Battling Nausea? Use Zofran with Caution

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Posted by vera | Posted in Birth, Health, Twins or Multiple Birth Pregnancy | Posted on 20-10-2017

shutterstock_261399308Today’s post is contributed by guest blogger Jen Holmes from zofranlawsuitguide.com

Carrying twins comes with the added risk of double the nausea and vomiting. As result, many women carrying twins and multiples may benefit from medical intervention to help them battle severe morning sickness.

One such drug sometimes prescribed to combat prenatal nausea is Zofran, a cancer drug. GlaxoSmithKline (GSK), the makers of Zofran, saw an open market in pregnant women and began offering kickbacks to physicians who prescribed the medication to expectant mothers.

Potential Negative Effects of Zofran

Unfortunately, GSK didn’t perform enough necessary studies on Zofran before promoting it to pregnant women. In fact, GSK admits that it never did an in-depth study on the medication before it started marketing it to pregnant women. Yet, numerous studies have been conducted by researchers and scientists, including in-depth research published by the National Institutes of Health (NIH), that indicated infants exposed to Zofran are at heightened risk of developing:

  • Cleft lip and cleft palate
  • Heart defects
  • Musculoskeletal defects
  • Kidney defects
  • Jaundice, and more

There have been at least two cases of infants deaths and more than 20 cases of babies born with serious heart defects after women in Canada alone were prescribed Zofran during pregnancy. In an in-depth report conducted in 2012, The Star revealed the information, that was otherwise publically unavailable by Health Canada.

Consequently, there are more than two dozen Zofran lawsuits currently pending against GSK, and as more women learn about the company’s alleged false marketing practices, this number is expected to grow.

If You’re Expecting Twins

If you’re expecting twins and are currently battling nausea, it’s important to understand the risks involved in taking certain medications. Although Zofran may help you battle devastating morning sickness, the research suggests that the end results are generally not worth it and the risks to your infants are too great to ignore.

While some women will take Zofran and go on to have healthy babies, others may not be as lucky. Be certain to discuss alternative options with a trusted physician in battling morning sickness before taking a prescription medication. For example, the Mayo Clinic suggests the following remedies to help mom battle nausea and vomiting prior to resorting to prescription drugs:

  • Take prenatal vitamins in the evening, followed by a light snack (sometimes taking vitamins in the morning causes additional nausea)
  • Increase your intake of Vitamin B6 (with physician’s recommendation)
  • Add ginger to your diet, including ginger ales, candies, and tea
  • Get additional rest
  • Avoid restaurants and other places where scents may make you queasy
  • Consider pregnancy-safe, over-the-counter nausea medication
  • Ask your doctor about anti-nausea wristbands, which trigger pressure points to help reduce nausea 

In Summary 

Canada health officials have repeatedly expressed concern with the prescription medication Zofran (ondansetron) and its effect on unborn infants. Although the drug is only approved for use by cancer patients and those undergoing surgery, many doctors across Canada continue to prescribe it for off-label use for pregnant women expecting twins, who generally experience difficult bouts of morning sickness.

Thanks to Jen Holmes at zofranlawsuitguide.com for alerting us to the dangers of Zofran

To Pump or Not to Pump

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Posted by vera | Posted in Birth, Parenting, Twins or Multiple Birth Pregnancy | Posted on 24-02-2014

medelaadvanced 3The Role of Breast pumps in the Twins + Breastfeeding Equation

Many families expecting twins or triplets choose to breastfeed, and wonder about pumping. “If you want to breastfeed”, they wonder, “why not just breastfeed?”

Good point!

Breastfeeding twins, triplets or more can be done, as Class Three, Feeding, in our 4-part prenatal course demonstrates.  And, if latching the babies on right after birth works for you, and feeding goes without a hitch, that’s great!

 


Preemies, Increased Milk Demands And Tired Moms And Babies

But, like any goal worth pursuing, breastfeeding multiples is not without its challenges.  Twins, triplets or more are often born prematurely, which means they have an even steeper learning curve when it comes to latching on and suckling effectively.  Multiple birth babies also require more milk production than a singleton, obviously.

The push for pumping is mainly to build up your supply.  Breastfeeding can be a bit tricky sometimes with two or more babies at first, and often everyone’s so tired and overwhelmed… and the pump offers a perfect latch every time, allowing new moms to effectively build up milk supply in those important early days.

