Transcript: Multiple Births | Jun 04, 2001

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An animated slate shows the title inside the shape of a house: "More to health." The opening sequence shows a wooden table with a small lit candle.
Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: "More to life."

Then, Maureen Taylor appears in a studio with textured yellow walls and the logo of the show in the background, which reads "More to life."

Maureen is in her late thirties, with wavy auburn hair in a bob. She's wearing a green shirt.

She says Hello, I'm Maureen TAYLOR AND WELCOME TO "MORE TO LIFE." WHEN THE DIONNE QUINTUPLETS WERE BORN IN 1934 THE WORLD WAS IN AWE. SINCE THEN MULTIPLE BIRTHS HAVE BECOME SO COMMONPLACE THAT THAT THE BIRTH OF QUINTS HARDLY GETS A MENTION IN THE NEWS. THOUGH WE CELEBRATE THE BIRTH OF THESE BABIES, AND SOME OF THE INFERTILITY TREATMENTS THAT LEAD TO THEIR BIRTH, MY NEXT GUEST IS SOUNDING AN ALARM. Dr. JON BARRETT IS A SPECIALIST IN MATERNAL FETAL MEDICINE AND THE HEAD OF ANTI-NATAL MULTIPLES AT SUNNYBROOK AT WOMEN'S COLLEGE HEALTH SCIENCES CENTRE. HE SAYS THE 39 percent INCREASE IN MULTIPLE BIRTHS IN THE PAST TWENTY-FIVE YEARS IS A SIGN OF AN EPIDEMIC THAT'S DRAINING OUR HEALTHCARE SYSTEM.

Jon is in his late thirties, clean-shaven, with short, receding brown hair. He's wearing glasses, a gray suit, white shirt and gray tie.

Maureen continues MULTIPLE BIRTHS ALSO RESULT IN A HIGHER INCIDENCE OF HEALTH PROBLEMS FOR PREGNANT MOTHERS AND THESE CHILDREN, ESPECIALLY AS THEY AGE. IF YOU HAVE QUESTIONS ABOUT CARRYING MULTIPLES OR OTHER TYPES OF HIGH-RISK PREGNANCY OR IF YOU JUST TO WANT SHARE YOUR OWN MULTIPLES' EXPERIENCE, GIVE US A CALL.

A caption reads "416-484-2727. 1-888-411-1234."
Then, it changes to "moretolife@tvo.org"

Maureen continues Dr. BARRETT, WELCOME, HI.

Jon says Dr. JON BARRET says HI MAUREEN.

Maureen says LET'S TALK FIRST ABOUT TWINS AND TRIPLETTS. HOW COMMON ARE THOSE BIRTHS IN CANADA?

The caption changes to "Doctor Jon Barrett. Obstetrician."

Jon says THEY ARE INCREASING AND AS YOU'VE QUITE RIGHTLY SUGGESTED, OVER ALL DURING THE LAST 25 YEARS, BULL PROBABLY MORE RECENTLY, THE LAST TEN YEARS, THE INCREASE IN TWINS HAS INCREASED IN THE COUNTRY BY ABOUT 30 percent AND WHEN YOU'RE TALK OF THE HIGHER ORDER OF MULT HE WILL BIRTHS OF WHICH WE SAY TRIPLETS AND QUADRUPLETS, THE INCREASE IN SOME AREAS HAS BEEN ALMOST 300 FOLD OR THREE 300 TIMES. SO THE INCREASE HAS BEEN EXPONENTIAL AND WIDESPREAD ACROSS THE COUNTRY AND IT'S NOT ONLY IN CANADA. IT'S A PHENOMENON THAT'S BEING SEEN ACROSS THE WORLD.

Maureen says PROBABLY THE DEVELOPED WORLD THOUGH, RIGHT? WHEREVER INFERTILITY TREATMENTS ARE OFFERED?

Jon says YES, THAT WOULD BE CORRECT.

Maureen says SO HOW COMMON WOULD THEY BE IF INFERTILITY TREATMENTS WEREN'T INVOLVED? HOW LIKELY AM I TO HAVE TWINS OR TRIPLETS. WELL THAT'S INTERESTING. YOUR "RISK" OR CHANCE OF HAVING A TWIN GENERALLY IS IN THE ORDER OF ABOUT 1 percent. THAT'S A FORMULA WHICH YOU MATHEMATICALLY COULD USE ABOUT ONE IN 80 TO THE NUMBER OF PREGNANCY YOU'RE TALKING ABOUT. SO IF TALKING ABOUT A TRIPLETT, ONE IN 80 TO THE POWER OF TWO WILL GIVE YOU THE NATURAL ORDER OF INCIDENTS BUT THAT DOES INCREASE AS A WOMAN GETS OLDER, INTERESTINGLY AND ALTHOUGH A LOT OF THE INCREASE IN MULTIPLE BIRTH HAS BEEN BECAUSE OF THE SUCCESS OF THE REPRODUCTIVE TECHNOLOGIES, THERE IS A BACKGROUND INCREASE INCIDENTS IN THE NUMBER OF MULTIPLES BEING BORN, PROBABLY, IT'S BEEN SPECULATED, NOT PROVEN, BUT PROBABLY BECAUSE AS WOMEN GET OLDER THE CHANCE OF MULTIPLES GETTING OLDER SO THERE IS BACKGROUND INCREASE INCIDENTS.

Maureen says AND WOMEN HAVE HAVING CHILDREN OLDER.

Jon says THEY'RE.

Maureen says WHY IS THAT, YOUR CHANCE OF HAVING A MULTIPLE INCREASES IN AGE? WHAT'S GOING ON BIOLOGICALLY?

Jon says I DON'T THINK ANYONE KNOWS EXACTLY, BUT IT'S PROBABLY GOT SOMETHING TO DO WITH THE FINE-TUNING OF OVULATION AND AS A WOMAN GETS OLDER IT ISN'T AS GOOD AS IT WAS AND COMING UP TO MENOPAUSE WE HAVE MULTIPLE OVULATIONS AS OPPOSED TO THE SINGLE EGG BEING RELEASED AS YOU ARE IN THE YOUNGER FERTILE AGE GROUPS.

Maureen says NOW I SAID THAT THE BIRTH OF QUINTS HARDLY GETS MENTIONED IN THE NEWS, BUT I THINK THOUGH, WITH SOME THE NEW TECHNOLOGIES, PERHAPS INFERTILITY CLINICS ARE STARTING TO CUT BACK ON THE NUMBER OF SAY EGGS IMPLANTED IN IVF MIGHT WE SEE A DOWNWARD TREND IN THIS SNOON.

The caption changes to "Today's topic: Multiple births."

Jon says I THINK THERE HAS BEEN A LOT OF WORK TRYING TO ILLUSTRATE WHAT WE'RE PROBABLY GOING TO BE TALKING ABOUT, THIS INCREASING INCIDENTS AND TO BE HONEST NOBODY WANTS THESE HIGH ORDER OF MULTIPLES. THEY'VE ALWAYS BEEN AS AN OFF-SHOOT OF TRYING TO GET SOMEBODY, A COUPLE PREGNANT WHO HERETOFORE HAVEN'T BEEN ABLE TO BECOME PREGNANT AND THE INDUSTRY AS A WHOLE I THINK HAS BEEN TRYING TO FIND THE TECHNIQUES THAT CAN LIMIT THE NUMBER AND IN FACT IN MANY PLACE, MANY PLACES AROUND THE WORLD IT'S BECOME LEGISLATED AS TO HOW MANY EMBRYOS ARE RE-IMPLANTED AND THAT KIND OF INITIATIVE HAS BEEN SUGGESTED IN CANADA. MANY OF THE HIGHER ORDER MULTIPLES, THE VERY HIGH ORDER MULTIPLES DON'T IN FACT COME ABOUT AS A RESULT OF IN VITRO FERTILIZATION AT THE MOMENT BUT COME ABOUT FROM THE INDUCTION OF OVULATION WITH DRUGS IN WHICH MANY FOLLICLES ARE PRODUCED EVERY MONTH AND THEN THOSE FOLLICLES ARE OVULATED BY A MEDICATION AND THEN FERTILIZATION HAPPENS BY SORT OF INTRA UTERINE INSEMINATION OR EVEN NATURALLY IN SOME CASES SO THOSE LESS ABLE TO BE CONTROLLED THAN HOW MANY EMBRYOS ABLE TO PUT BACK IN. CERTAINLY WHAT WE'RE SEEING IN OUR CLINIC IS THE HIGH ORDER MULTIPLES ARE MORE LIKELY TO BE AS A RESULT OF THAT THAN WHAT WE WOULD CALL PERHAPS THE INAPPROPRIATE PLACEMENT OF TOO MANY EMBRYOS.

A caption reads "moretolife@tvo.org."

Maureen says AND THEN ONCE YOU ARE PREGNANT, I GUESS THROUGH THE INFERTILITY DRUGS AND THE OVULATION WITH MANY FOETUSES, THE ONLY THING TO DO IS SELECTIVE REDUCTION IF YOU DON'T WANT TO CARRY THEM ALL TO TERM.

Jon says WELL THAT IS AN OPTION THAT'S AVAILABLE TO PEOPLE. IT'S AN OPTION THAT MANY PEOPLE FIND VERY DIFFICULT TO DO. IT'S A BIG EMOTIONAL, ETHICAL MORAL STEP FOR MANY PEOPLE TO ACTUALLY TAKE THAT STEP OF INTENTIONALLY REDUCING, EUPHEMISTICALLY REACCUSING, ALTHOUGH REDUCTION OF THE HIGHER ORDER MULTIPLES CERTAINLY HAS BEEN SHOWN TO RESULT IN A SORT OF BETTER TOTAL OUTCOME FOR PREGNANCY. SO MEDICALLY IT DOES MAKE SENSE, BUT EVEN ACCEPTING THAT MANY PEOPLE HAVE A LOT OF TROUBLE WITH IT. AT THE TIME THEY'LL DO IT AND CERTAINLY, AND THE PEOPLE THAT I SEE AFTERWARDS, WHEN THE BABIES ARE BORN, HAVE A LOT OF TROUBLE COPING WITH IT, SO THE COUPLES ARE REALLY PUT IN A DIFFICULT POSITION, AND AS A MEDICAL PROFESSIONAL WE SHOULD PERHAPS TRY NOT TO PUT THEM IN THAT POSITION IN THE FIRST PLACE IF WE COULD HELP IT.

Maureen says LET'S TALK ABOUT THE RISKS FIRST OF ALL IN THE PREGNANCY WHEN YOU'RE CARRYING MULTIPLES. WHAT ARE THE THINGS YOU HAVE TO LOOK OUT FOR?

Jon says LIKE MOST THINGS IN OBSTETRICS WE'RE TALKING ABOUT MATERNAL OR RISKS TO THE MOTHER AND BABY RISK AS WELL, IF WE'RE TALKING ABOUT THE FOETAL OR BABY RISKS FIRST, THE BIGGEST RISKS FOR MULTIPLE PREGNANCIES IS PRE TERM BIRTH AND DELIVERY, PRE TERM BIRTH IS THE CAUSE OF MOST OF OUR, WHAT WE CALL OUR NEAR-NATAL MORTALITY, A BABY DYING OR NEAR-NATAL MORBIDITY, WHICH IS VIRVEING BUT WITH SOME KIND OF A HANDICAP AND BOTH IN MULTIPLES AM AND SINGLETONS, PRE-TERM BIRTH AND PRE-TERM LABOUR IS THE MOST IMPORTANT CAUSE FOR THESE KIND OF ADVERSE OUTCOMES, AS WE CALL IT. PRE-TERM BIRTH AND PRE-TERM LABOUR IN MULTIPLES IS A MAJOR PROBLEM. EVEN ONLY TWINS, I WOULD SAY, HAVE A 50 percent CHANCE BEING BORN WHAT WE WOULD CALL EARLY, AND THIS NUMBER INCREASES DRASTICALLY AS THE NUMBER OF BABIES ARE BORN. WITH REGARD TO THE MATERNAL RISKS, I WOULD THINK IN MOST CON VOK INDICATIONS YOU CAN THINK OF IN PREGNANCY, SUCH AS HIGHER BLOOD PRESSURE OR DIABETES OR THE CHANCE OF BLEEDING ARE ALL INCREASED AS WELL IN THE MULTIPLE PREGNANCY. SO THERE IS A MATERNAL HEALTH RISK OR CONSEQUENCE, I WOULD CALL IT, FOR THE MOTHER AS WELL.

