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Baby, Baby, Baby!
Advice for parents expecting twins, triplets … and more!
By Christa Burlakoff-Lawcock
If you think you’re seeing double lately, it may not be your eyes. Multiple births have risen dramatically in the past decade. According to the National Center for Health Statistics, the number of twins born in the United States increased 74 percent between 1980 and 2000, and the number of non-twin multiple births increased fivefold.
While many women may wish aloud they could have twins, the question looms large: “Is it really double trouble?” And, if two is twice the trouble, does adding one more make it three times as hard? Or, because of the built-in playmate factor, does having multiples actually make life easier for everyone – save the one who does the laundry?
More than those questions combined, however, is this: “How, oh how, does anyone handle it?”
“With an awful lot of help and very little sleep,” quips Hannibal Kruger, dad to not one, but two sets of twins (plus a 4-month-old singleton). His wife, Heather, adds, “Trying to stay organized and enlisting your spouse is also key. You’re going to need his help!”
Samantha Clayton, wife to Royce Clayton of Diamondbacks fame and mom to 18-month-old Royce Junior, is about to find out just how true Heather’s words ring. Samantha, who is due Dec. 1, but expecting to be induced earlier, wasn’t sure what to think when she learned she was carrying triplets.
“Royce was out of town, and I didn’t know whether to laugh or cry, so I kind of did both. I didn’t know how to tell him,” she confesses as she chuckles at the memory of when she finally did break the news. “I think he was in pure shock. He didn’t really believe it till he saw it on the ultrasound with his own eyes.”
Even though ultrasound images are a familiar sight these days, moms expecting multiples average four or more ultrasounds compared to a single-birth mom. Nothing can quite prepare you for the actual birth of these bundles of joy – or the panic that ensues.
First-time mom Renee Rider of Phoenix remembers asking herself, “Am I going to be a good mom, especially with two of them? How am I going to spend enough time with them, and are they going to get enough special time?”
Add ten additional fingers and toes (as in triplets), and Kathy Brown of Scottsdale was concerned about having enough time in the day to do everything necessary. “When they’re that little, it’s really nonstop!”
How They Do It
Like scores of other mothers of multiples, these women do manage. Here’s how.
For starters, ask for help early on (even if “asking” runs more along the lines of begging, pleading, or whining). Many multiple births result in complete bed rest at some point in the pregnancy, which makes it imperative to have a good support network from the onset.
If you don’t have a mom like Clayton’s, who left everything behind in England to move in and help, turn to friends and/or professional services. From finding personal chefs and weekly housekeepers, to researching and helping hire a day nanny, night nurse, or mother’s helper, the opportunity to build a support system has never been easier.
Dianna Hughes, owner of Minding Multiples in Phoenix, says her company offers moms of multiples everything from fulltime to part-time nannies, night nannies and nurses, background checks, psychological testing and baby nurses. And, if a family needs help with eating or sleep training, she can help there too. “This accounts for our largest source of business as of late,” she adds.
Brown couldn’t agree more. Hiring help was her best decision. “I know a lot of families who can’t afford it, but you can cut corners somewhere to find someone, even if for only a few hours or even a week.”
Hughes agrees, noting that her service is not just for the “über-rich.” She works with whatever the family’s budget allows.
Pediatricians
If you read a newspaper or watched the news lately, you know Arizona has a serious doctor shortage. While it may seem like there are thousands of pediatricians here, you may be surprised to learn many aren’t taking on new patients. So while the All You Need To Know While You’re Pregnant book may advise you to interview pediatricians in your last trimester, it would be a better idea to move up that date – and quickly.
When looking for a pediatrician, pay attention not only to the hours, the office location, and the phone policy, but also to the intangibles. Specifically, do they share your feelings about antibiotics, immunizations, well baby checks, feeding philosophy and other items you feel strongly about? Are they comfortable working with multiples? What’s their philosophy on doctor visits for multiples? Some doctors advise parents to book separate appointments on separate days for each so the parent can focus on one child at a time, making sure not to overlook anything. Others doctors want to see all the children on the same day and will block out additional appointment times.
Most importantly, ask yourself how comfortable are you with the pediatrician. Can you talk honestly with him/her? Does (s)he take time to talk with you?
Let’s face it: Once you hit your six-week postpartum appointment, visits with your pediatrician will be much more frequent than those with your OB/GYN or family physician. Their ability to spot fatigue, postpartum depression, or sleep deprivation is imperative, for you and your children.
Dr. Harold Magalnick, a well-known Phoenix pediatrician (and fraternal twin himself) with Pediatrix Medical Group, makes it a point to mentally examine all of his parents, paying additional attention to parents of multiples. “Parents can get more easily fatigued, and their ability to get a routine in place is also more difficult, because Mom can get very tired, very quickly. So you look to see if Mom is really coping. It’s a high priority,” he explains. ”People have a tendency to think we are experts at everything. We’re not. We are a team with you, which is even more important when you are the parents of multiples.”
Take Stock
Before rushing out to buy every product advertised, find out what mothers of multiples really use. Moms are the greatest resource you can have, and moms of multiples are invaluable. While the swing ranks high on most moms’ lists, the bouncy chair and front-to-back double strollers were lifesavers for the Krugers. Heather’s only regret was not discovering it sooner. “With the double side-by-side, we couldn’t get anywhere in it – it never fit.”
Don’t worry about having two of everything, either. You’ll be surprised how often one just sits in a corner, not being used. But do make sure you get the best quality products you can afford. When they do get used, they get used a lot!