 

Getting Help With Pumping

Pumping right away also ensures you have plenty of help around if needed:  Most hospitals now offer the services of a lactation consultant on site, and they are generally more than happy to spend a few extra minutes with mothers of multiples, showing them how to work the equipment.

There are also many good resources available on the Internet, through the hospital and from support groups such as La Leche League which can offer guidance and support with pumping and with breastfeeding in general.  Look for things that are twins- and multiples-specific.

 

Many Paths With The Pump

The idea is not to replace breastfeeding with pumping, but rather to use the pump as a supplement to breastfeeding, to encourage adequate milk production.

I’ve had several moms of multiples tell me that they breastfed each baby, and then pumped for a few minutes afterwards, just to build up milk supply in those early days at the hospital and get things flowing.  Then, once things were in order, they exclusively breastfed, and ditched the pump.

Others kept up with pumping because it allowed spouses and other family members to feed expressed breast milk (some just used formula), and others still never touched a pump, and breast fed exclusively from day one, and everything was fine.  And of course, many choose to or end up bottle feeding exclusively, too.

The real message here is that there are many pathways, and lots of “sub-pathways”… Our online prenatal course presents several pictures and videos of real-life families with multiple babies feeding in action, to help you navigate the maze more effectively.  Ultimately — as the new expert of your twins, triplets or more — you will find what works for you and your babies.

 

New Twins Book Falls Short

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Posted by vera | Posted in Birth, Books, Parenting, Twins or Multiple Birth Pregnancy | Posted on 23-11-2013

Involved fathers are often overlooked in pregnancy and baby books, even though they play a key role, especially with twins, triplets or more.

Involved fathers are often overlooked in pregnancy and baby books, even though they play a key role, especially with twins, triplets or more.

Twins by Carol Cooper and Katy Hymas (published by DK press) recently found its way into my professional library.

What first attracted me to this book was its subtitle: “the practical and reassuring guide to pregnancy, birth and the first year”. Who doesn’t love “practical and reassuring”, especially when you’re expecting twins?!

I also appreciated that it was not an American publication – nothing against Americans, but as a Canadian, I am very aware of how saturated the market can get, and it is nice to be able to read a different perspective sometimes (this book is a publication out of the UK).

Another thing that attracted me to Twins by Cooper and Hymas was the fact that it is coauthored by a family doctor and a writer, both of whom are parents of twins themselves.  These are important factors to consider when picking up any book about twins and multiples; does it have credible voice from both a medical perspective and a practical parenting perspective, from someone who’s walked the talk?  This book, presumably, offers both.

 

Non-inclusive Images Of Twins Families

Upon doing a pre-reading picture walk, though, I became a little wary… There are three things I am looking for, visually, when I leaf through a new resource: Families of colour, LGBTQ representation and images of dads with their babies, as these usually give me a sense of the overall flavour of the book, philosophically speaking.

This book had precious few of any of these three.  Although there were a few black women included, the vast majority of images portrayed light-skinned families consisting of a man and a woman and two white babies.  (I did discover one image of a father without a woman beside him; he was bathing a baby.)

While such a book may be “practical” and visually “reassuring” for white couples who happen to be straight and who have mom doing most/all of the child rearing, it does little to promote the sense that all kinds of different people are having twins these days.

 

Comprehensive Overview Of Topics

Determined not to judge the book (too much) by its pictures, I flipped to the contents.

The usual topics were included: Pregnancy, labour and delivery, babycare, and considerations for the first year.  The subtopics looked practical (“your hospital bag – what to pack” and how to manage “outings and holidays” once the twins arrive) as well as informative (“common symptoms” and “complications” in twins pregnancies, and “presentation of twins”).

Some of the chapters themselves fall short for those readers who are keen for specifics.  Current philosophy (when it comes to the rights of multiple births children) is also not reflected.  For example, the section on “twins demystified” refers to “identical” twins, the layperson’s descriptor for twins who originate from the same zygote. (It is commonly understood within the multiple births community now that monozygotic twins – though they share the same DNA – are unique individuals, and that this should be reflected in how we refer to them, i.e. “monozygotic” rather than the less empowering “identical”. Similarly, “fraternal” twins – who may not always be boys, as the label suggests, are more accurately “dizygotic”, meaning, from two zygotes, regardless of sex.)

