Monthly Archive for November, 2007

To DVD or not to DVD

Published
by
twinutero
on November 27, 2007
in Getting Around and Learning & play
. 0 Comments

We just returned from a road trip – a six hour drive in each direction to visit relatives. That’s twelve hours with two toddlers and a preschooler immobilized in their car seats. We rented a minivan for this excursion, having found the CRV too small and cramped for long trips. The van allows the non-driving parent (usually me) to move among the three kids, delivering snacks, reading stories, retrieving sippy cups (getting thoroughly carsick).

This was the second time we had rented a minivan. The first time, to our surprise, the van came equipped with a DVD player. I object on principle to watching DVDs in the car. I mean, when I was young we learned how to entertain ourselves on long trips and how to appreciate the wonderful scenery. Of course, we weren’t strapped into car seats. I remember “appreciating” scenery while squished against the rear window, or missing scenery altogether because my brothers had me pinned to the car floor. Anyway, we didn’t need video entertainment – we didn’t have video entertainment.

But here we were, the kids, my husband and I, heading out of town with Bob the Builder. As it turned out, we were mighty thankful for the DVD player because, unbelievably, we got lost en route. A six hour drive became a nine hour drive. The kids were oblivious. It could have been a fifteen hour drive. All heads were fixed in position and all eyes were locked onto a tiny screen. We drove through beautiful country (highway 41 for those in Ontario) but the kids couldn’t have cared less. The trip was easy for us, if somewhat mind-numbing for the kids.

Our most recent trip, however, was sans DVD. I’ll admit this was daunting at first. Once you have it, you really believe you can’t live without it. We did, and although it was more work than travelling with a DVD player, it wasn’t a lot more work.

Thomas learned to play “I spy” and even the twins shouted excitedly, “I see it!” And they did see it – everything. The sun going down, the moon coming up, planes taking off, yellow, blue and green road signs, the big city, the lack of big city, the final bridge and final corner to Grandma’s house. I won’t claim they were perfect. There was screaming and fighting and whining. But there was also plenty of quiet time – time when the kids actually noticed their surroundings and found their own entertainment.

All good practice for our transcontinental travel coming up next month….

Prenatal testing with twins

Published
by
twinutero
on November 9, 2007
in Coping, Guilt and Pregnancy
. 0 Comments

I underwent prenatal genetic testing during my pregnancy with Thomas (when I was 38) and with Alex and Jon (when I was 39). Both times, my husband and I agonized over the decision. We received genetic counseling before consenting to amniocentesis with Thomas. This is standard practice in Ontario, probably elsewhere as well. However, counseling is required only once and therefore we were not sent for (nor did we seek out) the standard counseling classes when I was pregnant with the twins.

But prenatal testing is different for multiple gestations. We gradually learned of these differences through our own research and through umpteen phone calls to the wonderful team of counselors at CHEO (our regional children’s hospital).

There are many academic and technical papers on the web describing the procedures, risks, and benefits of prenatal testing. Some of these talk about multiples. However, I have never found a website, written in plain language, that lays out the differences between testing in a single versus a multiple pregnancy.

So, with the hope that it will help other parents making this profoundly emotional decision, here is what I have learned. (And here’s my disclaimer: I am not a doctor. This is my understanding of the facts but best to check them with your doctor!)

1. If you have fraternal twins, the chances that you will give birth to a child with a genetic abnormality are much greater. The chance that any one of the babies is affected remains the same as for a singleton, since fraternal twins are the result two separate conceptions (two eggs; two sperm). However, because you’re having two babies at the same time, the total risk for that birth is doubled.

2. Prenatal screening in a singleton pregnancy usually involves testing the mother’s blood in the first and second trimester to measure levels of fetal proteins (called maternal serum screen), and an ultrasound in the first trimester to measure a fluid-filled sac at the back of the fetus’ neck (called nuchal translucency). In a multiple pregnancy, however, the blood tests are not an accurate screen for Down syndrome or trisomy 18. Therefore, screening for these conditions is done using nuchal translucency only.

3. The maternal serum screen is not accurate for two reasons. First, there is not enough information on normal levels of fetal proteins in a multiple pregnancy. It’s therefore difficult to know what is abnormal. Second, normal versus abnormal gets completely messed up when more than one fetus contributes proteins to the mother’s blood. For example, higher levels from one baby may be masked by lower levels from its sibling.

4. Because the blood tests cannot be used, the screen is much less reliable. In a singleton pregnancy, when blood tests are used, the boundary between a positive and negative screen is usually set at one in 250. In other words, if the screen shows that the risk of Down syndrome or trisomy 18 is greater than one in 250, the screen is positive; if it is less than one in 250, the screen is negative. However, in a multiple pregnancy, this all-important boundary is set at one in 375. This means that many more results will be positive, and this is simply because the test is not very accurate.

5. Amniocentesis increases the risk of miscarriage. There is about a one in 200 chance of fetal loss following the test. This risk is higher for twins that are in separate amniotic sacs. This is because two needles are required sample fluid from the two sacs. The rate of miscarriage may be increased for up to five weeks following the test. (I haven’t read about amniocentesis for higher order multiples. I’m not sure if it’s done.)

6. Amniocentesis with twins can be tricky not only because the babies may be in two amniotic sacs, but also because they may be on top of each other or positioned in another way that makes it difficult to reach. If this happens (as it did with us), the test may be delayed for a week or so until the babies shift. Furthermore, it is recommended that no more that two needles are inserted during one test. If the doctor cannot successfully draw two samples after using two needles, the test must be delayed at least 24 hours.