Expecting Multiples

/Expecting Multiples
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Bedrest During Higher Order Multiple Pregnancy

Bedrest might be recommended while you are at home or you might be admitted to the hospital for bedrest.  Bedrest is recommended for various reasons and for various lengths of time. Sometimes your doctor will want you to stay off your feet for a few days after a procedure early in your pregnancy or if you are experiencing vaginal bleeding. Some mothers are put on strict bedrest for months at a time. Many mothers restrict their own activities because they feel that their body needs to take it easy. Some women adjust easily to bedrest while others find it more difficult. Remembering that you are doing this for your babies usually makes bedrest easier. It really is for only a short time even though some days might feel like forever! – Dr. John Elliott

Limiting physical activity helps alleviate or prevent stress on the mother’s vital organs, such as the heart, kidneys or circulatory system. It increases blood flow to the uterus and conserves energy, increasing the nutrients directed towards the babies. Equally importantly, it takes pressure off the cervix and may help keep the uterus from contracting, reducing the risk of preterm labor.

“Bedrest” might mean something different between you and your doctor. Even doctors and health professionals can mean different activity levels with the term “bedrest”. To help you know what level of bedrest your doctor wants you to follow,  use our Bedrest Activity Checklist, found under the Pregnancy heading on our website (Yes, you can print it!). We encourage you to use this list to clarify with your health care provider what you are allowed to do and in what amount.

Tips for Managing Bedrest

Bedrest sounds so much easier than it actually is: physically, mentally and emotionally. The following are many of the different emotions expectant mothers have described feeling while on bedrest:

·         A loss of independence as a result of a reduction in activity level, inability to care for family and perhaps even total dependence on others

·         Feelings of inadequacy because you are not able to have a “normal” pregnancy like other women, are not able to work outside the home or care for other children and your household.

·         Feelings of helplessness/loss of control may be experienced by both parents due to an inability to change the situation. Partners may feel overburdened by an increased work-load at home or financial burdens.

·         Feelings of isolation or being different from other having “normal” pregnancies and being confined to home, bed or the hospital. Support systems normally available through work or outside activities may be gone due to activity restrictions or hospital isolation. You may be worried about your health and the well-being of your unborn children.

·         Feeling misunderstood when others say you are lucky to get to “rest” and “lie around all day” when bedrest and gestating is actually the expectant mothers “work” right now and must be taken seriously. Some of the medications and treatments are also not much fun.

·         The major shift in household responsibilities means the entire burden of the household is now on the co-parent or is a huge concern for a single mother or one with a partner not able or willing to help.

·         Frustration caused by watching other parents excitedly prepare for their baby’s birth and not being able to do this. Expectant parents of multiples may be unable to make decisions or preparations due to uncertainty of the outcome especially if they have had past pregnancy losses. Sometimes people try to help by saying “everything will be all right” but parents know this is not always the case.

·         The financial demands of going from a double to a single income when medical bills are rising especially when the mother may have carried the insurance or been a major financial contributor.

Expecting mothers have found online support groups to be a safe place to share anxieties during this time. Relaxation techniques, having someone who can listen and knowing that someone else has been in a similar situation can also be helpful in decreasing stress during bedrest.

Here are 20 tips and ideas from Sidelines of Oregon to help you manage bedrest.

1.        Wear clothes during the day if possible and be neat and clean: keep up personal hygiene

2.        Set goals, keep them in mind and focus on WHY you are doing this not WHAT you are doing

3.        Shop by phone or online

4.        Plan your weekly meal menus and organize the grocery list.

5.        Consider using a grocery delivery services from your local store or online

6.        Do crossword, word-search or jigsaw puzzles

7.        Have visitors but only when you feel up to it. Watch favorite shows together

8.        Do something special for yourself such as having someone come in to give a manicure, pedicure or facial

9.        Keep a journal of your pregnancy and a calendar to chart your progress.

10.     Focus on how far you have come, not how far you have to go

11.     Listen to books on tape or learn a new language with tapes from the library

12.     Make a list of tasks people can do for you, so when they ask, you can easily offer them a choice.

13.     Request a childbirth class in the home if available

14.     Have a “date” with your partner with take out food and candles

15.     Do craft projects such as cross stitch, needlepoint, knitting, etc. to make something special for the babies or someone else

16.     Do passive bedrest exercises with approval from your physician.

17.     Read books on high-risk pregnancy, multiples, and premature babies such as this one

18.     Pay bills, compile tax data, reorganize files or update your address book

19.     Order and address birth announcements

20.     Call a friend or relative or other support person. Find someone who understands your fears and hopes. And of course, you can reach out to us!

