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Identical twins occur when one egg divides into two, so that the babies have the same genetic makeup. Fraternal twins occur when two separate eggs are fertilized. Like fraternal twins, identical twins normally have two separate amniotic sacs. It is extremely rare for these twins to share one sac, and dangerous, too, since the babies’ umbilical cords could get entangled during the pregnancy. Your girls could indeed be identical, especially if they look a great deal alike. The fact that they have the same blood type isn’t a clear indication, as it is quite common for siblings within any family to have the same blood type. The only way to know for certain is to have the girls genetically tested. Their doctor should be able to help you find out how to do this and the costs involved.
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I’ve been receiving conflicting opinions concerning childbirth classes, specifically Lamaze. I am 61/2 months pregnant with my 170 first baby and would like to know your views on the subject. Is a program like Lamaze helpful if I’m planning to use an epidural? I am from Sweden, and in my country, this doesn’t seem to be such a big issue. I don’t want to take the classes just because it’s expected.
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All labor involves some pain. Even though you wish to have an epidural, it is very important to learn about alternative ways of dealing with labor pain, and books simply cannot teach you the coping skills the way a class can. Whether your childbirth class involves Lamaze breathing and relaxation techniques or other approaches to childbirth, the class should incorporate discussions of natural methods of coping with pain as well as medication options.
As with all types of education, childbirth classes are taught by some great teachers and some not-so-great teachers, but in general these classes are extremely helpful as preparation for labor and birth. Your course should help you understand what will happen with your body in labor and how to work with this natural process. Your teacher should tell you what you need to know so that you won’t be afraid of what your body is going through and so that you can make informed choices in labor. The classes provide this information in an open, accepting atmosphere in which you feel your questions are welcome. A good instructor will teach you to be flexible, because labor is always somewhat unpredictable, and will help you to feel supported, confident, and capable. By taking the classes, you will be better prepared to have a positive birth experience, whether you end up giving birth vaginally with an epidural, having a non-medicated birth at home, or having a planned or unplanned cesarean. Finally, by emphasizing that there is no right or better way to give birth, your instructor will dispel any anxiety or guilt you may feel about your choices.
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As your baby and your uterus grow, the pressure upward on your stomach increases. This causes stomach acids to back up into your esophagus. The condition may also cause Breech Position Transverse Position sudden vomiting, without the lingering nausea that is usual with morning sickness.
Be sure you let your practitioner know about this problem. He or she may recommend an antacid and offer some additional suggestions for relief.
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I am pregnant with my second child. My first child was born by cesarean section under general anesthesia because of fetal distress. For this second baby, I will be having another cesarean, but my doctor told me that he would rather I have a spinal anesthetic than go to sleep. My question is this: Are there any side effects from a spinal? The thought of a needle going near my spine is quite scary!
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Except in emergencies, spinal anesthesia is usually preferred over general anesthesia for cesarean births. General anesthesia has no long-term effects on babies, but if they are exposed to it in the uterus for more than a few minutes, they can be quite sleepy at birth. Spinal anesthesia works quickly and lasts for only a couple of hours. It is very safe for the baby.
The thought of a needle in the back can be frightening. I hope that by explaining the process of spinal anesthesia, I can ease your fears about it. An anesthesiologist administers a spinal anesthetic by placing a specially designed needle through the membrane outside your spinal fluid in the lumbar region of your back (well below the end of your spinal cord.) The doctor injects a numbing medication directly into the spinal fluid. A spinal differs from an epidural in that, with a spinal, the needle passes through the membrane where the spinal fluid is; with an epidural, it does not. Also, with an epidural a tiny catheter is inserted. This allows more doses to be given for longer pain relief. Both procedures produce numbing from the breasts or belly button down to your toes.
Fewer than 4 percent of women who have spinal anesthesia get a “spinal headache,” which occurs after a small amount of spinal fluid leaks out. This problem is corrected with a “blood patch,” in which a small amount of the woman’s own blood is injected into the area.
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Cesarean sections are performed differently today from when your mother had her babies. The surgery requires two incisions, one through the mother’s skin and the other in the mother’s uterus. When your mom had her cesareans, her uterine incision was probably vertical, or classical. Today, cesareans are performed with horizontal uterine and skin incisions. A horizontal uterine incision is called low transverse. As several studies confirmed in the early 1990s, this type of incision makes it safe to attempt a vaginal birth after cesarean (VBAC) with a second pregnancy. More recent studies have found a small risk—1 chance in 200 to 400—of the uterus’s tearing during VBAC with a horizontal incision. (The risk is much greater after multiple cesareans.) Because of these latter findings, the trend toward repeat cesarean sections has increased in recent years. Yet many women still choose VBAC, and 70 percent of those who do elect this type of delivery succeed in delivering vaginally.
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I’ve heard that only a small percentage of women actually have their “bag of waters” break prior to labor. With my first child, my amniotic sac ruptured at 29 weeks and I delivered at 31 weeks.
There was no known cause, such as infection, for the premature rupture. Now I am 32 weeks along in my second pregnancy, and preterm labor began in my 26th week. I am doing very well, taking terbutaline tablets, and staying on bed rest. Could my water bag break before this baby’s birth, too?
