Transcript: Twin Pregnancy and Iron Deficiency Anemia
The Twin Talks
Twin Pregnancy and Iron Deficiency Anemia
CHRISTINE STEWART-FITZGERALD: Caring more than one baby creates a higher demand on expecting mother’s body during pregnancy. This often includes tapping into her iron supply which can results in iron-poor blood for mamma and babies. If you are pregnant with twins should you be concerned? What can you do to prevent this condition? Can it be treated effectively? We are here today with Dr. Wade Schwendemann, a specialist in maternal-fetal medicine.
Today we are talking about twin pregnancy and anemia.
This is twin talks.
[Introduction and Theme music]
CHRISTINE STEWART-FITZGERALD: Welcome to twin talks. Twin talks are your online on the go support group for expecting and new parents of twins. I am your host Christine Stewart-Fitzgerald. Do you have an episode idea for us? Visit the episode guide on our website on www.NewMommyMedia.com for a list of the episodes we have released so far. That is also where you can also subscribe to our newsletter to learn about our latest episodes. If you like to listen to episodes on the go then subscribe to twin talks on iTunes or download our free apps.
Here is Sunny with details on how you can get involved with twin talks.
SUNNY GAULT: All right so we have some segments that I think all our listeners will be interested in because we want to get you involved in the show. We are glad that you listen every week every time we record a new episode but we also want you to become part of our shows and the best way to do that is you are not coming on as one of the parents on our show is to be part of some of these segments.
You can always go to our website on www.NewMommyMedia.com, go to the twin talk section and click on segments for our complete list. There are a couple that I wanted to highlight right now so we have a segment called “Annoying Twin Comments” and this is your chance to rant and rave about your latest trip to the grocery store or sometimes you are out in public and someone said the craziest thing to you about your twins so, we know we like to talk about this online and on Facebook and stuff like this on our private group so we have created a segment for it so send us your comment about that.
We are also looking for apps that you guys really like. What has helped you as a twin parent better parent or helped you throughout your twin pregnancy? We know there are a lot of apps out there but at least my personal experience has been that not all of these apps allow you to put in two or more babies if you are trying to follow things at once. So, what apps have really helped you? Let us know and we will talk about them on the show and we will share them with some other parents.
Those are a couple of ideas but again head on over to our website for more.
CHRISTINE STEWART-FITZGERALD: Let us take a moment and introduce ourselves and who we've got with us today. First, I am going to go to Rebecca, can you tell us a little bit about your family?
REBECCA MAZATCHI: I am Rebecca Mazatchi, my fraternal twin boys are three and a half years old now, and I am a stay at home mom with them, luckily for me.
CHRISTINE STEWART-FITZGERALD: Oh my gosh, I am thinking three and a half, that is a great age for boys but they have lots of energy.
REBECCA MAZATCHI: Yes, we have a fitness program we have them on. Every day we have like to get outside and we have to go at least a mile, it doesn't matter how we get there, bikes, running, walking, something, at least the mile must be traveled in order for them not to become wild animals.
CHRISTINE STEWART-FITZGERALD: Do they have their own Fitbit's? I had to ask.
REBECCA MAZATCHI: No, I keep track it on my phone, so they probably go more than a mile because they are often running further and coming back or whatever but they have their little strider bikes, can't recommend those enough
CHRISTINE STEWART-FITZGERALD: And Sunny tell us about your family.
SUNNY GAULT: I have four kids, my oldest two are my single tens, I have a five-year-old who is turning six in a couple of months and then I have actually just yesterday my three years old turned four, so now I have to practice saying I have a four-year-old, it's been a while since I had to say that. My twins are my girls who are about two and a half years old and they are identical girls. As far as today's topic is concerned I did have anemia throughout my pregnancy with my girls. I also think I am just a bit anemic in general so it wasn't really a big surprise but yes, I have some experience with today's topic.
CHRISTINE STEWART-FITZGERALD: I am you host Christine Stewart -Fitzgerald and I have my twins who are six years old and very curious. I see them peeking in as we are speak
SUNNY GAULT: They are like I know you are talking about me.
CHRISTINE STEWART-FITZGERALD: Yes, and then I do have a single girl and she is three years old going to three and a half, so we call her the third twin and she is our smunky one I have to say that. As far as out topic is concerned, I didn't experience anemia during my pregnancy but I did have anemia postpartum that is for sure.
[Theme music]
SUNNY GAULT: All right before we start our conversation today we are going to share an iTunes review. You guys know you can listen to twin talks through iTunes if you have an iPhone, a little podcast app and we are available on there as well. We are always asking our listeners to leave reviews because this is the best way for people to find twin talks if you are a fan of iTunes and if you use iTunes.
The more reviews you get in iTunes and the more people rate you, the higher you show up in search results. So, it is really important for twin parents to be able to find us and that is a great way to do it. We have a review here, I would say the person's name but it is written in Hebrew and I can't read Hebrew so I am sorry whoever wrote this but I want to thank you.
The title of this review is “I enjoy your podcast so much,” and he or she gave us five stars and this is what it says. “Hi, Sunny I have been listening to all of your new mommy media podcasts for years from Jerusalem Israel. I have two single teens but I still enjoy listening to twin talks. I am a nurse and I enjoy the information I get there. Thanks.”
So, I thought this was so interesting, I think about twin talks in terms of parents of obviously twins and triplets listening to us but I never think about parents of single teens listening. I shared this with Christine and I thought this is the coolest thing ever that someone is listening to us from Jerusalem? I thought that was really awesome.
CHRISTINE STEWART-FITZGERALD: And you know it is my guess since we get caught up and we see all the twin stuff from our own country mostly here in North America, but you know it is those universal challenges and if you have got kids that are close in age because we always hear oh well I have the kids that are thirteen months apart so it is just like having twins.
For all of you out there who have Irish twins, it can be for you too.
SUNNY GAULT: Absolutely, and obviously for people all over the country and all over the world. This is awesome we really do appreciate it. If you haven't left a review for twin talks please do so, it is super easy to do. Look for that ratings and review section again whether you listen through the iTunes app on your laptop or your desktop or if you have your iPhone those are the best ways to do it, super easy just a couple of quick clicks and you are there.
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Today we are here to talk about anemia, it’s a medical condition that affects many pregnant women and especially those carrying twins. We are here with Dr. Wade Schwedemann of San Diego Perinatal center who is helping identify the risks and treatment of this condition. So, Dr. Schwedemann can you just give us an overview of what is anemia and it is a major concern during pregnancy?
DR. WADE SCHWENDEMANN: Absolutely, anemia is a major concern during pregnancy. Specifically, anemia refers to a low blood count. There are literally dozens of different causes for anemia but by far in pregnancy and especially in a twin pregnancy, the most common cause is iron deficiency anemia.
When a woman becomes pregnant her blood volume increases by about 50 percent but the red cell mass and the blood cell mass only increases by about 33 percent. Naturally a person becomes more anemic when they get pregnant over the course of the first half pregnancy or so. This is basically nature’s way of protecting women from excess blood loss of the time of delivery.
Your blood volume increases by up to two and a half liters by the time you're full term and so by making sure that your blood is thinner your body is still able to carry that oxygen around even if you lose all a little bit of extra blood at the time of your delivery. Back before we had immediate access to blood transfusions nor the medical care that we have now, so it is a great natural demonstration of how evolution has protected us a little bit.