Maureen says AND THIS PRE-TERM DELIVERY, IS THAT JUST A MATTER OF THEIR RUNNING OUT OF ROOM AND THE BODY SAYS IT'S TIME TO GO, I HAVE NO MORE ROOM IN HERE?

Jon says WELL, I WISH WE KNEW. IT'S A LITTLE BIT EMBARRASSING, I WOULD THINK TO TO SAY, DESPITE THAT THIS IS THE BIGGEST PROBLEM WE'RE FACING, WE STILL IN THE YEAR 2000, 2001 WE DON'T KNOW THE CAUSE OF PREMATURE LABOUR EITHER IN SINGLETONS OR MULTIPLES. THE SPECULATION IS IT'S GOT SOMETHING TO DO WITH A STRETCH REFLEX OF THE UTERUS, WHATEVER CAUSES NORMAL LABOUR IS INITIATED EARLIER BECAUSE OF THIS BIGGER STRETCH REFLEX BUT THERE ARE PROBABLY MANY MECHANISMS OF PRE-TERM LABOUR, ONE OF THEM BEING THE STRETCH REFLEX AND OTHERS BEING THAT WE DON'T REALLY KNOW THE CAUSE OF AND THIS MIGHT BE WRONG.

Maureen says I CAN'T GET THE E-MAIL UP RIGHT NOW BUT WHEN Dr. NANCY DURAND LAST WEEK WAS ON WHO IS A COLLEAGUE OF YOURS, SOMEONE E-MAILED TO TALK ABOUT SHE WAS CARRYING TWINS AND MISCARRIED ONE BUT STILL HAD THE OTHER ONE. HOW COMMON IS SOMETHING LIKE THAN?


Jon says IT DEPENDS WHAT GESTATION OR TIME PERIOD IN THE PREGNANCY YOU'RE TALKING OF. IF YOU'RE TALKING AN EARLY PREGNANCY AND THESE DAYS WITH THE MODERN ULTRA SOUNDS AND REPRODUCTIVE TECHNOLOGY, IT'S POSSIBLE TO IDENTIFY THAT YOU'RE CARRYING TWINS AS EARLY AS FIVE OR SIX WEEKS PREGNANT AND IF YOU LOOK AT THE FOETAL LUSCH OR EMBRYONIC WASTE, IT'S ANOTHER EUPHEMISTIC TERM, BETWEEN SEVEN AND 12 WEEK IT'S VERY HIGH. MAYBE EVEN 20 percent OF PREGNANCIES WILL START OFF AS A MULTIPLE AND THEN BY 12 WEEKS THERE'LL ONLY BE ONE BABY LEFT. THAT'S EVEN GOT NAME, IT'S CALLED THE VANISHING TWIN SYNDROME. MAYBE IT DOESN'T VANISH BUT YOU CAN'T SEE IT ANYMORE AFTER 12 WEEKS. ONCE YOU GET OVER THAT, INTO THE SECOND AND THIRD TIME NEST STER, IT'S MORE UNUSUAL FOR ONE BABY TO DIE AND ANOTHER ONE TO SURVIVE BUT IT'S CERTAINLY NOT AN UNCOMMON EVENT AT ALL, AND CERTAINLY IN THE SCENARIO OF IDENTICAL TWINS, WHEN THEY'RE SHARING ONE PLACENTA CAN BE DANGEROUS IT. CAN AFFECT THE SURVIVING TWIN SO IT IS SOMETHING THAT WE HAVE TO BE CONCERNED ABOUT AND HAVE TO WORRY ABOUT.

Maureen says ALL RIGHT, PERHAPS IF THAT VIEWER IS WATCHING AGAIN, SHE MAY WANT TO RE-E-MAIL HER QUESTION FOR Dr. JOHN BARRETT TODAY, A SPECIALIST IN MATERNAL FOETAL MEDICINE AND THE HEAD OF THE ANTINATAL MULTIPLES UNIT AT SUNNYBROOK AND WOMEN'S HEALTH COLLEGE SCIENCES CENTRE. IF YOU HAVE MULTIPLES, YOU'RE PREGNANT WITH MULTIPLES, IF IT'S A HIGH RISK PREGNANCY YOU'RE CURIOUS ABOUT, IF YOU HAVE STORIES ABOUT BEARING TWINS, TRIPLETS AND MORE GIVE US A CALL.

The phone numbers and email reappear briefly.

Maureen continues KATHY IS IN GUELPH. HELLO.

The Caller says HELLO AND HELLO TO YOU Dr. BARRETT. IT'S KATHY SULLIVAN CALLING.

Jon says HI KATHY, HOW ARE YOU?

The Caller says WELL I'M FINE THANK YOU. I WAS JUST SURFING WHILE ONE MOVE MY GIRL, THEY ARE NOW THREE, IS ACTUALLY SICK WITH A FEVER AND WE SAW YOU AND I JUST HAD TO ECHO SOME SENTIMENTS THAT I KNOW MYSELF AND O'MOTHERS FROM THE MULTIPLE BIRTH CANADA HAVE FELT, I MYSELF, FOR A LITTLE BACKGROUND INFO HAVE SPONTANEOUS TRIPLETT GIRLS, AND MANY MANY OF THE WOMEN THOUGH THAT I KNOW CERTAINLY HAVE HAD TO GO THROUGH FERTILITY PROGRAMMES TO BE ABLE TO GET PREGNANT AND CONCEIVE. AND CERTAINLY AS YOU SAID, IT WAS NOT THEIR INTENTION TO EVER HAVE TWO, THREE HE, FOUR OR FIVE CHILDREN. AND THE AREA I'M CONCERNED ABOUT IS THE IMPACT ON THE FAMILIES ONCE THE CHILDREN ARE BORN. OF COURSE THERE'S ALWAYS THE WORRY OF HOW WELL THEY'RE GOING TO DO, BECAUSE THEY TEND TO BE BORN PREMATURELY, AND ONCE YOU GET THEM HOME, IF YOU'RE SO LUCKY TO GET ALL OF THEM HOME, THE STRESS ON THE FAMILY IS REALLY QUITE INTENSE. THE FIRST YEAR IS VERY, VERY DIFFICULT AND I KICKOFF MY HAT TO ANYONE WHO CAN GET THROUGH IT. AND I THINK THERE'S JUST AN AWFUL... NOT AN AWFUL LOT OF APPRECIATION OUT THERE, WHETHER IT BE FROM THE GENERAL PRACTITIONER FIELD TO THE NEIGHBOUR NEXT DOOR ON JUST HOW DIFFICULT IT REALLY CAN BE, TRYING TO MANAGE ON YOUR OWN.

Maureen says YEAH. THAT'S SOMETHING YOU LOOK INTO A LOT AT THE MULTIPLES CLINIC, IS HOW PARENTS DO AFTER THEY LEAVE THE HOSPITAL.

Jon says THAT'S RIGHT. HI CATHY, NICE TO HEAR FROM YOU AGAIN.
IT'S ONE OF THE AREAS THAT AS A FOCUS AREA WE'RE VERY KEEN TO INVESTIGATE. THE IMPACT OF THE MULTIPLE FAMILY OR THE MULTIPLE BIRTH IS NOT JUST ON THE HEALTHCARE SYSTEM, THE HEALTH OF THE BABY OR THE MOTHER IT IS IN FACT ON THE HEART OF THE SOCIETY. THE LITERATURE, LOOKING AT THE IMPACT THAT THIS MULTIPLE HAS ON THE FAMILY UNIT IS VERY ALARMING. FOR EXAMPLE, IF WE LOOK AT THE USUAL INDICATORS OF FAMILY DYSFUNCTION, DIVORCE, VIOLENCE, CHILD ABUSE, SEPARATION, THEY ARE ALL TWO TO THREE-FOLD HIGHER IN FAMILIES OF MULTIPLE BIRTH AND IF YOU SPEAK TO ANY MOMS OF MULTIPLE, THEY WILL TELL THAT YOU NOTHING CAN REALLY PREPARE THEM FOR THIS KIND OF IMPACT THAT THESE, HAVING THESE BABIES HAVE ON THEM FINANCIALLY, SOCIALLY, INTERPERSONALLY AS THEY GET HOME AND ONE OF THE THINGS WE'RE INVESTIGATING IN OUR CLINICS IS HOW DO WE IMPROVE PARENTS' ABILITY TO COPE WITH THESE BABIES ONCE THEY GET HOME AND TO SORT OF SET UP AN INFRASTRUCTURE. YOU SEE ALTHOUGH THIS IS, THERE'S A HUGE INDUSTRY ALLOWING PEOPLE TO BECOME PREGNANT, THE ONLY SORT OF AGENCY THAT HAS BEEN AVAILABLE TO HELP THESE FAMILIES WHEN THEY GET HOME HAS BEEN AS A VERY SMALL, VOLUNTEER-BASED ORGANIZATION WHICH HAS BEEN CALLED POMBA, NOW IS BEING CALLED MULTIPLE BIRTHS CANADA, WHICH IS RUN BY PARENTS OF MULTIPLE BIRTH WITH NO FUNDING, NO GOVERNMENT SUPPORT, NO INFRASTRUCTURE AND THIS HAS BEEN THE ONLY ORGANIZATION THAT HAS BEEN ABLE TO HELP THESE MOMS COPE WITH THESE HUGE IMPACTS WHEN THEY GET HOME. OFTEN WITH BABIES WITH SPECIAL NEEDS, BECAUSE THEY ARE PREMATURE, AND IT'S REALLY BEEN AN AREA OF NEGLECT, SOMETHING WHICH WE'VE BEEN TRYING TO WORK TOGETHER, WITH GOVERNMENT AND CHARITABLE FOUNDATIONS TO TRY AND GET AN INFRASTRUCTURE TO SUPPORT THESE MOMS WITH MULTIPLES WHEN THEY GET HOME.

Maureen says JUST THE, THE COMMON THINGS LIKE HOW DO YOU FEED THREE BABIES? AND DIAPER... THE DIAPERING COSTS MUST BE ASTRO NUMBER CAL. I KNOW WHEN THE SEPTUPLETS IN THE STATES AND THE OCTUPLETS ARE BORN, COMPANIES SOMETIMES STEP FORWARD IN THE FIRST YEAR TO DONATE THINGS. HOW COMMON IS THAT IF CANADA FOR PARENTS OF MULTIPLES?

Jon says WELL I THINK IT'S PROBABLY MURB AND AS YOU SAY IT'S BECOME PASSÉ NOW, SO JUST BECAUSE YOU'VE GOT THREE OR FOUR, WELL THAT'S NOT EVEN USABLE TODAY. SO WE DON'T REALLY AS I SAY SEE THE HIGHER NUMBERS OF ORDERS OF THOSE BUT THEY'RE CERTAINLY NOT MENTIONED IN THE PRESS AND THESE FAMILIES' NEEDS, BOTH SOCIALLY, FINANCIALLY ARE IMMENSE. AND THEY NEED HELP. AND THERE HASN'T BEEN INFRASTRUCTURE TO HELP THESE PEOPLE.

Maureen says NO. OKAY, KATHY, THANKS VERY MUCH FOR YOUR CALL. WE HAVE AN E-MAIL ABOUT THE HEREDITARY ASPECT OF MULTIPLES.

