Multiple Births: Myths and More

By Shawn Tassone, MD and Kathryn Landherr, MD

Multiple births are on the rise in the United States. Twenty years ago, the number of twins born in this country was 90,118; in 2006, that number increased to 137,085. This increase is a result of fertility drugs, medical technology that is used to “save” high risk pregnancies, and women bearing children at older ages. Approximately 35 percent of pregnancies that occur from the use of fertility drugs result in multiple births. Of course, a woman can naturally conceive twins, triplets or quadruplets, particularly if she is:

• Over age 35
• Has a history of multiple births on her side of the family
• Is of African descent
• Has had one previous multiple pregnancy

Myths have always surrounded the topic of multiple pregnancies and births. Following are some statements and beliefs that we frequently encounter in our clinic.

• The majority of multiple births come from infertility treatments.

Believe it of not, this statement is false. The majority of multiple births occur   naturally.

• You can’t breastfeed multiples, or if you do, you must never supplement with or use a bottle.

Another false statement. You can breastfeed twins and you can use a bottle.

The logistics of breastfeeding twins is a good conversation to have with a  lactation specialist.

• There’s a good twin and a bad twin in every pair.

Maybe in movies and books this tends to be true, but not in real life.

• Multiples are always born by C-section.

Although the chances of having a C-section increases with a multiple  pregnancy, the procedure is not always required. If conditions are favorable,  many doctors are willing to try a vaginal delivery. In fact, obstetricians even  have a lower C-section rate with twins than with single births.

• Twins have ESP.

There are no hard facts to prove that twins are more psychic than others.  This is more the stuff of movies and fiction.

Famous People With a Twin

• Mario Andretti, race car driver (twin brother Aldo)
• Montgomery Cliff, actor (twin sister Roberta)
• Vin Diesel, actor (fraternal twin brother Paul Vincent)
• Joseph Fiennes, actor (twin brother Jacob)
• Andy Garcia, actor (parasitic twin brother removed from Andy’s shoulder; died soon after)
• Jon Heder, actor (identical twin brother Daniel)
• Scarlett Johansson, actress (twin brother Hunter)
• Ashton Kutcher, actor (fraternal twin brother Michael)
• Alanis Morissette, singer (twin brother Wade)
• Elvis Presley, singer (twin brother Jesse Garon died at birth)
• Isabella Rossellini, actress (twin sister Isotta Ingrid)
• Curtis Strange, pro golfer (identical twin brother Allen)
• Kiefer Sutherland, actor (twin sister Rachel)

There are so many men out there that have this strange fear that they will poke the baby in the head if they have sex with their significant other.  This is actually one of the funnier myths out there, and it is funny for a couple of reasons.

First of all, the baby is protected by the amniotic fluid, uterine tissue, and finally the cervix.  While the penis is hard it is hardly something sharp and destructive and the cervix is actually about as firm as the penis so if anything women might get vaginal bleeding from the cervix after intercourse.  I think the myths comes from the fact that men have this fascination with their penis’ and the fact that they think it is so long that they will actually be able to hit a baby that is 14 inches away in most cases.  It is also obvious that men have absolutely no conceptual understanding of the female anatomy or the potential anatomy of the pelvis.

TO ALL THE MEN, the female body is made so this type of trauma will not occur and so sex can be an enjoyable part of life even during pregnancy.  In 99.9% of cases the penis is directly pointing at the baby and in fact it is moving past the head of the baby because of the vector of the vagina and the way that we are all made.  Even if it is a straight shot I would say that we all need to be a bit more realistic about the size and length of the penis and the fact that it is not a vorpal weapon that will cut through anything it encounters.  The penis is a soft tissue organ and it is made that way for a reason, although Viagra commercials would have us believe that it needs to be erect 24/7.

Sex is good during pregnancy unless you are specifically told by your physician or caregiver that you need to refrain.  Occasionally, you might be placed on pelvic rest because of placenta previa or premature contractions.  The male semen has a chemical called a prostaglandin that can make the uterus contract.  So, unless you are specifically told not to have sex, go ahead and enjoy your body, either pregnant or not pregnant.  If he doesn’t want to have sex with you because he fears that he is going to poke the baby then give him an anatomy lesson and bring him back to reality.

