A National Institute of Neurological Disorders and Stroke and the California Birth Defects Monitoring Program study of more than 155,000 children found that twin pregnancies produced a child with cerebral palsy (CP) more than 10 times as often as pregnancies producing a single child. The study examined 2985 individuals from 1537 twin pairs who were born between 1983 and 1985 in four northern California counties and who survived to age three. The researchers found that among the almost 3000 children from twin pairs, 20 children in 18 pairs had CP. Approximately seven out of every one thousand twin children had moderate or severe CP. And, more than 10 twin pairs out of every thousand twin pregnancies had CP in one or both members.
One possible explanation offered by the researchers is that twins are often born with a low birth weight (less than 2,500 grams, or 5 1/2 pounds) which is strongly associated with CP. The authors reported that the risk of CP in low birth weight twins was similar to the risk of CP in single children of low birth weight. However, twins who were born at a normal birth weight (more than 2,500 grams) were shown to be at an increased risk of CP, more than three and one half times that of single children born at normal birth weight. The findings were replicated by a study conducted in Western Australia, which reported that twin pregnancies produced a child with CP eight times more often than single pregnancies, while in triplet pregnancies a child with CP was produced 47 times more often.
— Pediatrics, 1993
Readers, let's discuss possible causes for this correlation. Think about technological intervention, for example. Ideas? Send your thoughts to email@example.com.
Birth Works National Conference
Clarion Hotel Conference Center in Cherry Hill, NJ
New! Featuring Henci Goer, Jean Sutton, Cathy Daub, Michel Odent and Suzanne Arms
For a complete listing of workshop topics and speakers visit
Multiples in Pregnancy and Birth
Be sure to check for a history of liver disease or disorder, including drug use. Four droppersful daily of spring dandelion root or yellow dock root tincture will give the liver a boost. It is normal to see more swelling, a lot more weight gain, a somewhat higher blood pressure, an increased desire for salt, and a somewhat lower hemoglobin than in a singleton pregnancy. These physiological compensations are no cause for alarm.
— Anne Frye, Understanding Diagnostic Tests in the Childbearing Year, 6th ed., Labrys Press, 1997
Diagnosing multiple gestation:
- Pregnancy resulted from in vitro fertilization or ovulation-inducing drugs
- Family history (dizygotic twins only)
- Ravenous appetite
- Large-for-dates uterine growth, especially if the size indicates you should hear the fetal heart or find fetal small parts, but you cannot, particularly after 20 weeks. Also consider:
- Polyhydramnios with a single fetus
- Large single baby
- Unexplained anemia develops
- Polyhydramnios develops
- Rapid and more than usual weight gain
- Woman reports feeling fetal motion everywhere
- Feeling three large parts on palpation
- Rule out fibroids or other growths
- Hearing two distinct fetal heartbeats, the difference between them being at least 8 beats per minute with a region of less intensity between the two areas of greatest intensity
- A crease felt in the fundus, down the front or elsewhere on the uterus
- May also occur in a distorted uterine contour with one baby or an abnormal uterus, and may be absent in twins pregnancy.
— Anne Frye, Holistic Midwifery Vol. 1, Labrys Press 1995
A study from the Centers for Disease Control and Prevention in Atlanta and from Peking University of almost 250,000 women conducted by the federal government provides evidence that pregnant women taking the vitamin folic acid to prevent birth defects are not at an increased risk of giving birth to twins. Previous small studies had suggested women taking the vitamin might have a higher chance of giving birth to twins.
— The Lancet, Feb. 1, 2003
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I am doula-ing for a mother with two prior c-sections and diabetes. I'm trying to be really careful. She's five weeks and is having a light sensation-type cramp, no spotting. I'm not sure what is "normal" with the health history she's had. What is this sensation? I've heard of "burrowing" sensations but this seems a little late for that.
— C. Suter
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The 25th Annual California Association of Midwives Conference
The Revival of Midwifery—A Rebirth in Consciousness
May 30–31 and June 1, 2003
Camp Newman in Santa Rosa, California
Speakers include: Michel Odent, MD, Rahima Baldwin, Suzanne Arms, Betty Idarius, Jeannine Parvati Baker and Laura Kaplan Shanley.
Download the brochure:
Laura Stalker, firstname.lastname@example.org
Question of the Week
Q: I am a student midwife trying to find out what to do about PROM. I've researched it and everyone seems to have a different opinion! Some authors say to monitor closely for an infection, some say to try to induce labor, and some say to not do anything—the mother can go even four weeks with no danger at all.
SEND YOUR RESPONSE to email@example.com with "Question of the Week" in the subject line.
The Frontier School of Midwifery and Family Nursing
The Frontier School of Midwifery and Family Nursing is a private, non-profit, distance-education graduate school offering directed web-based learning certification for nurse-midwifery, family nurse practitioner and OB/GYN nurse practitioner with a 9-credit Master's Degree completion at Frances Payne Bolton School of Nursing Case Western Reserve University. Visit us at www.midwives.org or phone us (606) 672-2312.
