cry or smile is a “nurture seeking strategy” which, in turn, allows the mother (father/grandmother/etc.) to fall in love and bond with the infant. By 5 or 6 months you will begin to notice babies acting differently towards one particular person. That person is their primary attachment figure. Secondary attachment figures are often fathers, grandmothers, nannies, aunts or uncles and so forth. Children feel safe with these people, but are not bonded in the same way. Tertiary attachment figures are familiar people such as the waitress at the restaurant you always go to, or the man at the grocery store you always shop at. Again, there is a sense of familiarity so there is some ease there for the child, as long as their primary or secondary attachment figure is with them as well.

Although most people do have someone who becomes their primary attachment figure, the big question is whether one is “securely” or “insecurely” attached. If your primary attachment figure is extremely unpredictable (as in, they sometimes come when the child cries, but often times do not. Or if they tell the child to have a stiff upper lip and not allow them to have their feelings and so on) then this child grows up to be what John Bowlby (that’s him in the picture to the right) called “avoidant”. That is, these children grow up to be compulsively self-reliant and have very strong feelings, but are unable to express them. OK…this is every mother’s nightmare. Please don’t think that if your child cries and you don’t rush to be by his side he will be doomed forever. That is not what Bowlby is saying. It’s much more extreme.

Sir Richard Bowlby mentioned that his father, John Bowlby, was raised, in the early 1900’s, by his nanny. He literally only saw his mother for one hour a day “after tea time”. Thus, for him, that nanny became his primary attachment figure. When she left the family it was, to him, as tragic as if his own mother had died. There was a twin mother in the audience who later asked a question about attachments to a nanny as she was, out of necessity, a working mom and had great fears about not being her children’s primary attachment figure. The sob in her voice as she asked the question brought tears to many of us there that day as so many mothers have that same fear and could so relate. Bowlby had a lovely response that I think brought her a lot of peace. He brought up the fact that his father’s nanny had actually lived with them and slept in the nursery with him so that she was the one who always came for him when he needed someone. Always. If you are unable to be with your child during the day, remember, he said, that night time is when children tend to be most afraid and most needy and this is an opportunity for the primary attachment figure to secure their role.

How to help your baby make secure secondary attachments to a nanny/preschool teacher/daycare provider etc:

  1. When you first introduce the baby to a daycare provider (for example), do it at your home if possible. The mother (for argument’s sake – but really it’s primary attachment figure) and daycare provider should arrange previously that they will embrace in front of the child to give the child the idea that mother already knows this person.
  2. The mother should then visit the daycare with the baby and spend time there alongside the people who work there. This allows your child to feel safe in exploring the environment.
  3. Mother should then begin to hide for short periods; having the daycare providers help the child calm their attachment seeking behaviors.
  4. Then primary attachment figure leaves for slightly longer to let the child use the practitioner when they need soothing. This should be continued over a period of about a month. And by a month, Bowlby means daily/frequently/regularly. The child is then able to form a secondary attachment to at least one, if not more, people at the daycare.
  5. If you must let a nanny go or leave a daycare, please try to make the transition a slow one. It can be extremely hard for some children to separate from people they have formed strong attachments to.
This made a lot of sense to me as it is almost exactly how we made the transition to preschool. And it took me at least 3 weeks, if not longer, before my kids felt at ease there. Thank goodness the school was totally on board with the process! According to this theory, it actually takes people two years to form new neural pathways that allow for attachment to a new primary figure. Studies done where groups were asked who they would call if they were in a plane about to crash show that people in a love relationship of less than two years would call their mother; whereas those in relationships over 2 years would call their partners. Fascinating, no?
The brain holds our past and then layers new memories and experiences on top of the old stuff. There can be scar tissue from past trauma (literally or figuratively), but humans are born to repair. Think of how many cuts, scrapes and broken bones you may have lived through! Attachment theory isn’t a therapy, it’s an insight. Once you understand your attachments, or lack thereof, you decide what to do with that information.
After Bowlby’s lecture we broke for lunch sponsored by Milk + Bookies, a wonderful organization dedicated to empowering teen and college students to earn community service hours, and learn the importance and impact of peer-bases philanthropy. At lunch, 5 round table discussions were set up with topics like “raising an only child”, “attachment and discipline”, “attachment and the special needs child” etc.
parenting from the inside outThe next keynote speaker was Mary Hartzell, who is a child development specialist, parent educator, and co-author with Dan Siegel of the amazing book “Parenting From The Inside Out”. She is also the director of the nationally recognized, Reggio-inspired First Presbyterian Nursery School in Santa Monica, and has taught children, parents, and teachers for more than thirty years.
Mary spoke about self- understanding and relationships. She began by reminding us that we have a template in our minds of how to parent, based on how we were parented. Whether you look at your childhood as terrible or wonderful, it is important to remember that parenting is an opportunity to re-parent ourselves.
Memory is a fascinating thing. We all have both implicit and explicit memories. Implicit memories are ones that we can’t actually recollect when recalled; these include behavioral, emotional and perceptual memories. Thus, they effect you, but you are not always sure where the effect is coming from. Explicit memory develops during the 2nd year of life and there is a sense of recollection. This includes factual and autobiographical memory.
 