The definition actually involves a hematocrit level of less than 33 percent during the first trimester and less than 32 percent during the second or third trimester. To put it into perspective the normal for a woman is generally from 35-45 percent. So for pregnancy they have already set the bar a little bit lower in terms of what is anemic when you are pregnant versus when you are not.
CHRISTINE STEWART-FITZGERALD: Wow, and for expecting moms of twins are these standards still the same as for women only carrying one baby?
DR. WADE SCHWENDEMANN: The cutoffs are the same but the incidence or the chance that you are going to get it is much higher because just like everything else when you are carrying twins, I am sure you guys have talked about this many times, you are much more likely to have it when you are carrying twins that when you are carrying one baby. Virtually every pregnancy complication is increased in twins and anemia is no different.
CHRISTINE STEWART-FITZGERALD: So it much common for moms of twins to have anemia compared to moms of single terms.
DR. WADE SCHWENDEMANN: Virtually all twin moms will have some degree of anemia and its pretty uncommon for all twin moms not need iron supplementation at some point even during pregnancy, so if you are a twin mom and you have gone all the way through pregnancy without being on iron supplementation consider yourself lucky.
REBECCA MAZATCHI: I am surprised that my OB/GYM did not tell me that. I wish that I had been told that along with all other risks of twin pregnancy because anemia seems like such an easy thing to treat or prevent.
CHRISTINE STEWART-FITZGERALD: It does, I mean it does require you to regular supplements but it sounds as though the regular supplements themselves aren't necessarily adequate for twin moms.
DR. WADE SCHWENDEMANN: That is true, some doctors will have people take an extra prenatal vitamin if you are carrying twins. Not everyone does that, I would not say there is a standard, there is not necessarily right or wrong. There is a lot of different potential ways that people treat anemia. The problem with iron supplementation is that if you don't take it exactly right you are going to end up being very constipated and not really absorb much the iron at all.
CHRISTINE STEWART-FITZGERALD: It is really more about the mother providing the iron and its adaptation but is there any relation to the type of twins that she is carrying whether they are sharing the placenta or is there any difference for her or the twins in the different twin types?
DR. WADE SCHWENDEMANN: There is not really in terms of anemia for moms. Mom is just as likely to become anemic whether she is carrying monochorionic twins or dichorionic twins, so identical twins versus fraternal twins. The twins themselves, however, one of them could become anemic in utero and we will touch on the next segment but that is something that really doesn't have a direct link to whether or not mom is anemic. Mom is basically anemic because babies are doing what babies do and growing and taking the nutrient supply from mom, and sometimes they take more than mom really should be giving but they are going to take it anyway so that is how it goes.
REBECCA MAZATCHI: I was going to say that it continues for years, right? Take and take whatever they need.
CHRISTINE STEWART-FITZGERALD: You mentioned some statistics about how much hematocrit is in the blood and so how is the diagnosis usually done to say you have got anemia?
DR. WADE SCHWENDEMANN: The diagnosis is made through blood count assessment. We routinely do a complete blood count for every mom during her initial prenatal labs of and so we look at the hemoglobin and hematocrit rate. If hematocrit rate is less than 33 percent during the first trimester and less than 32 percent during the second or third trimester, mom is diagnosed with anemia.
At that point there are several like I said, dozens of different types of anemia, there is another test that comes with the blood count which is called the “mean corpuscular volume”, basically it tells us about the level of volume of the cells themselves. That test if it is normal or a little bit low can be a sign of iron deficiency. That is the most common result and it is important to check that, as doctors, we are always making sure that we have that because sometimes we would pick women who otherwise would have had a history of inherited anemia like thalassemia or sickle cell anemia or something on those lines though that number would be low.
We routinely screen everybody during the first trimester and we screen them again when you do your wonderful diabetes test at 24-28 weeks.
CHRISTINE STEWART-FITZGERALD: The beautiful diabetes test, yes. So, it sounds like the most twin moms when they are getting just a regular prenatal care early on they would be doing some type of a lab, say providing blood sample in a lab and with this through your regular OB I mean we know you are a specialist in maternal fetal medicine, but not all twin most are necessarily seeing a maternal fetal specialist, so is this something that regular OBs would be requesting as well?
DR. WADE SCHWENDEMANN: Absolutely, every single pregnant mom is going to have the routine blood work drawn during her first trimester, you probably remember going in and getting your six or seven tubes of blood drawn for all the infection studies and things like that, does that sound familiar with all of you? At that point, one of the tests that are done is a complete blood count.
CHRISTINE STEWART-FITZGERALD: It is good to know that we don't have to ask for it.
DR. WADE SCHWENDEMANN: No, we screen everybody for it and hopefully we as doctors we of course review every piece of paper that comes in front of our office and digital lab results that comes through, so we are often reviewing lab results every day and if we see anything or get a call from somebody and they will tell you about what to do next.
CHRISTINE STEWART-FITZGERALD: And speaking of what to do next, you mentioned earlier about taking iron supplements with prenatal forms of iron supplements so is that the typical treatment or are there other recommended treatments for anemia during the pregnancy?
DR. WADE SCHWENDEMANN: Sure, the most important thing is to make sure we know what kind of anemia you have. We are talking about anemia in general here but the great majority of anemia in pregnancy, especially in moms carrying twins, is iron deficiency anemia. So, if a person is low in iron our treatment is to give them back some extra iron. There are a couple of ways to do that, several different iron preparations or you can try to consume additional amounts of iron rich foods. If a mom has a low enough iron level we may talk about intravenous iron rather than pills. Intravenous iron works faster in getting your blood count up, but if we go a whole month with treatment, the effectiveness is the same.
So, if I give you IV iron today and I give you 48 hours later which is the typical practice, we usually give two doses, sometimes three. What we end up doing is we raising your blood count faster with IV iron on day five and day fourteen with those frequent testing times, there are earlier testing times but if we get all the way to a month and a half, the IV iron has not changed your blood count any more than the pills will, so for people who are generally mildly anemic will end up just using pills instead a great majority of people end up using just pills.
Occasionally if someone's blood count is particularly low we end up using IV iron, but that is a lot more expensive, it is done in a hospital or in an oupatient center, much more difficult to do for moms and a lot more time involved with additional testing is required, it’s a pain.
CHRISTINE STEWART-FITZGERALD: I now have to ask, you mentioned some of the iron supplements are constipating, is IV is that constipating too? Maybe somebody should ask I can just get the IV?
REBECCA MAZATCHI: I have to say I really didn’t want to take the iron pills, because who wants to be constipated? I looked at everywhere and I found liquid floradix and it is truly the most horrible taste and it smells even worse, so it was torture two times a day, but I was not constipated at all I am happy to report and it really worked. It is pricey but I really felt that it was worth it. There are a couple of times I skipped a day because I felt I could not taste it. I would feel the effects immediately, I would start to feel light headed again and tired and the symptoms of anemia would come back. It was good and I ended up taking it eight weeks postpartum and there was no constipation. I can vouch for it. I don't know if it would feel like that for everybody but that taste was worth it for that.
CHRISTINE STEWART-FITZGERALD: You know Rebecca, I want to take a step back because I want us to talk about how you discovered that you were anemic because I think talking about doing tests, not everybody figures that they are anemic just from lab tests how about for you?