Maureen reads from a laptop computer and says S.W.'S HUSBAND HAS TWINS ON HIS SIDE. DOES THAT MEAN THEY'RE AT HIGHER RISK OF HAVING TWINS?

sJon says VERY GOOD QUESTION, PROBABLY BUT VERY SLIGHTLY. EVEN THOUGH THEY'RE CALLED FRATERNAL TWINS WHICH IMPLIES SORT OF A MALE THING, FRATERNAL, THE GENE IS PROBABLY MUCH MORE DOMINANT FROM THE FEMALE SIDE SO YOUR CHANCE OF HAVING TWINS IN THE FAMILY IS MORE LIKELY RELATED TO THE MOTHER'S SIDE, ALTHOUGH THE FATHER'S HISTORY HAS A SMALL RELATIONSHIP BUT THE MOTHER'S GENETICS ARE MUCH MORE IMPORTANT.

Maureen says AND WHAT ABOUT THIS? WAS IT A WIVES' TALE THAT THEY SOMETIMES SKIP A GENERATION OR IS THAT JUST SOMEONE'S OBSERVATION?

Jon says WELL IT IS A WIVES' DISPEAL A REASONABLE OBSERVATION AS WELL. IT'S FASCINATING BECAUSE NOW WE ARE MAPPING THE HUMAN GENOME. THERE IS PROBABLY NEW EVIDENCE COMING OUT THAT THERE IS A GENE SOMEWHERE IN US WHICH CONTROLS THE OVULATION, WHICH IS NOT SURPRISING, BUT IT CONTROLS YOUR CHANCE OF HAVING A MULTIPLE. AND WHAT THEY'VE FOUND IS THAT PEOPLE WHO ACTUALLY HAVE THIS GENE, WHEN THEY GO THROUGH FERTILITY TREATMENT ARE THE ONES THAT ARE MORE LIKELY TO RESPOND TO THESE MULTIPLE BIRTHS. IN OTHER WORDS WHY SHOULD SOME WOMEN WHO GOES TO FERTILITY TREATMENT HAVE TWINS AND OTHERS SPOON BY SEVEN? PEOPLE IMMEDIATELY THINK WELL, IT WAS SORT OF MISMANAGEMENT OR INAPPROPRIATE PUTTING BACK OF TOO MANY EMBRYOS BUT IT MIGHT NOT BE. IT MIGHT BE THAT WELL'S GENOME OR HER BIOLOGY WHICH IS RESPONSIBLE FOR THAT WOMAN'S PROPENSITY TO HAVE MORE MULTIPLES. SO THERE IS DEFINITELY A GENE. THE LINKAGE AS WE CALLED IT, IN OTHER WORDS THE WAY THAT IT'S PASSED ON FROM GENERATION TO GENERATION HASN'T BEEN WELL-ESTABLISHED AND IT'S POSSIBLE IT MIGHT SKIP A GENERATION BECAUSE IT'S NOT A DIRECT LINKAGE PHENOMENON BUT IT'S A FASCINATING AREA WHICH THEY'RE STILL INVESTIGATING.

Maureen says LET'S DO THE ANATOMY LESSON AGAIN. FRATERNAL TWINS ARE TWO EGGS THAT COME UP AND ARE OVULATED BY HOW MANY SPERM, OVULATE THOSE TWO EGGS.

Jon says WELL A SPERM DOESN'T OVULATE, IT FERTILIZES.

Maureen says SORRY, HOW MANY ARE FERTILIZING.

Jon says FRATERNAL TWINS OR WE PREFER TO CALL THEM DI-ZYGOTIC TWINS ARE FERTILISED BY TWO SEPARATE SPERMS AND THEN YOU HAVE THE IDENTICAL, OR MONO-ZYGOTIC TWINS, ONE EGG FERTILIZED BY ONE SPERM WHICH THEN AT SOME POINT AFTER FERTILIZATION SPLITS INTO TWO SEPARATE IDENTICAL FOETUSES OR EMBRYOS.

Maureen says IN A SPONTANEOUS MULTIPLE PREGNANCY LIKE KATHY HAD IS ONE MORE COMMON THAN THE OTHER?

Jon says YES, THE FRATERNAL OR THE DI-ZYGOTIC, AND ONE-THIRD OF THE MONO-ZYGOTIC PREGNANCIES.

Maureen says OKAY, GETS TO BECKY IN TORONTO. HI BECKY.

The Caller says Hi, I HAVE A QUESTION FOR THE DOCTOR. MY SISTER-IN-LAW HAS HIGH BLOOD PRESSURE AND SHE'S EXPERIENCING PROBLEMS WITH HER FIRST PREGNANCY AND NOW SHE'S CARRYING TWINS AND SHE'S JUST WONDERING, HER DOCTOR'S BEEN RECOMMENDING THAT SHE GO ON SOME MEDICATION TO CONTROL HER HIGH BLOOD PRESSURE. IS MEDICATION HER ONLY OPTION OR WOULD BEDREST ALSO BE AN OPTION TO DEAL WITH THAT PROBLEM?

Jon says THANK YOU FOR THE QUESTION. CERTAINLY ONCE YOU'VE HAD HIGH BLOOD PRESSURE IN A PREVIOUS PREGNANCY YOUR CHANCE OF HAVING IT AGAIN IN THE NEXT PREGNANCY IS INCREASED AND WE ALSO KNOW THAT HIGH BLOOD PRESSURE IS INCREASED IN MULTIPLES. SO CERTAINLY YOUR SISTER HAS A NUMBER OF RISK FACTORS WHICH WOULD PREDISPOSE HER TO HIGH BLOOD PRESSURE IN THE TWIN PREGNANCY. WHETHER OR NOT A MEDICATION... AND WE OFTEN USE MEDICATION TO CONTROL BLOOD PRESSURE TO ALLOW THE PREGNANCY TO GET TO A LONGER DURATION. WHETHER THERE ARE OTHER METHODS ALONE THAT WOULD CONTROL WOULD REALLY DEPEND ON THE TYPE OF BLOOD PRESSURE, THE LEVEL OF BLOOD PRESSURE AND YOUR SISTER'S OVERALL HEALTH AND RESPONSE TO THE MORE CONSERVATIVE MEASUREMENT. I WOULD SAY AS A RULE WE GENERALLY DO RECOMMEND SOME KIND OF LIMITATION OF ACTIVITY IN SOMEBODY WHO HAS HIGH BLOOD PRESSURE BUT VERY OFTEN WE DO NEED TO USE MEDICATION. AND THERE ARE MANY THAT ARE AVAILABLE THAT ARE, THAT HAVE BEEN USED WIDELY AND HAVE BEEN SHOWN TO PROLONG THE GESTATION SO IF THAT IS WHAT IS RECOMMENDED, I THINK IT WOULD BE A GOOD IDEA TO FOLLOW THAT. WHETHER YOU WANT TO EXPLORE SOME OTHER REMEDIES AS WELL, SUCH AS REST OR SOME OTHER NATURAL APPROACHES, ET CETERA, I'M SURE WOULD BE IN ORDER AS WELL.

Maureen says AND THIS IS A MEDICATION THAT'S BEEN FOUND TO BE SAFE FOR THE FOETUSES WELL?

Jon says THAT'S CORRECT, YES.

Maureen says OKAY. AND THANKS VERY MUCH, BECKY. AN E-MAIL.

Maureen reads from the laptop and says I DELIVERED MY ONE-YEAR-OLD FRATERNAL TWINS BY C-SECTION AT THE AGE OF 426789 THESE WERE MY FOURTH AND FIFTH CHILDREN. THEY WERE BOTH IN THE TRANSVERSE POSITION IN THE WOMB WITH MUCH EXCESS FLUID. WE NARROWLY MISSED UTERINE RUPTURE. THE BABIES CAME 36 WEEKS AND SEEMED HEALTHY. A LITTLE WHILE LATER THEY WERE DIAGNOSED WITH PLAGIOCEPHALY CRANIAL STENOSIS, MISSHAPE PEN HEAD, LOCKED SUTURES. I'D NEVER HEARD THIS BEFORE BUT IT'S BEING IT'S COMMON IN MULTIPLES. THEY'RE BEING TREATED WITH HELMETS.

Jon says THIS IS AN UNUSUAL CONDITION WHICH IS ASSOCIATED WITH THE FAILURE OF THE SUTURES... YOU KNOW THE BUMPS ON THE BABY'S HEAD, TO SEPARATE. AND AS A RESULT THE BABIES' HEADS DO TAKE ON AN UNUSUAL SHAPE. IF AS THE BABIES GROW, AND THE HEAD EXPANDS. I DIDN'T KNOW THAT IT WAS MORE COMMON IN MULTIPLES, AND I SHOULD DO IF I'M AN MULTIPLES EXPERT, SO THANK YOU FOR THAT I SHALL CERTAINLY LOOK IT UP, AND SEE IF IT IS MORE COMMON IN MULTIPLES, BUT OBVIOUSLY YOU'VE DONE YOUR RESEARCH AND KNOW THAT IT IS SO. THANK YOU FOR THAT.

Maureen says WHAT'S THE LONG-TERM PROGNOSIS.

Jon says I BELIEVE IT'S VERY GOOD, IF DIAGNOSED AND TREATED. THE BABIES UNFORTUNATELY HAVE TO HAVE SURGERY BUT WITH THAT IT ALLOWS THE HEAD TO EXPAND AT A NORMAL RATE AND IF THAT'S THE ONLY THING WRONG I THINK THE PROGNOSIS WOULD BE EXCELLENT.

Maureen says WHAT POSITION ARE THESE BABIES IN... WHEN IT'S A SINGLE PREGNANCY WE'RE WORRIED IS IT BREACH, BUM FIRST, SHOULDER... I GUESS THEY COULD BE ANYWAY IN THERE FOR A MULTIPLE PREGNANCY. YOU JUST WANT TO GET THEM OUT.

Jon says CORRECT. WELL, THERE CAN BE ANY COMBINATION, THOSE TWO BABIES AND THERE CAN BE ANY COMBINATION OF HEAD DOWN, SECOND ONE BUM DOWN, VICE VERSA OR TRANSVERSE. STILL THE COMMONEST WAY THAT THEY WOULD PRESENT WOULD BE BOTH BABIES FACING HEAD DOWN, WHICH WOULD BE THE COMMONEST WAY, AND THE SECOND COMMONEST PRESENTATION WOULD BE THE FIRST BABY HEAD DOWN AND THE SECOND BABY BREACH OR BUM FIRST.

Maureen says WHAT DO YOU DO THEN?

Jon says WELL, THAT'S A GOOD QUESTION. UP UNTIL NOW, AND CERTAINLY WHAT WE CURRENTLY DO IS DELIVER... IS PLAN FOR A VAGINAL BIRTH. THERE IS SOME WORK IN PROGRESS NOW SUGGESTING WHETHER OR NOT CAESARIAN SECTION IS MORE APPROPRIATE WITH THAT CIRCUMSTANCE BUT THE EVIDENCE TO DATE SUGGESTS THAT BECAUSE ONCE THE FIRST BABY HAS BEEN DELIVERED AND OPENS UP THE BIRTH PASSAGE, SO TO SPEAK, IT'S SAFE TO DELIVER THE SECOND BABY IN A BREACH POSITION AND THAT'S OUR CURRENT PRACTICE ALTHOUGH THERE IS ON GOING RESEARCH INTO THAT QUESTION.

Maureen says OKAY, LISA IS IN SCARBOROUGH. HELLO LISA.

The Caller says HI.

Maureen says HI.

The Caller says MY QUESTION IS ABOUT OIMT U.G.R. I'M CARRYING TWINES AND I WAS TOLD THAT ONE OF THE TWINS IS A LOT SMALLER THAN THE OTHER ONE AND THEY'RE REALLY CONCERNED THAT IT'S SO SMALL, SO I WAS WONDERING WHAT CAUSES I.U.G. SCOMPRMT HOW COMMON IS IT IN TWINS.