To me, the most interesting thing about this is that if you don’t process things, trauma gets encoded in implicit memory. A difficult childhood (or even difficult moments in an otherwise “normal” childhood) is alive in the mind in unprocessed feedback loops. Implicit memories are often what are at work when people say something “triggered” them to behave in a way unlike their normal selves (like when I get all my buttons pushed by my kids & lose my temper). In those moments a person is unable to make good choices and is actually behaving as their “child-self”. 
 
Mary told a really interesting story to illustrate this. She would take her boys to the shoe store when they were younger and she would anticipate it being a great experience for them all. But every time she would find herself being terribly anxious and end up ruining their time together. Finally, one of her boys triggered her memory about her own experience shopping for shoes as a child which was always extremely stressful and disappointing. Once she was able to connect to the memory and process it, she no longer experienced shopping for shoes with her kids in such a negative way. She had made an implicit memory, explicit and was no longer operating in a way that she was triggered by something from her past.
 
If you are having struggles with your child (and who doesn’t), remember: every child is doing the best they can in the moment to get their needs met. Meet your child where he is at to allow him to feel valued, seen, heard and understood. For a child, this means “I love you, just the way you are”. Being heard is what gives someone comfort. Haven’t you ever said to your husband “I don’t need you to fix it! I just want you tohear what I’m saying!”?
 
Attunement is matching the state the child is in. Do not simply say positive things; listen in a way to mirror back to the child. You will be meeting your child where they are and allowing them to feel “felt” and attuned to. When you first return home after work is a wonderful time to attune to your child. You may wish to first change your clothes and get a glass of wine (the latter, especially, if you’re my husband) and being greeted at the door by an excited toddler wanting you to read them a book may be the last thing you want to deal with in that moment. You may say nicely, “in a minute honey. Let me change my clothes (get a glass of wine)” and you will be greeted by wailing and stomping feet chasing you down the hall as you try to get out of your work clothes. Now you have irritated mommy, frustrated/sad child and no one is getting what they want. Instead, if you chose to reconnect with them for even 15 minutes of 100% focused time when you come in you will see a huge difference in their ability to let you, then, do what you need to do. As you sit with your children be sure to say out loud “I really like being with you”.
After the keynote speakers we broke off into workshops. Every workshop sounded so interesting, and I chose to attend Betsy Brown Braun’s lecture on “Triangular Attachment” which was about the attachment of multiples to each other and to their parents (or primary and secondary attachment figures). Betsy is mother of adult triplets, a child development and behavior specialist, parent educator, multiple birth parenting consultant, and best-selling author of a book called “Just Tell Me What To Say“.  She has also just written another called “You’re Not The Boss Of Me: Brat-proofing your 4- to 12-year-old child”.
 