REBECCA MAZATCHI: Yes, the doctor mentioned a test in your first trimester at twenty-four weeks and I was right in the middle when I was diagnosed I was eighteen weeks pregnant. I almost fainted at work and came to and I was sick I ended up going to the hospital in an ambulance not really knowing what was wrong. I was diagnosed with anemia there but my biggest concern, of course, was the babies and to see them on the ultrasound just flaying away and having a great old time in there. I'm like struggling to remain vertical, it was reassuring that they were fine. I was the one that needed to have a little boost and I was glad of all possibilities that I could even be rushed to the hospital. Anemia is an easy fix
CHRISTINE STEWART-FITZGERALD: And you fainted at work so I'm sure that was really fun experience and concerned colleagues.
REBECCA MAZATCHI: I'm a middle school teacher and so luckily there were no students around it was lunch time but it's definitely not a good feeling to be so powerless especially in a situation when you are supposed to be on top of things and in charge. It was really scary but luckily I have wonderful colleagues and they took care of me and I got what I needed.
CHRISTINE STEWART-FITZGERALD: That is great and I think Sunny, I don't think your experience was quite as traumatic
SUNNY GAULT: No it wasn't. Mine was pretty boring Rebecca compared to yours. As I mentioned earlier I'm a bit anemic even when I am not pregnant. If I am going to give blood or something I have to take pills before I do give blood. I have to watch it I don't do anything, I don't do any kind of regular maintenance on a day to day basis. I probably should but I don't with the exception of taking multi-vitamin or something which I'm sure is helping. I don't take anything specifically just for iron. I didn’t actually with my singletons either to my knowledge, but I hope my OBs didn't tell me to do something and I didn't do it. I don't think it was of great concern with my single term pregnancy, it wasn't until my twin pregnancy. I think it was pretty much from the very beginning, so once they did all these tests they were like you are low and I'm like I can handle taking the pills, and they are little tiny ones.
For those of you who have to take them and you don't like swallowing pills, I hope most of them are the small ones, I got the really tiny. I don't like swallowing pills either I have to take stuff with something other than water or it will come right back up. I am just not a good pill taker. So, this are really tiny little pills and I think I had double the dosage and I couldn't just take one, I had to do two. I had to do that a couple of times a day, so I was pretty low like Doctor Schewndemann would probably to say more on that, but I was really low and I just went for the good old pills and to my knowledge I don't recall ever being constipated. So, it worked for me but with the traditional round, no fainting, no nothing then now I am feeling like it was a really boring pregnancy, which is what you want, you want a boring pregnancy.
REBECCA MAZATCHI: Definitely you want a boring pregnancy. My first pregnancy, this is my first and only pregnancy I didn't know what was normal and what wasn't normal. I didn't have a single term pregnancy to compare it to. I was just like oh, pregnant ladies just must be dizzy all the time? I didn't know what was doing on.
CHRISTINE STEWART-FITZGERALD: Dr. Schewndemann I think you said you have this kind of sayings in your office
DR. WADE SCHWENDEMANN: Exactly right, every one of these would be an interesting case in medicine, period. Because what the doctor that would be very interesting, that just means we don't see it as often.
SUNNY GAULT: You don't want to be the case study that is what you are saying.
DR. WADE SCHWENDEMANN: Getting back the iron thing real quick the thing to not being constipated when you take the pills is to take your iron on an empty stomach which is sometimes tough to do because it can be a little bit hard on your stomach but your body absorbs iron very poorly.
If there is anything else that your body can absorb it is going to absorb that first more or less. Okay, so Sunny if you happened to be taking your pills with orange juice instead of water, that will help because vitamin C helps your body absorb iron as well. Making sure that you take you iron pills with orange juice, but if you are diabetic you have to be careful because you will have to take a vitamin C supplement instead, but those sets of things are great. The concern is that if your body doesn't absorb the iron and it gets into your colon, that is where constipation really comes from.
So yes, it’s a great way to try and do that. I will tell you, sometimes we have women on iron three times a day so twice a day is bad but it gets worse.
REBECCA MAZATCHI: I was doing twice a day
SUNNY GAULT: I was twice a day too
CHRISTINE STEWART-FITZGERALD: We are going to take a break and when we come back we are going to talk more about what the discovery and treatment process for anemia looks like
[Theme music]
CHRISTINE STEWART-FITZGERALD: Welcome back. Today we are talking with Dr. Schewdnemann about diagnosing and treating anemia. He is helping us understand what the risks are and what we can do about it.
So now we have been focusing on the aspect of moms being anemic during their pregnancy and some of the treatments which are iron supplements primarily, so that does mean that if the mom is taking iron supplements that it guarantees that the twins won't be anemic at birth?
DR. WADE SCHWENDEMANN: No it doesn't guarantee the twins won't be anemic at birth, but also being iron deficient doesn't guarantee the twins will be anemic at birth. As we are saying, babies tend to take what they need from Mom whether we want them to or not, and so there is still the risk for moms beings anemic as well but the twins becoming anemic generally that only happens in cases where there is something going on for the twins. So if there were abnormal problems through the placenta those sorts of things can cause the twins to be anemic if babies lost blood or if Mom is RH sensitized or sensitized to other things that can cause the destruction of the baby's red blood cells. Generally, there has to be something going on that involves the babies themselves.
CHRISTINE STEWART-FITZGERALD: Yes, if the mom is anemic it doesn’t affect the baby, so usually it is a totally separate case altogether and I wanted to ask you, I have heard about a particular kind of anemia and I wasn't sure if there is a relation with the moms anemia and I hope I am going to say this correctly, but it is “twin anemia polycythemia sequence”, so I am just wondering, how is this different from general anemia, is there any relation? Can you tell us about that?
DR. WADE SCHWENDEMANN: Sure, twin anemia polycythemia sequence is a diagnosis that is of the babies themselves. Basically, what happens is that one baby has a high blood count, that is the polycythemia and the other baby is anemic meaning having a low blood count like we talked about before. This has nothing to do whatsoever with mom’s anemia or not. If mom is anemic or mom does not have anemia it has nothing to do with twin anemia polycythemia sequence. That is something that is a diagnosis of the babies themselves.
Twin anemia-polycythemia sequence is related more to one baby getting a little bit of extra blood from the other and so we see this in the case of twin to twin transfusion syndrome that has been corrected which is a much longer separate discussion that we wouldn't want to touch on here. The bottom line is twin anemia polycythemia sequence is a very rare condition and as physicians we are still working out what is the best thing to do with this information is once we make this diagnosis because sometimes and unfortunately this is one of the times when we make a diagnosis and we don't necessarily have a great treatment for it. So we just watch more closely and maybe deliver the twins early that sort of thing.
CHRISTINE STEWART-FITZGERALD: It sounds like that is something that is totally different and its only happening in the monochorionic twins so it is for the majority of expecting twin moms we don't have to worry about that then.
DR. WADE SCHWENDEMANN: That is correct.
CHRISTINE STEWART-FITZGERALD: So about the twins again, what happens if the twins are born a bit anemic at birth, so what can mom expect within the first couple of days of birth? Are they going to be taking iron supplements just like mom did during pregnancy?
DR. WADE SCHWENDEMANN: Yes, that is a question that really depends on how anemic they are. The majority at times, if babies are anemic to the point where it is affecting their growth and development, they will actually receive a blood transfusion rather than just given iron supplementation. Occasionally they will help but most of the time babies are struggling enough and we don't want them to have any lack of oxygen anywhere so we will give them the ability to carry more with a blood transfusion. Fortunately this in babies is pretty uncommon and certainly much less common in anemia in pregnancy for women.
