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Creating a Medical Plan of Action A Monochorionic Placenta What is Twin to Twin Transfusion Syndrome Monochorionic Placental Pictures Sonography and Appointment Questionaire Cervical Assessment, Nutrition and Bedrest Planning for Your Delivery When Pregnancy Continues with a Loss Medical Research and Articles History of Twin to Twin Transfusion Syndrome Placental Protocol Professional Letters of Support Quotes from Parents About Their Doctors International Registry

Planning for Your Patient's Delivery

Box In planning for the delivery, it is very helpful to encourage your patient to take a birthing class or go to their local library and take out tapes that educate on vaginal births and c-sections. It is helpful to be educated on this prior to the delivery day. In the midst of a diagnosis, parents may be too in shock or feeling too hopeless to do this. However, it is one 'normal' thing that the parents can do when their pregnancy seems so 'medical'.

Box It is very important, as part of your patient's extended plan of action, to discuss with them the possibility of a vaginal birth vs. a c-section and the medications involved with both. The more they know ahead of time, the easier it will be to be part of the decision making process and to "accept" the way their babies are born. Sometimes parents have a vision in mind of what their delivery will be like, and just like the pregnancy, the delivery may not be what they dreamed. But, it can be close to it. Encourage the family to think in their heart how they would like their delivery to be and find a compromise between that, and what is medically best for their babies.

Box Have the parents visit the NICU unit so they can see what babies look like at different gestational ages. This will help prepare them for a possible early delivery. This will also help them make provisions, if they indeed need the special care this unit provides.

Box Encourage them to read the enclosed information, as well as research on their own, regarding the benefits to mother and babies from breastfeeding. Breastfeeding is truly the best nutrients to give babies and is a beautiful way to bond. Contact the lactation consultant in your hospital and arrange for a meeting with the mother. She will gladly meet with the mother and help her prepare for breastfeeding prior to the delivery. Breastfeeding is so much easier then bottle-feeding and helps protect babies from many illnesses including SIDS. It is also very helpful in helping mothers quickly return their uterus to pre-pregnancy size along with losing added weight effortlessly. It may take 3-4 weeks to really become comfortable with breastfeeding, but after that, it becomes really natural. It always gets better and easier. After parents have been through the nightmare of TTTS and possibly the loss of one of their twins, breastfeeding is one thing they can do that helps them really bond with their children and feel like a good mother. This is especially true because it comes from the body they may 'feel' let them down during the pregnancy.

Box Many parents take the time on bedrest to think of special gifts they would like to give their babies when they are born. Encourage your patient to think about a few special things they would like to give to them such as baby blankets, needlepointed ornaments, teddy bears, special matching outfits, family pictures, letters of love, and/or other special gifts. Sometimes parents are afraid to gather these gifts because of the syndrome and being unsure if their babies will even survive. But, let them know they are already parents to their babies and this gives them a chance to give their babies something special on the day they come into our world. This is especially important if their babies pass away (see compassionate deliveries.) Parents that have done this feel very glad that they did. It is also a tremendous help when a mother is on bedrest because it give her something to do.

Box If the parents have other children, encourage them to think of others who could watch their children at the hospital when the babies are being delivered. Often parents want their children in the room with them during the delivery. Have a conversation about their options.

Box Tell the parents to bring a bag including a 35mm camera, video camera (one can be borrowed), change of clothing for the hospital stay, clothes to come home in, and toiletries. Include their gifts for their babies in this bag, so they won't be forgotten at home. The reason to tell them to bring the photography equipment is also in case one or both of their babies do not survive. If this happens, the next priority is to make sure they have as many keepsakes of their babies as possible. What happens at the delivery is the key to their sense of peace for the rest of their lives. It is crucial if one baby passes away, that the delivery not be treated as a single delivery. Both babies need to be seen together and the keepsakes need to be of both so they go home with 'twin' keepsakes.

Box Talk with your patient about their placenta and how you want it to be sent to pathology for an analysis, including being photographed, to confirm twin to twin transfusion syndrome. You can provide the pathology department with our placental protocol. Other areas of interest to confirm twin to twin transfusion syndrome will be the hematocrit levels of each baby when they are born, and the differences in the sizes of their hearts. Often many pathology departments to not know how to analyze the placenta correctly for TTTS. You can serve a tremendous service to this cause and to the parents by making sure the pathology department has the instructions that they need to do the job right. And, please, make sure that the placenta does NOT get thrown away. This happens all the time and destroys many families' hopes of getting more information about what happened to their babies. Remember, what happens at the delivery is key to the sense of peace families feel for the rest of their lives. It is often so serious, after the loss of one or both twins, that marriages end in divorce. Anything we can do to prevent that, we need to.