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Your question concerns two topics: the rupture of the water bag (amniotic sac) before labor begins, and premature labor. Let’s address these two separately. In the movies, labor always seems to begin with the breaking of the water bag. But labor actually begins this way for only 10 to 15 percent of women. When it does, it usually happens at full term, between 37 and 41 weeks. Labor seldom begins before 37 weeks. But when it does, it often begins with rupture of the membranes. Sometimes, there has been a mild infection in the uterus and amniotic sac. This condition, called chorioamnionitis, can be difficult to diagnose and treat. In other cases, undiagnosed cervical dilation has caused the amniotic sac to break. In still others, the amniotic membrane was weak for some reason.
The fact that your water bag ruptured prematurely in your first pregnancy does not necessarily mean it will this time. Although both the premature birth of your first baby and the premature labor you have experienced in this pregnancy increase the likelihood that you’ll deliver prematurely again, the terbutaline and bed rest appear to be working well for you. Hang in there for just a few more weeks!
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A trained labor assistant, or doula (from a Greek word for “woman’s helper”) provides continuous physical, emotional, and informational support to mothers and their partners during labor and birth. Studies have shown that continuous labor support decreases the use of pain medication, epidural anesthesia, episiotomies, and cesarean sections and provides greater feelings of control and satisfaction for women in labor.
A doula would play a unique role on your birth team. She would not replace your own loving support for your partner. Instead, she could help both of you by offering suggestions about comfort measures—such as relaxation, visualization, breathing, massage, aromatherapy, use of a birthing ball, and spending time in the tub or shower—and assistance in carrying out these measures. She would not influence any medical decisions that you and your partner may need to make, but she could help you figure out what questions to ask of your practitioner and your nurse to help you in making these decisions. Each person on the birth team has different responsibilities, and everyone working together makes the amazing dance of labor a very positive experience for the mother and her partner.
The cost of using a doula can vary a great deal. The community hospital in my neighborhood provides free doula services to women who have no partner, friend, or relative to accompany them in labor. Doulas usually charge for their work, however, and I have seen fees ranging from $350 to more than $1,000. Fortunately, some insurance companies are reimbursing couples for a portion of a doula’s fee. You may want to check with your insurance provider.
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Many physicians now have ultrasound scanners in their offices. With these machines, it is usually possible to see the baby’s heart beating at 6 to 8 weeks. Most ultrasound scanners have amplifiers, so you can hear as well as see the heartbeat by this early date. If your doctor or midwife doesn’t have an ultrasound scanner, he or she will listen with a Doppler, a small, ultrasonic device that amplifies the sound of the baby’s heartbeat. With a Doppler, it’s sometimes possible to hear the baby’s heartbeat at 6 to 8 weeks, but it’s much easier to do so at 11 or 12 weeks.
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PUPPP stands for pruritic urticarial papules and plaques of pregnancy (say that ten times quickly!). Among the many skin rashes that can develop during pregnancy, this one most commonly occurs in abdominal stretch marks but can also occur on the buttocks, thighs, and arms. As you know, PUPPP is itchy, itchy, and itchier. Its cause is unknown, but PUPPP is not a serious condition; it poses no danger to you or your baby. It lasts about six weeks, on average, and disappears within two weeks after birth. It generally doesn’t recur, even in subsequent pregnancies.
To lessen the itching, you can try taking oatmeal baths or use an over-the-counter anti-itch cream containing 1 percent hydrocortisone. If this doesn’t help, your doctor or midwife may suggest an antihistamine or, if the itching is very severe, a corticosteroid.
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Help! My mother was recently exposed to fifth disease. I’m seven months pregnant, and I have been advised to stay away from my mother. I had never heard of fifth disease before; it’s not even mentioned in the books I’ve looked at. What are the symptoms, how dangerous could it be to my baby, and what should I do now?
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Fifth disease, caused by a parvovirus, is so called because it is the fifth in a group of six childhood diseases that cause rash and fever. The symptoms of rash and fever are generally mild and frequently go unnoticed. It is uncommon to develop fifth disease during pregnancy. Most women are in fact immune, having been infected as children without being aware of the infection.
Very rarely, infection with fifth disease during pregnancy increases the risk of an early miscarriage or a rare form of fetal anemia. It is best to follow your practitioner’s advice in your situation, but you and your baby are likely to be completely unaffected.
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Thank you Shannon — and congratulations on your new book! I would be happy to read it over. Please send the PDF to me as well as any media info at tori@thejoyofpregnancy.com. If you need an address you can find all my contact information at http://www.torikropp.com
Warmly, Tori Kropp
About Tori Kropp
Known as "the Dear Abby of pregnancy," Tori has been interviewed on national television and radio and in national print publications, including CNN, The Wall Street Journal, New York Post, Washington Times, Atlanta Journal Constitution and Chicago Sun-Times.
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Ask Your Question
I had twin girls four years ago. When I was pregnant, I was told they were in separate sacs and therefore not identical. Once they were born, the doctor said they might be identical, because they had the same blood type. They look very much alike, and I am asked all the time if they are identical. Is there any way to know for sure whether they are identical or fraternal?