CHRISTINE STEWART-FITZGERALD: Do babies get this diagnosis and transfusion within the first few days of birth? How does this work usually with the diagnosis of anemia?
DR. WADE SCHWENDEMANN: Babies pretty much obviously we collect a little bit of blood from the umbilical cord after we have done our delayed cord clamping and letting the cord which sometimes are pulsating so babies get that blood and even in cases of very preterm babies sometimes we milk blood to them so that they are basically having a little bit of a transfusion out of the placenta.
That said, after we do that we collect blood from the placenta and we check the babies blood count from that blood. Placenta blood is baby’s blood and so we are checking the blood count on it if to see if there is any sort of abnormalities, and if we see anemia then the pediatrician or neonatologist will start to investigate why that anemia is there and treat it appropriately.
CHRISTINE STEWART-FITZGERALD: Back to the mom, and we have been talking about the twins, but back to the moms. Postpartum anemia I think it's probably pretty common and I experience that myself. Is the postpartum treatment any different than treatment during the pregnancy?
DR. WADE SCHWENDEMANN: It's really not the key is making sure that we've got the iron that will build back. Your body has an incredible ability to re-build its own blood store. When you lose blood at the time of delivery, most of the time we don't have to give you blood back we just let your body naturally build back up on its own red blood cell count and its own iron stores can go on from there. So, by giving you iron that processes accelerated we give you all extra iron after delivery trying to help up.
Some people they have a higher chance of blood transfusion after delivery and before but usually we try to keep that treatment going for at least six weeks postpartum visits sometimes eight weeks are more.
CHRISTINE STEWART-FITZGERALD: Does the type of delivery have any effect whether it is a vaginal delivery or C-section on whether a mom might experience more blood lose or have iron poor blood? I don't know, does that affect in any way?
DR. WADE SCHWENDEMANN: Absolutely, the average amount of blood loss from a virginal delivery is less than 500 ml or 500 cc that is half a liter, the average blood loss from a C-section is a little bit less than 1 liter. It is about double the blood loss from a C-section as it is from a virginal delivery. The chance for anemia is much higher with C-section and the chance for needing iron treatment from that anemia is, therefore, high as well.
One more reason to avoid a C-section and definitely for those of you with twins out there. Don't just do a C-section because you think it is going to be easier, you absolutely can still try virginal delivery and so push it towards that because there is no doubt you recover from it faster and that gives you a better chance to chase after two brand new-born.
CHRISTINE STEWART-FITZGERALD: So there is more to it, as soon as we hear about moms of C-section saying oh I feel sore, I feel really tired and moms doing virginal delivery saying oh you know I had energy so it’s not just the hormones, but it literally could be lots of blood loss, I didn’t know that.
In the treatment, the postpartum treatment, how long is the typical time they would be getting iron supplements and getting treated?
DR. WADE SCHWENDEMANN: Usually it is six to twelve weeks. Sometimes it can take up to three months to really fully re-build that red blood sublime but most people it is in that six-day treatment, and to be quite honestly most people stop taking it when they are tired of it, whether we tell them or not.
SUNNY GAULT: I think I fall into category
REBECCA MAZATCHI: I was such a naive first-time mom, I thought oh the baby is already born and I don't have to take all these pills and do all these things, and they were like no you keep taking them and I was so sad about that. I tried as long as I could and I think I really needed it for the full eight weeks and after that, good riddance!
SUNNY GAULT: I think I quit when my babies came out. I don't remember taking them and they are still in my cabinet so I know I didn't finish the battle.
DR. WADE SCHWENDEMANN: You should probably check to ensure they are not expired and if they are then you should get rid of them.
CHRISTINE STEWART-FITZGERALD: Thanks so much our parents for joining us today and be sure to visit our episode page on our website for more information about anemia and other medical conditions related to twin pregnancy and also our other resources.
This conversation continues for members of our Twin Talks Club. After the show, we will talk about some foods that are a great source of iron. For more information about the Twin Talks Club, visit our website, www.NewMommyMedia.com .
[Theme music]
SUNNY GAULT: Before we wrap up our episode today we have a segment I was telling you about. One of the segments that we do on the show is called “twin, oops” and I love these stories because these are the funny things that have happened that we have experienced with our twins. It could be a situation that happened between you and your twins or maybe it is something funny that happened between your twins. We posted a question actually a while back now on the Multiples of America Facebook page. We got a bunch of requests or submissions I should say, people sharing their stories and this one comes from Ann and I think it is probably something we can all relate to because all of us on the core of parents have toddler age or even older twins.
So this is what Ann says:
"Long drive to see my family, twins were around two years old in the middle captain's chair, one twin is really wanting the leap frog signing matching toy his brother has. We say we are going to switch toys in just a few minutes, they each had one. One had animals the other had cars so one twin says, do you want this now? The other says yes, the twin with the toy went to give it to his brother and just as the brother reached for it, he took the toy back and then “dropped” the toy beside the car seat at the sliding door. Brother screamed bloody murder as he could not get the toy that had fallen down and the twin who dropped the toy was very pleased with himself for making his brother mad.'
Then she says we saw the whole scenario unfold and she was driving looking back in the mirror and what she is going to do about this, but I think the older the twins get, I noticed that sometimes my girls they are a little devious, they are like you want this? Oops, I dropped it!
I could just see all this situation and this poor mom in the car just saying I just want to get to where I am going and her twins are fighting in the back. Anyone else having any kind of experience with twins doing crazy stuff like this?
REBECCA MAZATCHI: Mine will know if one is playing with the toy the other one wants. He will go to his most favorite thing and starts playing with it. If he notices he will drop it and then they run across the room. It’s funny how early they learn to manipulate each other.
SUNNY GAULT: That is exactly what it is, it is manipulation
CHRISTINE STEWART-FITZGERALD: Oh my gosh, you know what, I have to say my car looks like a complete disaster right now. We go to school and they usually have a little bit of breakfast before we leave but then also like to bring things with them, so that just means total disaster. I have crums and fruit and rotting bananas and everything else, but you know it's the whole thing of manipulation, I hand them things and they are in separate roles now and I would say can you hand this to your sister and they go no, no. I mean they just flat out refuse and then it ends getting its seats on the seats then it just gets cold and dry out. I'm not going to eat it now. So then we basically have rotting fruit and stuff.
SUNNY GAULT: Right, I feel like it is the alpha male or maybe in our case it is the alpha female depending on if you have male or female twins. I feel like that is what is going on, they are testing each other to see who has the upper hand here, so anyway, thank you, Ann, for sending this in. We do really appreciate it, if you guys want to send us a twin oops, you can post it on our Facebook page, you can send us an email through our website at www.NewMommyMedia.com and we will share it with our audience.
CHRISTINE STEWART-FITZGERALD: That wraps up our show for today, we appreciate your listening to twin talks.
Don’t forget to check out our sister show:
• Preggie Pals for expecting parents
• The Boob Group for moms who give breast milk to their babies
• Parent Savers for moms and dads with infants and toddlers and
• Newbies for newly postpartum moms
This is twin talks, parenting times two.
[Disclaimer]
This has been a New Mommy Media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. While such information and materials are believed to be accurate, it is not intended to replace or substitute for professional, medical advice or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: How would you like to have your own show on the New Mommy Media Network? We are expanding our line-up and looking for great content. If you’re a business, or organization interested in joining our network of shows through a co-branded podcast, visit our website at www.NewMommyMedia.com.