Question of the Week Responses
Q: I am currently pregnant with twins, my third and fourth children. I have had two previous vaginal births with little complication. We are planning a homebirth with two experienced midwives. What special care should be taken with a multiple pregnancy, labor, and delivery? As a doula and childbirth educator, I have a lot of book knowledge about the subject but would like to hear from those who have experienced or taken care of women in a multiple birth situation.
A: I have seen twins born at home with three midwives in attendance. The first baby was born, cord was cut and clamped. Uterine contractions (UC) subsided. They tried everything to get labor going. The second twin always had good heart tones and there was no discharge. Emotional stress could have been the issue—the husband was out of town and en route to be at the birth. Upon his arrival, UCs picked up and she redilated quickly and birthed her second twin. The births happened eight hours apart, and the babies were beautiful and healthy. The mom, a midwife, had carried the twins to 37+ weeks. She was devoted to a meticulous diet, exercising, and herbal supplements. She was 40 and this was her second pregnancy.
It is nice to have a few extra hands available. Women who are knowledgeable about homebirth and who have good energy, help too. Have faith in yourself and the process.
A: I gave birth to twins in the hospital with no drugs and no complications except that the second born had low blood sugar at birth and a weak suck (he was 4 lbs 4 oz). I highly recommend the book "Having Twins," by Elizabeth Noble. Knowledge is power.
A: Four years ago I gave birth to twins (fourth and fifth children) in the hospital with my midwife as a doula (she had also provided the majority of my prenatal care). I had a natural birth even though one twin had to be turned to feet-first position to be delivered. The two things I remember my midwife saying were:
- Eat a lot of protein—it helps prevent premature labor in multiple pregnancy. I drank at least one protein shake each day and sometimes added a raw egg to it.
- As the first baby is born, she "grabs" the second baby from the outside to keep it from turning to an undeliverable position.
When I gave birth that is what she did. However, even though my second baby was still facing the right direction, she went into a pike position, and no amount of poking would get her to draw her feet back. So the doctor went in and grabbed the feet, and she was born feet first. The doctor and I had discussed the possibility that he might have to reach in and move the baby to a proper position for birth, so we were ready for that. The birth of my twins was the easiest and smoothest of all my births.
— Diane Weatherford, doula
A: I am a rural midwife and caught twins for a woman who had had two previous homebirths with me. She refused to go to the hospital for the twins, so we put together a homebirth team of midwives, including a wonderful pediatric nurse practitioner. She had a lovely straightforward labor and birthed with grace—like I imagine you will.
About nausea [Issue 5:10]:
A: I suffered from morning sickness with all three pregnancies. The levels of severity and length of time varied. For each pregnancy ginger did the trick. I took it in different forms because with each pregnancy my body behaved a little differently. I survived on hard ginger candy for one pregnancy, very strong ginger beer, and lastly, ginger tea and ginger slivers kept under my tongue for extended periods of time. I also increased my intake of vitamin B6. Taking ginger was the only way I kept food in me. My symptoms subsided in two out of the three pregnancies by the middle of my second trimester. All my babies were born healthy, at home, and of good size. I also found that dousing my food with cayenne pepper helped. I was a vegan at the time, only eating brown rice, whole grains, fruit, and plenty of vegetables. I learned that white rice was better for my stomach so long as it was prepared without salt and oil. I avoided all citrus fruits. I ate like this only until my symptoms were gone, then resumed my regular diet.
A: I had debilitating hyperemesis with both of my pregnancies. I tried everything, including sea bands, vitamin B complex, liver-supporting vitamins, protein, but I had constant, unending nausea and periodic, daily vomiting. I noted the emotional aspects of this condition: hopelessness, frustration, various fears (about condition of baby, and will this ever end?), even felt I was dying (though irrational, this condition can feel like having a wasting disease, and many times I momentarily forgot I was pregnant), annoyance at the ignorant comments of others, and the inability of even close loved ones to understand the physical debilitation of this condition. I couldn't cook or clean; just getting up the stairs was an ordeal.
I continued to do my doula work and mother my child. I sniffed a container of vaporub until I fell asleep—it seemed to help. I adapted during the struggle (growing quite skilled at sudden vomiting-while-driving on the freeway), but I did note with the last pregnancy I felt that although I was coping, I was being pushed to my very limits and that at times I felt hopeless to cope with another hour of nausea, aching, and pain from daily vomiting. One helpful thing was using the "pain-coping mindset" as during labor, finding what works, what doesn't, and keeping track, applying it to the next day.
The best thing was the kind words of my midwife. She was an endless source of support and expected nothing of me. She offered an understanding smile, kind words (comments about my strength just when I felt the weakest—reminding me I was strong after all), a hug if I needed it, and an extended hand of support.
The book "Morning Sickness No More" talks about real hyperemesis, validates its existence, provides a coping format, and gives very doable tips about identifying foods and tastes that might stay down. It also includes stories about other women who have struggled with this condition. I found it immensely helpful for myself and for family and friends.