When two of something is absolutely necessary, savvy moms ask for a discount. Most big-name retailers and some Internet stores offer 10 percent discounts (or more) for purchasing the same item in quantity. Saving even 10 percent on a big-ticket item like a crib can really add up.
Although nothing beats other moms’ advice, don’t overlook books and reviews, such as consulting Denise and Alan Fields book, Baby Bargains.
Finding Your Groove
Some families thrive with routine, while others enjoy a more laidback approach to life. Whatever your family’s style, go with what works for you.
“Everyone kept making me feel like it was going to be so bad,” recalls Rider. “If people had said, ‘there are different ways to parent, and that’s okay,’ I would have been so appreciative.” Rider was repeatedly told to keep her twins on a schedule, but she never did. “When they went down together, that was fine, I could get stuff done,” she continues. “When they didn’t go down together, I got one-on-one time, and it was perfect for us.”
Also be willing to adjust your system. Janet Bentley’s mother-in-law was more than willing to help out every morning for weeks. After a while, Bentley of Buckeye felt confident she could handle things on her own. “And that’s when the nightmare began!” she laughs.
Getting Out
The idea of getting out of the house – especially in the early months – can be intimidating for a lot of new moms. Figuring out how to do it en masse is even more daunting.
Know in advance that some activities may require more than one set of hands. Take storytime, for example. While it may sound like fun, many moms of multiples have been reduced to tears as they desperately try to corral two toddlers crawling in different directions while making hand signals to the The Itsy Bitsy Spider. Although the storytime coordinator is likely used to it, the stares from other parents are sometimes more than even the strongest can bear.
This is where support groups come in (visit www.azparenting.com and click on Mom’s Clubs). Many offer playgroups for kids and some target multiple birth parents. Ahwatukee mom Libby Peterson was reluctant to join one, but after being “pressured by this one particular mom,” she relented. Four years later, the kids still socialize on a regular basis, and Peterson gained some incredible friends. In fact, the family of the “ever-persistent mom” from the original playgroup and Peterson’s spend every Christmas Eve together.
Time for Yourself
While time is a valuable commodity for all new moms, as a mother of multiples, days truly do fly by. The constant feedings, diaper changes and loads of laundry keep even the most organized hopping. It’s a wonder there’s enough time in 24 hours to sleep. The idea of taking time out for themselves, then, is something many new moms don’t even consider. But you must! If Mom isn’t at her best, how can anyone else be?
“I used to do yoga, but I haven’t done it for a while because of the time. So I go to the gym or climb the mountain, because it helps get me out,” says Brown. “I also try to get a massage every few months, though it doesn’t always happen!” she laughs. At least she consistently tries.
Kruger agrees, “Even going to Target alone for an hour is a good break.”
Can’t quite pull yourself away? Money’s tight? Babysitters scarce? Don’t underestimate the power of mini-breaks. Those five-minute “mind vacations” you take can do wonders.
While it may seem silly at first, make it a point to take a mind vacation twice a day. Claim it as your time and your time only. That means no phone, no babies, no laundry, no lists and no multitasking whatsoever. Take a timer along with you, set it for your allotted time, and give yourself permission to relax and rejuvenate. Then double the time the next day – with a house of multiples, everything’s doubled, tripled, or quadrupled anyways, so why not include yourself in that too!
Remember Your Partner
It’s important for the relationship to plan time alone with your partner too. “Your role as husband and wife gets lost,” explains Dr. Magalnick. “It’s important to continue having time to be husband and wife.”
Make sure your couple time is quality, uninterrupted time. Making a regular date time – even if it’s only 30 minutes over coffee once a week or a few hours for dinner and a movie once a month – can keep your relationship from getting lost in the everyday hustle and bustle of life.
While getting time away may not be as easy as it was pre-babies, it can be done. The Krugers used to go out every single week, but it’s tapered off with their newest addition. Still, Hannibal says, “We have a calendar we put it on every single week, and we really make it a priority. You have to!” (Bonus: Dates are a great opportunity to get out of spit-stained shirts.)
And triple the sentiment if there are additional children in the household. As Dr. Magalnick notes, “Especially if the babies are high-risk. The anxiety the parents feel really trickles down to everyone else in the family, and their ability to talk about how they are feeling is really important.”
Additionally, carving out special time just for the non-multiple siblings can make all the difference in the world, as can making sure they know how large a part they play in this exciting new adventure.
Though big brother Casey was only two when the babies were born, the Bentleys didn’t waste a moment in getting him involved. “We kept reinforcing that he was going to have someone to play with all the time, and that he could teach them things, show them how to ride a bike, and he was actually pretty excited about them,” recalls Janet. It’s no wonder her favorite part of being a mom is “just seeing them have fun together.”
When all else fails, Janet reminds us all, “Not to sweat the small stuff. Do the best you can: That’s all you can do. Heck, that’s all I’ve been doing—for years!”
Christa Burlakoff-Lawcock is a freelance writer, who lives in Phoenix with her husband, dog, two cats and 6-year-old twins.
Resources
- The National Organization of Mothers of Multiples website, www.nomotc.org, is chock full of information: new parent advice, medical issues faced by preemies, a multiples-specific store, etc. With a network of more than 475 local clubs representing over 23,000 individual parents of multiples, this website has something for everyone.
- Looking for a support group in a neighborhood near you? Check out www.ASMOMO.org for information on Arizona State Mothers of Multiples Organization. Click on Clubs for meeting locations, times and contact info.
- There’s no need for Dad to feel left out. Find great articles, tips and hints for him at http://multiples.about.com/od/dadsofmultiples/a/dadtwintips.htm.