Maureen says AND LISA, SORRY, HOW FAR ALONG ARE YOU.

The Caller says RIGHT NOW I'M ALMOST 38 WEEKS.

Maureen says OH, OKAY.

Jon says HI LISA, THANK YOU FOR THE QUESTION. THIS IS WHAT WE CALL INTRA OUT RUN GROWTH RESTRICTION AND THIS TERM MEANS THAT SOMETHING IS RESTRICTING THE GROWTH OF THE BABY. THERE ARE MANY MANY CAUSES OF INTRAUTERINE GROWTH RESTRICTION. IT IS MOST COMMONLY ASSOCIATED WITH SOME FORM OF PLACENTAL FAILURE, ONE PLACENTA IS NOT GIVING THE BABY AS MUCH NUTRIENTS AS THE OTHER BABY, SO AS A RESULT ONE GROWS NORMALLY AND THE OTHER DOES NOT GIVE AS MUCH TO THE BABY. IT'S VERY COMMON IN DIVISION PREGNANCIES AND BESIDES PRE TERM BIRTH IS RESPONSIBLE FOR MUCH OF THE OTHER PROBLEMS WE GET IN TWIN PREGNANCIES. IT IS MORE COMMON IN IDENTICAL TWINS AS OPPOSED TO FRATERNAL TWINS BUT CAN HAPPEN IN EITHER TIME. IT'S A CONCERNING PROBLEM BECAUSE WE KNOW EVENTUALLY A PLACENTA THAT IS NOT SUSTAINING THE BABY SUFFICIENTLY MIGHT FAIL AND THEN IT THE BABY COULD GET INTO A VERY SEVERE PROBLEM. ON THE COUNTER SIDE IF IT'S BEEN DIAGNOSED AND YOUR BABIES ARE BEING MONDAY FORRED FOR SIGNS OF PLACENTAL DYSFUNCTION NOTHING SHOULD HAPPEN TO YOUR BABY. I WOULD ANTICIPATE, ALTHOUGH I DON'T KNOW YOUR SITUATION IF ONE BABY IS VERY SMALL AND YOU'RE ALREADY 38 WEEKS, DELIVERY WOULD PROBABLY BE PLANNED FOR YOU IN THE NEAR FUTURE.

Maureen says CAN THAT HELP IF YOU THINK THAT THE ONE IS NOT GETTING THE NUTRITION IT NEEDS, DO YOU GO IN AND DELIVER A LITTLE EARLIER THAN THE BABIES ARE TELLING YOU IT'S TIME FOR?

Jon says CORRECT THAT IS WHAT... YOU WATCH THE BABY TO SEE IF THERE'S ANY SIGNS OF BABY DISTRESS IN THE BABY, AND HOPEFULLY BEFORE THAT TIME, THERE'S OBVIOUSLY A BALANCE BETWEEN DOING IT TOO EARLY AND WAITING TOO LATE BUT BY THE TIME YOU WAIT UNTIL 38 WEEKS, AND YOU'VE GOT MATURE FOETUSES, IF YOU'RE WARROAD ABOUT THE GROWTH OF BABY DELIVERY BY ONE METHOD OR THE OTHER WOULD PROBABLY BE ON THE CARDS SOON. IF YOU FIND IT VERY EARLY ON IN THE PREGNANCY WHEN THE BABY'S VERY PREMATURE, THEN IT CAN BE VERY DIFFICULT TO DECIDE ON BALANCE WHAT'S MORE RISKY. THE GROWTH FAILURE OF THE BABY OR THE PRE TERM DELIVERY. THAT CAN BE VERY TRICKY.

Maureen says 38 WEEKS IS VERY GOOD, ISN'T IT, TO GET TO THAT STAGE.

Jon says YEAH THAT'S EXCELLENT. SO YOUR BABY SHOULD BE FINE AT THAT GESTATION EVEN IF ONE IS A LITTLE BIT SMALL.

Maureen says I WAS ASKING THIS BEFORE THE SHOW BUT MAYBE WE COULD TALK ABOUT IT. YOU LIKE TO SEE BABIES GET TO HOW MANY WIEBES BEFORE YOU DELIVER THEM.

Jon says WELL WE LIKE TO GET THEM TO...

Maureen says TO 40.

Jon says WELL TO AT LEAST 38 WEEKS BUT IN TERMS OF THE OUTCOME OF BABIES THAT ARE BORN PREMATURELY, ONCE YOU GET OVER 30 WEEKS, THEN YOU GET A VERY GOOD SURVIVAL RATE AND ALSO A VERY LOW CHANCE OF A SEVERE HANDSY CAP RATE. STILL WITH LOTS OF WORK AND RISK IN THE NEONATAL INTENSIVE CARE UNIT. WHEN LESS THAN 30 WEEKS SURVIVAL IS STILL EXCELLENT THESE DAYS. BABIES AT 26 WEEKS HAVE UPWARDS OF 80 percent TO 90 percent SURVIVAL BUT YOUR CHANCE OF HAVING SOME FORM OF HANDICAP INCREASES THE EARLIER ON. IT'S ALWAYS GOOD TO AIM FULL TERM BUT IF YOU CAN GET OVER THE 30 WEEK MARK YOUR CHANCES OF A NORMAL OUTCOME ARE VERY GOOD.

Maureen says LISA, BEST OF LUCK. I'M SURE IT'S GOING TO HAPPEN SOON FOR YOU. WE HAVE ANOTHER LISA ON THE LINE IN WHITBY. HI LISA.

The Caller says HI. I HAD TRIPLETS TWO AND A HALF YEARS AGO. AND THEY WERE BORN AT 26 WEEKS. THEY'RE DOING REALLY GOOD NOW BUT I WILL LIKE TO HAVE ANOTHER CHILD IN ANOTHER YEAR OR SO, BUT I'M WONDERING, I DON'T WANT TO HAVE MORE THAN ONE THIS TIME, SO HOW, HOW RISKY IS IT FOR ME TO GET PREGNANT WITH MORE THAN ONE THE NEXT TIME? LIKE IT WAS I THINK FURTINEX WE USED AND I RELEASED 12 EGGS. SO I THINK I WAS LUCKY TO END UP WITH JUST THREE KIDS BUT...

Maureen says DON'T WANT THAT AGAIN.

The Caller says I DON'T WANT THAT TO HAPPEN AGAIN.

Maureen says AND IS THERE ANY RESEARCH THAT SAYS SHE MAY NOT NEED FERTILITY TREATMENT FOR THE NEXT PREGNANCY? BECAUSE IS IT NOT EASIER AFTER THE FIRST, AFTER YOU'VE HAD THE FIRST ONE?

Jon says WELL CERTAINLY I HAVE LOTS OF PEOPLE WHO GO THROUGH YEARS OF INFERTILITY AND THEN THEY HAVE TWINS OR TRIPLETS AND I SEE THEM POSTPARTUM AND I SAY OKAY WHAT ARE YOU GOING TO USE FOR CONTRACEPTION AND THEY LAUGH AT ME ALL COME BACK A YEAR LATER PREGNANT SO THAT'S A COMMON STORY. I THINK YOU'VE GOT A GOOD EXAMPLE HOW MANY OF THE HIGHER ORDER MULTIPLES ARE AS A RESULT OF THE SUPER OVULATION OF 12 FOLLICLES AND YOUR CHANCE OF HAVING THE HIGHER ORDER MULTIPLE OR MULTIPLES AT ALL, IF I WAS TO PREDICT IT I WOULD PREDICT YOU'RE ONE OF THESE PEOPLE WITH FERTILITY GENES THAT ARE GOING TO RESPOND YOU REALLY NEED TO HAVE A GOOD CAREFUL TALK WITH YOUR REPRODUCTIVE ENDOCRINOLOGIST AND SAY THAT, YOU KNOW, MAYBE NEXT TIME WE SHOULDN'T OVULATE, WE SHOULD ABORT TH CYCLE AND NOT OVULATE IF I'VE GOT 12 FOLLICLES AND WAIT FOR LESS OR EVEN GO THE I.V.F. ROUTE AND GO FOR THE MORE CONTROLLED IMPLANTATION OF FEWER NUMBERS OF EMBRYO. BUT THERE IS ALWAYS THAT OPTION IN THE REPRODUCTIVE ENDOCRINOLOGY CYCLES OF NOT TO OVULATE. YOU'VE GOT YOUR 12 FOLLICLES, MAYBE I SHOULDN'T USE THIS CYCLE. BUT YOU'RE UP AGAINST... THERE'S TWO SIDES OF THINGS. PEOPLE ARE PAYING LOTS OF MONEY AND WANT A BABY. ON THE OTHER HAND SO YOU'VE GOT THESE 12 FOLLICLES, IT'S VERY TEMPTING BOTH FOR THE PATIENT AND THE DOCTOR SIGH WELL THAT'S WHAT WE WANT, GETS AHEAD AND OVULATE AND SEE WHAT COMES UP. AS A CONSEQUENCE, YOU GET THE HIGHER ORDER MULTIPLES SO YOU'VE GOT TO BE REALLY CAREFUL THEN ABOUT WHEN YOU OVULATE THESE PEOPLE.

Maureen says AND IF YOU SKIP THAT CYCLE?

Jon says THEN YOU CAN START AGAIN THE NEXT CYCLE, PERHAPS GIVE A LOWER DOSE OF DRUGS AND ONLY WAIT UNTIL YOU GET SIX FOLLICLES NEXT TIME. OF COURSE YOUR PREGNANCY RATE MIGHT BE LOW. YOUR CHANCE OF GETTING ANY BABY.

Maureen says AND YOU'RE PAYING per CYCLE.

Jon says AND YOU'RE PAYING LOTS OF MONEY PER CYCLE... WELL, I DON'T KNOW IF IT'S PER CYCLE OR SESSION, IT'S PROBABLY PER CYCLE THAT YOU'RE PAYING AND IT'S THOUSANDS AND THOUSANDS OF DOLLARS. SO THERE'S THESE KIND OF CONFLICTING DECISIONS TO MAKE BUT IF YOU'RE SURE AND YOU'VE BEEN THROUGH WHAT YOU'VE BEEN THROUGH THAT YOU DON'T WANT THE HIGHER ORDER MULTIPLE, THEN YOUR OPTION REALLY SL TO CHOOSE A FERTILITY CLINIC THAT'S GOING TO BE REALLY CAREFUL AND SELECTIVE ABOUT WHEN AND WHAT TECHNIQUE THEY'RE USING.

Maureen says BY GUESS THE FIRST THING TO DO IS GO AHEAD AND TRY TO HAVE A BABY on YOUR OWN.

Jon says ABSOLUTELY IF YOU HAVEN'T BEEN TRYING BY YOURSELF, I WOULD... PEOPLE HAVE FORGOTTEN WHAT NORMAL FERTILITY IS LIKE. BECAUSE THERE'S ALL THESE FERTILITY CLINICS AVAILABLE I OFTEN SEE PEOPLE AND I TAKE THE HISTORY AND I SAY TO MYSELF, BECAUSE I DON'T WANT TO MAKE PEOPLE FEEL GUILTY BUT WHY DID YOU GO TO FERTILITY TREATMENT ANYWAY? THESE ARE PEOPLE WHO'D BEEN PREGNANT... TRYING FOR MAYBE FOUR, FIVE MONTHS, SIX MONTHS AND THEY'VE GONE TO FERTILITY CLINICS BECAUSE THEY DON'T WANT TO WAIT ANYMORE, AND IT SOUNDS CRAZY BUT I SEE IT ALL THE TIME. WHERE AS THE "OLD" DEFINITION OR CLASSIC DEFINITION OF FERTILITY WAS YEAR OF TRYING WITHOUT PREGNANCY. AND I SEE MANY PEEP DISBEL TO FERTILITY... FERTILITY CLINICS WHO HAVEN'T BEEN TRYING FOR A YEAR AND OFTEN THERE'S THE AGE PRESSURE, SHE'S 341 OR 42, I DON'T WANT TO WAIT A YEAR TO FIND OUT I CAN'T. SO I'M GOING TO GO AHEAD AND DO IT AND THAT'S SOMETHING WHICH COULD PROBABLY BE AVOIDED WITH A BIT MORE RESPONSIBLE THINKING ABOUT WHAT'S NORMAL AND NOT NORMAL.