Bedrest with an Older Child

If you have older children, finding someone else to care for them during bedrest may be easier on you. Whether or not that is possible, below are some ideas to entertain them. This can be challenging, but try to make the best of the situation. The days/weeks/months you are on bedrest are really just a short period of time in your children’s lives, and in the long run delivering the healthiest babies possible is better for the babies, their older siblings and for you:

·         If you have toddlers and no older children, make your bedroom into a giant playpen. Put everything out of reach and shut the door so you do not have to worry about where your child is.

·         Watch television, read, play board or video games or just talk

·         Make videos together of you and your child(ren) singing or talking

·         Have a small ice chest next to your bed packed with the day’s drinks and snacks and keep supplies/toys in a laundry basket near your bed.

·         Make a paper chain and have your child take one off for every day

·         Keep a roll of paper towels near your bed for spills

·         Use an old sheet or blanket as a playtime cover to spare your bedspread

·         Let your child play under the covers or Play “I Spy”

·         Play “bed-bowling” with paper cups and a small ball

·         Play “bed-basketball” by tossing rolled up socks into an empty basket

·         Play “bedspread traffic” using small cars to follow the bedspread design

·         Go bed fishing using magnets and paper fish with paper clips

·         Use a mirror to make faces expressing feelings

·         Make hand shadows on the wall with a flashlight.

·         Work jigsaw puzzles, construct building blocks or play board games

·         Play red light-green light with you being the traffic cop

·         Cut up magazines and paste them on cardboard for paper dolls

·         Get children’s books from the library and read

·         Use coloring books or play dough

·         Trace letters/numbers on your child’s back that they can guess

June 4th, 2019|Expecting Multiples, Toddler Multiples|

Ob/Gyns Warn Against ‘Vaginal Seeding’ Trend for Newborns

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Special thanks to our friends at HealthDay for providing this story.

 

The U.S.’s leading group of obstetricians and gynecologists is warning against a new trend where babies born by C-section are “seeded” via cotton swabs with vaginal microbes from the mother.”Vaginal seeding” is growing in popularity because it’s thought that babies born through Cesarean-section miss out on certain “helpful” vaginal microbes that might shield the infant from asthma, allergies and immune disorders.

“Vaginal seeding has become a rising trend for patients,” noted Dr. Jennifer Wu, an ob/gyn at Lenox Hill Hospital in New York City. “Patients read about the benefits of a vaginal delivery and hope to replicate these benefits with vaginal seeding.”

As explained by the American College of Obstetricians and Gynecologists (ACOG), it’s thought that contact with healthy vaginal bacteria helps stimulate the infant immune system, prevents the growth of dangerous bacteria and regulates the gut.

That contact doesn’t happen for babies born via C-section, however, so in vaginal seeding, a cotton swab with vaginal fluids from the mother is used to transfer vaginal bacteria to a newborn.

But in a statement issued Oct. 24, ACOG — the nation’s largest ob/gyn organization — said the procedure is not recommended because the known risks outweigh any potential benefits.

“Due to the lack of sufficient data, the very real risks [of vaginal seeding] outweigh the potential benefits,” Dr. Christopher Zahn, ACOG’s vice president of practice activities, said in a college news release.

“By swabbing an infant’s mouth, nose or skin with vaginal fluid after birth, the mother could potentially, and unknowingly, pass on disease-causing bacteria or viruses,” he explained.

Wu agreed. “There are very real risks attached to this practice,” she said. “Certain viruses, such as group B strep and herpes, can cause serious illnesses such as meningitis in newborns.”