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Alternative Birth
A crash course in the roles of doulas, midwives and birth assistants
By Christa Burlakoff-Lawcock
Believe it or not, there was a time when pregnancy was seen as a natural process in a woman’s life and not a medical procedure.
While the health of the mother (and the baby) were certainly important, the idea of spending countless hours in a doctors office was unheard of, save for rare experiences. Row upon row of books on everything from Your Pregnancy and You did not fill the local bookstore, and there were not – brace yourselves! – photographers specializing in 3-D images of your unborn child.
Instead, there was a community of family members, friends, and female companions who passed information down to the overjoyed (and often, overwhelmed) new mom. And while medical technology has certainly added to the safety of the birth process and the health of mother and child, the reality is many families today are choosing to be more active participants in their family’s beginning.
That beginning often starts with the introduction of a doula, a birth assistant, and/or a midwife to their pregnancy team.
Doulas
If you’re wondering what exactly a doula is – and whether they differ from a midwife, a birth assistant, nurse midwife, or even a CNM (they do!) – read on…
While doulas may be all the rage today (thank Hollywood for that!), they actually have been a part of the childbirth experience for years. Helping guide the woman through her labor and delivery, doulas are women who provide non-medical, emotional, informational, and physical support to the expectant mother and her partner.
As a support person, the doula stays by the woman’s side throughout the labor, offers suggestions and promotes techniques to help throughout the labor and delivery process. Relaxation, breathing techniques, helping the woman find a comfortable position, and helping keep the mom relaxed and informed are all part of her job description.
At this point, you may be wondering, “Isn’t that what the Dad’s supposed to be doing?” Rest assured, he is, and does. Doulas do not replace partners in any way. Rather, they are additional support members to both parents.
Shillana Sanchez, a Glendale mother of 3-year-old Lucy, explains, “It took the pressure of him, so he was able to just enjoy the pregnancy with me. Any questions I had, I’d call Kate (Frost, her doula). I asked her, “What’s going on? Is this normal?” I’d even call her after my regularly scheduled OB appointments. She was more … accessible, in that she was “user-friendly,” so to speak.” And because of her user-friendly status, Sanchez did not feel the need to read every single pregnancy book out there, worry over every little hiccup or constantly turn to her husband for answers to questions neither of them knew. It made the experience much more relaxing for both of them, and actually helped increase their bond as husband and wife as well as partners.
When Sanchez went into labor, the first person she called was Frost. Though they arrived at the hospital separately (many doulas help begin the labor process at home with the mother until labor progresses further and contractions are closer), they felt “a palpable difference” when Frost got there. Though they had a birth plan in hand when they entered the hospital, it seemed to get “lost” in the hubbub of activity. There was paperwork to be filled out, vitals to check, tests to run, nurses to see … and see … and see...
“When Kate came in, there was a moment of total relaxation,” says Sanchez. “Kate deals with the nurses and the doctors, everyone suddenly was looking at our birth plan, and all we had to do was have the baby. It was such a huge difference: We could all just breathe.”
So how do you find a doula? As with anything, ask! You may be surprised to learn who has used one in their own birth, from friends to family members, even your doctor!
DONA International has a great website with a directory of local providers, as does Adobe Doulas Organization and Birth Education Association in Phoenix. Because doulas are non-medical support personnel, it’s important both partners feel comfortable with her.
Find out what kind of training your prospective received (doulas typically attend a three-to-seven day workshop covering anatomy, childbirth education and the labor and birth process), how many births they participated in and whether they offer delivery and post-partum, breastfeeding, or other support afterwards.
Most importantly, the expectant family needs to build a rapport with her. This is a very intimate setting, and the whole purpose of hiring a doula is for the woman’s comfort. If she’s nervous about having someone see her bum on the table, well, maybe that doula isn't the right one for her after all. And, that’s okay: There’s a doula to fit every personality.
Birth Assistants
Like a doula, a birth assistant adds another level of care to the laboring couple. Commonly referred to as “mothering the mother,” a birth assistant typically meets with the parents in their second or third trimester. She may help an expectant mom develop her birth plan, determine prelabor from active labor and make the transition to the hospital (or birthing center).
Because of her involvement in the earliest moments of early labor, a birth assistant can help shorten the time a family spends in the hospital if that is what the family wants. Some women prefer not to go to the hospital until the very last moment when labor is imminent, while others prefer going as soon as the stick shows that tell-tale “your pregnant!” sign. In either case, knowing the type of birth experience the mother and her family desire, and helping implement it, is the assistant’s primary job.
Again, training differs, as birth assistants are non-medical personnel; so checking references, getting to know them personally in advance and learning about what types of training they have had should all be considered.
Midwives
While still offering support throughout the pregnancy and delivery, midwives are members of the medical team. There are a variety of different “types” of midwives, from Certified Nurse Midwives to Licensed Nurse Midwives to Empirical Midwives. Certified Nurse Midwives are the most common. As their name suggests, they are trained through nursing programs that’s usually affiliated with a university medical school and have at minimum a bachelor’s degree in nursing. There are over 4,000 CNM’s working in the United States today, and many local hospitals have at least one CNM on staff.
Ingrid Gold, a Certified Nurse Midwife who practices at Phoenix Memorial Hospital, notes that they deliver about 10 percent of all births today in Arizona alone. On Native American Reservations and in rural areas, delivery is almost exclusively by midwives!
Gold notes, “Doulas are great as advocates, and can show the mom different options and provide lots of support for her during the pregnancy. But a doula and a midwife are completely different. They don’t provide the same role at all.”
