twinutero

Anyone visiting a doctor’s office, maternity ward or prenatal screening clinic in Canada will likely see pamphlets for Canadian Scholarship Trust fund RESPs, encouraging parents-to-be to start saving for their child’s post-secondary education.

I rarely take notice of such advertisements, and have picked one up and filled it out only once in my life. As a result of that weak, nervous, distracted moment in the waiting room, we found ourselves relentlessly hounded by the salespeople of CST. And, a few months later, we found ourselves signed up for 18 years of payments into the fund.

It was only when we began to prepare for our relocation overseas that we revisited this decision – with regret.

It seems that RESP group plans (such as CST) work well when all goes according to schedule i.e., your kids grow up and complete four years of post-secondary education, AND you continue to pay into the plan until that point. Any deviation from this arrangement, however, presents a problem.

We learned that Canadian law does not permit paying into RESPs if you live outside Canada. Moving to South Africa therefore means stopping our payments. However, stopping payments before university is completed also means losing hefty “enrollment fees” charged by CST. We stand to lose about $4000.

The only way around this is to continue paying into the plan at the same rate to which we originally agreed. Our helpful salesperson recommended that we resume payments when we return to Canada, or (his preferred scenario) by providing a fake Canadian residential address while we are overseas. Hear that Revenue Canada?

I’m not saying CST is a scam. I’m sure it works well if you follow the standard course. But the fine print is extensive and extraordinarily cryptic. Even our financial advisor had trouble deciphering the details. So, I am saying beware. Be aware – before you sign up.

Check out this Georgia Straight article for more information.

The holiday season is here, and as much as I wish the world were less materialistic, most parents, myself included, will likely be buying toys. There are lots of “best toy” sites to direct shopping. Here’s mine.

1. Ikea wooden train tracks. By far, this has been the best entertainment value for money in our house. The tracks are compatible with Brio and Thomas sets, but are much, much cheaper. We’ve supplemented with a few extra Thomas pieces and trains to make the set more interesting. So many toys advertise that they supply “hours and hours” of fun. This one really does.

2. Other Ikea toys. Actually, you can’t go too far wrong with any Ikea toys. Our kids love the tent, the pots and the wooden stacking blocks.

3. Baby Einstein Alphabooks. A box of 26 short books, one for each letter of the alphabet. There’s no text – only the sort of engaging pictures that have made Baby Einstein famous. Jon has dragged this box around the house for months and, for a boy just two, has learned a surprising number of letters and words. Not that Baby Einstein needs any extra advertising, but this is definitely a “best toy” in Jon’s world.

4. Playskool Spin Arcade. When our wonderful Aunt Sam bought this for the twins, we were skeptical. When we flipped the “on” switch, we were repelled. But Sam has a way of choosing toys, and this one turned out to be a favorite. When the twins were just learning to stand, they would pull themselves up, press the buttons, and chase the balls. When the novelty wore off, they put other objects on the spinner – bottles, cars, spoons – and watch the result with intense curiousity. Experimentation at one year old.

5. Cars. Thomas loves trains; Alex loves cars. We have a few second-hand garages and a bucket of toy cars. He sorts, arranges, then resorts and rearranges. No batteries (and not much money) required.

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.

Something that connects my previous posts on toxic substances and outdoor activities: the garden hose. I bought a new one last week so I could water the garden and fill the kids’ wading pool without dodging spray from the various holes in our old hose.

The new one worked wonderfully. As I was gathering the packaging for recycling, however, I read the back of the label. It carried the following warning, “This product contains one or more chemicals known to the State of California to cause cancer, birth defects or other reproductive harm. Wash hands after handling.” The warning lends a whole new meaning the company’s slogan, “The last hose you’ll ever buy.”

I searched the web and learned that most garden hoses carry similar warnings, and unless it is clearly stated otherwise, they are not designed for drinking. Adults generally don’t drink from the hose. Kids, on the other hand, can’t resist. Even if they don’t slurp from the hose, they gulp from the pool. Once again, lead is the culprit. It leaches from the polyvinyl chloride (PVC) used to make most garden hoses. I suspect that the fungicides used to protect hoses from rotting also contributes to their carcinogenicity.

Here are a couple of good websites on the topic:
Consumer Reports. 2003. Dare you drink from a garden hose?