Maureen says VERY GOOD. WE'RE TALKING WITH Dr. JON BARRETT THIS AFTERNOON ABOUT MULTIPLES, HIGH RISK PREGNANCIES AND PARENTING MULTIPLES. SO WE'D EITHER LIKE TO HEAR YOUR STORIES OF HAVING MULTIPLES OR IF YOU HAVE QUESTIONS FOR Dr. BARRETT GIVE US A CALL.

The phone numbers and email reappear briefly.

Maureen says WE'LL GO TO LEANNA IN LINDSEY, HI LEANNA.

The Caller says HI THERE.

Maureen says HI.

The Caller says I HAVE ACTUALLY KIND OF A TWO PART QUESTION.

Maureen says OKAY.

The Caller says THE FIRST PART, JUST A BIT OF A HISTORY. I HAVE TWO KIDS, ONE'LL BE FOUR IN SEPTEMBER, ONE'LL BE TWO IN OCTOBER. I JUST HAD A MISCARRIAGE LAST MONTH AT ABOUT SIX AND A HALF, SEVEN WEEKS. THE FOETUS SIZE WAS ONLY FOUR WEEKS. SO THAT'S WHERE I'M AT AND MY TWO-PART QUESTION IS MY MOM MISCARRIED, OR I GUESS THEY CALLED IT STILL BORN TWIN BOYS AT ABOUT FIVE AND A HALF, SIX MONTHS BETWEEN ME AND MY OLDER SISTER SO I'M WONDERING ABOUT WHEN YOU TALK MORE ON THE MATERNAL SIDE VERSUS THE PATERNAL SIDE THAT MEANS THAT THE RISK IS SLIGHTLY HIGHER ON MY SIDE. MY SECOND PART OF THE QUESTION IS AFTER YOU'VE HAD A MISCARRIAGE, AND I DID HAVE A D AND C, ARE THERE INCREASED RISKS TO RELEASING MORE THAN ONE EGG THE NEXT TIME YOU OVULATE OR IS IT JUST LIKE ANY OTHER NORMAL CYCLE?

Jon says TWO GOOD QUESTIONS. CERTAINLY I WOULD THINK YOUR RISK OF TWINS WOULD BE INCREASED BECAUSE OF YOUR MOTHER'S TWINS. I DON'T THINK NECESSARILY YOUR RISK OF STILL BORN TWINS WOULD BE INCREASED. I'M SURE THAT WAS MANY YEARS AGO PERHAPS AND THINGS MIGHT BE DIFFERENT. I WOULDN'T BE TOO CONCERNED ABOUT THAT HAPPENING TO YOU, ESPECIALLY JUST BECAUSE YOUR MOTHER HAD THIS UNFORTUNATE EPISODE BUT YOUR BACKGROUND RISK OF TWINS WOULD BE HIGHER AND THE OTHER POINT YOU MENTIONED ABOUT D AND C, THEY HAVE SHOWN THAT CONCEPTION IN THE IMMEDIATE CYCLE FOLLOWING EITHER A MISCARRIAGE OR THE CESSATION FROM THE BIRTH CONTROL PILL HAS A HIGHER INCIDENTS OF MULTIPLE CON ACCEPTING SO JUST IN THAT NEXT CYCLE THERE SEEMS TO BE AGAIN... A BODY WHICH HASN'T OVULATED FOR A TIME PERIOD BECAUSE OF THE PILL OR BECAUSE OF MISCARRIAGE DOES A DOUBLE... CATCH-UP OVULATION AND DOUBLE OVULATES. SO CERTAINLY WAIT A COUPLE OF MONTHS, I WOULD THINK TO GET THE BODY GHOOK ITS NORMAL CYCLE TYPE OF PROCESS.

Maureen says THANKS VERY MUCH, LEANNA. WE WERE TALKING ABOUT THE RISK TO THE MOTHER IN A PREGNANCY AND YOU'VE ALLUDED TO THE HANDICAPS IN THE CHILDREN WHO ARE BORN TOO EARLY. CAN YOU TELL US A LITTLE BIT ABOUT WHAT THOSE MIGHT? WHAT DO YOU SEE IN THE CHILDREN?

Jon says THE BIGGEST CONCERN TO EVERYBODY IS CEREBRAL PALSY, AND CEREBRAL PALSY IS AS A RESULT OF AN INSULT AT BIRTH TO THE BABY'S BRAIN, AND BECAUSE THE PREMATURE BRAIN IS MUCH MORE VULNERABLE, AND THE INCIDENTS OF SOME KIND OF CEREBRAL PALSY IS SIGNIFICANTLY HIGHER IN PREMATURE INFANTS. SO THAT'LL BE THE MAJOR RISK WHICH PEOPLE THINK ABOUT. IN ADDITION TO THAT, ONE OF MY COLLEAGUES, Dr. OSTELLO SAID THAT SOME WOMEN'S... HE'S DONE SOME UNIQUE LONG-TERM STUDY SGORK WHAT THEY'RE FINDING IS NOT ONLY IS THERE A VEEB BALANCE PALSY CONCERN, AND CEREBRAL POLS SEE IS OFTEN THOUGHT OF MORE AS A MOTOR, FUNCTIONAL THING BUT COGNITION OR THE WAY THAT PEOPLE THINK, THEIR COGNITIVE ABILITY, THE INTELLIGENCE QUOTA, SOMETHING WHICH WE HAVEN'T REALLY CONCENTRATED ON BECAUSE WE'VE BEEN MORE SORT OF CONCERNED ABOUT LIFE OR DEATH BUT COGNITION CAN ALSO BE IMPORTANT. OTHER SORT OF EFFECTS OF THE SMALL BABY ARE THINGS LIKE THE BLINDNESS, DEAFNESS AND THE IMPACT OF BEING ON A VENTILATOR FOR A LONG TIME CAN AFFECT THE BABY'S LUNGS AND CAN LEAD TO SOME KIND OF CHRONIC LUNG DISEASE. THERE'S FEEDING DIFFICULTIES, A WHOLE RANGE, A SPECTRUM OF THESE IMPACTS THAT THESE PREMATURE BABIES CAN HAVE. AND I DON'T THINK WE EVEN SCRATCHED THE SURFACE IN TERMS OF THE SO-CALLED MINOR LEARNING DISABILITIES, ATTENTION DEFICIT DISORDER, LEARNING DISABILITIES IN SCHOOL WHICH CAN HAVE A HUGE IMPACT ON FAMILIES AND THEIR CHILD AND SOCIETY THROUGHOUT THEIR WHOLE LIFE.

Maureen says ARE RESEARCHERS WATCHING CHILDREN LONG-TERM TO TAKE NOTES OF THESE THINGS?

Jon says CERTAINLY, YES.

Maureen says MICHELE IS IN WATT FORD. HI MICHELE?

The Caller says HI.

Maureen says HI, GO AHEAD.

The Caller says MY SHUS A TWIN AND HE WAS BORN YEARS AGO IN EUROPE AND AT THE TIME MY MOTHER-IN-LAW SAID THAT THERE WERE TWO PLACENTAS SO SHE SAID THAT MY HUSBAND AND HIS TWIN ARE NOT IDENTICAL TWINS. NOW THEY LOOK IDENTICAL, THEIR HAIR IS IDENTICAL, THEY HAVE THE SAME COLOUR EYE, THEY'RE BOTH LEFT HANDED, THEY'RE BOTH 6'2''. I WAS WONDERING IF THERE IS ANY TRUTH TO THAT. THERE'S BEEN A LITTLE BIT OF MYSTERY REGARDING THAT AND I WAS JUST WONDERING IF YOU CAN CLEAR IT UP FOR ME.

Jon says CERTAINLY CAN. YOU CANNOT TELL IF THE TWINS ARE IDENTICAL OR NOT FROM THE NUMBER OF PLACENTAS. ONE THIRD OF IDENTICAL TWINS HAVE TWO SEPARATE PLACENTAS AND THE REASON THAT HAPPENS IS BECAUSE THE EMBRYO SPLITS AT SUCH AN EARLY STAGE, SORT OF WITHIN THE FIRST THREE DAYS AFTER FERTILIZATION THAT TWO COMPLETELY SEPARATE PREGNANCIES ARE AS A RESULT AND I WOULD THINK YOU'RE PROBABLY RIGHT. IF THEY LOOK THE SAME AND THEY'VE GOT SIMILAR CHARACTERISTICS, THEY PROBABLY ARE IDENTICAL TWINS, EVEN THOUGH THEY DID HAVE TWO SEPARATE PLACENTAS.

Maureen says OH, SO THERE YOU GO. DO THEY ALWAYS LOOK THE SAME MORE IN CHILDHOOD THAN THEY DO IN ADULTHOOD? UNLESS THEY MAKE A CONCERTED EFFORT, I SUPPOSE, TO KEEP THE SAME BODY WEIGHT AND COMB THEIR HAIR THE SAME WAY.

Jon says I THINK THAT'S PROBABLY TRUE. THERE'S MORE THAT HAPPENS TO US AS WE GET OLDER THAT CAN AFFECT THE WAY WE LOOK THAN WHEN WE'RE YOUNG. THAT'S PROBABLY TRUE.

Maureen says THE LEFT HANDEDNESS, IS THAT AS A RESULT OF BEING IDENTICAL TWINS?

Jon says YES, THERE'S A VERY HIGH INCIDENTS OF... I'VE FORGOTTEN THE TERM, A HANDEDNESS CONCORD DANSEY IN IDENTICAL TWINS. SO IF ONE'S LEFT HANDED THAT'S VERY HIGH CHANCE THE OTHER ONE WILL BE THE SAME.

Maureen says TWINS BECOME VERY POPULAR LATER ON IN MEDICAL RESEARCH BECAUSE THEY LIKE TO LOOK AT THE EFFECTS OF DIFFERENT THINGS ON IDENTICAL TWINS I TAKE IT. DO THEY... HOW CLOSE IS THEIR DNA EXACTLY?

Jon says A FASCINATING QUESTION. UP UNTIL NOW IT'S BEEN THOUGHT THAT THEY MUST BE IDENTICAL BECAUSE THEY'RE IDENTICAL TWINS, COME FROM ONE SPERM AND EGG THAT SPLIT SO THEY SHOULD HAVE IDENTICAL DNA. AND THE WHOLE REASON THAT TWIN RESEARCH HAS HAPPENED IS BECAUSE YOU CAN FINALLY... OR YOU CAN START TO ANSWER THE QUESTION OF WHAT'S MORE IMPORTANT IN A WAY A PERSON ACTS, THINKS, INHERITS DISEASE, NATURE VERSUS NURTURE, THE WHOLE CONTROVERSY, SO THE TWINS WERE AN IDEAL SORT OF BIOLOGICAL EXPERIMENT FOR THAT. NOWADAYS WHEN THEY'VE GOT DOWN TO WHAT WE CALL BASE PAIRS, WHICH ARE THE FINAL TINY PARTICLES WHICH MAKE UP OUR CHROMOSOMES, NOT THE BIG PICTURE BUT THE TINY TINIEST BUILDING BLOCKS OF WHAT IS PART OF OUR GENETIC MATERIAL THEY'RE FINDING A FAIRLY SIGNIFICANT AMOUNT OF DISCORDANCY. IN OTHER WORDS THE BASE PAIRING, THE ACTUAL MOLECULES ACTUALLY ARE SIGNIFICANTLY DIFFERENT IN MANY IDENTICAL TWINS. THE LAST CONFERENCE I WENT TO THERE WAS A WHOLE SESSION, DESCRIBING ARE IDENTICAL TWINS REALLY IDENTICAL? SO THAT'S A FASCINATING, EVEN THE SMALLER WE GET AND THE CLOSER WE LOOK WE'RE FINDING ACTUALLY WHAT WE WOULD THINK OF QUITE CONSIDERABLE DIFFERENCES IN THE DNA OF IDENTICAL TWINS.