And Zahn stressed that there’s a much safer way for a new mom to transfer her helpful bacteria to her newborn: Breast-feeding.

“Breast-feeding for the first six months is the best way to overcome the lack of exposure to maternal vaginal flora at birth,” Zahn said. “The bacteria present in breast milk and on the nipple is sufficient for natural colonization or seeding of the gut. There may be some initial difference in the gut [microbes] of infants based on mode of delivery, but research has shown that difference disappears after about six months,” he added.

If a woman does insist on vaginal seeding, her ob/gyn needs to make sure the patient understands the potential risks, ACOG said.

Dr. Mitchell Kramer is head of obstetrics and gynecology at Huntington Hospital in Huntington, N.Y. He agreed that breast-feeding is a good means of transmitting healthy microbes from a mom to her baby, but that “the jury is still out on [vaginal seeding] and further study is necessary before this is recommended as a routine protocol.”

SOURCES: Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; Mitchell Kramer, M.D., chairman, obstetrician/gynecologist, Huntington Hospital, Huntington, N.Y.; American College of Obstetricians and Gynecologists, news release, Oct. 24, 2017.

Docs: Infants Should Share Parents’ Room to Help Prevent SIDS

parent-and-infant-handsFrom our friends at HealthDay

Infants should sleep in the same room as their parents — but not in the same bed — to reduce the risk of sudden infant death syndrome (SIDS), new guidelines from the American Academy of Pediatrics advise.

The recommendations call for babies to share their parents’ bedroom for at least the first 6 months of life and, ideally, for the first year.

This could reduce the risk of sudden death by as much as 50 percent, the guideline authors say.

“Room sharing makes a lot of sense,” said Dr. Paul Jarris, deputy medical officer at the March of Dimes.

The rationale is that having the infant within view and reach makes for easier monitoring, comforting and feeding. Because the baby is nearby, parents might notice any potential difficulty, Jarris said.

“If we look at how strong the evidence is, parents will be well advised to adopt room sharing,” Jarris said.

It’s important, however, that infants have their own separate sleep surface, such as a crib or bassinet. They should never sleep on a soft surface like a couch or armchair, the doctors’ group warns.

Nor should babies sleep in the same bed as their mothers, the guidelines say. But, since infants do feed throughout the night, the doctors recommend that mothers feed the baby in bed.

“Babies should be brought to bed for feeding, but following feeding they should be returned to a separate sleep surface,” said report co-author Dr. Lori Feldman-Winter, a professor of pediatrics at Cooper Medical School in Camden, N.J.

“Breast-feeding can reduce SIDS by as much as 70 percent,” added Feldman-Winter.

Because moms may sometimes fall asleep during feeding, the AAP recommends keeping the parents’ bed free of pillows, loose sheets, blankets and other soft bedding that could suffocate the baby, she said.

Each year in the United States, some 3,500 babies die from sleep-related deaths, including SIDS. The number of infant deaths dropped in the 1990s after a national safe-sleep campaign that emphasized placing infants on their back. However, momentum has stalled in recent years, Feldman-Winter said.

Besides room sharing and breast-feeding, the academy’s recommendations to create a safe sleep environment also include the following:

  • Put the baby on his or her back on a firm surface, such as a crib or bassinet, with a tight-fitting sheet.
  • Keep soft bedding, including crib bumpers, blankets, pillows and soft toys, out of the crib. The crib should be bare.
  • Avoid exposing the baby to smoke, alcohol and illicit drugs.
  • Never use home monitors or other devices, such as wedges or positioners, to reduce the risk of SIDS.

Although SIDS risk is greatest from 1 to 4 months of age, evidence shows that soft bedding is still a hazard for older babies.

One pediatric specialist thinks room sharing might be difficult for some parents to accept.

“Room sharing is probably the most controversial recommendation,” said Dr. David Mendez, a neonatologist at Nicklaus Children’s Hospital in Miami.

Parents have strong feelings one way or the other, Mendez said. “Some parents want the baby in the bed right next to them; some parents want the baby to have its own room,” he said.

