Double Duty: The Parents' Guide to Raising Twins, from Pregnancy through the School Years (2nd Edition)

By Christina Baglivi Tinglof

Not 10, but 20 fingers and 20 toes!
The classic guide to parenting twins-now completely updated and revised!

You're excited to hear your baby's heartbeat during the ultrasound. But what happens when you hear two heartbeats instead of one? Having a baby can cause any parent to feel overwhelmed, and with twins those concerns are multiplied by two. Having twins is a unique experience, and expert Christina Tinglof brings you the fully updated essential guide to help you cope with any issue that can arise-from pregnancy through the school years. With multiple pregnancies becoming more common, the second edition of this timely book provides you with the much needed information, practical tips, and strategies for handling the everyday challenges of parenting twins. Double Duty includes:

• Up-to-date information on diagnosis and treatment of complications common to multiple pregnancies-plus dietary guidelines specific to a twin pregnancy
• The latest must-have products that simplify day-to-day life
• Survival tips and trouble-shooting techniques for the critical first month
• Tips on how to breastfeed or bottle feed two infants at once
• Money-saving advice for accommodating two new additions to the family
• The pros and cons of placing twins in the same classroom
• Advice on how to discourage unhealthy sibling rivalry

Includes the TOP FIVE:

• Exercises for extremely pregnant women
• Ways to bond with premature babies
• Baby wardrobe essentials
• Bedtime strategies
• Ways to establish each child's individuality

VEndorsements for Double Duty 2nd Edition (ISBN: 0071613447) by Christina Baglivi Tinglof

“Double Duty 2nd Edition

is singularly successful in combining practical advice with reassurance and encouragement from seasoned parents of twins. It neither sugar coats nor overstates the challenges, but presents a straightforward picture of what parents can expect from their twins at every stage, from pregnancy through the teen years.

Tinglof mingles thorough research with personal anecdotes to present a comprehensive resource for parents of twins. With updated information about the medical issues of multiple pregnancy and new insights about the psychology of the twin relationship, the new edition is recommended reading for all prospective parents of twins”
-Pamela Fierro, Guide to Twins & Multiples at About.com

• Language: English
• Publisher: McGraw-Hill Education
• Release date: May 31, 2009
• ISBN: 9780071613453

Christina Baglivi Tinglof

As an Italian-American growing up in her grandfather's pizzeria at the Jersey Shore (anyone remember La Grotta in Long Branch?), Christina Baglivi Tinglof learned what good, regional Italian food was from an early age. She soon turned her love of Italian food, writing, and photography into a career. Her travel features have been published in the Los Angeles Times, the Chicago Tribune, the Boston Herald and dozens of other newspapers. She’s also the author of five books including Northern Italy: A Taste of Trattoria, her first guidebook and the inspiration for this e-book series.

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Introduction

When I wrote the first edition of Double Duty more than 10 years ago, my fraternal twin sons were two-year-old toddlers. In those days, just as I would sit down with an intriguing research paper ready to pound away on the keyboard explaining the latest study on twins, they’d decide it was time to run in opposite directions.

That was then, and what a decade it has been since.

My little toddlers have grown to teenagers. They still take off in opposite directions, but this time it’s usually on skateboards. Ten years ago, my boys also greeted a new baby brother, and I got to find out what it’s like to mother a singleton (yes, it is different than parenting multiples). Those of you with single-born children know that I am wise to mention him here, as singletons sometimes get overlooked when there are twins in the mix. Many, including my younger son, don’t take kindly to that fact!

It’s been a good decade for new parents expecting twins, too, as we’ve learned so much more about how to increase the chances of a healthy twin pregnancy (load up on those calories and protein) and how multiples develop cognitively, physically, and emotionally (no, they won’t suffer if you place them in the same kindergarten class).

Learning the News

Like most of you reading this book right now, my husband, Kevin, and I learned about the impending arrival of our double bundle of joy while in the ultrasound room. Just six weeks into my pregnancy, I lay on the examining table, craning my neck to see the video screen, with Kevin by my side. (A high level of human chorionic gonadotropin [hCG] in my blood prompted the early visit and subsequent diagnosis.) Barely visible to our untrained eyes, two tiny hearts blinked in unison against a dark backdrop, flickering like interstellar fireflies. My doctor’s suspicions were confirmed—we were expecting twins.

Our first reactions were similar to the ones you probably felt when you learned the news: disbelief, excitement, and, of course, fear. Like you, I was worried about the pregnancy and whether our babies would be born healthy. I had read that twins often show up prematurely (three weeks on average) and that it was extremely important that I take exceptional care of myself to ensure a happy outcome. My efforts paid off—I carried my sons to term (they induced me at Week 39). Joseph weighed about 6 pounds, 8 ounces; Michael was 6 pounds, 12 ounces. Yet part of it was sheer luck as I never knew the importance of weight gain for moms carrying multiples. (Thankfully I indulged my constant craving for big, juicy hamburgers—I would pick one up while on the way home from work at least twice a week!)