While a woman still needs to be under a doctors care throughout her pregnancy and delivery if she is using a doula or birth assistant, an expectant mother typically only sees her nurse midwife for care from preconception through the post-partum period.
While a CNM is part of the medical community, Gold says a midwife is “more holistic than the medical model, and takes the needs of the patient as a whole person into consideration versus just addressing their medical needs.” Because she’s able to write prescriptions, order medications (epidurals included!) and perform simple medical procedures, the midwife adds another dimension to a family’s birth experience. “I think midwives really stress education to their patients so that they can make educated choices,” continues Gold.
Mikael TripkeHughes of Phoenix couldn’t agree more. “We used a Certified Nurse Midwife and a doula for our first child, and a Certified Nurse Midwife only for our second!”
Like many women, TripkeHughes began her pregnancy care by interviewing different OB’s, but “we felt as if we were not allowed to ask many questions. ‘Don’t worry about that, we’ll get to that later,’ was a common response,” explains TripkeHughes. “We often walked away with the feeling that we were just there to show up and they would do the real work. That was not the kind of birth I wanted to be a part of.”
Wanting someone “to walk along the process” her, TripkeHughes found her midwife through word-of-mouth after sharing her search (or “quest”, as she calls it) with their family and friends. TripkeHughes and met with her while in her fifth month, and they never looked back, and would “absolutely!” recommend it for others.
And while TripkeHughes’s husband was at first “cautious,” he now says, “It’s the only way to go. The one-on-one care we received was exactly what won me over. It was quite amazing.”
Although TripkeHughes’s first pregnancy was “very painful, but a smooth birth overall,” she says she felt much more in control of her body and choices by using a midwife. It’s no surprise, then, that one of her closest girlfriends, Lupe Rojas, will be using her same midwife when she gives birth this December!
Christa Burlakoff-Lawcock, a freelance writer, lives in Central Phoenix with her husband, dog, two cats and 6-year-old twins.
Resources
ALACE
Association of Labor Assistants and Childbirth Educators
480-560-8415
www.alace.org
Bethany Women’s Center
www.bethanywomen.com
DONA International
Detailed information on doulas
www.dona.org
North American Registry of Midwives
www.narm.org
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Healthy Baby Briefing
Simple Ways to Increase Your Chances for a Healthy Baby
By Frank Fara, M.D.
From buying a house to taking a vacation, relationships are full of decisions, but the decision to conceive a child is the most important one a couple will ever make. By knowing the appropriate steps to take, a couple can increase their chances of having a healthy baby.
Make Healthy Choices
When a baby begins to develop in a woman’s womb, a tiny disk of cells begins to roll up to form the neural tube, which will become the brain and spinal cord. If this tube does not finish closing within the first 28 days of pregnancy, neural tube defects (NTD) can result such as spina bifida, a leading cause of childhood paralysis. Consuming the recommended amount of folic acid (a type of vitamin B) can prevent nearly 70 percent of NTDs.
To help reduce the risk of having a baby with NTD, the U.S. Public Health Service and the March of Dimes recommend women consume 400 micrograms of folic acid everyday at least three months prior to conception and during the first four weeks of pregnancy.
Foods such as green leafy vegetables, beans, peas, orange juice and liver are good natural sources of folic acid. However, the best way to ensure the recommended amount of folic acid is consumed is to take a multivitamin supplement with at least 400 micrograms of folic acid every day.
Women should also avoid foods high in fat and sugar. Drink caffeine in moderation – no more than the amount in two standard 8-ounce cups of coffee, before and during pregnancy. Also, avoid secondhand smoke, alcohol and illegal drugs. Women who smoke should stop.
Making Fitness Count
During pregnancy, women should try to get plenty of exercise. Pregnant women who exercise decrease the likelihood and severity of common pregnancy discomforts including fatigue, backache, constipation, varicose veins and weight gain.
Although there is no evidence that exercise leads to a healthier baby or a shorter, easier labor, it may help mothers recover more quickly after delivery. Expectant mothers should consult with their physician to determine an exercise regimen that’s safe for the mother and baby.
Prenatal Care
Once pregnant, a woman must continue routine visits to her physician. All women need to receive prenatal care regardless of whether it’s her first or fifth child. Through regular visits physicians can detect problems that a pregnant woman would be unaware of otherwise. Because each woman is different and no pregnancy is the same, some women are offered special tests. If your doctor requests additional tests, don’t panic. Testing doesn’t necessarily mean there is a problem. It may just be that certain conditions (age, genetics, mom’s health, etc.) have put the baby in a “possible” risk category for certain health problems.
A typical prenatal care schedule for a low-risk woman with a normal pregnancy includes: one visit every four weeks during the first four to 28 weeks of pregnancy, four visits every two weeks during the 28th through 36th week and one visit each week from 36 weeks to birth.
During the prenatal visits, the physician will monitor a woman’s weight, blood pressure and the heartbeat of the baby to make sure the development is on track. By the second trimester many physicians offer an ultrasound examination to measure the growth of the baby and evaluate for normal anatomy.
Deciding to have a baby can be very exciting and a little overwhelming. Prenatal care visits with a physician and a healthy routine can help increase the chance of a healthy pregnancy and baby.
For more information about having a healthy baby log on to www.marchofdimes.com.
Frank Fara, M.D., is an obstetrician and gynecologist with CIGNA Medical Group.
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Baby Naming Ceremonies
By Wendy Schwimmer
The process of naming a baby doesn’t necessarily have to end once you’ve filled out the birth certificate. A baby naming ceremony, one that officially welcomes a child into the world by bestowing a name onto him or her, can make naming your baby a cherished, memorable event.