Mendez said he’s more concerned with other risk factors for SIDS, such as smoking and excess bedding.

“I would rather have the parents put the baby in a separate room if they’re smokers than room share,” he said.

“Having the baby on a firm surface on his back and keeping soft pillows and loose bedding that the baby can get tangled up in out of the bed or crib — those things probably play a much bigger role in preventing SIDS than being in the same room with the baby,” Mendez added.

The new recommendations, published online Oct. 24 in the journal Pediatrics, were to be presented Monday at the academy’s annual meeting, in San Francisco.

SOURCES: Lori Feldman-Winter, M.D., M.P.H., professor, pediatrics, Cooper Medical School, Rowan University, Camden, N.J., David Mendez, M.D., neonatologist, Nicklaus Children’s Hospital, Miami, Fla.; Paul Jarris, M.D., deputy medical officer, March of Dimes; November 2016, Pediatrics

Pregnancy Problems More Likely with Boys?

pregnant womanSerious pregnancy complications are more likely when women are carrying baby boys, new research suggests.

After analyzing more than half a million births in Australia, researchers said the baby’s gender could be linked to the health of both mother and child.

“The sex of the baby has a direct association with pregnancy complications,” said study first author Dr. Petra Verburg, of the Robinson Research Institute at the University of Adelaide in Australia.

Boy babies were more likely to be born early, which sets up infants for more health problems. Also, women carrying boys were slightly more likely to have diabetes during pregnancy (gestational diabetes), and pre-eclampsia, a serious high blood pressure condition, when ready to deliver, the study authors said.

Although it isn’t totally clear why this is so, “there are likely to be genetic factors,” Verburg said.

The findings ring true, said Dr. Querube Santana-Rivas, a neonatologist at Nicklaus Children’s Hospital in Miami, who wasn’t involved in the study. She said she sees the differences in her own practice.

“Male gender is a risk factor for a lot of the complications right after birth, especially in the premature population,” Santana-Rivas said.

The results also echo some findings from previous studies, Verburg said. A potential explanation is that the placenta, the organ that nourishes the developing fetus, is different in boys and girls.

“The placenta is critical for pregnancy success, and it is an organ that technically belongs to the baby, so it is genetically identical to the baby,” said study co-author Claire Roberts, another researcher at the Robinson Research Institute.

In previous research involving normal pregnancies, Roberts’ team found sex differences in the expression of 142 genes in the placenta. The researchers said that defects in how the placenta develops and works are linked with pregnancy complications.

For the new study, Verburg, Roberts and colleagues evaluated more than 574,000 Australian births from 1981 through 2011.

Compared to girls, boys had 27 percent higher odds of preterm birth between 20 and 24 weeks’ gestation; 24 percent greater risk for birth between 30 and 33 weeks; and 17 percent higher odds for delivery at 34 to 36 weeks, the study found. Full-term birth is between 39 and 41 weeks, according to the American College of Obstetricians and Gynecologists.

Moreover, gestational diabetes was 4 percent more likely in women carrying boys, and pre-eclampsia at term was 7.5 percent more likely with boys, the researchers said.

However, women carrying girls had a 22 percent higher risk of getting pre-eclampsia early in pregnancy, requiring preterm delivery, the study found.

Still, the research merely shows an association between gender and birth complications, not a cause-and-effect relationship. The findings shouldn’t alarm mothers-to-be, no matter what the sex of their unborn child, said Roberts.

The advice, for now, is the same as for all women who become pregnant, Roberts said. That means eating a good diet and attempting to maintain a healthy weight before conceiving.

“Even if the pregnancy was unplanned,” Verburg said, “there is still a window of opportunity for a woman to reduce her risks for pregnancy complications.” A woman can stop smoking, not drink alcohol and stay physically fit, she said.

Santana-Rivas agreed. She said the take-home message from the new study is for women to be aware of the potential risks “and to get good prenatal care.”

Depending on what future research finds, prenatal programs for pregnant women might one day vary based on whether they are carrying a boy or a girl, the researchers said.

The study was published online July 11 in PLOS ONE.