[00:38:09]
[End of Audio]
Episode Transcript
The Twin Talks
Twin Pregnancy and Iron Deficiency Anemia
CHRISTINE STEWART-FITZGERALD: Caring more than one baby creates a higher demand on expecting mother’s body during pregnancy. This often includes tapping into her iron supply which can results in iron-poor blood for mamma and babies. If you are pregnant with twins should you be concerned? What can you do to prevent this condition? Can it be treated effectively? We are here today with Dr. Wade Schwendemann, a specialist in maternal-fetal medicine.
Today we are talking about twin pregnancy and anemia.
This is twin talks.
[Introduction and Theme music]
CHRISTINE STEWART-FITZGERALD: Welcome to twin talks. Twin talks are your online on the go support group for expecting and new parents of twins. I am your host Christine Stewart-Fitzgerald. Do you have an episode idea for us? Visit the episode guide on our website on www.NewMommyMedia.com for a list of the episodes we have released so far. That is also where you can also subscribe to our newsletter to learn about our latest episodes. If you like to listen to episodes on the go then subscribe to twin talks on iTunes or download our free apps.
Here is Sunny with details on how you can get involved with twin talks.
SUNNY GAULT: All right so we have some segments that I think all our listeners will be interested in because we want to get you involved in the show. We are glad that you listen every week every time we record a new episode but we also want you to become part of our shows and the best way to do that is you are not coming on as one of the parents on our show is to be part of some of these segments.
You can always go to our website on www.NewMommyMedia.com, go to the twin talk section and click on segments for our complete list. There are a couple that I wanted to highlight right now so we have a segment called “Annoying Twin Comments” and this is your chance to rant and rave about your latest trip to the grocery store or sometimes you are out in public and someone said the craziest thing to you about your twins so, we know we like to talk about this online and on Facebook and stuff like this on our private group so we have created a segment for it so send us your comment about that.
We are also looking for apps that you guys really like. What has helped you as a twin parent better parent or helped you throughout your twin pregnancy? We know there are a lot of apps out there but at least my personal experience has been that not all of these apps allow you to put in two or more babies if you are trying to follow things at once. So, what apps have really helped you? Let us know and we will talk about them on the show and we will share them with some other parents.
Those are a couple of ideas but again head on over to our website for more.
CHRISTINE STEWART-FITZGERALD: Let us take a moment and introduce ourselves and who we've got with us today. First, I am going to go to Rebecca, can you tell us a little bit about your family?
REBECCA MAZATCHI: I am Rebecca Mazatchi, my fraternal twin boys are three and a half years old now, and I am a stay at home mom with them, luckily for me.
CHRISTINE STEWART-FITZGERALD: Oh my gosh, I am thinking three and a half, that is a great age for boys but they have lots of energy.
REBECCA MAZATCHI: Yes, we have a fitness program we have them on. Every day we have like to get outside and we have to go at least a mile, it doesn't matter how we get there, bikes, running, walking, something, at least the mile must be traveled in order for them not to become wild animals.
CHRISTINE STEWART-FITZGERALD: Do they have their own Fitbit's? I had to ask.
REBECCA MAZATCHI: No, I keep track it on my phone, so they probably go more than a mile because they are often running further and coming back or whatever but they have their little strider bikes, can't recommend those enough
CHRISTINE STEWART-FITZGERALD: And Sunny tell us about your family.
SUNNY GAULT: I have four kids, my oldest two are my single tens, I have a five-year-old who is turning six in a couple of months and then I have actually just yesterday my three years old turned four, so now I have to practice saying I have a four-year-old, it's been a while since I had to say that. My twins are my girls who are about two and a half years old and they are identical girls. As far as today's topic is concerned I did have anemia throughout my pregnancy with my girls. I also think I am just a bit anemic in general so it wasn't really a big surprise but yes, I have some experience with today's topic.
CHRISTINE STEWART-FITZGERALD: I am you host Christine Stewart -Fitzgerald and I have my twins who are six years old and very curious. I see them peeking in as we are speak
SUNNY GAULT: They are like I know you are talking about me.
CHRISTINE STEWART-FITZGERALD: Yes, and then I do have a single girl and she is three years old going to three and a half, so we call her the third twin and she is our smunky one I have to say that. As far as out topic is concerned, I didn't experience anemia during my pregnancy but I did have anemia postpartum that is for sure.
[Theme music]
SUNNY GAULT: All right before we start our conversation today we are going to share an iTunes review. You guys know you can listen to twin talks through iTunes if you have an iPhone, a little podcast app and we are available on there as well. We are always asking our listeners to leave reviews because this is the best way for people to find twin talks if you are a fan of iTunes and if you use iTunes.
The more reviews you get in iTunes and the more people rate you, the higher you show up in search results. So, it is really important for twin parents to be able to find us and that is a great way to do it. We have a review here, I would say the person's name but it is written in Hebrew and I can't read Hebrew so I am sorry whoever wrote this but I want to thank you.
The title of this review is “I enjoy your podcast so much,” and he or she gave us five stars and this is what it says. “Hi, Sunny I have been listening to all of your new mommy media podcasts for years from Jerusalem Israel. I have two single teens but I still enjoy listening to twin talks. I am a nurse and I enjoy the information I get there. Thanks.”
So, I thought this was so interesting, I think about twin talks in terms of parents of obviously twins and triplets listening to us but I never think about parents of single teens listening. I shared this with Christine and I thought this is the coolest thing ever that someone is listening to us from Jerusalem? I thought that was really awesome.
CHRISTINE STEWART-FITZGERALD: And you know it is my guess since we get caught up and we see all the twin stuff from our own country mostly here in North America, but you know it is those universal challenges and if you have got kids that are close in age because we always hear oh well I have the kids that are thirteen months apart so it is just like having twins.
For all of you out there who have Irish twins, it can be for you too.
SUNNY GAULT: Absolutely, and obviously for people all over the country and all over the world. This is awesome we really do appreciate it. If you haven't left a review for twin talks please do so, it is super easy to do. Look for that ratings and review section again whether you listen through the iTunes app on your laptop or your desktop or if you have your iPhone those are the best ways to do it, super easy just a couple of quick clicks and you are there.
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Today we are here to talk about anemia, it’s a medical condition that affects many pregnant women and especially those carrying twins. We are here with Dr. Wade Schwedemann of San Diego Perinatal center who is helping identify the risks and treatment of this condition. So, Dr. Schwedemann can you just give us an overview of what is anemia and it is a major concern during pregnancy?
DR. WADE SCHWENDEMANN: Absolutely, anemia is a major concern during pregnancy. Specifically, anemia refers to a low blood count. There are literally dozens of different causes for anemia but by far in pregnancy and especially in a twin pregnancy, the most common cause is iron deficiency anemia.
When a woman becomes pregnant her blood volume increases by about 50 percent but the red cell mass and the blood cell mass only increases by about 33 percent. Naturally a person becomes more anemic when they get pregnant over the course of the first half pregnancy or so. This is basically nature’s way of protecting women from excess blood loss of the time of delivery.
Your blood volume increases by up to two and a half liters by the time you're full term and so by making sure that your blood is thinner your body is still able to carry that oxygen around even if you lose all a little bit of extra blood at the time of your delivery. Back before we had immediate access to blood transfusions nor the medical care that we have now, so it is a great natural demonstration of how evolution has protected us a little bit.