“Recognizing a new life and publicly giving the child a name is perhaps the most joyous celebration we can share with our family and friends, “ says Charlotte Eulette, national director of the Celebrant USA Foundation, a nonprofit educational institute dedicated to helping families personalize celebrations to mark life’s milestones.
How It Works
Once you’ve decided on a name, determine when, where and how to share the news announcing the baby’s arrival into the world. Do you want the ceremony to be a simple, intimate ceremony at home or a nature inspired one at a public garden or park? Choose a place that fits your lifestyle or has some significance to you and your spouse.
After deciding where to have it, you’ll need to make some decisions on how to conduct it and what you want to convey to your guests. The beauty of a baby naming ceremony is how personalized it is – you create it from your heart. Following are some suggestions, courtesy of the Celebrant USA Foundation.
Explain the Name. There may be nothing more intimately coupled with our individuality than the name by which we are called. Names are rich with cultural and personal significance. Tell your guests what your child’s name means and why you chose it – perhaps you are paying tribute to a family member or to your ethnic heritage.
Acknowledge ancestors. Pay tribute to great grandparents and grandparents to highlight the continuity of family bonds from generation to generation. Include a moment of reflection for those who have passed on. Ask grandparents to offer the parents some words of wisdom about raising a child.
Make vows to your child. You made vows to your spouse at your wedding; now is the time to make promises to your child. Share your hopes and dreams for your baby and how you view your role as a parent.
Include your child’s peers. If your child has cousins, invite them to take part in the ceremony by presenting a bouquet of flowers, a drawing or a simple handmade gift to the baby.
Select godparents or guide-parents to mentor your child. Explain to guests why you’ve chosen these people for this important role, and ask them to publicly declare that they will help to nurture your child.
Ask the community to make a pledge to your child and to children everywhere. It truly does “take a village” to raise a child, and a baby naming ceremony is the perfect time for all participants to recognize their responsibilities to the next generation.
Set up a “wish box.” Inspire your guests to share something they hope to do with or teach your child as (s)he grows and/or have them write down a heartfelt wish for your child’s life.
Keep it short and simple. Remember, your baby’s attention span is limited. To avoid too much fussing, keep the ceremony 20 to 25 minutes long. Any longer and you may lose the cooperation of the guest of honor.
Information: www.celebrantusa.org.
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C-Section Delivery on Demand
By Susan Warhus, M.D.
How much power do you have to determine the type of delivery for your baby? Can you march into your doctor’s office and demand a Cesarean delivery?
Naturally, doctors must still abide by a high standard of medical practice and not perform unnecessary procedures. However, in some situations the choice may be uncertain and the decision of Cesarean (C-section) versus vaginal delivery may be influenced by your desires.
Prior C-section
A few years ago, vaginal birth after Cesarean was the popular choice. Subsequently, some studies have shown that the risk of uterine rupture, while still low, is higher than the medical community initially thought. Therefore, the trend toward repeat C-section is on the rise.
Phoenix mom Judy (last name withheld) delivered her firstborn by C-section because he was breech. Her second baby was a vaginal delivery. For her third delivery, she opted to have another C-section.
Judy liked the idea of a planned delivery because it enabled her to arrange childcare for the other children. She also wanted to have her tubes tied and this could easily be done at the time of the C-section. Judy and her doctor discussed the pros and cons and proceeded with the planned C-section.
When deciding whether to deliver vaginally or by C-section, there are several factors to weigh.
If you had a previous C-section, the type of incision made on your uterus is a major consideration. (The incision made on your skin is not necessarily the same type made on your uterus.) If a vertical cut was made during your first C-section, the healed incision may not be strong enough to endure contractions, and your doctor will probably recommend another C-section to avoid the possibility of uterine rupture. Although there is a small chance of uterine rupture with a horizontal incision, the likelihood is about ten times greater with a vertical one.
The reason for your first C-section is another concern when choosing a delivery method. If your first C-section was necessary because your pelvis was too small, it’s likely still the case. However if it was due to fetal distress, herpes, breech, or twins, the condition is less likely to reoccur during the next labor.
Also think about future childbearing. If you plan to have additional children, a vaginal delivery may be preferable to avoid multiple C-sections. Conversely, if you’re sure this is your last baby, you may elect to have a tubal ligation during your scheduled C-section.
History of Herpes
If outbreaks are frequent during pregnancy, doctors often recommend you begin a preventive anti-viral medication at about 36 weeks to minimize the chance of an outbreak just prior to delivery. This improves the chances of a safe vaginal delivery. However, if you have an active herpes lesion at the time of delivery, a C-section is usually recommended to avoid infectious contact with the newborn.
Because Amy (last name withheld) of Scottsdale had a history of herpes and was terrified of passing it onto her baby during delivery, she took the anti-herpes medication during pregnancy. However, it wasn’t enough to ease her concerns. Eventually, she told her doctor she wanted a C-section as a preventive measure against herpes. In addition, she wanted it performed March 18, one week before her due date. But Amy had another unusual request. She wanted exactly 18 skin staples to close her incision. Her doctor explained that she might need more or less than 18 staples to properly close the incision. In the end, Amy delivered a healthy baby boy on March 18 by C-section and was able to received exactly 18 staples in her incision, just as she had hoped.
Remember, even if you feel an outbreak coming on, but don’t actually have a visible lesion when labor begins, it’s important to tell your doctor immediately. Explain your symptoms and concerns so he can properly assess the situation. There’s a good chance he may err on the side of caution and opt for a planned C-section.