In planning for the delivery, it is very helpful to encourage your patient to take a birthing class or go to their local library and take out tapes that educate on vaginal births and c-sections. It is helpful to be educated on this prior to the delivery day. In the midst of a diagnosis, parents may be too in shock or feeling too hopeless to do this. However, it is one 'normal' thing that the parents can do when their pregnancy seems so 'medical'.

Box It is very important, as part of your patient's extended plan of action, to discuss with them the possibility of a vaginal birth vs. a c-section and the medications involved with both. The more they know ahead of time, the easier it will be to be part of the decision making process and to "accept" the way their babies are born. Sometimes parents have a vision in mind of what their delivery will be like, and just like the pregnancy, the delivery may not be what they dreamed. But, it can be close to it. Encourage the family to think in their heart how they would like their delivery to be and find a compromise between that, and what is medically best for their babies.

Box Have the parents visit the NICU unit so they can see what babies look like at different gestational ages. This will help prepare them for a possible early delivery. This will also help them make provisions, if they indeed need the special care this unit provides.

Box Encourage them to read the enclosed information, as well as research on their own, regarding the benefits to mother and babies from breastfeeding. Breastfeeding is truly the best nutrients to give babies and is a beautiful way to bond. Contact the lactation consultant in your hospital and arrange for a meeting with the mother. She will gladly meet with the mother and help her prepare for breastfeeding prior to the delivery. Breastfeeding is so much easier then bottle-feeding and helps protect babies from many illnesses including SIDS. It is also very helpful in helping mothers quickly return their uterus to pre-pregnancy size along with losing added weight effortlessly. It may take 3-4 weeks to really become comfortable with breastfeeding, but after that, it becomes really natural. It always gets better and easier. After parents have been through the nightmare of TTTS and possibly the loss of one of their twins, breastfeeding is one thing they can do that helps them really bond with their children and feel like a good mother. This is especially true because it comes from the body they may 'feel' let them down during the pregnancy.

Box Many parents take the time on bedrest to think of special gifts they would like to give their babies when they are born. Encourage your patient to think about a few special things they would like to give to them such as baby blankets, needlepointed ornaments, teddy bears, special matching outfits, family pictures, letters of love, and/or other special gifts. Sometimes parents are afraid to gather these gifts because of the syndrome and being unsure if their babies will even survive. But, let them know they are already parents to their babies and this gives them a chance to give their babies something special on the day they come into our world. This is especially important if their babies pass away (see compassionate deliveries.) Parents that have done this feel very glad that they did. It is also a tremendous help when a mother is on bedrest because it give her something to do.

Box If the parents have other children, encourage them to think of others who could watch their children at the hospital when the babies are being delivered. Often parents want their children in the room with them during the delivery. Have a conversation about their options.

Box Tell the parents to bring a bag including a 35mm camera, video camera (one can be borrowed), change of clothing for the hospital stay, clothes to come home in, and toiletries. Include their gifts for their babies in this bag, so they won't be forgotten at home. The reason to tell them to bring the photography equipment is also in case one or both of their babies do not survive. If this happens, the next priority is to make sure they have as many keepsakes of their babies as possible. What happens at the delivery is the key to their sense of peace for the rest of their lives. It is crucial if one baby passes away, that the delivery not be treated as a single delivery. Both babies need to be seen together and the keepsakes need to be of both so they go home with 'twin' keepsakes.

Box Talk with your patient about their placenta and how you want it to be sent to pathology for an analysis, including being photographed, to confirm twin to twin transfusion syndrome. You can provide the pathology department with our placental protocol. Other areas of interest to confirm twin to twin transfusion syndrome will be the hematocrit levels of each baby when they are born, and the differences in the sizes of their hearts. Often many pathology departments to not know how to analyze the placenta correctly for TTTS. You can serve a tremendous service to this cause and to the parents by making sure the pathology department has the instructions that they need to do the job right. And, please, make sure that the placenta does NOT get thrown away. This happens all the time and destroys many families' hopes of getting more information about what happened to their babies. Remember, what happens at the delivery is key to the sense of peace families feel for the rest of their lives. It is often so serious, after the loss of one or both twins, that marriages end in divorce. Anything we can do to prevent that, we need to.

Inside Deliveries

-NICU Help for your Patients

The TTTS Foundation In The News

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