Like you, too, we hit the bookstores to find a pregnancy book on multiple births. In those days, not many filled the shelves. These days, however, it seems that books on multiple births are bountiful, but you, dear reader, just happened to find the right one.

Welcome to the Second Edition of Double Duty

Throughout the second edition of Double Duty, you’ll find plenty of new material, beginning in Chapter 1, So You’re Having Twins, where you’ll discover all sorts of fun twin facts. Did you know, for instance, that the days of double-digit increases in twinning may finally be coming to an end as the medical community calls for single embryo transfer (SET) instead of the two, three, or more embryos that were standard practice for in vitro fertilization (IVF) just a few years ago? You can also feel confident as a new parent of twins when you guess your twins’ zygosity (the medical term for twin type) as studies have shown that merely following a simple checklist results in 95 percent accuracy.

Diet is stressed in Chapter 2, Fifty Pounds and Still Gaining—Thriving in a Multiple Pregnancy, as recent published reports show that not only the more weight a mom-to-be with multiples gains results in a longer gestation and heavier babies, but when she puts it on (the earlier the better) is just as important. The chapter also delves further into twin-to-twin transfusion syndrome, a rare but sometimes devastating disease that affects 15 percent of identical twin pregnancies who share a common placenta (most monozygotic or identical fetuses have two placentas). But recent research offers lots of hope as new diagnostic and surgical breakthroughs emerge in the medical community every day.

Not only does the latest, cutting-edge research play a big role in this edition of Double Duty, but parents have a stronger voice as well. From the United States, Canada, and Australia, 39 families with young twins volunteered to answer a lengthy survey covering not only their prenatal and postnatal experiences but the more practical aspects of life with infant twins, such as what baby equipment they couldn’t live without (turn to Chapter 3, It’s All in the Planning, to find out) and what they thought was a waste of time (can anyone say Diaper Genie?). In Chapter 4, The First Month: Dirty Little Secrets Parents Won’t Tell You, parents share their clever tricks for handling nighttime feedings whether you’ll be bottle feeding or breastfeeding your infants. And their responses surrounding feeling the baby blues and their postpartum bodies were touchingly honest and insightful, sure to offer you both comfort as well as inspiration.

Once the chaos of the first month subsides, Chapter 5, Months 2 Through 6, focuses on troubleshooting, with advice on how one person can handle stressful situations alone, like when your twins cry at once. Chapter 6, Months 7 Through 12, takes a look at twins’ developing autonomy, with parents offering unique ways of carving out alone time with all their children. (Wouldn’t you love to have had the mom who lets each of her kids play hooky from school for a special mother-and-child day?) We even dig up that old debate of whether dressing twins alike affects twins’ quest for individuality. I’ll tell you what the research says—it’s not what most parents believe.

Yet Double Duty still includes the old favorites such as Top Five Lists, quick references to the most popular ways of handling your duo from the Top Five Birthday Party No-Nos to the Top Five Twin Gadgets, as well as Developmental Milestones—many unique to twins—so that you know what to expect both physically and emotionally from your doppelgängers in the coming months. For instance, don’t expect your babies to start actively interacting until well after they’ve reached their first birthday. But once they’ve hit that marker, their twinness will blossom and become fascinating to observe. Twins will temporarily choose roles in their relationship—one will become the leader, the other, the follower. But several months later, they often reverse positions (just to keep you on your toes).

This new edition includes Chapter 7, The Toddler Years, where parents lament about the naptime blues. Just when you thought you had this twin thing down, the little critters remind you that toddler twins often band together to cause all kinds of mischief, especially at nap-time. And you’ll never laugh as hard as when you read the terrible two tales, as parents regale you with stories of double naughtiness. Not to worry—these seasoned moms and dads are on top of it and have plenty of advice to help you circumvent it all. Finally, Chapter 8, School Days, closes out the book with the latest on the hotly debated classroom placement issue. While recent research shows that some twins benefit from being placed together, there are no studies to show that it harms twins’ self-esteem and sense of autonomy.

Even though there’s plenty of new information in this second edition, one thing has remained constant—Double Duty still shares strategies about the day-to-day circumstances that new parents of twins face, from how to nurse or bottle feed two babies at once to getting twins on the same schedule. Whether you’re concerned about giving each baby enough individualized attention or deciding whether to put them in the same class in school, Double Duty has the answer. Let it be your guide to life with multiples. Happy trails!