On the other hand, a relatively in-depth discussion of relationships and learning is included.   “The Year Ahead”, moves beyond the basics, and gives practical ideas for how to help growing baby twins develop their own identities and learning, which is sometimes a rare find in books about raising twins.

 

Non-Inclusive Material Shines Through

Unfortunately, the suspicions I had from the photos when I first flipped through the book were generally confirmed when I began reading.

Potentially practical sections like “doctor’s advice” and “ask the parents” sprinkled throughout the chapters are overshadowed by almost oppressively mainstream assumptions like “Even some midwives don’t always realize [that the number of placentas isn’t linked with the number of eggs]” (boy, would I ever be mad if I were a professional midwife!)

The assumption that “all aspects of childcare, meal preparation, errands and light housework” will be done by the mother, and that it could be useful to have a “mother’s helper” (sorry to all the Dads I know who are raising or co-raising twins; you don’t get a “dad’s helper”!) is stifling in this day and age.

The entire book seems to be aimed at mothers (from the very beginning, the chapters are addressed to the women pregnant with multiples, inviting her to remember when she first discovered she was having twins, and talking with her husband about this, that or the other). This is surprising, considering that dads – and especially fathers of twins and multiples – are more involved than ever in preparing for and raising their children.

Interestingly, the word “partner” is often used instead of “husband”. Yet the photos would suggest that said partner is always male.  It’s as though the book makes a token effort at being inclusive, but doesn’t follow through with the substance to support it.

Twins by Cooper and Hymas offers a somewhat informative and easy read for white, mainstream mothers.  If you’re looking for something more comprehensive or culturally current, look elsewhere!

Twin Engines Baby Shower

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Posted by vera | Posted in Birth, Birthdays, Twin Baby Shower | Posted on 26-10-2013

Planning a twins baby shower can be fun, but when you couple it with a co-theme, like aviation, the result can be a real adventure!

This summer, one of the fellows in my flying club out in PEI had twins, and we decided to host a “twin engines” aviation-themed multiples baby shower for him and his wife and their dizygotic twins.

The first challenge was convincing a bunch of middle-aged guys that baby showers can be for men, too! — Many had heard rumours about this sacred right that women traditionally plan and participate in, and they were SCARED!

Themed Foods and Decor

Once we convinced the boys that hanging out with a couple of babies for the afternoon could be fun, it was time to prepare the “twin engine” theme:  First, we found some baby shower napkins that had a picture of a twin engine airplane on it.  We used this as a model for other items.

Themed cookies and a matching cake were ordered, based on the picture on the napkin.

We also looked for, but did not find, balloons with an airplane on them.  No matter, the cake and cookies did the job, and we chose sets of two more generic baby shower balloons.

Twins Baby Shower Games

With a bunch of pilots on hand, the shower entertainment was great fun:  First we planned a written quiz with questions about other pilots who were parents of twins, and about what consumes more “fuel”, an hour-long flight in a Cessna 172, or a week of feeding the baby pilots.  Things got competitive pretty quickly.

We also deviated from the twin engine theme a little, in favour of introducing the men to some more “traditional” games, like Sniff the Diaper and Guess the “poop” (some of the guests were blindfolded, and had to smell three different diapers with things like chocolate, prunes and green peas and identify which was which).  It was quite entertaining to watch grown men who can fly airplanes shrink in terror at having to smell a diaper filled with… CHOCOLATE!!!

Practical Gifts

As I always preach in my online twins prenatal course, multiple births baby showers should include practical gifts rather than the traditional blankets, sleepers and endless cutesy stuffed animals.

As the organizer of the shower, I hit each of the guests up for a couple of bucks, and then used the combined donations to purchase a large, fancy exersaucer. (I looked for one with airplanes, but the best we could find was a Jungle-themed exersaucer.)  The timing was perfect, because the twins were just 7 weeks old, and the exersaucer could be reconfigured into three different stages, including a tummy time mat which the babies could use right away.

The new parents liked this piece of equipment so much, they ended up buying themselves another one on Craigslist!

