twinutero

This question has been on my mind since I started reading mommy-blogs – more so since I started my own.

What is the difference between showing cute photos of your children to relatives, friends, or even acquaintances met on airplanes, and posting those same photos to a blog? In my mind, a big difference.

Sharing pictures and guess-what-my-kid-did-today stories with relatives deepens a personal and hopefully enduring connection. Same for friends. Sharing with strangers and acquaintances strengthens your connection with that person, but does little for your kids.

In all of those circumstances, though, you have control over who sees the photos and hears the stories, and more often than not you get direct feedback, so you know whether you want to continue sharing with this person.

Not so with a blog, of course. That photo of your baby breastfeeding, your toddler in diapers or your preschooler sleeping are out there for anyone with an internet connection to see.

Call me paranoid, Luddite, introverted (I may indeed be all of those) but I have a problem with posting intimate moments of my child’s life to the world. It is, after all, their life.

“Your children are not your children,” as Kahil Gibran famously wrote and Sweet Honey in the Rock beautifully sang.

That photo, now cataloged on the internet, is a fragment of a life that will expand in a million directions to form a complex adult with a very real and personal past. We’d think twice about posting a candid bedroom shot of our spouse or an entertaining faux pas of a sibling. I don’t think children are different.

Informed consent and benefit-sharing are two basic ethical principles drilled into every student of moral philosophy. It’s generally acknowledged that receiving informed consent from a young child is impossible. As for sharing benefits? Well, why do we blog? To share our “lessons learned” with a community of peers; to see our writing and photography published; to be heard; to gain a following; to earn money….

Few of these benefits go directly (if at all) to the main subjects of the blog, our children. Yet they carry a fair share of the risks, mainly loss of privacy although one could imagine worse.

So where do you draw the line? Have I already crossed it, despite attempts to respect my family’s privacy? Are all memoirs – and blogs are memoirs of a kind – exploitative? As with most ethical issues, debate is open and sometimes the best criterion is “I know it when I see it.”

I’ve seen plenty of insightful, respectful mommy- and daddy-blogs. I’ve also seen many where my sole thought is, “Are those kids going to be pissed….”

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.

I was asked many questions during the waddling stage of my twin pregnancy. Among the most frequent was “Are you planning to nurse them?” The question was posed with some combination of curiosity, admiration and incredulity, usually depending on the speaker’s own experience with breastfeeding.

I did plan to nurse my twins. In fact, I took a prenatal class on the topic. From this class I learned that it was possible, either in succession or in tandem, and that many mothers have nursed multiples for months or even years. I was also encouraged by my experience with our first son: Nursing came easily to both of us. I was confident that I could and would nurse the twins as well.

And I did, exclusively, for their first four days. Both Jon and Alex were voracious and gained weight before leaving the hospital, something the nurses said was unusual for twins. Except for the fact that I rarely slept, things were going pretty well.

Enter the unexpected. After one day at home, I was rushed back to the hospital with indescribable pain. My parents rushed to the store for bottles and formula. I was in and out of the hospital for the next ten days but was determined not to give up breastfeeding. I pumped… and pumped… every few hours when I was alone in the hospital and when I was in too much pain to hold my sons. We had two beautiful babies, but it was otherwise a pretty rough time.

I can’t remember making a deliberate decision, but we soon developed a routine of breastfeeding one twin while formula-feeding the other. We’d switch their places at each feeding. It was a good compromise – easier physically for me, and the babies were still breastfed about four times a day.

When I was stronger (a month or so after delivery), I again tried exclusive breastfeeding. As with everything in parenting, there’s the ideal and the reality. Ideally, twins would eat and sleep at the same time, thereby making life easier for their parents. In reality, twins are individuals who likely have different eating and sleeping patterns. Alex likes to do everything quickly, except eat. He would nurse and drink his bottle at leisure, sometimes taking a break to digest. Jon likes to do everything slowly – except eat. He would gulp milk so fast that he would choke, and cry, and get even more hungry, and even drink faster, and choke again. Try tandem nursing that!

Successive nursing might have worked, had I been healthier mentally and physically, and had we full-time help. But I wasn’t and we didn’t. My husband was back to a demanding job, my parents were coping with another family emergency a thousand miles away, and we had a 15-month-old son who was no doubt wondering what all the fuss was about. We therefore settled into a schedule of nursing and supplementing at each feeding, and continued this way for six months.

I stopped when Alex stopped. Alex has a rather fiery temperament. When he’s good, he’s very very good. When he’s bad, well, suffice to say he was unequivocal in his preference for the bottle. Jon would probably have continued but I was, frankly, in need of a rest. I had been pregnant and/or breastfeeding for two and a half years, I was well below my pre-pregnancy weight, and I was exhausted, thoroughly exhausted.

Am I rationalizing? Probably. Do I feel guilty about not nursing more and for longer? Yes – and no. We all know “breast is best”. How could it be otherwise? I would advise all mothers to try breastfeeding. If it’s your first time, be persistent. If you have multiples, be even more persistent. It is something that must be taught to, and learned by both mother and baby. And it’s beautiful when it happens.

It is easy, however, to underestimate the tremendous energy needed to breastfeed, especially if you’re feeding two (or more!) babies. You have to eat often and well, and you have to be rested. You have to have help. You have to find what works for your babies and for you.

A few asides:

1. We use Medela bottles, nothing else. They are made from polypropylene, whereas most baby bottles are made from polycarbonate. There is evidence that bisphenol-A, a chemical used in making polycarbonate, mimics estrogen and causes developmental disorders. Why take a chance?Some useful sites:
   Wikipedia entry on Bisphenol-A
   Environment California’s Guide to Bisphenol-A in Baby Bottles
2. On a different note, chances of conceiving twins are apparently nine times higher while breastfeeding. Just so you know….