Breech Position
Most fetuses will be in the head-down position by 36 weeks. However, about three percent will be in a breech position (buttocks or feet down). Breech vaginal deliveries are considered high-risk because the head is the last part of the baby to be delivered. Since the head is the largest and firmest part of the baby, it could become stuck or difficult to deliver. The resulting lack of oxygen to the baby could cause serious harm.
If your baby is in a breech position, discuss your delivery options with your doctor. Some provide handouts on exercises to try at home in hopes of causing your unborn child to rotate. Another option is the “version,” a procedure performed in the hospital whereby one or two doctors place their hands on your pregnant abdomen and manually attempt to turn the baby into the head-down position. Version has about a 50 percent success rate. Your other option is to schedule a C-section.
Twins
Your risk of having a C-section is higher with twins. Although, there is an excellent chance a C-section may not be necessary. The decision to deliver vaginally or by C-section is determined largely by the position of the babies. As delivery time nears, the majority of twins are both in the head-down position, which is ideal for vaginal delivery. However, some doctors recommend a C-section if the babies’ positions are anything other than both head-down.
Belinda (last name withheld) was full term and pregnant with twins. She was also married to a Scottsdale surgeon who witnessed the aftermaths of difficult vaginal deliveries. He didn’t want his wife to endure the potential pelvic relaxation and urinary incontinence that could accompany a difficult vaginal delivery, so he found an OB/GYN willing to perform a C-section to avoid potential pelvic damage. The C-section went well and the twins were delivered without problems. When the hospital board discovered the questionable indication for C-section, the OB/GYN was brought up on charges and placed on six months probation.
Instrumented Vaginal Delivery
Just about everyone agrees that it’s preferable to have a natural delivery without the use of instruments. However, after several hours of pushing or in the case of fetal distress, an instrumented delivery may be attempted in hopes of avoiding a C-section.
On occasion, mother and doctor agree to forgo an instrumented delivery attempt and proceed directly with a C-section. In light of the medical and legal environment, some practitioners prefer to perform a C-section instead of using a vacuum or forceps. Talk with you doctor about his or her training and thoughts on these issues.
Michelle (last name withheld) of Tempe, a petite, young woman concerned about a traumatic vaginal delivery, has been diagnosed with an anal fissure (rectal tear) and is worried that a vaginal delivery would exacerbate her situation. Her sister, who has the same small build, recently experienced a very difficult forceps delivery. Since Michelle plans to become pregnant later this year, she is currently seeking a doctor who will promise a C-section delivery based on her small frame and history of anal fissure.
Keep in mind that while the doctor is the medical expert, this is still your baby and your birth experience. After all, your pregnancy and the birth of your child are very special times in your life. That’s why it is important for you and your doctor to discuss your expectations, wishes, and concerns during your entire pregnancy. Together, you can make the best decision for you and your baby.
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Making Babies: Myths and truths of increasing your chances of getting pregnant
By Jacqueline Bodnar
With over 6 billion people on the planet, you can’t help but think having babies is an easy process. While that may be true for some, others need to work a little harder to conceive. Fortunately, there are things that can be done at home and with the help of a doctor to increase the chances of getting pregnant.
However, prior to attempting conception, women should ready their bodies by taking folic acid on a daily basis. According to the Center for Disease Control and Prevention (CDC) two-thirds of women in the United States do not get enough folic acid. This B-vitamin is essential in the prevention of neural tube defects. And, because it’s vital for fetus development, it’s important for women to make sure they get enough folic acid prior to conception and throughout pregnancy. The CDC recommends 400 micrograms of folic acid per day, which can come from supplements or fortified and enriched foods.
What’s Long Enough?
Once a couple starts trying to conceive, they may find it a little more difficult than expected. The CDC reports around 6.1 million Americans experience infertility each year.
“Infertility is defined as one year of unprotected intercourse,” says Dr. Jay Nemiro, medical director for the Arizona Center for Fertility Studies in Scottsdale. Nemiro advises younger couples to try for one year before seeking help. For those over age 35, he suggests seeking help after trying unsuccessfully for six months.
Even if a woman has already given birth, that doesn’t mean she’ll be able to easily conceive again. “Primary (conception) is more common, but secondary is a huge issue,” says Dr. Nemiro. Millions of people are surprised each year when they find themselves experiencing secondary infertility.
Common Problems
Finding an exact cause for not getting pregnant can be difficult. Once a couple seeks medical help, tests are done on both partners to narrow the possibilities. Although more tests are performed on women than men, causes for infertility are generally split equally between genders; and for 20 percent of all infertility cases, no specific cause can be identified.
According to the American Society for Reproductive Medicine the most common factor for male infertility is a lack of sperm cells being produced. Other problems include sperm cells being malformed or dying before reaching the egg. In females the most common factors are ovulation disorders and blocked fallopian tubes.
Dr. Nemiro advises couples to do a thorough evaluation and not stop upon finding the first possible cause for infertility. For many couples, there is more than one reason for not conceiving, and couples could miss something by not completing the evaluation.
Considerations
Many things can affect fertility:
Age: Today many women are waiting longer before having children. While they are building a career and seeing the world, their biological clock is ticking away, reducing their chances of being able to easily conceive. During a woman’s prime reproductive years she typically has about 400,000 eggs. By the time she reaches age 40, that number drops to below 50,000. For a healthy female the chances of getting pregnant per cycle in her mid-20s is about 35 percent. That number drops to about 20 percent by her mid-30s and about 4 percent by mid-40.