The definition actually involves a hematocrit level of less than 33 percent during the first trimester and less than 32 percent during the second or third trimester. To put it into perspective the normal for a woman is generally from 35-45 percent. So for pregnancy they have already set the bar a little bit lower in terms of what is anemic when you are pregnant versus when you are not.
CHRISTINE STEWART-FITZGERALD: Wow, and for expecting moms of twins are these standards still the same as for women only carrying one baby?
DR. WADE SCHWENDEMANN: The cutoffs are the same but the incidence or the chance that you are going to get it is much higher because just like everything else when you are carrying twins, I am sure you guys have talked about this many times, you are much more likely to have it when you are carrying twins that when you are carrying one baby. Virtually every pregnancy complication is increased in twins and anemia is no different.
CHRISTINE STEWART-FITZGERALD: So it much common for moms of twins to have anemia compared to moms of single terms.
DR. WADE SCHWENDEMANN: Virtually all twin moms will have some degree of anemia and its pretty uncommon for all twin moms not need iron supplementation at some point even during pregnancy, so if you are a twin mom and you have gone all the way through pregnancy without being on iron supplementation consider yourself lucky.
REBECCA MAZATCHI: I am surprised that my OB/GYM did not tell me that. I wish that I had been told that along with all other risks of twin pregnancy because anemia seems like such an easy thing to treat or prevent.
CHRISTINE STEWART-FITZGERALD: It does, I mean it does require you to regular supplements but it sounds as though the regular supplements themselves aren't necessarily adequate for twin moms.
DR. WADE SCHWENDEMANN: That is true, some doctors will have people take an extra prenatal vitamin if you are carrying twins. Not everyone does that, I would not say there is a standard, there is not necessarily right or wrong. There is a lot of different potential ways that people treat anemia. The problem with iron supplementation is that if you don't take it exactly right you are going to end up being very constipated and not really absorb much the iron at all.
CHRISTINE STEWART-FITZGERALD: It is really more about the mother providing the iron and its adaptation but is there any relation to the type of twins that she is carrying whether they are sharing the placenta or is there any difference for her or the twins in the different twin types?
DR. WADE SCHWENDEMANN: There is not really in terms of anemia for moms. Mom is just as likely to become anemic whether she is carrying monochorionic twins or dichorionic twins, so identical twins versus fraternal twins. The twins themselves, however, one of them could become anemic in utero and we will touch on the next segment but that is something that really doesn't have a direct link to whether or not mom is anemic. Mom is basically anemic because babies are doing what babies do and growing and taking the nutrient supply from mom, and sometimes they take more than mom really should be giving but they are going to take it anyway so that is how it goes.
REBECCA MAZATCHI: I was going to say that it continues for years, right? Take and take whatever they need.
CHRISTINE STEWART-FITZGERALD: You mentioned some statistics about how much hematocrit is in the blood and so how is the diagnosis usually done to say you have got anemia?
DR. WADE SCHWENDEMANN: The diagnosis is made through blood count assessment. We routinely do a complete blood count for every mom during her initial prenatal labs of and so we look at the hemoglobin and hematocrit rate. If hematocrit rate is less than 33 percent during the first trimester and less than 32 percent during the second or third trimester, mom is diagnosed with anemia.
At that point there are several like I said, dozens of different types of anemia, there is another test that comes with the blood count which is called the “mean corpuscular volume”, basically it tells us about the level of volume of the cells themselves. That test if it is normal or a little bit low can be a sign of iron deficiency. That is the most common result and it is important to check that, as doctors, we are always making sure that we have that because sometimes we would pick women who otherwise would have had a history of inherited anemia like thalassemia or sickle cell anemia or something on those lines though that number would be low.
We routinely screen everybody during the first trimester and we screen them again when you do your wonderful diabetes test at 24-28 weeks.
CHRISTINE STEWART-FITZGERALD: The beautiful diabetes test, yes. So, it sounds like the most twin moms when they are getting just a regular prenatal care early on they would be doing some type of a lab, say providing blood sample in a lab and with this through your regular OB I mean we know you are a specialist in maternal fetal medicine, but not all twin most are necessarily seeing a maternal fetal specialist, so is this something that regular OBs would be requesting as well?
DR. WADE SCHWENDEMANN: Absolutely, every single pregnant mom is going to have the routine blood work drawn during her first trimester, you probably remember going in and getting your six or seven tubes of blood drawn for all the infection studies and things like that, does that sound familiar with all of you? At that point, one of the tests that are done is a complete blood count.
CHRISTINE STEWART-FITZGERALD: It is good to know that we don't have to ask for it.
DR. WADE SCHWENDEMANN: No, we screen everybody for it and hopefully we as doctors we of course review every piece of paper that comes in front of our office and digital lab results that comes through, so we are often reviewing lab results every day and if we see anything or get a call from somebody and they will tell you about what to do next.
CHRISTINE STEWART-FITZGERALD: And speaking of what to do next, you mentioned earlier about taking iron supplements with prenatal forms of iron supplements so is that the typical treatment or are there other recommended treatments for anemia during the pregnancy?
DR. WADE SCHWENDEMANN: Sure, the most important thing is to make sure we know what kind of anemia you have. We are talking about anemia in general here but the great majority of anemia in pregnancy, especially in moms carrying twins, is iron deficiency anemia. So, if a person is low in iron our treatment is to give them back some extra iron. There are a couple of ways to do that, several different iron preparations or you can try to consume additional amounts of iron rich foods. If a mom has a low enough iron level we may talk about intravenous iron rather than pills. Intravenous iron works faster in getting your blood count up, but if we go a whole month with treatment, the effectiveness is the same.
So, if I give you IV iron today and I give you 48 hours later which is the typical practice, we usually give two doses, sometimes three. What we end up doing is we raising your blood count faster with IV iron on day five and day fourteen with those frequent testing times, there are earlier testing times but if we get all the way to a month and a half, the IV iron has not changed your blood count any more than the pills will, so for people who are generally mildly anemic will end up just using pills instead a great majority of people end up using just pills.
Occasionally if someone's blood count is particularly low we end up using IV iron, but that is a lot more expensive, it is done in a hospital or in an oupatient center, much more difficult to do for moms and a lot more time involved with additional testing is required, it’s a pain.
CHRISTINE STEWART-FITZGERALD: I now have to ask, you mentioned some of the iron supplements are constipating, is IV is that constipating too? Maybe somebody should ask I can just get the IV?
REBECCA MAZATCHI: I have to say I really didn’t want to take the iron pills, because who wants to be constipated? I looked at everywhere and I found liquid floradix and it is truly the most horrible taste and it smells even worse, so it was torture two times a day, but I was not constipated at all I am happy to report and it really worked. It is pricey but I really felt that it was worth it. There are a couple of times I skipped a day because I felt I could not taste it. I would feel the effects immediately, I would start to feel light headed again and tired and the symptoms of anemia would come back. It was good and I ended up taking it eight weeks postpartum and there was no constipation. I can vouch for it. I don't know if it would feel like that for everybody but that taste was worth it for that.
CHRISTINE STEWART-FITZGERALD: You know Rebecca, I want to take a step back because I want us to talk about how you discovered that you were anemic because I think talking about doing tests, not everybody figures that they are anemic just from lab tests how about for you?