With three kids in diapers, poop happens a lot in our house. Here’s the scoop on cloth versus disposable diapers for multiples.

For their first six months, our twins were diapered in generic disposables. It seemed the easiest and cheapest option, and I couldn’t muster the energy to explore alternatives. My conscience prodded me each garbage day, however, as I sent several bags of paper, chemicals and human excrement to the landfill. I finally decided to switch to cloth.

We had used cloth diapers – on and off – for our first son so I knew what was involved in sorting, washing and drip-drying. I also knew I was not up to the same for three kids. I found a diaper service in the yellow pages, and signed on. We now get seventy cloth diapers delivered, and the soiled ones picked up, for just under $20 a week – about what we had been spending on disposables.

Do cloth diapers work as well as disposables? No, unfortunately. The chemicals in disposable diapers are super-absorbent and unless a BM is deposited, a paper diaper can last three or four hours. Outrageously expensive diapers like Pampers Cruisers last even longer. Disposables are convenient. They also linger in landfills for about five hundred years.

Cloth, on the other hand, is a little less convenient but much more virtuous – or so I hope. Our diaper service uses “prefolds”, one of the simplest diapers on the market. (And a confusing term as they aren’t obviously folded at all. They’re flat squares of multi-layered cotton.) Prefolds are used with wraps, more elaborate versions of the plastic pants that I wore as a baby. Much depends, I have found, on the quality of the wrap. Here’s a quick review of the brands we have tried:

-Bummis Whisper wraps with Velcro: Good at preventing leaks but the Velcro is rough and sometimes leaves scratch marks. That would make me cranky!

-Mother-ease wraps with Velcro: Good fit and good leak prevention but same scratchy Velcro and a tight waist-band. Looks uncomfortable.

-Bummis Whisper wraps with snaps: Scratchy Velcro problem solved.

-Nikky: Super-soft cotton and great fit. Not as good at leak prevention as Bummis.

-Fuzzi Bunz: The ultimate cloth diaper. Soft, snug, and very absorbent. They are designed for use with Fuzzi Bunz insert pads, but also work well with prefolds. The only deterrent is the initial cost of over $20 per diaper.

With a good wrap, the twins are comfortable in prefolds for about two hours. We use lots of barrier cream (Zincofax, Aveeno, Peneten) and have had only one serious diaper rash so far.

These diapers don’t work as well for our two-year old. One pee and he’s soaked, trousers and all. While this helps with toilet training, on a daily basis it’s frustrating for everyone. So we still use disposables for our older son, as well as on the twins at night and during long outings. Nonetheless, with the diaper service, we have cut our weekly landfill contribution from three garbage bags to about one. Now, if only our municipality would get a composting program….

An old Family Circus cartoon shows an unflustered mother in a swirl of children. Calm-mom in a toddler tornado. A passer-by says something like “How do you divide your love among so many kids?” She replies, “I don’t divide it, I multiply it.”

My first, and most difficult lesson so far is to let the love multiply but try – try – to keep the guilt in check.

Guilty feelings seem a part of motherhood. One of the first things a friend said to me after the delivery of her second child was “The guilt….” This seems more true now than in my mother’s generation because the demands have changed. We know the importance of early mother-infant bonding and that being an attentive, responsive mother is doesn’t spoil a baby but is vital to their development. It’s easy, especially with multiples, to feel there is never enough of you to go around, and that surely your children will be permanently damaged as a result.

Small reminders of responsibility and potential inadequacy are everywhere. The Schopenhauer Cure, a novel I was reading during my daily few minutes of escapism says: “Children deprived of a maternal love bond fail to develop the basic trust necessary to love themselves, to believe that others will love them, or to love being alive.” Granted this is fiction – but fiction written by a professor of psychiatry. So much for escapism. (I’ve given up on the novel.)

I find books like the Sears’ Baby Book which advocates ‘attachment parenting’ (breastfeeding, co-sleeping, and wearing your baby as much as possible) also fuel guilt – partly because I think they are right. The mother and biologist in me says that human infants need to be carried, breastfed on demand and held closely as they gradually become independent people. But try it with twins. Try it with twins and a toddler. All three are crying and you have only two arms. Who do you reach for first?

In her book Dish, Barbara Moses argues that guilt is an overused term, and makes the distinction between guilt and shame. Betraying, or feeling you have betrayed, moral values can give rise to guilt. I might feel guilty if I return to work full-time but believe that staying home with my kids is really the right thing to do. Shame, however, stems from failing to comply with social pressure to behave in a particular way. Even if I am completely comfortable with returning to work, I might feel shame if I am subjected to constant pressure (from other mothers etc.) to spend more time with my children. I think this is useful distinction for these types of problems and I may write more about it when I return to work in a few months.

But another more useful distinction for me is that between guilt and regret. I regret that I can’t hold all three babies at once or give each my undivided attention. I shouldn’t, though, feel guilty about it. I am not doing anything wrong. In fact, I am almost turning myself inside out to do everything right.

I don’t have this all figured out, and I struggle daily with conflicted emotions as I aspire to something resembling a balanced life. In the meantime, I have to trust that there is, and always will be, an unique bond between me and each of my kids. But I also know that I am not the only “significant other” in their lives. Grandparents, our part-time nanny, our toddler’s home-care provider, and of course, their Dad all have a special and invaluable relationship with our kids.