Maureen says THAT'S INTERESTING. LET'S GO NEXT TO, IS IT SHAMS IN SCARBOROUGH? YEAH, HI SHAMS.

The Caller says HI, HOW ARE YOU?

Maureen says GOOD THANKS.

The Caller says OKAY, I HAVE A QUESTION FOR Dr. JON. I'M 24 WEEKS PREGNANT FOR TWINS. AND I HAVE A BIG SIZE UTERUS, IT'S REALLY BIG, LIKE A BASEBALL SIZE, AND THE DOCTOR SAY I GOING TO HAVE A C-SECTION. SO I'M 28 YEARS OLD, SO THE SAME TIME HE DOESN'T SAY THAT IT HAVE TO BE DONE, TAKE OUT THE UTERUS AT THE SAME TIME THAT BABIES, THE C-SECTION, AND AT THE SAME TIME THEY'RE GOING TO TAKE OUT THE UTERUS, TOO. SO IS THAT OKAY FOR ME OR NO? OR ARE YOU GOING TO TAKE ONLY THE FIBROIDS.

Maureen says SO THEY'RE SAYING THEY MIGHT TAKE OUT YOUR WHOLE UTERUS, NOT JUST THE FIBROID?

The Caller says YEAH, IT'S REALLY BIG SIZE. THE SIZE IS REALLY BIG, THAT'S WHY.

Maureen says BECAUSE THE FIBROID IS SO BIG.

The Caller says YEAH.

Jon says LET ME ANSWER THE QUESTION THIS WAY. FIBROIDS IN PREGNANCY CAN CAUSE SIGNIFICANT PROBLEMS IN THE SURGICAL APPROACH TO IF YOU NEED A CAESARIAN SECTION. YOU DON'T HAVE TO HAVE A CAESARIAN SECTION JUST BECAUSE YOU'VE GOT FIBROIDS. VERY OFTEN WE TRY TO AVOID CAESARIAN SECTIONS IF YOU'VE GOT FIBROID AND WE DO C-SECTIONS IF THE FIBROID IS IN FRONT OF THE BABY BLOCKING THE BIRTH CANAL. AS A GENERAL RULE I WOULD SAY WE TRY NOT TO REMOVE THE FIBROIDS AT THE SAME TIME AS A CAESARIAN SECTION BECAUSE IT CAUSES MUCH BLEEDING AND CERTAINLY WE DON'T... ET SPECIALLY IN A YOUNG WOMAN, WE WOULD TRY NOT TO DO A HYSTERECTOMY STATEMENT AS A CAESARIAN SECTION. NOW YOU MIGHT HAVE VERY UNIQUE CIRCUMSTANCES THAT ARE BEYOND THE SCOPE OF THIS PROGRAMME TO DISCUSS IT. OR YOUR DOCTOR MIGHT BE SAYING TO YOU THAT BECAUSE OF THE SIZE OF THE FIBROID THERE IS A RISK PERHAPS OF THIS NEEDING TO BE DONE BECAUSE OF COMPLICATIONS THAT MIGHT ARISE FROM THE SURGERY, BUT THE PLANNING OF SUCH A SURGERY, IF YOU STILL WANT FURTHER PREGNANCIES, WOULD BE HAVE VERY UNUSUAL THING SO I WOULD GO BACK TO YOUR DOCTOR AND CHECK IF YOU, IF YOU'RE HEARING THE SAME THING AS HE'S SAYING, AND GO OVER THIS AGAIN IN DETAIL AS TO WHY YOU CERTAINLY NEED TO HAVE THE HYSTERECTOMY OR IS IT PERHAPS THAT IT MIGHT HAVE TO BE BECAUSE OF THE COMPLICATIONS THAT YOU'RE HAVING WITH YOUR FIBROIDS SO CHECK THAT AGAIN.

Maureen says FIBROIDS ARE ON THE OUT SIDE OF THE UTERUS, RIGHT?

Jon says USUALLY FIBROIDS ARE WITHIN THE UTERINE WALL, COULD BE ON THE INSIDE OUR OUTSIDE AS WELL. THERE ARE DIFFERENT TYPES.

Maureen says WHERE DO YOU SEE THEM? WHEN YOU'RE DOING AN ULTRASOUND?

Jon says YEAH, YOU CAN SEE THEM, FEEL THEM. THEY'RE VERY COMMON, ACTUALLY. MOST WOMEN OVER THE AGE OF 30 WILL HAVE A FIBROID SOMEWHERE.

Maureen says AND THEY'RE NOT URBLGLY A PROBLEM BUT IN THE CASE OF A PREGNANCY, IF YOU... LIKE AS YOU DESCRIBE IT COULD BE A PROBLEM.

Jon says EVEN IN PREGNANCY THEY'RE NOT USUALLY A PROBLEM. THERE ARE JUST SPECIFIC TYPES OF THEM, IF THEY'RE IN THE WRONG POSITION OR COMPLICATE CAN CAUSE A PROBLEM.

Maureen says ALL RIGHT, THANKS SHAMS, GOOD LUCK. DEARARY IS IN OAKVILLE.

The Caller says HI. HI Dr. BARRETT, IT'S KERRY TAVIT HOW ARE YOU?

Jon says I KERRY, HOW ARE YOU?

Maureen says OH, FORMER PATIENTS.

The Caller says I JUST WANTED TO LET PEOPLE KNOW WITH THE PROPER CARE THE OUT KOOCHL MULTIPLE PREGNANCY CAN HAVE A POSITIVE OUT COME. MY QUADRUPLETS ARE ALMOST FOUR YEARS OLD AND THANKS TO THE EXCELLENT CARE OF WOMEN'S COLLEGE AND Dr. BARRETT THEY HAVE NOT HAD A HEALTH PROBLEM AMONG THEM.

Maureen says GOOD! HOW MANY WEEKS WERE YOU WHEN YOU DELIVERED?

The Caller says THIRTY-ONE. AND I DO THINK PEOPLE HAVE OPTIONS IN CARE AND SOMETIMES THEY DON'T REALIZE THAT THEY JUST HAVE TO STICK WITH THEIR LOCAL DOCTOR.

Maureen says SO YOU RECOMMEND SEEKING OUT A SPECIALTY CLINIC.

The Caller says FOR SURE. YOU HAVE TO DO WHAT'S BEST FOR YOU AND FOR THE SITUATION OF YOUR PREGNANCY.

Maureen says WHAT ABOUT PARENTING THE MULTIPLES? HOW WAS YOUR FIRST YEAR?

The Caller says UM, I GUESS OURS WAS SORT OF NOT THE NORM. WE HAD A LOT OF VOLUNTEER HELP AND SUPPORT, SO NOW IT REALLY SEEMS LIKE A BLUR THAT THEY'RE OLDER, BUT WE HAD VERY CARING DOCTORS AND A PEDIATRICIAN THAT ALSO MADE HOUSE CALLS FOR SIX MONTHS.

Maureen says WOW! THAT'S PRETTY GOOD. HOW MANY PEGS TEE CLINICS LIKE THE ONE AT SUNNYBROOK AND WOMENS ARE THERE IN ONTARIO?

Jon says HI KERRY, THANK YOU. WELL THERE IS THE ONLY ONE IN ONTARIO AT THE MOMENT, ALTHOUGH ABOUT FOUR YEARS AGO WHEN WE STARTED THE CLINIC WE REALIZED EXACTLY WHAT KERRY WAS SAYING, THAT THERE IS A HUGE INCREASE IN THE NUMBER OF WOMEN WITH MULTIPLES THAT THESE MULTIPLES REALLY ARE IN MANY CASES HIGH RISK, NEED SPECIAL CARE, AND YET THERE'S NO NEED, AND IT'S IMPOSSIBLE FOR ALL THOSE MULTIPLES TO BE SEEN IN A HIGH RISK CENTRE AND MANY OF THEM DON'T NEED TO BE. CERTAINLY THE QUADRUPLETS WILL PROBABLY ALWAYS NEED TO BE BUT THEY DON'T NEED TO BE SEEN IN THE HIGH RISK CENTRE AND IT DISLOCATES PEOPLE FROM THE COMMUNITY, IT'S EXPENSIVE, TIME CONSUMING AND IT CAN AFFECT JOBS TO ALWAYS COME DOWN TO THE MAIN CENTRES WHICH ARE OFTEN TIMES DOWNTOWN TORONTO. SO HOW ARE WE GOING TO IMPART THE BEST LEVEL OF CARE AND ADVICE TO PEOPLE, THE BEST SUPPORT TO PEOPLE WITHOUT DISLOCATING THEM FROM THEIR DOCTORS, FROM THEIR COMMUNITIES? AND THAT'S WHAT THE CLINIC WAS SET UP TO DO. IN FACT THE CLINIC WAS UNIQUE IN THAT WAY IN THAT IT WAS A HIGH RISK CLINIC, NOT DESIGNED TO DELIVER PEOPLE. OUR AIM IS NOT TO DELIVER PEOPLE IN A HOSPITAL. WE CAN'T COPE WITH ALL THE NUMBER OF MULTIPLES ACTUALLY THAT WE HAVE. OUR AIM WAS TO WORK TOGETHER WITH OTHER OBSTETRICIANS OR CAREGIVERS IN THE COMMUNITY TO TRY AND WORK TOGETHER IN LOOKING AFTER THE PREG NAVES SEES, THAT THE ONES THAT ARE LOWER RISK DELIVER IN THE COMMUNITY HOSPITALS WHERE THEY SHOULD DELIVER AND THE ONES THAT ARE HIGHER RISK CAN PERHAPS GIVE THEIR ADVICE AND THE SUPPORT OF HIGHER RISK CENTRES AND THAT'S HOW WE STARTED THE MULTIPLES CLINIC AND THAT WOMEN SHOULD ONLY COME TOUR CLINIC FOUR FIVE TIMES IN A PREGNANCY AT KEY PARTICULAR POINTS BECAUSE THERE'S CERTAIN TIMES IN PREGNANCY WHERE YOU CAN DO WHAT WE CALL RISK PREDICTION. WE CAN LOOK AT A PREGNANCY PERHAPS AT 24 WEEKS AND SAY TO A WOMAN YOUR RISK OF PREMATURE BIRTH IS LOW, MAYBE NOT EVEN HIGHER THAN A SINGLETON, AND WE DO THAT BY A COMBINATION OF ULTRASOUND TECHNIQUE, MEASURING THE LENGTH OF THE SERVE VIC, PROTEINS IN THE CERVICAL MUECKE CAN YOU WE CAN MAKE PREDICTIONS AND SAY YOUR PREGNANT SEA'S VERY LOW RISK OR HIGH RISK, WE SHOULD PERHAPS TRY THIS OR THIS AND WORK WITH OTHER DOCTORS SO THE CLINIC'S BEEN SUCCESSFUL IN MEDICALLY HELPING WOMEN CHOOSE APPROPRIATE, OR HELP WITH THE PRIMARY PRACTITIONERS CHOOSE THE MOST APPROPRIATE PLACE WHERE A WOMAN SHOULD BE LOOKED AFTER. AT THE SAME TIME AS DOING THAT WE, AS I SAY, HAVE THE EDUCATION FUNCTION OF EXPLAINING TO ONE ABOUT MULTIPLE BIRTH AND SUPPORTING THEM, WHICH EVEN THE LOW RISK MULTIPLE NEEDS.