Let Your Imagination be Your Guide

Many themes exist for twins or triplets baby showers, and whether you have an additional theme to consider, or are “just” planning for the multiples, putting together a baby party is great fun!  Let your imagination guide you as you plan an entertaining and practical shower for twins, triplets or more.

Tips for Choosing the Right Prenatal Class – Part 1 of 2

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Posted by vera | Posted in Birth, Nannies, Parenting, Triplets, Twins or Multiple Birth Pregnancy | Posted on 03-09-2013

PPL_logoThanks to Alba Aguanno, RN, BScN, LCCE and Director of Childbirth Education at Port Perry Lamaze for inspiring and contributing to this blog post on the important topic of choosing the best prenatal class for you!

Expectant parents sometimes wonder if they should take childbirth classes at all. With a range of childbirth education options available, choosing the right class can be confusing, especially for those expecting twins or triplets!

Here are some tips to consider when choosing a childbirth preparation class.

1. Credentials

certificateFirst, inquire about the credentials of your potential instructor. Some have formal medical training or educational certification, while others have none. Are they health professionals (registered nurse, physiotherapist, medical doctor, chiropractor, or midwife), or do they have considerable experience with expectant parents and newborns?

Have they completed a recognized, formal course on childbirth education or education in general: Lamaze International certification (LCCE), International Childbirth Education Association (ICEA), Childbirth and Postpartum Professional Association – Childbirth Educator (CBE), Childbirth International (Dip CBEd), or Ontario College of Teachers (OCT) or a Masters in Education (M.Ed.) with an emphasis on early learning and/or adult education?

The Lamaze-Certified Childbirth Educator (LCCE) credential is the most widely-recognized and respected qualification in this field. It is the only childbirth education credential accredited by the U.S. National Commission for Certifying Agencies (NCCA), a government body ensuring quality in certification programs.

Certification doesn’t necessarily ensure an ideal learning experience, but it can certainly inspire expectant parents’ confidence that they are getting the most current and correct information.

2. Experience

Consider the instructor’s years of childbirth education experience: If they have been doing this a long time, they may offer a wealth of experience, but they may also be “burnt out”. Conversely, a newer instructor may be enthusiastic, but a little too “textbook”, lacking extensive real-life experience with twins, triplets and their parents.

Also, consider the amount of experience in other class content areas such as breastfeeding and early parenting support, especially with multiple births families. The last thing you need as an expectant parent is a child birth educator who has little or no experience with twins, triplets and quads.

3. Testimonials/Recommendations

handshakeDoes the potential instructor publish testimonials and endorsements for their classes? Read the feedback carefully to get a better picture of what past participants have thought of the classes.

Also, consider who is recommending the class. Have you found it on your own, were you recommended by a friend who heard about it or who took the course, or were you recommended by your obstetrician, family doctor, or midwife?

Many providers will collect endorsements from past students, and will publish at least a few of these on their website. If not, ask to see some, or speak to someone else to see what they thought of the class or instructor.

4. Location & Class Size


all-four-300x199Ask where (specifically) the classes will be taught.

Educators teach in a variety of environments. Some teach in hospital classrooms or medical offices, while others teach in community centres; some even teach in their homes or yours! Increasingly, prenatal classes are offered online, even prenatal classes for twins and triplets. Be sure to check the other tips before enrolling in an online class.

Some providers keep their class sizes small to maintain the quality of instruction and to facilitate meaningful interactions with participants. In certain cases, private classes may be offered. This can be ideal if you are in a remote part of town, where there are no other couples expecting twins or triplets, and you don’t want to be the class circus side show with unique prenatal issues particular to your multiples pregnancy.

There can be a lot to think about when deciding to enroll in prenatal classes, but for families expecting twins, triplets or more, the decision is among the first steps to a healthy twins pregnancy, labour and delivery.

More tips coming in Part 2… stay tuned! 

Begin as You Mean to Go On

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Posted by vera | Posted in Birth, Parenting, Sleep | Posted on 01-09-2013

twin boysI had the delightful opportunity to spend an evening with a colleague’s family, which included their 2-year-old son and his new 10-week-old twin sisters the other night, and I was reminded of the incredible amount of power held by parents, when it comes to paving the way for their children’s future behaviour.