Diet: “Good nutrition begins at the cellular level,” says Stephanie Green, a registered dietician, chef and founder of the Nutrition Studio in Phoenix. “Nutrients help make genetic material, so it’s a good idea to make sure that men and women are eating healthy, well balanced diets and taking a daily multivitamin.” An unhealthy diet can lead to being underweight or overweight, both of which can affect fertility. Being too thin can keep a woman’s body from producing enough estrogen and slow down reproductive cycles. Women who are overweight have more fat cells, which can lead to an overabundance of estrogen. When women produce too much estrogen, it gives the body a “birth-control reaction,” which limits chances of conceiving.
Chemicals: There are chemicals at work and around the house that are believed to be linked to fertility troubles such as anesthetic gases, beauty salon chemicals and organic solvents. Another product being researched for links to infertility is bis-phenol, a compound in common plastics used to make food containers. Researchers believe bis-phenol may contribute to the disruption of the reproductive function due to its estrogenic properties.
To help protect fertility, exercise caution when using chemicals around the house for cleaning or at work. Use gloves and a mask to keep the chemicals away from your skin. You may also consider storing food in glass dishes rather than in plastic.
Heat: Although it may be an old wives tale that men wearing tight underwear can have an effect on fertility, there may be some truth to it. According to the Center for Male Reproduction, when excess heat is applied to the testicles it can decrease sperm production. The same holds true for using hot tubs or taking hot baths. However, studies show sperm production returns to normal after a couple of months of avoiding these activities. So for pregnancy sake, it can’t hurt to have the male partner switch to boxers and skip the dip in the hot tub.
Herbs: Although many herbs are believed to be healthy, there are some that should be avoided if you’re trying to get pregnant. “Herbal agents including black cohash, wild yams, Dong Quai, aniseed, liquorice and soy products can have effects that are not well defined but could be counter productive in the pursuit of a successful pregnancy,” advises Dr. Thomas Lyons of the Center for Women’s Care and Reproductive Surgery in Atlanta, Ga. Other herbals believed to be detrimental to sperm and egg function include St. John’s-wort, Echinacea purpura, and gingko biloba.
Lifestyle: Having unprotected sex or having sex with someone when you don’t know their sexual history can put a woman at risk for a sexually transmitted disease that can later leave her with fertility challenges. Additionally, being more than a casual drinker or doing drugs can hamper fertility. Studies also link smoking to infertility in both sexes.
Fertility Rescue
After trying to conceive unsuccessfully for six months to a year, consider seeing the family doctor or a fertility specialist. There are many assisted reproductive technologies and treatments available to increase the chances of becoming pregnant.
A woman’s doctor may prescribe fertility drugs such as clomiphene citrate (Clomid). These prescriptions are easy to use, but could be costly ($200-$300 a month) if not covered by insurance – and most fertility drugs and procedures are not. According to the Women’s Health Resource Center approximately 90 percent of infertile women are treated with infertility drugs and around 40 percent will become pregnant within six months.
For those in need of more than fertility drugs there’s a variety of advanced procedures available including in vitro fertilization (IVF), a method that combines the egg and sperm in a laboratory dish. After fertilization occurs, the resulting embryo is transferred into the uterus to undergo natural development. Less than five percent of infertile couples use this procedure and the success rate is around 29 percent. Chances of success increase with the number of cycles attempted up to four cycles, and the average cost per cycle is more than $12,000.
Intracytoplasmic sperm injection (ICSI) is a procedure to help couples undergoing IVF due to male factor infertility. The procedure involves a single sperm being injected into the cytoplasm of a mature egg. Other advanced procedures are available for those with damaged tubes, damaged cervix and for those needing donor sperm or eggs.
Help at Home
Let’s face it, not everyone has thousands of dollars to spend at a fertility clinic or an insurance plan that will pick up the tab. A few things that can be done at home to try to increase the chances for pregnancy including charting your basal body temperature (your temperature upon first rising in the morning) to try to pinpoint ovulation, purchasing over the counter ovulation predictor kits and placing a pillow under the woman’s hips during intercourse to help more sperm reach the cervix.
Trying to get pregnant and not achieving that goal each month can leave a couple in a swirl of emotions, which can stress a relationship. “Infertility is one of the most difficult challenges that a couple can face,” explains Alyssa Mandel, a licensed clinical social worker and the director of Horizon Counseling of Phoenix located in Scottsdale, “This is primarily due to each person’s inevitable feelings of inadequacy and helplessness.”
It’s important for couples to not play the blame game and take their frustrations out on each other. If infertility is causing you to have emotional problems or wreaking havoc on your relationship, consider seeking professional help. “Utilizing counseling can be a wonderful way to keep the couple focused on the reasons they are together and what their ultimate goals are,” says Mandel.
Infertility by the Numbers
- 6.1 million Americans experience infertility each year.
- 3 million couples experience secondary infertility each year.
- 80 percent of the time the cause for infertility is equally distributed between the sexes.
- 20 percent of couples are infertile for unexplainable reasons.
- 25 percent of couples have more than one factor contributing to infertility.
- 70,000 babies born in the United States each year as a result of assisted reproductive technologies.
Pregnancy Myths & Truths
Trying to separate fact from fiction? Here are several old wives’ tales dispelled and a few truths revealed.
Myth: The baby’s sex can be determined by the shape of the belly and/or the way it is being carried.
Truth: Although many swear by the belief that pregnant women carry a boy low and a girl high, no evidence exists to support it. The way a pregnant woman’s belly looks and how the baby is being carried reflects her muscle tone, not the baby’s sex.