Maureen says YES.

Jon says NOW THIS CLINIC IS AND WAS UNIQUE WHEN IT STARTED. IN FACT ACROSS THE WHOLE OF CANADA THERE HASN'T BEEN ANOTHER CLINIC LEAK THIS. THE SORT OF SOCIETY OF OBSTETRICIANS AND GYNECOLOGISTS WHICH IS THE UMBRELLA GROUP RECOGNIZE THIS IMPACT OF MULTIPLES. AND IN FACT I HELPED THEM TO COORDINATE A CONSENSUS CONFERENCE LOOKING AT THIS ISSUE, AND FROM THIS CONFERENCE AROSE A SPECIAL S.O.G.C. WORKGROUP AMONG MULTIPLES AND SLOWLY OVER THE LAST THREE YEARS THERE'S BEEN A LOT OF INTEREST ACROSS THE COUNTRY, NOT JUST IN ONTARIO, SETTING UP THIS TYPE OF SPECIALIZED CLINIC. IT'S BEEN MORE OR LESS SUCCESSFUL IN MANY CENTRES. IN TORONTO THERE'S ONLY OUR CENTRE HAVING THE SPECIALIZED CLINIC AT THE MOMENT. BUT LONDON IS CLOSE TO GETTING ONE. ALBERTA IS VERY CLOSE TO IT. THEY'VE GOT A GOVERNMENT GRANT TO HELP THEM DO IT. ACROSS THE COUNTRY HOPEFULLY THERE SHOULD HAVE A... SHOULD BE A NETWORK OF THESE CLINICS THAT ARISING AND TOGETHER WE CAN WORK OUT SOME THE PROTOCOLS THAT WE NEED TO DO. AT THE MOMENT THERE'S JUST... IT'S NOT TO SAY NOBODY CAN LOOK AFTER TWINS, THERE'S CERTAINLY THE APPROACH DO IT BUT THIS KIND OF APPROACH, SHARED CARE APPROACH, EDUCATIONAL APPROACH, MULTIDISCIPLINARY APPROACH IS A UNIQUE ONE WHICH WE STARTED.

Maureen says KERRY SEEMS GRATEFUL. THANKS VERY MUCH FOR YOUR CALL. BEVERLY IS IN WINDSOR. HI BEVERLY.

The Caller says HI. MY QUESTION IS FIRST OF ALL I SHOULD SAY MY AGE. I'M 40. I HAVE THREE CHILDREN. OLDEST, 22, AND THE YOUNGEST IS SIX IN '97 I HAD A MISCARRIAGE AND WE'VE BEEN TRYING TO GET PREGNANT EVER SINCE AND JUST NO LUCK. AND MY MONTHLY PERIOD IS COMPLETELY MESSED UP. MY MAIN QUESTION IS THOUGH WITH INCREASE OF AGE WHAT IS THE PERCENTAGE OF MYSELF HAVING A DOWNS SYNDROME CHILD?

Jon says OKAY YOUR RISK OF A DOWN SYNDROME CHILD OR ANY WHAT WE CALL CHROMOSOME MALEY ABNORMAL CONCEPTION OF WHICH DOWNS SINNED COME IS THE COMMONEST DOES INCREASE WITH AGE. I HAVEN'T GOT MY TABLES WITH ME EXACTLY BUT I BELIEVE AT THE AGE OF 40 YOUR CHANCE OF HAVING A CHROMOSOMALLY ABNORMAL CHILD WOULD BE IN THE ORDER ABOUT ONE IN 80. NOT ALL OF THOSE WOULD BE DOWN, THE DOWNS SYNDROME RISK WOULD BE HIGHER THAN THAT, 1 IN 150 MAYBE. BUT APPROXIMATELY 1 percent OF ALL CONCEPTIONS THAT WOULD RESULT IN A CREME SOME MALEY ABNORMAL... IT MIGHT EVEN BE A LITTLE HIGHER. I'D HAVE TO HAVE MY CHART BUT IT IS AN ISSUE WHICH SOMEBODY ACTUALLY OVER THE AGE OF 35 HAS TO THINK ABOUT. SO THAT'S... YOUR DOCTOR COULD GIVE YOU THE EXACT INCIDENTS OR EVEN A GENETIC COUNSELLING CLINIC.

Maureen says BUT SHE WOULD BE AT HIGHER RISK OF MULTIPLE AS WELL, AS WE TALKED ABOUT EARLIER.

Jon says CORRECT.

Maureen says THANKS VERY MUCH FOR YOUR CALL BEVERLY. TRISH IS IN FRONT. HI TRISH.

The Caller says HI.

Maureen says HI.

The Caller says MY QUESTION IS I HAVE THREE CHILDREN. THE FIRST TWO WERE BORN BY CAESARIAN SECTION AND THE THIRD WAS VAGINAL BIRTH AND HE WAS 9'11... HE WAS 9 NINE POUNDS ELEVEN. THIS PREGNANCY IS TWINS, AND WHAT ARE THE CHANCES OF RUPTURE AFTER A VBAC.

Jon says BIRTH AFTER CAESARIAN SECTION. THERE'S NOT A LOT OF DATA ON THAT BUT WE DO NOT REGARD TWINS AS INDICATION FOR CAESARIAN SECTION IN SOMEONE WHO'S HAD A PREVIOUS CAESARIAN SECTION SO THE ANSWER TO THAT THEREFORE IS PROBABLY NO, THERE'S NO DATA TO SUGGEST THAT THE TWIN PREGNANCY WILL INCREASE YOUR YOU WOULD TRIN RUPTURE RATE THOUGH... AS YOU CAN IMAGINE IT'S NOT A VERY COMMON THING TO HAVE TWINS AFTER CAESARIAN SECTION, AND NONE OF THEM HAVE SHOWN RISKS ALTHOUGH NONE OF THE STUD TREES AS BIG AS WE'D LIKE THEM TO BE. YOU'VE HAD TWO CAESARIAN SECTIONS SO YOUR RISK OF UTERINE RUPTURE WOULD BE HIGHER, YOU THEN HAD A SUCCESSFUL VAGINAL BIRTH SO I WOULD THINK PROVIDED YOUR HOSPITAL, YOUR OBSTETRICIAN AND YOURSELF ARE AWARE OF RUPTURE AFTER TWO CAESARIAN SECTIONS, WHICH YOU OBVIOUSLY ARE OTHERWISE YOU WOULDN'T HAVE HAD YOUR LAST VAGINAL BIRTH IT WOULD BE A REASONABLE THING TO TRY AGAIN WITH PRECAUTIONS ABOUT THE MANAGEMENT AND POSSIBILITY AND DIAGNOSIS OF UTERINE RUPTURE SHOULD IT OCCUR.

Maureen says WHEN DO YOU START TO SEE THAT HAPPENING?

Jon says IT ALMOST ALWAYS ONLY HAPPENS IN LABOUR IN PEOPLE WHO HAVE HAD A PREVIOUS CAESARIAN SECTION. IT'S A RARE THING TO HAT. EVEN WITH TWO CAESARIAN SECTIONS IT PROBABLY ONLY OCCURS IN 2 percent TO 3 percent OF LABOURS BUT IF IT DOES OCCUR IT'S A SERIOUS SIGNIFICANT CONSEQUENCE FOR BOTH MOTHER AND BABY, SO IT CAN BE A PROBLEM.

Maureen says HAVE YOU EVER SEEN THIS HAPPEN IN THE EARLY STAGES OF PREGNANCY, AROUND 16 WEEKS?

Jon says ARE YOU TALKING RUPTURE?

Maureen says YEAH.

Jon says PERSONALLY, NO I HAVEN'T AND I WOULDN'T THINK IT WOULD BE A RECOGNIZABLE THING AFTER JUST A CAESARIAN SECTION. CERTAIN OTHER TYPES OF UTERINE SURGERIES...

Maureen says YEAH NO THIS WASN'T THAT I DID A STORY ON THIS WOMAN IN OTTAWA WHOSE UTERUS WITH EVERY PREGNANCY WOULD RUPTURE AT 16 WEEKS AND SHE'D LOSE THE BABY SO THE OBSTETRICIAN... THIS IS YEARS AGO, TOOK A PIECE OF GORTEX AND WHEN SHE GOT PREGNANT AGAIN HE SEWED A LINER OVER THE PLACE IT RUPTURED, KEPT HER IN BED FOR THE LAST I DON'T KNOW HOW MANY WEEKS AND HE BROUGHT THE BABY TO LIKE 36 WEEKS AND DELIVERED IT.

Jon says WHY DID IT RUPTURE?

Maureen says I DON'T KNOW, IT WAS LIKE A DEFECT. YOU COULD ACTUALLY SEE HOW WEAK IT WAS, FIN.

Jon says MUST BE A CONGENITAL...

Maureen says YEAH, SURE. SUSAN IS IN HAMILTON.

The Caller says HELLO?

Maureen says HI.

The Caller says HI, MY QUESTION IS I HAVE A TWIN SISTER, WE WERE BORN 36 YEARS AGO, AND I WAS FOR YOU POUNDS 15 OUNCES AND MY TWIN WAS 8 POUNDS SIX AND MY PARENTS HAVE ALWAYS MAINTAINED WE WERE ACTUALLY CONCEIVED A MONTH APART BECAUSE THE DOCTORS HAD TOLD THEM THAT BACK IN 1965 AND I'VE ALWAYS QUESTIONED THAT ALL MY LIFE BECAUSE I JUST DIDN'T THINK IT WAS PHYSIOLOGICALLY POSSIBLE. SO I'M WONDERING IF YOU COULD STRAIGHTEN THAT OUT FOR ME. AND I HAVE ANOTHER QUESTION ACTUALLY, I'M SEVEN WEEKS PREGNANT AND I'M SUFFERING DREADFUL DREADFUL NAUSEA AND I'M WONDERING HOW COMMON IS IT TO HAVE EXAGGERATED MORNING SICKNESS SYMPTOMS WITH A MULTIPLE? BECAUSE I DON'T KNOW IF I HAVE MULTIPLE BUT IT'S POSSIBLE BECAUSE I DO HAVE A TWIN AND ACTUALLY MY OTHER SISTER'S PREGNANT WITH TWINS RIGHT NOW AND IT JUST SEEMS TO BE RAMPANT.

Maureen says OKAY, DO YOU WANT TO DO THE SECOND QUESTION FIRST.

Jon says I CAN DO THE SECOND QUESTION FIRST. CERTAINLY INCREASED NAUSEA OR HIGH PAREMESIS IS MORE COMMON IN MULTIPLES AND YOU'RE A SITTING DUCK FOR A MULTIPLE SO GO GET AN ULTRASOUND SCAN BECAUSE IF YOU'VE GOT EXCESSIVE NAUSEA THAN YOU WOULD HAVE IN YOUR PREVIOUS PREGNANCY...

Maureen says AND YOU CAN TELL AT SEVEN WEEK?

Jon says AT SEVEN WEEKS AN ULTRASOUND CAN SEE TWO SACKS. CERTAINLY WITH A TRANSVAGINAL SCAN YOU WOULD BE ABLE TO SEE IT. YOUR FIRST QUESTION IS FASCINATING, I'VE ACTUALLY SEEN A CASE OF A WHAT WE CALL... IT'S GOT A NAME FOR IT SUPER FECUNDATION, AND IT IS... IT HAS BEEN DESCRIBED, CLEARLY WELL-DOCUMENTED OF TWO CON ACCEPTINGS A MONTH APART SO USUALLY A WOMAN'S BODY WILL STOP CONCEPTION ONCE ONE BABY'S CON RECEIVED BECAUSE IT STOPS OVULATING BUT OCCASIONALLY, VERY VERY RARELY, I DON'T KNOW HOW MANY ONE IN ONE HUNDRED THOUSANDS OR MILLIONS IT DIFFERENT AND IT IS WELL DESCRIBED. THE USUAL SCENARIO IS IN YOUR SITUATION ONE BABY IS GROWING WHILE ANOTHER BABY'S GROWTH RESTRICTED LIKE WE DESCRIBED EARLIER. SO IT'S SOMETIMES VERY DIFFICULT TO TELL WHICH IS WHICH. THE CASES THAT HAVE BEEN WELL-DOCUMENTED AND DESCRIBED, THE FIRST CASE, IT WAS REALLY DOCUMENTED AND PROVEN TO BE DIFFERENT, WAS A MOTHER WHO HAD TWINS WHICH WERE RAURBLLY DISTINCT, A MONTH APART.