1

So You’re Having Twins

Parents of twins hear all sorts of odd questions and misinformed comments about twinning from friends and family (and even strangers), such as "Are they paternal twins? and I thought all same-sex twins were identical!" High school science class covered the basics, but most folks have forgotten why and how this phenomenon happens. What follows in the next few pages is a crash course in Biology 101 so that you may go out and reeducate the world on the miracle of twinning. Now, class, pay attention. . . .

Just the Stats, Ma’am

A staggering 95 percent of all multiples are twins, and more than 125 million sets roam the world today. The number of multiples, particularly twins, has been on the rise since the early 1980s, when doctors first learned how to make women superovulate, or release multiple eggs in one cycle. In 2005 (the most recent year for which statistics are available), the United States reported more than 133,122 live twin births, compared with approximately 110,670 in 1998 (the year Double Duty was first published). Yet the number of twins was only 68,339 in 1980. That’s a 70 percent jump in 25 years. To bring those numbers a bit more in focus—during the 1980s, twins occurred in one in every 80 to 90 live births; in the late 1990s, it was one in every 40 to 45 live births. Today, twinning happens in about one in every 33 live births.

And what about other countries? Has twinning been on the rise around the world as well? You betcha! Canadian twin births, for instance, have also spiked through the years, rising more than 30 percent from 1974 to 1990. In the Netherlands, twinning has soared nearly 65 percent from 1970 to 1995. Australia, England, France, Denmark, Brazil, South Korea, Japan, and many other countries have also seen their share of double strollers these days.

Why the Increase?

The explosion of twinning is due to a number of complex biological, medical, and environmental factors. Some are well known and well documented; others are just speculative at best (but fun to read about nonetheless).

FERTILITY DRUGS

During the late 1970s, fertility drugs became widely available to couples who had problems conceiving due to ovulation disorders. Clomiphene citrate (Clomid), the most common of all ovulating-inducing drugs, stimulates a woman’s hypothalamus and pituitary glands to pump out more hormones, which in turn fuel the ovaries to produce and release more eggs at the time of ovulation. A woman who takes clomiphene citrate increases her chances of twinning by 10 percent. (Although some doctors say the percentage is much higher—especially if a woman already ovulates on her own.) A woman’s likelihood of a multiple birth rises even further if she takes more potent, injectable fertility drugs such as human menopausal gonadotropin (Perganol), human chorionic gonadotropin (Pregnyl), or follicle-stimulating hormone (Fertinex).

ASSISTED REPRODUCTIVE TECHNOLOGY

In vitro fertilization (IVF), the most common of all assisted reproductive technology (ART), has been helping infertile couples conceive for more than 25 years now. It involves removing eggs from the mother (following a round of ovulating-inducing drugs), fertilizing them in the laboratory using her partner’s sperm, and then implanting the embryos back into her uterus. Several are implanted at once to increase the likelihood of success. In recent years, however, the procedure has become so successful that two, three, or more embryos are often viable, contributing to the explosion in multiples births. (One report published in the journal Twin Research back in 2003 noted 40 percent of IVF babies results in twinning.) To help stem this tide, many in the medical community are calling for single embryo transfer (SET), especially for women under the age of 35 who have a longer time frame for conceiving. It may be working, too, as the year-over percentage increase in twinning is not nearly as dramatic as it has been in the past and is finally leveling off.

One mom who was interviewed for this book got pregnant with twins through IVF after having only two embryos implanted. She was shocked since just a few years earlier she conceived a singleton, a son, after transferring a whopping 10 embryos and hoping for a miracle.

AGE

A woman who delays childbearing until after age 30 is also at a greater risk of twinning. As a woman gets older, she produces higher levels of gonadotropins (peaking between ages 35 and 39), hormones that stimulate the ovaries to release more eggs. Two of these hormones are the follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both responsible for ovulation. A 35- to 40-year-old woman is three to four times more likely to have twins than a woman who is 20 to 24 years old. Older moms have clearly had an impact on the rise in twinning. In fact, more twins were born to moms aged 45 to 49 in 1997 than during the entire decade of the 1980s.

BIRTH CONTROL PILLS

A woman who gets pregnant shortly after the cessation of certain types of birth control pills has a greater chance of conceiving twins as well, although the results have been found to be inconclusive in some studies. (Of the 39 moms interviewed for this book, one mom of identical boys conceived almost immediately after stopping birth control pills. Coincidence? Perhaps.)

INHERITED TRAIT

Yes, twins do run in families, but only fraternal twins (not identical) and only through the female bloodline. Some women inherit a gene for hyperovulation, or the predisposition to produce multiple eggs in a single cycle. So if your mom is a fraternal twin, or has a set in her family, that could explain why you are expecting twins.

WOMEN WHO ALREADY HAVE HAD CHILDREN

Due to hormonal changes, the more children a woman has, the more likely she will conceive twins with each successive birth.

