Some advice to expectant families from our experience.

Get some good books about pregnancy, childbirth, breastfeeding and child-rearing. A good book to start with is Pregnancy Childbirth and the Newborn: The Complete Guide by Penny Simkin, Janet Whalley, and Ann Keppler.

Get a good obstetrician or midwife. If you live in the Boston area, it would be hard to imagine a better person than Dr. Beth Hardiman. Don't be afraid to switch if you don't like the person you have, even late in pregnancy. On the other hand, if you know you don't like your person, switch sooner rather than later. It's unlikely that things will improve with time.

Get a good pediatrician lined up in advance of the birth.

Assuming that you plan to breastfeed (which you should unless there is a medical problem), get a lactation consultant lined up before the birth. Maybe everything will be fine, and you won't need that person, but it's more common to have some level of difficulty that you could use help with, and it will be better to have the person on call to start with. We didn't do this, but eventually we found Beth Sargent of Newton, and she was very helpful.

If your babies are slow to learn to nurse, you should have a low threshold for using a breast pump (which you can rent) and feeding them the pumped colostrum or breast milk. You can use a syringe if you don't want to confuse the babies with bottle nipples. Otherwise it's very easy for poor nursers to get dehydrated (and somewhat more likely for them to get jaundice), and then you end up with extra hospital stays, formula feedings, IVs, and so on.

Arrange for lots of support from friends and family beforehand. It's hard to imagine just how much help you'll need if you have twins. Three full-time parents haven't really been up to the job: we have still needed lots of help.

Think about getting a baby scale. Perhaps they can be rented. It would enable you to tell whether your child is gaining weight properly, and so be reassured when everything is right. A very accurate scale will allow you to determine how much your child takes in an each feeding, but then you should not be concerned if the amount is quite variable, but only if the average is too low.

Get tested for hepatitis B. Current standard procedure is to vaccinate all newborns in the first day against hepatitis B. The purpose is to protect them in case they contracted it from their mothers, but doesn't it make more sense to have the mother tested and save the child a possibly painful shot?

Some things we've learned

Breastfeeding

Breastfeeding requires dedication. It's the best thing for babies by far, but you can't just say "oh, sure" unless you're lucky. If instead you have problems like babies in the hospital for jaundice or ones that don't really know how to suck, you really have to be committed.

"Feeding on demand" doesn't mean feeding your child between 1 and 2 hours after the last feeding. It means anywhere between 15 minutes and 4 hours.

Sleep

All the books tell you about when your child will be able to sleep through the night, but that's not what you desperately need. What you desperately need is to reach the time where your child or children do nothing at night but sleep, wake up and nurse efficiently, and go back to sleep. Being awake for half an hour every three hours is not a problem. Being awake for two hours every three hours is.

Realistic parenting

Parenting books give you an ideal, but often unrealistic, standard of child care. Good books tell you that you should feed your children as soon as they give feeding cues, and not wait for them to cry, but often you won't be able to manage it, because you're doing something that you can't leave, or merely because getting ready to breastfeed or warming bottles takes time. With twins, you might already be feeding one when the other is hungry, and feeding two simultaneously is a real circus if the kids aren't good at their part. But I don't think your children are going to be damaged by a short delay.

Diapers

The Consumer's Guide to Effective Environmental Choices: Practical Advice from the Union of Concerned Scientists reports on the relative environmental impact of paper and cloth diapers. According to the Union of Concerned Scientists, which has no reason to be biased on this issue, the situation is not at all clear cut. Paper diapers use space in landfills, while cloth ones require a lot of water for washing. Since we live in an area with chronic water shortages, while our garbage is incinerated rather than going to a landfill, we have chosen paper.

Doctors

It seems that a lot of doctors either don't have your best interests at heart or aren't paying attention. Sometimes you have to see whether there is really a good reason for the things that they want you to do, or whether it is just "standard procedure" for no reason.

For example, when Jocelyn had had phototherapy and her bilirubin level had come down to the point that she no longer needed it, the pediatrician in charge at Norwood hospital wanted to keep her there for 6 hours with no treatment and then check to make sure she had not rebounded. There wasn't any reason for it, and when we complained he said that if we really wanted to we could take Jocelyn home and bring her back later for testing. What was he thinking when he didn't tell us to do that to start with?

We switched pediatricians after the 4 month appointment. The precipitating event was that we asked our doctor about local anesthetics for vaccinations, and he said not to bother because "no one ever came back to complain to me about the vaccinations I'd given them as an infant". That seemed to us to be saying that he didn't care whether they hurt or not.

See also above about hepatitis B immunization.

Teething

Parenting books minimize teething, and claim that at most it should cause mild discomfort. That has not been our experience with Jocelyn. She's often very unhappy, and while we don't know for sure that it's her teeth, it seems to be strongly correlated with wanting to chew on everything. Benzocaine seems to be useful, although we can't really be sure of that either.

Cribs

Cribs are silly for small infants. Bassinets are great! People say "you'll outgrow it in 6 months!" But you know, those are important 6 months. We started with a small bassinet which we could actually put both babies in, graduated to the largest possible bassinet which we could still put both babies in after about 2 months.

The advantage of the bassinet is that you can carry it around (make sure you get one with a handle). It fits through your doors without disassembly. So you can decide to put the baby in the nursery or in your room or napping downstairs while you work on the computer or whatever with no effort, trying out different arrangements. We swapped off who had the babies at night and so we would carry the bassinet into the other person's room, complete with sleeping babies. When they got too big for carrying in there, it also had a wheely base, and we would wheel it around complete with sleeping babies.

Jocelyn and Perry home page

kdo@cosmos.phy.tufts.edu