She began by discussing the nature of attachment of multiples and broke it down into four different types.
  1. Proximity Seeking: child wants to keep their co-twin as close as posssible
  2. Separation distress: difficulty separating from each other.
  3. Safe Haven: multiples put a high priority on taking care of their co-twin
  4. Safe base: multiples see one another as a fall-back when psychologically separated from the mother.
Because there is such a world of fantasy about twins and their “special bond” it is very important, as the parent, to remember that each child’s attachment and attunement to each parent is more important than the twins’ attachment to each other.Remember, it is quality, not quantity when it comes to attuning to your children. And if you feel overwhelmed it is impossible to meet anyone’s needs, let alone twins’. Betsy likes to refer to “the rotating pill position”. At any given moment, one of your twins is going to be needy (thus: being a “pill”). There is always the possibility to give each the attention they need and it all equals out.

Factors to promote attachment in your twins

  • Accessibility. If mom is not available, your child will choose their co-twin for support.
  • Shared background experience. This is yet another reason to make family rituals, outings, customs a priority.
  • Temperament of the entire family. As pointed out in the twin lecture at UCLA, mis-matched temperament can be difficult to get past.
  • Types of multiples. That is, in general, identical twins or same sex fraternal twins will attach more readily than boy/girl twins. 

Factors that can get in the way of healthy attachment:

  • In higher order multiples (quads, quints etc.) the attachment to each other gets diluted. 
  • In b/b/g or g/g/b triplets, the odd man out may spend their life searching for that “best friend” to replicate the bond of their matched sex co-triplets.
  • If your twins’ identity from birth is as a part of a pair. For example, if they are constantly referred to as “the twins” or only see photos of themselves together they may grow up feeling as if they need to be together in order to matter. This can cause, among many other things, resentment.
  • They are burdened with expectations of how being a twin “should be”.
Types of twin attachments
  • Unit Identity: twins are merged. Each thinks of self as 1/2 of a whole personality. Separation is extremely difficult.
  • Interdependent Identity: twins are best friends and each other’s primary support. Their outside relationships replicate their twin bond. They are truly friends and have a symbiotic relationship (ie: one is bossy and the other needs decisions made for them).
  • Split Identity: The children define themselves as polar opposites (one is the “good” twin, the other the “bad” twin). Yet, each twin feels that they, themselves has some of the other’s qualities. Thus, the overvalued twin can feel relief at being separated because he/she gets rid of “bad” qualities. Not so great for the undervalued twin, is it? Remember, these values are placed by the children first and then may be echoed by others.
  • Idealized Identity: being a twin is the most important part of their identity. They take great pride in their relationship. Separation may be easy, but can be viewed as dangerous as their identity is as a twin. This situation is at it’s most extreme when fueled by a parent.
  • Competitive Identity: Twins have a strong empathetic bond with each other. They are proud of each other’s achievements and accepting of each other’s skills and talents. This type of identity has the most potential for growth outside of the twinship.
  • Sibling Attachment Identity: similar to having a close sibling, as opposed to a twin.

Encouraging individuality in your twins

There’s often ambivalence on behalf of the parents about this as it does make parenting harder. It’s much easier to have one doctor appointment, one play date, one parent/teacher conference etc. But you want your children to be close, not dependent. As Betsy said at the end: “you are the mirror that your twins see themselves in”. It’s your job to inform the world how you want your multiples to be seen. You want to reduce the expectation that they will always be together and allow them separate identities.
 
All in all, it was a wonderful day. The Skirball Center is a lovely place to spend a day and they did a terrific job of providing plenty of opportunities to discuss and learn. They have many lectures, but this was the first that was focused specifically on parenting. Let’s hope they have another one again soon!