It’s no accident, in my opinion, when children are polite and well behaved, like that night, I witnessed how this magical seed is planted: While we were finishing up the dinner that my partner and I had prepared and brought to the family we were hanging out with, their two-year-old left the table (he was “done”, and wanted to go play).

In their family, these parents have decided they it’s important to eat together, and to ask to be excused when one is finished at table.  So, in gentle yet firm tones, they instructed their toddler to return to the table, and to ask to be excused.

He did so, wiping his hands and face on a cloth they had laid out for him, and then went off to play.

Later that evening, when it was time for bed, parental patience and consistency were once again on display as Mom gave advance notice of the impending bedtime expectation, and Dad went to follow up when Toddler tried out a few tricks to delay the bedtime.  A few removed “Thomas” toys later, Toddler could be heard crankily settling down to sleep.

I marvelled at Mom and Dad’s consistency; each parent had a sleeping newborn in a sling next to their bodies for most of the evening, and even though my partner and I had brought dinner, and tried to do most of the set up and clean up of dishes, it was still busy – between feedings, diaper-changings and, chasing after the family dog and the toddler, there was little or no “down time”.  Not to mention, the sleep deprivation that comes with new twins was evident in their tired eyes.

Yet both parents found the energy to continue to guide their first-born through the mundane but important daily routines that would lead to his becoming a polite, well-adjusted child and young man later on.

Parenting can sometimes feel like a grueling, relentless task, especially when one is facing additional challenges like looking after new born twins or triplets while continuing to parent one or more older singletons.  But it is a task that – if done responsibly and with pleasure – can bring enormous rewards.

Twins Labour and Delivery

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Posted by vera | Posted in Birth, Twins or Multiple Birth Pregnancy | Posted on 06-06-2013

As discussed in more detail in Class 4 of our multiples prenatal course, it is often possible and even preferable to have a vaginal delivery with twins.

I recently had an email from a woman 31 weeks pregnant with twins. She was happy to discover that her babies were both head down, and wondered about her chances of vaginal delivery rather than the caesarean section originally planned.

Although recent research confirms that a vaginal birth is often preferable for twins, every multiples pregnancy is different. Some OBGYNs may still decide to deliver twins by C-section. This can happen for a number of reasons. 

If a vaginal birth is planned, once in the hospital, mom and babies will be closely monitored through labour to ensure all is going well.

Does “Head Down” = No C-Section?

While it is certainly true that having both babies head-down can make for an easier delivery, be aware that once Twin A is born, Twin B may flip around in his/her suddenly more spacious womb!

An experienced OBGYN may be comfortable turning one or both babies as needed, to accommodate a head-first vaginal delivery. That being said, if there is any sign of distress, the doctor may elect to perform a section delivery for one or both babies.

One Labour, Two Deliveries

In general, with twins, you (or your partner, if you are the non-carrying parent-to-be!) will have one labour, and two deliveries, probably in short succession (once twin A is born, the stage is already set for Twin B, who will follow shortly thereafter ).

One of Each?

Even with both babies head-down at or beyond 30 weeks pregnant with twins, there is some possibility that one or both babies will turn or move again before or even during labour — even though space is getting kind of tight in there! So even if your twins appear to be head down at this point, don’t be surprised if you end up with a section after all. (Although, as previously mentioned, breech presentation doesn’t necessarily mean a section delivery — many doctors are now very comfortable reaching in and turning babies as needed, so that you can still have a vaginal delivery.)

And yes, you may deliver one baby vaginally, and the other by section.

twinbabies.jpgDo Your Homework

Taking a multiples-specific prenatal class is an excellent way to begin preparing for the “big day”. Reading a good book or checking out a quality website that deals specifically with twins can offer additional information.

Two sites we like are: What to Expect and Baby Centre UK.

The first reviews stages of labour, and gives some different possible scenarios for twins deliveries. I like the second one because it is written in a very accessible Q and A format.

Once you’ve taken a prenatal course and done your reading, you can prepare a list of specific questions for your OBGYN. Coming prepared with intelligent questions that show you’ve done your homework can help the doctor take your questions more seriously, and respond more specifically in language you can understand.

Ask Other Parents of Twins

If you haven’t already done so, attend a meeting of your local twins club. It can be very helpful to chat with other parents who have recently (in the past two years) been through labour and delivery of twins.