So much mysticism and mythology surrounds the pregnancy due date.  Much of the mysticism is held by physicians who hold on to the old ways of  determining when a pregnant woman will deliver.  Believe me, most physicians would love a way to determine the due date so we could plan our lives around the deliveries of our patients, but the truth is only 1-2% of women will actually deliver on their due date.  So what determines a due date, and what is the difference between EDC (estimated date of confinement) and EDD (estimated date of delivery) and what the heck is Naegele’s Rule.  This post will help show the origins of the due date and how we are currently using a system that is about 250 years old.

Franz Karl Naegele (1778-1851) was the German obstetrician who initially came up with the rule to determine a woman’s due date based on her last menstrual period (LMP).  There are many ways to calculate Naegele’s Rule.  I use the system where you take the LMP, add 7 days, and subtract three months.  So if your LMP was April 1, 2009 then your due date would be January 8, 2010.  You can impress your friends at parties with this maneuver.  There are problems with Naegele’s Rule and many people have pointed out that this 250 year old method is no longer appropriate for our advanced age.  What are some of the potential errors with calculating the EDC in this method?

• It assumes that you are having a regular period and that you ovulate on day 14 of your cycle.  I am a gynecologist and there are many women out there that have irregular cycles that ovulate on day 20, 25, 12, 15….you get my point.  This obviously would add potential error to the EDC determination and could change things by days to weeks.
• There is another assumption that the routine pregnancy is 280 days long and that is based on our current calendar system.  The problem with this is that there are many months that contain 30 days or 31 days and what happens in a leap year, or if you are not pregnant over the shorter month of February.  The point is that there is a movement out there that is trying to say that the number should be 288 days and that we are inducing women that have premature babies.  A study done in 1990 stated that the proper method for determining a due date was to take the LMP, count back three months and add fifteen days for a primiparous (first pregnancy) woman or 10 days for a multiparous (subsequent births) woman.  This was published in the journal Obstetrics and Gynecology.
• There are many that argue this method of calculating the EDC is as archaic as the term EDC itself.  Lending to the agrarian societies from whence it came, the EDC literally came from the fact that a woman was confined to her bed for the last part of her pregnancy to prevent preterm labor.  While we still prescribe bedrest today as a possible therapy for preterm labor it does seem odd that the medical establishment uses terminology from the 1700′s.

The due date is as individual as the pregnant mother.  While the EDC is currently calculated by Naegele’s Rule this does seem a bit archaic and inefficient; especially if we are using this dating method to determine inductions and postdatism.  There have been other methods with increased accuracy but they require a woman to measure body temperatures and be move involved in her own self-care.  Many reading this article are very involved with birth and feel as though self-care is very important, but there are many women out there that simply choose not to be observant of their own cycle.  So, what do we “do” with the “due”.  Unfortunately, I think we will keep going with the current system and back it up with ultrasounds which are accurate within 5 days if done in the first trimester.

Approximately 3% of so-called term births (occuring after 37 weeks) are completed with fetal lung immaturity and this could be because the baby may have been between 35-37 weeks and not term.

Are we too involved in the birthing process?  Are there better ways to determine the pregnant due date or should we not worry wbout and just let man/woman  be born in his own time.  The latin word natura gives rise to the word natural and means “to be born”.  Maybe we should just leave well enough alone.

Thank to Laurie Puhn at Expecting Words for allowing us to be guest authors on her website.  We wrote an article on 5 pregnancy myths you need to know.  Obviously there are many more in our book, but we put 5 of them out there that you might not have heard of or didn’t know the answers.  Click on the link to read our article 5 Pregnancy Myths You Need to Know

MEDIA ALERT

Some people are fearful of the H1N1 vaccine, and being pregnant may add to a woman’s concern.  Myths about the vaccine are spreading, and these myths only increase fears.  