WOMEN WHO ALREADY HAVE HAD FRATERNAL TWINS

Indeed, lightning can strike the same place twice. A woman who has already given birth to fraternal twins without the use of fertility drugs doubles her chances of repeating it again with her next pregnancy since she’s already proven that she’s fecund, or able to produce abundant offspring!

RACE

African races (especially West Africans) have the highest incidence of twinning (they are about 20 percent more likely than Caucasian women to have twins), followed by Europeans, and then Mexicans. Asian women have the lowest incidence.

BODY TYPE

If a woman is tall and heavy with a body mass index (BMI) of 30 or above, her chances of having fraternal twins is significantly greater than a woman with a BMI of 20 or less since overweight women tend to produce more FSH.

DIET, ENVIRONMENT, AND OTHER FACTORS

If you search hard enough, you can find a host of other theories that explain the rise in twinning. The Journal of Reproductive Medicine, for instance, reported in 2006 that women who regularly eat dairy products are five times more likely to conceive fraternal twins than women who don’t. Researcher and author of the study, Dr. Gary Steinman, theorized that the synthetic growth hormones given to some diary cows could be the culprit. Once the insulin-like growth hormone enters a woman’s bloodstream through her high diary consumption, it accelerates ovulation. And bingo—fraternal twins!

Large amounts of folic acid have also been associated with twinning. Even yams, rich in the compound phytoestrogens and a dietary staple in many parts of Africa, are thought to promote hyperovulation. And finally, there’s even a report or two proclaiming that an abundance of daylight induces hyperovulation. That could explain the higher number of multiples born in early spring in some Nordic countries as they benefit from nearly 12 hours of sunlight during the summer solstice.

Twin Types

There are two definitive types of twins—dizygotic (DZ) or fraternal, who share 50 percent of their genes (at best), and monozygotic (MZ) or identical, who share 100 percent. There’s growing speculation surrounding a third type called semi-identical or half-identical twins, as well. Fertilization determines twin type.

FRATERNAL

The most common type of twins, fraternal, occurs when two separate eggs are fertilized by two separate sperm. Fraternal twins have different DNA (at most they share only 50 percent) and often don’t look anything alike. They’re simply womb-mates; two siblings sharing the same space for nine months. Since so many different factors are associated with dizygotic (or fraternal) twinning, their frequency varies from country to country anywhere from 4.5 percent to 6 percent.

Fraternal twins are formed when two eggs are fertilized by two sperm.

IDENTICAL

A mysterious anomaly in nature, identical twins occur when one egg, fertilized by one sperm, splits into two embryos. The mystery doesn’t end there. Depending on when the zygote splits determines how the embryos will grow in the womb. If the zygote splits within the first three days of fertilization, it’s a diamniotic-dichorionic pregnancy, each baby having his or her own placenta and amniotic sac. If, however, the zygote splits between Days 3 and 9, each baby will have his or her own sac (diamniotic) but share one placenta (monochorionic). If it splits between Days 9 and 12, the result will be monochorionic and monoamniotic—one sac and one placenta. And finally, if the mass splits after Day 12, the result will be conjoined twins.

Identical twins share the exact same DNA and, therefore, are always the same sex (except in a few extremely rare cases). They often look exactly alike (but surprisingly have different fingerprints). Identical twins account for only 30 percent of twinship and unlike fraternal (or dizygotic) twins, their prevalence worldwide remains fairly constant at 0.3 to 0.4 percent. It’s interesting to note, too, that although the incidence of identical twins is random in nature, science does inadvertently help it along. According to research studies, women who undergo IVF have a two to three times higher chance of having identical twins. The reason why is still unknown.

Twenty-five percent of identicals are mirror twins—that is, many traits like dental patterns, hair swirls, and birthmarks appear on opposite sides of each twin’s face. Many mirror twins are opposite handed, too. One twin is a lefty, while the other is a righty.

Identical twins are formed when one egg fertilized by one sperm splits into two embryos.

SEMI-IDENTICAL

The theory goes that if an egg splits first and is then fertilized by two separate sperm, semi-identical (or half-identical) twins are the result. Since they receive the same exact genes from their mother but different genes from their father, these twins share about 75 percent of each other’s DNA, not the 100 percent of identical twins nor the 50 percent shared by fraternal twins. For years the validity of this third twin type has been questioned, but a 2007 study published in Human Genetics verified that it does in fact exist (however rare). So the next time you see fraternal twins that look remarkably like identical (how about actresses Mary-Kate and Ashley Olsen?), think semi-identical.

Determining Twin Type

Unless your twins are a boy and a girl, determining twin type can be tricky, especially immediately following their birth. (Don’t all newborns look