REBECCA MAZATCHI: Yes, the doctor mentioned a test in your first trimester at twenty-four weeks and I was right in the middle when I was diagnosed I was eighteen weeks pregnant. I almost fainted at work and came to and I was sick I ended up going to the hospital in an ambulance not really knowing what was wrong. I was diagnosed with anemia there but my biggest concern, of course, was the babies and to see them on the ultrasound just flaying away and having a great old time in there. I'm like struggling to remain vertical, it was reassuring that they were fine. I was the one that needed to have a little boost and I was glad of all possibilities that I could even be rushed to the hospital. Anemia is an easy fix
CHRISTINE STEWART-FITZGERALD: And you fainted at work so I'm sure that was really fun experience and concerned colleagues.
REBECCA MAZATCHI: I'm a middle school teacher and so luckily there were no students around it was lunch time but it's definitely not a good feeling to be so powerless especially in a situation when you are supposed to be on top of things and in charge. It was really scary but luckily I have wonderful colleagues and they took care of me and I got what I needed.
CHRISTINE STEWART-FITZGERALD: That is great and I think Sunny, I don't think your experience was quite as traumatic
SUNNY GAULT: No it wasn't. Mine was pretty boring Rebecca compared to yours. As I mentioned earlier I'm a bit anemic even when I am not pregnant. If I am going to give blood or something I have to take pills before I do give blood. I have to watch it I don't do anything, I don't do any kind of regular maintenance on a day to day basis. I probably should but I don't with the exception of taking multi-vitamin or something which I'm sure is helping. I don't take anything specifically just for iron. I didn’t actually with my singletons either to my knowledge, but I hope my OBs didn't tell me to do something and I didn't do it. I don't think it was of great concern with my single term pregnancy, it wasn't until my twin pregnancy. I think it was pretty much from the very beginning, so once they did all these tests they were like you are low and I'm like I can handle taking the pills, and they are little tiny ones.
For those of you who have to take them and you don't like swallowing pills, I hope most of them are the small ones, I got the really tiny. I don't like swallowing pills either I have to take stuff with something other than water or it will come right back up. I am just not a good pill taker. So, this are really tiny little pills and I think I had double the dosage and I couldn't just take one, I had to do two. I had to do that a couple of times a day, so I was pretty low like Doctor Schewndemann would probably to say more on that, but I was really low and I just went for the good old pills and to my knowledge I don't recall ever being constipated. So, it worked for me but with the traditional round, no fainting, no nothing then now I am feeling like it was a really boring pregnancy, which is what you want, you want a boring pregnancy.
REBECCA MAZATCHI: Definitely you want a boring pregnancy. My first pregnancy, this is my first and only pregnancy I didn't know what was normal and what wasn't normal. I didn't have a single term pregnancy to compare it to. I was just like oh, pregnant ladies just must be dizzy all the time? I didn't know what was doing on.
CHRISTINE STEWART-FITZGERALD: Dr. Schewndemann I think you said you have this kind of sayings in your office
DR. WADE SCHWENDEMANN: Exactly right, every one of these would be an interesting case in medicine, period. Because what the doctor that would be very interesting, that just means we don't see it as often.
SUNNY GAULT: You don't want to be the case study that is what you are saying.
DR. WADE SCHWENDEMANN: Getting back the iron thing real quick the thing to not being constipated when you take the pills is to take your iron on an empty stomach which is sometimes tough to do because it can be a little bit hard on your stomach but your body absorbs iron very poorly.
If there is anything else that your body can absorb it is going to absorb that first more or less. Okay, so Sunny if you happened to be taking your pills with orange juice instead of water, that will help because vitamin C helps your body absorb iron as well. Making sure that you take you iron pills with orange juice, but if you are diabetic you have to be careful because you will have to take a vitamin C supplement instead, but those sets of things are great. The concern is that if your body doesn't absorb the iron and it gets into your colon, that is where constipation really comes from.
So yes, it’s a great way to try and do that. I will tell you, sometimes we have women on iron three times a day so twice a day is bad but it gets worse.
REBECCA MAZATCHI: I was doing twice a day
SUNNY GAULT: I was twice a day too
CHRISTINE STEWART-FITZGERALD: We are going to take a break and when we come back we are going to talk more about what the discovery and treatment process for anemia looks like
[Theme music]
CHRISTINE STEWART-FITZGERALD: Welcome back. Today we are talking with Dr. Schewdnemann about diagnosing and treating anemia. He is helping us understand what the risks are and what we can do about it.
So now we have been focusing on the aspect of moms being anemic during their pregnancy and some of the treatments which are iron supplements primarily, so that does mean that if the mom is taking iron supplements that it guarantees that the twins won't be anemic at birth?
DR. WADE SCHWENDEMANN: No it doesn't guarantee the twins won't be anemic at birth, but also being iron deficient doesn't guarantee the twins will be anemic at birth. As we are saying, babies tend to take what they need from Mom whether we want them to or not, and so there is still the risk for moms beings anemic as well but the twins becoming anemic generally that only happens in cases where there is something going on for the twins. So if there were abnormal problems through the placenta those sorts of things can cause the twins to be anemic if babies lost blood or if Mom is RH sensitized or sensitized to other things that can cause the destruction of the baby's red blood cells. Generally, there has to be something going on that involves the babies themselves.
CHRISTINE STEWART-FITZGERALD: Yes, if the mom is anemic it doesn’t affect the baby, so usually it is a totally separate case altogether and I wanted to ask you, I have heard about a particular kind of anemia and I wasn't sure if there is a relation with the moms anemia and I hope I am going to say this correctly, but it is “twin anemia polycythemia sequence”, so I am just wondering, how is this different from general anemia, is there any relation? Can you tell us about that?
DR. WADE SCHWENDEMANN: Sure, twin anemia polycythemia sequence is a diagnosis that is of the babies themselves. Basically, what happens is that one baby has a high blood count, that is the polycythemia and the other baby is anemic meaning having a low blood count like we talked about before. This has nothing to do whatsoever with mom’s anemia or not. If mom is anemic or mom does not have anemia it has nothing to do with twin anemia polycythemia sequence. That is something that is a diagnosis of the babies themselves.
Twin anemia-polycythemia sequence is related more to one baby getting a little bit of extra blood from the other and so we see this in the case of twin to twin transfusion syndrome that has been corrected which is a much longer separate discussion that we wouldn't want to touch on here. The bottom line is twin anemia polycythemia sequence is a very rare condition and as physicians we are still working out what is the best thing to do with this information is once we make this diagnosis because sometimes and unfortunately this is one of the times when we make a diagnosis and we don't necessarily have a great treatment for it. So we just watch more closely and maybe deliver the twins early that sort of thing.
CHRISTINE STEWART-FITZGERALD: It sounds like that is something that is totally different and its only happening in the monochorionic twins so it is for the majority of expecting twin moms we don't have to worry about that then.
DR. WADE SCHWENDEMANN: That is correct.
CHRISTINE STEWART-FITZGERALD: So about the twins again, what happens if the twins are born a bit anemic at birth, so what can mom expect within the first couple of days of birth? Are they going to be taking iron supplements just like mom did during pregnancy?
DR. WADE SCHWENDEMANN: Yes, that is a question that really depends on how anemic they are. The majority at times, if babies are anemic to the point where it is affecting their growth and development, they will actually receive a blood transfusion rather than just given iron supplementation. Occasionally they will help but most of the time babies are struggling enough and we don't want them to have any lack of oxygen anywhere so we will give them the ability to carry more with a blood transfusion. Fortunately this in babies is pretty uncommon and certainly much less common in anemia in pregnancy for women.
