Friday, March 03, 2006

Expecting times two or three or four

Expecting times two or three or four

Clinic Cares for women pregnant with twins or more

By Pamela Appea

Barbara Luke is a firm advocate of bed rest. At least that’s what she prescribes for women expecting twins, triplets or quadruplets.

Luke, a nutritionists and professor of obstetrics and gynecology at the University of Michigan, founded her 4-year-old clinic to provide personal care and specialized treatment for women expecting multiple babies. The clinic helps to meet a growing need.

Statistics from the National Center for Health show that there were more than 110,000 multiple births in the United States in 1997.

“It’s a huge rise in the last 10-15 years,” Luke said.

Luke, 49, said her method gets results.

Women who go to her clinic have babies that are born later, heavier and healthier than those of mothers who don’t get such counseling, she said.

Luke hopes to reach even more women with her recently published book, “When You’re Expecting Twins, Triplets or Quads” which she co-authored with Tamara Eberlein, a New York mother of twins. Luke’s patients quickly find out that their pregnancies are different from what she calls a singleton pregnancy.

Kristi L. K. Mawby, 31, who lives in Ypsilanti Township, Michigan first went to see Luke when she was eight weeks pregnant back in 1996. The rules laid down by Luke at Mawby’s first appointment were intimidating, Mawby said.

“First you will gain lots of weight,” she recalled Luke saying. “I was hoping not to. Second you will eat protein, red meat, until its coming out of your ears; third was all of the vitamin supplements; fourth you will rest. You will stop working; you will be lazy and gestate.”

“Maybe I was in denial of what a twin pregnancy was about,” Mawby continued.

“At first I thought, “You’ve got to be kidding. It’s not that bad.”

But as Mawby learned more about twin pregnancies, she began to see Luke’s advice as sound. Put on bed rest for eight weeks, Mawby later delivered at 38 ½ weeks. Her twins, a boy and a girl, will be 3 in May.

Although multiple births have become more common, Luke said. many people don’t seem to understand the risks involved, including low-birth weight, learning disabilities and other long-term effects if babies are born prematurely.

Good nutrition and proper care help to significantly reduce these risks, she said. Many expectant mothers of multiples, Luke said, are guilty of not taking care of themselves or continuing a high-paced lifestyle at work and home. And the main detrimental result of not slowing down is the risk of premature delivery, Luke said.

Part of her job as a nutritionist, coach and advocate for women expecting multiples, she said, is to get mothers to relax and take the time to gestate. A multiples pregnancy is different physically, Luke said. Women get larger faster than if they are pregnant with one child.

For example, a woman expecting triplets who is 24 weeks pregnant may look like a woman pregnant with a singleton at 36 weeks, Luke writes in her book.

At first many mothers of multiples are determined to work until their ninth moth, not always realizing that their children may be born a few weeks early and that working can cause stress related problems on the pregnancy. That’s why early on, Luke counsels her patients on the importance of scheduling time off from work well in advance.

Ann Seifart of Jackson took Luke’s advice to heart when she found out she was pregnant with quadruplets in 1996. Seifart, now 46, took off work from her dental hygienist job when she was four months pregnant. Her quadruplets were born at 31 weeks and, though small, all thrived.

“I took things one step at a time,” said Seifart.

“I had success and unfortunately there are women who haven’t.”

Tim Johnson, chair of the OB/GYN clinic at the University of Michigan, said Luke’s clinic and research on multiples is an effective part of the [University of Michigan’s] multidisciplinary effort.

A woman’s regular check-appointment may only be 15 minutes, Johnson said.So that’s why it’s important that a team of nurse-midwives, nutritionists, social workers and other health care providers supplement the prenatal care women expecting multiple babies receive, Johnson said.

“You can imagine why patients love Dr. Luke. The doctors love her and the hospital loves her. Having healthier babies is good for everybody,” Johnson said.

At a patient’s first visit to her clinic, Luke puts the emphasis on nutrition, particularly during the first trimester. The early weeks—the first 13 to 14 weeks— of the pregnancy are the most crucial.“That’s really when the major organs are formed,” Luke said.

“The risks of birth defects are greatest during that period.”Luke finds patients often get unhelpful advice, such as, “Try not to gain too much weight,” from family members and others. Luke’s advice is to eat as much as possible during a multiples pregnancy.

One of her biggest battles, Luke said, is convincing women that during such a pregnancy is not the time to watch her weight.Luke has counseled mothers of 150 sets of twins, a dozen sets of triplets and Seifert, the mother of the quadruplets.

Despite the long hours, Luke said she can’t imagine doing any other type of work.“I really love what I do,” she said. “I realize admire my patients. The women have tremendous strengths.”

And the best thing for the nutritional health expert, she said, is hearing from former patients months or years afterwards about their children.“It’s a vote of confidence that we’re doing it right,” Luke said.

*Copyright 2000 by Pamela Appea for The Ann Arbor News.