Maureen says I THOUGHT I READ ABOUT THIS IN THE INQUIRY.

Jon says YEAH, THAT'S A TRUE MEDICAL CASE FROM A LONG TIME AGO. THESE DAYS... AND SINCE THEN THERE HAVE BEEN OTHER CASE PROVEN BY DNA AS OPPOSED TO OTHER WAYS BUT CERTAINLY IT COULD BE THE CASE, AND AN ASTUTE PEDIATRICIAN COULD TELL THE DIFFERENCE BETWEEN A GROWTH RESTRICTED BABY AND A BABY THAT'S A MONTH EARLY AS WELL, DEPENDING ON WHEN THE BABY WAS BORN. SO YOU COULD, EVEN 36 YEARS AGO PERHAPS LOOK AT A BABY AND SAY THIS BABY LOOKS 38 WEEKS, THIS BABY LOOKS PREMATURE, IT LOOKS 34 WEEKS, AS OPPOSED TO LOOKING LIKE A 38 WEEKER WHICH HASN'T GROWN.

Maureen says THERE'S NO WAY THE DNA WITH THE TWO SISTERS COULD DETERMINE THIS NOW?

Jon says NO, BECAUSE IF IT'S THE SAME PARENT IT'LL BE THE SAME DNA SO NOW, I DON'T THINK THERE'D BE A WAY TO TELL...

Maureen says LET ME GET THIS STRAIGHT. MY SIBLINGS AND I HAVE THE SAME DNA BUT NOT AS MUCH THE SAME AS IDENTICAL TWINS, RIGHT NUMBER.

Jon says CORRECT.

Maureen says BUT WHAT ABOUT FRATERNAL TWINS AND MY SIBLINGS?

Jon says THEY'D BE EXACTLY THE SAME AS YOU AND YOUR SIBLINGS.

Maureen says THAT'S RIGHT. I THOUGHT HE WAS GOING SAY THAT, SO ONLY IN THE TABLOID, SUSAN, BUT APPARENTLY IT HAPPENS. ROBIN IS IN OSHAWA.

The Caller says HI.

Maureen says HI.

The Caller says I JUST WANTED TO SAY THREE YEARS AGO I HAD TWINS DELIVERED AT 27 WEEKS BY YOU, ACTUALLY, AS A RESULT OF TWIN TWIN TRANSFUSION AND THEY WERE BORN BY CAESARIAN SECTION BECAUSE ONE OF MY BABIES WAS IN SEVERE TROUBLE. MY QUESTION IS BECAUSE PREMATURE BABIES' SKULLS ARE SO FRAGILE, IS THERE LESS CHANCE OF A DISABILITY DURING A C-SECTION THAN A VAGINAL BIRTH? AND WHY WOULD DOCTORS RATHER TRY A VAGINAL FIRST?

Jon says HELLO. THERE'S NO EVIDENCE THAT CAESARIAN SECTION PROTECTS PREMATURE BABIES OVER VAGINAL BIRTH OTHERWISE WE'D ALWAYS DO C-SECTIONS FOR PREMATURE BABIES, WHICH WE DON'T. THE SOFTNESS THE SKULL DOESN'T SEEM TO BE A PREDISPOSING THING FOR BRAIN DAMAGE, ALTHOUGH INTUITIVELY YOU'D THINK IT MIGHT BE BUT THEY HAVE LOOKED CLOSELY AT STUDIES ON PREMATURE BABIES, C-SECTION REMEMBERS US VAGINAL BIRTH BUT THERE HASN'T BEEN AN ADVANTAGE TO IT. IT MIGHT NOT BE TRUE IN THE CASE OF A BREACH BABY AND IN BABIES BORN BREACH THERE MIGHT BE AN ADVANTAGE FOR CAESARIAN SECTION IN THE PREMATURE INFANT BUT CERTAINLY BABIES BORN HEAD FIRST THERE DOESN'T SEEM TO BE THAT ADVANTAGE.

Maureen says OKAY. WE TALKED A LITTLE BIT ABOUT BEDREST IF THERE'S HIGH BLOOD PRESSURE. SHOULD WOMEN CARRYING MULTIPLES CUT BACK ON EXERCISE, JUST TAKE A LITTLE BIT EASIER THAN WOMEN WITH ONE BABY?

Jon says THERE IS NO EVIDENCE AT ALL THAT ROUTINE BEDREST PROLONGS PREGNANCY IN MULTIPLE PREGNANCY. THERE HAVE ACTUALLY BEEN QUITE GOOD RANDOMIZED CONTROL STUDIES... ACTUALLY USE OF HOSPITAL BEDREST IN PATIENTS, PUT THEM IN HOSPITAL ROUTINELY AND THE HOSPITAL DIDN'T... PREGNANCY DIDN'T LAST LONGER BY STAYING IN HOSPITAL. WE'RE GETTING A BIT BETTER NOW AT PREDICTING WHICH WOMAN IS MORE LIKELY TO BENEFIT FROM INTERVENTION. IF YOU TAKE A WHOLE ROOM OF WOMEN, NONE AT GREAT RISK FOR PREMATURELY DELIVERING, PUT HALF OF THEM IN BED IT'S NOT SURPRISING YOU DON'T BEHIND IN ANY DIFFERENCE. WHEREAS IF YOU HONE IN YOUR DETERMINING WHICH ARE AT RISK, PERHAPS THEY MAKE A DIFFERENCE BUT AGAIN WE STILL DON'T KNOW THAT YET.

Maureen says WHAT ABOUT EATING FOR THREE OR FOUR OR FIVE? WHAT ARE THE WEIGHT RESTRICTIONS I GUESS WHEN YOU'RE CARRYING MULTIPLES?

Jon says WEIGHT IN PREGNANCY, I THINK IT'S AN IMPORTANT THING TO WOMEN. THEY ALWAYS WANT TO KNOW HOW MUCH WEIGHT AM I GAINING? AND THERE IS STILL A LOT OF CONCEPTION THAT HOW MUCH I EAT IS GOING TO MAKE A DIFFERENCE TO HOW MUCH MY BABIES WEIGH, AND I WISH THAT WERE TRUE BUT IT PROBABLY ISN'T. THERE'S NO GOOD CORRELATION BETWEEN WEIGHT GAIN AND BABY WEIGHT GAIN. THERE IS SOME CORRELATION AND MOTHER WHOSE ARE UNDERWEIGHT PERHAPS HAVE BABIES THAT ARE SHOOTLY SMALL ARE BUT THERE ARE CONFOUNDING VARE YAG I CAN'T BELIEVES. MOTHERS ARE UNDER WEIGHT ARE USUALLY UNDER WEIGHT FOR REASONS AND HAVE AN ASSOCIATED REASON, BE IT STRESS OR SMOKING OR OTHER REASONS. THERE IS A MULTIPLES CLINIC IN THE STATES RUN BY A COLLEAGUE OF MINE CALLED BARBARA LU KEMD WHO'S A NUTRITIONIST AND SHE'S GOT SOME DATA TO SHOW THAT MOTHERS... IT WAS IN THE PRESS A WHILE AGO, YOUR VIEWERS MIGHT HAVE SEEN THIS, TO SHOW THAT TWIN MOTHER WHOSE GAIN MORE WEIGHT DELIVER BABIES LATER IN PREGNANCY, BUT REALLY, IF YOU LOOK AT THE DATA CLOSELY, THERE WERE A LOT OF CONFOUNDERS IN THE STUDY. MOST OF THE... THERE WAS IDENTICAL TWINS WHICH HAVE A MUCH WORSE OUTCOME THAN NOT IDENTICAL TWINS WEREN'T EQUALLY BALANCED BETWEEN THE TWO GROUPS. SO YOU'VE GOT TO READ THIS RESEARCH VERY CLEARLY AND CAREFULLY AND THERE'S NOT A LOT OF EVIDENCE TO SHOW HOW MUCH WEIGHT YOU GAIN IN THE PREGNANCY MAKES THAT MUCH OF A DIFFERENCE. ON THE OTHER HAND, EATING WELL, WITH A HEALTHY LIFESTYLE, STRESS-FREE IS IMPORTANT, AND THE BALANCE OF NUTRIENTS IMPORTANT. SUPPLEMENTS ARE PROBABLY IMPORTANT IN MULTIPLES BECAUSE THEY DO TAKE AWAY A LOT FROM YOU. AND THERE ARE GUIDELINES AS TO HOW MUCH YOU SHOULD OR SHOULDN'T WAICHLT BUT IF YOU DON'T PUT ON WHAT THE GUIDELINES SAY, DON'T PANIC ABOUT IT. WHAT'S MORE IMPORTANT IS HOW YOU'RE FEELING, HOW YOUR HEALTH IS AND HOW YOUR BABIES ARE GROWING, INDEPENDENT ON HOW YOU'RE GROWING.

Maureen says AND JUST IN THE LAST MINUTE WHAT DO YOU THINK IS AHEAD IN MULTIPLES, IN RESEARCH AND METHODS OF BOTH PREGNANCY AND DELIVERING?

Jon says I THINK THERE'S THE TWO MAIN THRUSTS STILL IN MY FIELD OF MULTIPLES WOULD STILL BE PRE TERM BIRTH AND PREVENTION AND PREDICTION AND THE INTERVENTIONS PERHAPS THAT WE CAN DO NOW THAT WE'VE IDENTIFIED WHICH WOMEN ARE AT HIGHER RISK, WHAT INTERVENTION CAN WE DO TO MAKE THAT RISK LOWER? DOESN'T ALWAYS FOLLOW THAT JUST BECAUSE YOU KNOW WHAT INTERVENTIONS SOUND LOGICAL WILL WORK. THAT'S THE ONE AREA WHICH I THINK WE'RE GOING TO BE PROGRESSING IN ON, AND THE SECOND IS I THINK WE STILL DON'T KNOW WHICH IS THE BEST WAY TO DELIVER THESE BABIES, ESPECIALLY WITH ALL THESE DIFFERENT POSITIONS WE'RE TALKING. SO THAT'S GOING TO BE ANOTHER NEW AREA OF INTEREST.

Maureen says I HOPE WE TALK AGAIN. THANKS VERY MUCH FOR DOING THIS TODAY.

Jon says THANK YOU.

Maureen says Dr. JON BARRETT IS AN Obstetrician AND HEAD OF THE ANTE NATALS MULTIPLES CLINIC AT SUNNYBROOK AND WOMEN'S COLLEGE HEALTH SCIENCES SECTION. FOR MORE INFORMATION on multiple births...

A slate reads "Society of Obstetricians and Gynaecologists of Canada. www.sogc.org."

Maureen says FOR FAMILIES WITH MULTIPLES AN EXCELLENT RESOURCE FOR SUPPORT AND INFORMATION IS...

A slate reads "Multiple Births Canada, www.multiplebirthscanada.org; 1-866-228-8824."

Maureen says AND THAT'S OUR PROGRAM FOR TODAY. THANKS FOR WATCHING "MORE TO LIFE." I'M MAUREEN TAYLOR HOPING YOU'LL JOIN ME MONDAY THROUGH FRIDAY ONE TO TWO O'CLOCK.

A slate reads "The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances."

Watch: Multiple Births