Myth: If the fetal heart rate is faster, it’s a girl.
Truth: No evidence exists that supports the claim by some that male fetuses have slower heartbeats.
Myth: You can increase your chances of conceiving if you stand on your head after sex.
Truth: There is no proven evidence that standing on your head increases the chances of getting pregnant. However, some experts recommend lying down for up to half an hour after having intercourse, which may increase the chances of conceiving because it keeps the sperm inside.
Myth: Excessive heartburn during pregnancy means your baby will be born with a lot of hair.
Truth: Heartburn during pregnancy is very common, but it has nothing to do with the amount of hair your baby will have at birth. The pressure the fetus is putting on the intestines and organs, which sometimes pushes contents up into the esophagus, is usually the cause of heartburn during late pregnancy.
Myth: Stress will keep you from getting pregnant.
Truth: Only in very rare cases does stress change hormonal levels, causing irregular ovulation.
Myth: You can increase the chances of determining the sex of the baby by timing intercourse.
Truth: Although many long for the ability to choose their child’s gender, no scientific evidence indicates that timing intercourse can determine the baby’s sex.
Myth: You need to have sex every day to get pregnant.
Truth: Having sex daily only minimally increase your chances of conceiving. Most experts say having sex every other day is adequate when trying to achieve pregnancy.
Myth: You can’t get pregnant if it’s your first time having sex.
Truth: This common myth among youngsters couldn’t be further from the truth. There is no protection against pregnancy simply because it’s the first time.
Take the test -Are you at risk for infertility?
- Are you older than 40?
- Have you ever had unprotected sex or didn’t know your partner’s sexual history?
- Do you smoke or use drugs?
- Are you under- or overweight?
- Do you drink alcohol more than moderately?
- Do you have painful, absent or irregular menstrual periods?
- Do you work around high levels of pesticides?
If you answered yes to any of these questions you could be at risk for infertility and should consult a physician for further information.
References
American Society for Reproductive Medicine
www.asrm.org
Center for Male Reproductive Medicine
www.malereproduction.com
Resolve: The National Infertility Association
www.resolve.org
Women’s Health Resource Center
www.healthywomen.org top of page
June Baby FYIs (2005)
Safe Ride
More children are killed as passengers in a car crash each year than from any other injury. Each year approximately 1,800 children ages 14 and younger are killed as occupants in motor vehicles when not wearing seatbelts.
The good news is that these statistics are preventable. When child safety seats and safety belts are correctly installed and used, they can help prevent injury and save lives. According to the National SAFE KIDS campaign, safety seats reduce the risk of death by 71 percent for infants and by 54 percent for children ages 1 to 4.
“Generally the safest seat in the car and best place for the car seat is the center of the back seat,” says Maggie Ingraham, L.P.N. and certified car seat inspector with CIGNA Medical Group. Ingraham also advises that children should never be put in a rear-facing car seat in the front seat if the airbag is turned on.
The American Academy of Pediatrics recommends the following for safe transportation of children:
- Infants should ride in the back seat in rear-facing child safety seats until they have reached both 20 pounds and are 1 year old.
- When children outgrow the rear-facing seat, sit them in a forward-facing seat for as long as the child fits well in the back seat and is between 20 and 40 pounds. Examples of fitting well include ears below the top of the back of the seat and shoulders below the seat strap slots.
- All children ages 12 and younger should ride in the back seat, the safest part of a vehicle in the event of a crash.
Many hospitals will now check for a properly installed car seat prior to discharging a newborn baby and most fire stations in Maricopa County have several check-up events per year.
To learn more about the proper use of child safety seats, visit www.aap.org, www.nhtsa.dot.gov and www.safekids.org.
Newborn Jaundice
Most newborns develop a mild jaundice, a condition that makes skin look yellowish, in the first few days after birth because it takes a few days for baby’s liver to efficiently remove bilirubin, a chemical that can build up in the system.
Jaundice usually appears first in the face and then moves to the chest, abdomen, arms and legs. The whites of the eyes may also be yellow. Although usually harmless, in unusual cases it can become dangerous and even lead to brain damage.
The hospital’s staff watches for jaundice while mom and baby are residents. Once baby is home, the American Academy of Pediatrics recommends having newborns checked again between 3 to 5 days old because this is when a baby’s bilirubin level is highest. Consult with your doctor directly if baby’s skin turns more yellow; his/her abdomen, arms, legs or whites of the eyes are yellow; or if a jaundiced baby is hard to wake or not nursing or taking formula well.
Information: www.aap.org
Born Too Soon
According to the March of Dimes, one out of eight babies in the U.S. will be born this year before their due date.
“Each year in the United States, 4,000 babies die because they are born prematurely and many more struggle to survive respiratory and cardiovascular disease. Some preemies suffer from blindness, cerebral palsy, mental retardation and are hearing impaired,” explains Frank Fara, M.D., an obstetrician and gynecologist with CIGNA Medical Group. “Because all women are at risk of having a premature baby, it’s so important that they receive prenatal care, regardless of whether it’s their first or fifth child.”
The March of Dimes encourages women who experience any of the following symptoms prior to the 37th week of pregnancy to call their healthcare provider or go to the hospital immediately.
- Contractions every 10 minutes or more often.
- Clear or bloody discharge.
- Pelvic pressure (the feeling that baby is pushing down).
- Low, dull backache.
- Cramps that feel like your period.
- Abdominal cramps with or without diarrhea.
“I tell all of my patients, I would much rather they call and question something that does not feel right, and it be nothing, than wait to see if a condition worsens,” says Fara.
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