Ann Lovejoy. June 2007. Do you know what’s really in that hose? Seattle Post Intelligencer

Both of these sites are based on U.S. information. I went in search of a “safe for drinking” garden hose here in Canada. The major hardware box-stores (Home Depot, Rona, Canadian Tire) had no idea what I was talking about. Locally owned shops (an environmental store, an organic gardening center, and our neighbourhood hardware store) were no wiser. I checked the labels on half-a-dozen hoses for sale in these shops. All carried warnings against drinking – and all of the warnings were printed on the back of the label (which I had to rip off to read). It is unlikely that anyone would see this before buying, if at all.

I finally found a drinking-water safe, FDA-approved hose at a marine supply shop. The hose is meant for RVs and boats but works just as well for the garden. About thirty seconds after hooking up and turning on our new non-toxic hose, the water was flowing straight into Jon’s mouth….

Okay. Enough on toxins. My next post is on family mealtimes. With three kids under three years old, the only thing toxic about mealtimes is the dining room floor.

In my earlier post on nursing and bottle feeding, I wrote that we use only Medela bottles, largely because they are made from polypropylene rather than polycarbonate. The latter contains bisphenol-A, a chemical that mimics estrogen and has links to developmental and neurological abnormalities as well as cancer.

Since that post, the Globe and Mail has published several articles on bisphenol-A and sales of glass baby bottles in Canada has soared. It’s still a fringe market – you won’t find glass bottles at Babies ‘R’ Us. Yet the growing popularity of non-polycarbonate bottles is a clear sign that many parents are concerned about bisphenol-A.

Feeling somewhat vindicated (I have been called neurotic about such issues), I scanned the kitchen for more polycarbonate. The Brita pitcher. We filter all of our drinking water through the Brita. In part, it’s habit. Brita’s advertising has been so effective that it now seems reckless to fill a water glass straight from the tap. We also use Brita because our house was built in 1909. We replaced lead water pipes inside the house when we renovated, but the pipes from the city mains into our house are still lead. There may be controversy over the health effects of bisphenol-A but there’s no controversy over lead. Its neurological effects, especially on children, are well documented. Brita claims that their filters remove 90% of lead.

So, with my vast amount of spare time, I tried to determine (1) if Brita pitchers are made from polycarbonate and (2) if we really need to filter our drinking water.

Answering the first question was not straightforward. Brita should get the most-annoying-website award. I emailed them, explaining my concerns about bisphenol-A and asking what tests had been done on Brita pitchers. They responded (within 48 hours as they promise) that “the reservoirs and pitchers are made either from NAS (a Styrene based plastic) or SAN (Styrene Acrylonitrile).” I am not a chemist; I assumed they were trying to tell me that the pitchers do not contain bisphenol-A but wasn’t sure. I asked for clarification. The second response came by regular mail about ten days later. The cover letter stated that the information I requested was enclosed. It wasn’t. Other than the cover letter, the envelope was empty. I emailed once again and got a quick response: “Brita pitchers do not contain bisphenol-A”. Seemed like a lot of work for an answer that Brita should have been happy to provide.

READ APRIL 2008 UPDATE ON BISPHENOL A

The second question, whether or not we should filter our drinking water, was easier. Our city tests household water as a free service. We provided samples of flowing tap water, as well as water that had been sitting in the pipes for half an hour. The results took about a week. Turns out that the lead level in our water is 1.2 parts per billion. The maximum acceptable concentration set by Health Canada is 10 ppb, and water leaves our city treatment plant at 0.5 ppb. So, while our water is considered safe, the old lead pipes are adding to the amount of lead that we are consuming.

Is it still worth running our water through (rather expensive) Brita filters? According to the city employee who tested our water, yes. While there are guidelines for “safe” levels of lead in our bloodstream, toxic effects of lead have been reported in children at well below these levels. For infants and children there is essentially no safe dose. Drinking water is only one source. For families living in older homes like ours, lead paint is no doubt a more significant source. I could write a long and repetitious book about my efforts to rid our house of lead paint. Ask my husband. The bottom line is that any reduction in lead exposure is worth the effort if you have young children. According to our helpful city employee, under normal circumstances, Brita removes about 60%, not 90%, of lead, and only if the filter is changed regularly. If the filter is old, the lead content of the water in the pitcher could actually be higher than that in the tap.

And what about the safety of NAS and/or SAN plastic? And PVC water pipes? And bisphenol-A in the lining of baby formula cans? No wonder I am – not – neurotic.

Some useful reading:
Having Faith. An Ecologist’s Journey to Motherhood. 2001. Sandra Steingraber.

In Harm’s Way. 2000. Greater Boston Physicians for Social Responsibility

August 9, 2007 article on bisphenol-A and phthalates in baby bottles from ENN.