People love to share their stories, and in person, you can ask many questions.

I would even go so far as to suggest stopping people in the mall, on the street or wherever you see the tell-tale sign of a twin stroller, to chat. Although we POMs sometimes dislike being irritated by nosy strangers, if you are pregnant with twins, you have instant access to our sympathy and our endless advice!

ImageFocus On The Things Over Which You Have Control

When thinking about labour and delivery with twins, it can be quite overwhelming to consider all the possibilities. For all the build-up throughout your twins pregnancy, the actual labour and delivery of your babies is only one small event in their  (and your) lives, and the truth is that it tends to be an event you have very little control over.

You are already taking good care of your babies by thinking about all this, by reading up on how to have a healthy twins pregnancy, by taking a prenatal course. And you’ve probably made all kinds of decisions during your pregnancy that are positively affecting your babies.

Once your twins are born, and you bring them home, you will have a lifetime to take care of them. So yes, the birth is important, but it is only one thing. Kind of like a wedding day in the life of a full marriage!

Episode 2 – Premature Twin Births, and How To Be a Great Advocate

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Posted by vera | Posted in Birth, podcast, Twins or Multiple Birth Pregnancy | Posted on 08-05-2013

twins girlsTruong is a father of 3-week-old twin girls and a two year old son. He shares how he and his partner have managed to overcome some of the toughest challenges associated with a premature birth, and preparing their toddler for the arrival of his new twin sisters.

You’ll learn exactly what an advocate needs to do in the absence of a midwife, and later, find out how Truong stopped an unprofessional nurse from stressing everyone out during labour.

Preparing for the Birth of Your Multiples? Here’s What to Pack

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Posted by vera | Posted in Birth, Parenting, Twins or Multiple Birth Pregnancy | Posted on 23-04-2013

third trimester

While browsing “expecting twins and triplets” online forums and Facebook groups, we’ve seen the same question pop up a few times, regarding what to pack for the hospital, especially for the babies. 

Given that twins often come early, it can be helpful to have your hospital bag packed in advance.  That way, you’ll be ready to go when the time comes.

Below are some ideas about what to pack… 

Consider Both Mom And Babies

A large, comfy nighty and robe are essential items – remember that even once the babies are born, the bulge will hang around for a bit.  Don’t pack your pre-pregnancy sleepwear for this outing!  And if you are planning to breastfeed, remember to pack buttoned shirts or other “easily accessible” clothing.

Toiletries such as toothpaste, toothbrush and lipbalm will help make your stay more comfortable.  You’ll also need sanitary napkins, big ones!  (Sorry, ladies, you didn’t think your old friend was gone forever, did you?!)

Chewing gum or mints can help make the early stages of labour more manageable, and your breath more bearable for others, later, if you are having a C-section and just can’t get yourself from your bed to the washroom to brush your teeth that first night or the next morning!

For the babies, consider some small sized sleepers and/or onesies.  Some gentle wipes and several newborn sized diapers will also be a necessity, as most hospitals do not provide these.

paperwork for multiple birthsPaperwork, Paperwork… and More Paperwork

One thing a lot of people forget about is the immense amount of paperwork generated by two, three or more live births.  Each baby needs an application for a birth certificate, health card and SIN (optional).

The hospital can help with a precise list of necessary paperwork for your region. No matter what, be prepared to consume considerable time and ink!

Some forms can be completed online.  Consider having your partner complete some or all of the forms in the hospital, after the babies are born, and before you head home. 

Stamping and pre-addressing envelopes now for forms that need to be mailed off saves time in the hospital, and applications that need to be completed in hard copy can be sent off as soon as they are filled out after the births.

Don’t Forget Your Partner/Labour Coach

Your partner may be spending more time at the hospital than anticipated, so be sure to pack a bottle of water and/or some snacks for him/her as well.  A granola bar can be packed well in advance, and throw a piece of fruit in the bag on your way out the door, too! 

Consider packing change for the vending machine and/or parking meter, so that your partner can take care of those things easily.  

If you are past 26 weeks pregnant with twins, hopefully this blog post has given you a head start as you think about what to prepare for in the weeks ahead. 

A more comprehensive guide to when and what to pack for giving birth to twins, triplets or more at the hospital is included in Class Four of our online prenatal course for multiples