— Tiffany Collins, CD (DONA)
A: I just read a great book ("Protecting Your Baby to Be—Preventing Birth Defects in the First Three Months of Pregnancy," by Margie Profet, Little Brown, London 1995 ISBN 0316914215) that has a very plausible explanation for nausea in pregnancy. The author, a biologist, says that all plants make bitter toxins to stop animals from eating their essential parts—especially their leaves, roots, and seeds. Food made from these parts therefore contain high levels of natural plant toxins that are potentially toxic to growing embryos who are at the most vulnerable stage of development. These are the foods we usually go off in pregnancy—vegetables, coffee, and other bitter foods.
Also, we develop an acute sense of smell to alert us to food that isn't fresh, as well as to these bitter foods. When we cook food, apparently, toxins can be released from the cooking vapours, which may be why we go off the smell of (and the act of) cooking.
She believes that this is why women with nausea are less likely to miscarry—because they choose the appropriate foods to eat and so protect their babies. She lists good and not-so-good foods, including potatoes—the only food to have toxins that are stored in the body, in this case for several weeks. She notes that Ireland, with a high potato intake, also has the highest rate of neural tube defects in the world and that this incidence increases in time of potato blight, when the plants are making even more toxins (solanine—the toxin in green potatoes, and chaconine) to counteract the fungus. Other foods high in natural toxins include broccoli, brussels sprouts, peppers/capsicum, onions, garlic, mustard, and other hot and/or spicy foods, most herbs and spices, mushrooms, and barbecued or burnt foods. She cautions against herb teas, especially bitter flavoured herbs (including ginger), tea, coffee, and colas.
She also notes that fruits are low in plant toxins—obviously, the plant wants you to eat this part (and spit out the seeds)—as are dairy/milk products (obviously designed for digesting), grains (especially those with the outer husk removed, i.e., processed/white grains because the husk contains the most toxins), fresh meat, and fresh eggs.
She cautions about other vegetables, even those that aren't bitter, as well as oils and sweet foods containing bitter ingredients (e.g., chocolate), suggesting that women keep their intake of these foods low in early pregnancy.
She notes also that our sense of smell actually becomes less sensitive than normal in late pregnancy, perhaps so that we lose the food aversions from our first trimester. Now that our babies are fully formed, we need the foods that we have avoided because they are also rich in nutrients.
She also discusses other symptoms of early pregnancy according to this theory—e.g., excess salivation may help expel toxins; frequent urination happens because our kidneys filter about 50% more efficiently to keep our toxin levels low; and fatigue keeps our food intake, and therefore our toxin levels, low. (I read a study that suggested that low food intake in early pregnancy is associated with a better outcome, in terms of the baby's weight.)
— Sarah J Buckley
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Midwifery Today magazine Question of the Quarter
Theme for Issue No. 67: Fear in Midwifery and Birth
Question of the Quarter: What do you do to overcome your fears in midwifery and/or birth?
Please submit your response by June 15, 2003 to firstname.lastname@example.org.
(All responses are subject to editing for space and style.)
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If you only have time for a short response, be sure to answer our Question of the Quarter. Tell us what you're thinking!
The International School of Traditional Midwifery
The International School of Traditional Midwifery is an Oregon Licensed Private Midwifery Career school. Our 2–3 year traditional midwifery program prepares students for the CPM exam.
We offer an Onsite Program (September start), Distance Learning Program, and Anatomy and Physiology for Midwives Correspondence Course. We assist students with clinical opportunities, including our foreign midwifery projects. www.globalmidwives.org
About fathers attending the births of their children [Issue 5:08]:
I was very put off by the article about the possibility of dads being excluded. My personal experience of having nine children has been different each time; however, the constant in each one was my husband. He was there to lovingly create them, why should he be denied the privilege of lovingly help them into the family? He can share in the story of their birth, and when he tells his friends about how amazing it was he is promoting the midwifery model of care. Just as a mom's maternal instincts drive her in how to birth, care for, and protect her child, dad's instincts drive him to provide for this precious new child.
My husband is involved in a program called Boot Camp for New Dads that offers a workshop-type class run by dads to tell them dad-to-dad what will happen at birth, what mom's needs are, and basic dos and don'ts from dads who have done it. They do a follow up when babe is 2–3 months old.
Childbirth is so incredibly special, no father should be excluded.
— Laura R Carlson
As a doula, I have suggested the father make a favorites music tape for the mom to use during labor. It is from his heart to hers, and she always loves it. These are songs he would sing to her. I suggest one side be upbeat for walking and birthing ball and the other be slower and more sentimental for quiet relaxation. These can be easily rewound for the appropriate mood of the mother. It is also a wonderful background for the videos of the birth and will be enjoyed and loved by the baby as she grows up. Knowing her parents were so in love is wonderful for the older child.
— Ann Robinson
About myeloproliferative syndrome disease remedies:
The following websites may be helpful:
— Ellen Baumann
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firstname.lastname@example.org, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.
TAKE BACK BIRTH: MIDWIVES AND FAMILIES WORKING TOGETHER
Join us for the Region 4 MANA Conference in Chicago June 6–8, 2003! Speakers include Ina May Gaskin, Jill Kent, Jennifer Williams, and many others. For more information, contact Vicki Johnson at Babylady55@aol.com, or www.flyingpigsoapworks.com/mana.htm
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