CHRISTINE STEWART-FITZGERALD: Do babies get this diagnosis and transfusion within the first few days of birth? How does this work usually with the diagnosis of anemia?
DR. WADE SCHWENDEMANN: Babies pretty much obviously we collect a little bit of blood from the umbilical cord after we have done our delayed cord clamping and letting the cord which sometimes are pulsating so babies get that blood and even in cases of very preterm babies sometimes we milk blood to them so that they are basically having a little bit of a transfusion out of the placenta.
That said, after we do that we collect blood from the placenta and we check the babies blood count from that blood. Placenta blood is baby’s blood and so we are checking the blood count on it if to see if there is any sort of abnormalities, and if we see anemia then the pediatrician or neonatologist will start to investigate why that anemia is there and treat it appropriately.
CHRISTINE STEWART-FITZGERALD: Back to the mom, and we have been talking about the twins, but back to the moms. Postpartum anemia I think it's probably pretty common and I experience that myself. Is the postpartum treatment any different than treatment during the pregnancy?
DR. WADE SCHWENDEMANN: It's really not the key is making sure that we've got the iron that will build back. Your body has an incredible ability to re-build its own blood store. When you lose blood at the time of delivery, most of the time we don't have to give you blood back we just let your body naturally build back up on its own red blood cell count and its own iron stores can go on from there. So, by giving you iron that processes accelerated we give you all extra iron after delivery trying to help up.
Some people they have a higher chance of blood transfusion after delivery and before but usually we try to keep that treatment going for at least six weeks postpartum visits sometimes eight weeks are more.
CHRISTINE STEWART-FITZGERALD: Does the type of delivery have any effect whether it is a vaginal delivery or C-section on whether a mom might experience more blood lose or have iron poor blood? I don't know, does that affect in any way?
DR. WADE SCHWENDEMANN: Absolutely, the average amount of blood loss from a virginal delivery is less than 500 ml or 500 cc that is half a liter, the average blood loss from a C-section is a little bit less than 1 liter. It is about double the blood loss from a C-section as it is from a virginal delivery. The chance for anemia is much higher with C-section and the chance for needing iron treatment from that anemia is, therefore, high as well.
One more reason to avoid a C-section and definitely for those of you with twins out there. Don't just do a C-section because you think it is going to be easier, you absolutely can still try virginal delivery and so push it towards that because there is no doubt you recover from it faster and that gives you a better chance to chase after two brand new-born.
CHRISTINE STEWART-FITZGERALD: So there is more to it, as soon as we hear about moms of C-section saying oh I feel sore, I feel really tired and moms doing virginal delivery saying oh you know I had energy so it’s not just the hormones, but it literally could be lots of blood loss, I didn’t know that.
In the treatment, the postpartum treatment, how long is the typical time they would be getting iron supplements and getting treated?
DR. WADE SCHWENDEMANN: Usually it is six to twelve weeks. Sometimes it can take up to three months to really fully re-build that red blood sublime but most people it is in that six-day treatment, and to be quite honestly most people stop taking it when they are tired of it, whether we tell them or not.
SUNNY GAULT: I think I fall into category
REBECCA MAZATCHI: I was such a naive first-time mom, I thought oh the baby is already born and I don't have to take all these pills and do all these things, and they were like no you keep taking them and I was so sad about that. I tried as long as I could and I think I really needed it for the full eight weeks and after that, good riddance!
SUNNY GAULT: I think I quit when my babies came out. I don't remember taking them and they are still in my cabinet so I know I didn't finish the battle.
DR. WADE SCHWENDEMANN: You should probably check to ensure they are not expired and if they are then you should get rid of them.
CHRISTINE STEWART-FITZGERALD: Thanks so much our parents for joining us today and be sure to visit our episode page on our website for more information about anemia and other medical conditions related to twin pregnancy and also our other resources.
This conversation continues for members of our Twin Talks Club. After the show, we will talk about some foods that are a great source of iron. For more information about the Twin Talks Club, visit our website, www.NewMommyMedia.com .
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SUNNY GAULT: Before we wrap up our episode today we have a segment I was telling you about. One of the segments that we do on the show is called “twin, oops” and I love these stories because these are the funny things that have happened that we have experienced with our twins. It could be a situation that happened between you and your twins or maybe it is something funny that happened between your twins. We posted a question actually a while back now on the Multiples of America Facebook page. We got a bunch of requests or submissions I should say, people sharing their stories and this one comes from Ann and I think it is probably something we can all relate to because all of us on the core of parents have toddler age or even older twins.
So this is what Ann says:
"Long drive to see my family, twins were around two years old in the middle captain's chair, one twin is really wanting the leap frog signing matching toy his brother has. We say we are going to switch toys in just a few minutes, they each had one. One had animals the other had cars so one twin says, do you want this now? The other says yes, the twin with the toy went to give it to his brother and just as the brother reached for it, he took the toy back and then “dropped” the toy beside the car seat at the sliding door. Brother screamed bloody murder as he could not get the toy that had fallen down and the twin who dropped the toy was very pleased with himself for making his brother mad.'
Then she says we saw the whole scenario unfold and she was driving looking back in the mirror and what she is going to do about this, but I think the older the twins get, I noticed that sometimes my girls they are a little devious, they are like you want this? Oops, I dropped it!
I could just see all this situation and this poor mom in the car just saying I just want to get to where I am going and her twins are fighting in the back. Anyone else having any kind of experience with twins doing crazy stuff like this?
REBECCA MAZATCHI: Mine will know if one is playing with the toy the other one wants. He will go to his most favorite thing and starts playing with it. If he notices he will drop it and then they run across the room. It’s funny how early they learn to manipulate each other.
SUNNY GAULT: That is exactly what it is, it is manipulation
CHRISTINE STEWART-FITZGERALD: Oh my gosh, you know what, I have to say my car looks like a complete disaster right now. We go to school and they usually have a little bit of breakfast before we leave but then also like to bring things with them, so that just means total disaster. I have crums and fruit and rotting bananas and everything else, but you know it's the whole thing of manipulation, I hand them things and they are in separate roles now and I would say can you hand this to your sister and they go no, no. I mean they just flat out refuse and then it ends getting its seats on the seats then it just gets cold and dry out. I'm not going to eat it now. So then we basically have rotting fruit and stuff.
SUNNY GAULT: Right, I feel like it is the alpha male or maybe in our case it is the alpha female depending on if you have male or female twins. I feel like that is what is going on, they are testing each other to see who has the upper hand here, so anyway, thank you, Ann, for sending this in. We do really appreciate it, if you guys want to send us a twin oops, you can post it on our Facebook page, you can send us an email through our website at www.NewMommyMedia.com and we will share it with our audience.
CHRISTINE STEWART-FITZGERALD: That wraps up our show for today, we appreciate your listening to twin talks.
Don’t forget to check out our sister show:
• Preggie Pals for expecting parents
• The Boob Group for moms who give breast milk to their babies
• Parent Savers for moms and dads with infants and toddlers and
• Newbies for newly postpartum moms
This is twin talks, parenting times two.
[Disclaimer]
This has been a New Mommy Media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. While such information and materials are believed to be accurate, it is not intended to replace or substitute for professional, medical advice or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: How would you like to have your own show on the New Mommy Media Network? We are expanding our line-up and looking for great content. If you’re a business, or organization interested in joining our network of shows through a co-branded podcast, visit our website at www.NewMommyMedia.com.
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