Drs. Shawn Tassone and Kathryn Landherr–a husband-and-wife OB-GYN team and co-authors of the new book Hands Off My Belly!: The Pregnant Woman’s Survival Guide to Myths, Mothers, and Moods–are available to speak on this topic:

What are some common myths about this vaccine and pregnancy?

• Vaccines don’t work in pregnant patients

• There are many serious side effects or it can cause birth defects
• It is untested and not safe in pregnancy
• I will become ill with H1N1
• If I get the vaccine it will weaken my immune system and pregnancy already has weakened me
• The vaccine contains thimerosal
• Pregnant women are contraindicated for the vaccine
• I may have had H1N1 so I am immune and don’t need the vaccine

What is true about this vaccine?

• H1N1 vaccine is made just like seasonal flu vaccine
• It is expected to be as safe as seasonal flu vaccine
• The single dose injections do not contain thimerosal (mercury)
• This H1N1 vaccine will not prevent seasonal flu
• You can get both seasonal flu and H1N1 vaccines when pregnant
• It is an inactivated virus and will not cause the flu
• All pregnant women are recommended to get the vaccine
• Pregnant women are one of the highest risk groups for this virus
• Pregnant women are being admitted to hospitals with severe flu infections

Contact Prometheus Books publicity at 800-853-7545 or publicity@prometheusbooks.com to request author contact information, a review copy or press materials.

In a hurry? Contact the doctors directly at 520-544-0906 or ladeaobgyn@yahoo.com to schedule. See their bio here: http://www.handsoffmybellyguide.com/bios.php.

Six Common Pregnancy Myths

Excerpts from “Hands Off My Belly! The Pregnant Woman’s Guide to Surviving Myths, Mothers, and Moods” Prometheus Books (2009), Amherst, NY.

Shawn A. Tassone, M.D.

Kathryn M. Landherr, M.D.  

1).  I heard that if I eat more breakfast cereal I will have a boy

• Really, can you imagine?  Actually this is a shred of truth in this statement based on a study done in England regarding pre-pregnancy diets and their relation to fetal gender, scientists found more boys are born to women who ate a high-calorie diet.  More specifically, a higher percentage of boys were born to women who ate breakfast cereal each morning prior to becoming pregnant.

2).  You must drink whole milk when you’re pregnant  and especially if you are  going to breastfeed

• Got Milk?  The National Dairy Council would have you believe that drinking milk is necessary for strong bones and healthy teeth.  Realistically, we are the only species that drinks milk into adulthood, and bovine milk at that.  There are many other ways to get calcium and more importantly vitamin D into your diet.  If you like milk, go ahead and drink it, but please do not feel as though you must drink milk in order to have a healthy pregnancy.

3).  There are more babies born during a full moon.

• One study actually evaluated individual behaviors and their relationship to the lunar cycle.  The researchers discovered that, contrary to popular belief, he phases of the moon did not increase the rates of birth.

4).  I will automatically receive an episiotomy during delivery

• Episiotomy is probably one of the more common procedures that is performed on a pregnant woman, but that is not to say that the procedure itself is common.  It has been estimated that episiotomies are performed in less that 5% of all deliveries and the numbers are decreasing.  In most instances the baby’s head or shoulders will make its own room as it comes out.  Your physician should discuss the episiotomy before performing the procedure and you should have a say as to whether or not you agree to have the episiotomy performed.

5). Clean teeth mean lower chances of preterm birth.

• You have many reasons to smile when you’re pregnant.  Healthy teeth and gums will indeed reduce the risks of preterm birth.  The preterm birth rate for those women receiving regular dental care was 6.4%, while the birth rate for those not receiving dental care was 11 %.

6).  If the fetal hear rate is below 140 beats per minute, it’s a boy; if it’s above 140, it’s a girl

• This is probably the most common of the fetal gender prediction myths we discuss in the book.  Studies, however, show no significant difference between a male and female heart rate, at least statistically speaking.  Fetal hear rates are normal anywhere between 120-160 beats per minute and if they are excited or relaxing will have a direct effect on their heart rate.

Have you been told any myths surrounding pregnancy? We want to hear them!

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