Why did you write this book?

Imagine the feeling you might have if you signed up for a dream cruise, only to find once you get to the port that the boat doesn't exactly look seaworthy. You get on it anyway because the tickets were nonrefundable, and you spend the entire time feeling ripped off. All the while you're struck with the worst case of seasickness the doctor has ever seen, you're confined to your bed for the duration, and by the time it's all over you feel completely worn out – but you tell everyone you see at work the next week that it was the best trip of your life, because you're not about to let them think you're a wimp.

When a woman finds out that she's pregnant, only to discover later that she's having twins, she may very much feel like she's been “duped.” Her fear and insecurities may mount as stories of complications are thrown at her by well-meaning friends. She may go to the bookstore in search for reassurance and find little to comfort her. This woman would give anything for a long talk with a girlfriend who has been where she is and has lived to tell the tale.

I discovered I was expecting twins during the routine “what is it?” ultrasound at 17 weeks, when I saw two hearts side by side. I went numb with fear – fear of pregnancy complications, fear of loss of control over my life and career, and fear of how I could possibly manage it all. I began laughing for fear I'd cry. In my own difficult search for reassurance, I finally picked up a copy of “The Girlfriend's Guide to Pregnancy,” and felt the release that only good humor can bring. I resolved to write a similar book that would give information in a concise format while helping the reader to appreciate her condition in ways I had not been able to.

What is the book about?

Consider it the “Girlfriend's Guide to Pregnancy” for women expecting more than one. I used a humorous and sisterly tone in its creation, and strive to provide accurate medical information while helping the reader to laugh at her unique – and sometimes quite awkward – situation.

I used journal entries from my own twin pregnancy to introduce the chapters (other journal entries are sprinkled throughout) and to give the book a “been there, done that” quality I hope will reassure women and allow them to know that someone else knows exactly what they're experiencing. The chapters focus on coming to terms with the big surprise, eating and exercising for multiples, facing the “woes of pregnancy” with humor, including what to expect in each trimester and during delivery, and handling the logistics of bringing home more than one while striving to become oneself again. Rapid reference guides in the back provide easily searchable information on problems that might be encountered during pregnancy and in the NICU.

Why the tone?

Because by the time you've suffered the shell shock of discovering you are having twins, the one thing you really need, right at that moment, is the ability to laugh. By the time it's all over and you're hopelessly sleep-deprived, you need to be able to read about how miserable you really were – because hormonal amnesia might hit at any minute and you might get the fool idea to give pregnancy another try. And once you've recovered enough to have a social life again, you need to be able to win the “Who Had the Worst Pregnancy Contest” at the baby shower of the next sap that's pregnant.

The “What” Contest?

You know the game if you've ever been to a shower. It's the one where someone asks the pregnant lady when she's due. Then contestant number one talks on and on about the forty-eight hour labor she suffered without so much as a Tylenol. Contestant number two had a five-day labor and the doctor pulled the baby out with forceps. Contestant number three says she tore so badly they couldn't put the pieces back together again, and the winner, contestant number four, lifts her shirt to reveal the C-section scar that hasn't healed in thirty years. The guest of honor (the poor girl) leaves the room to have a panic attack, and the contestants smile smugly to themselves while eating the rest of the cake.

This game is closely related to “My Life is Busier than Your Life,” “We're So Poor We Couldn't Go to Barbados Again this Year,” and “My Kid's Smarter than Your Kid.” It's a wonder no reality shows have yet been planned.

On a more serious note, what are the guides for?

Unfortunately, those of us who are expecting multiples have a few more things that can go wrong with our pregnancy than can other women. Rather than bury them in the book where they are difficult to find, or feature them prominently where they can scare the fire out of someone, I created two sections at the end of the book, one for pregnancy and one for those whose babies are in intensive care. These sections describe in detail the diagnosis, symptoms, treatment and possible complications of the most commonly encountered conditions. The emphasis in both sections is on what the expectant couple can do to prevent the condition or on how they can help the situation be better. I believe that education and empowerment are the most important tools new parents can have in an uncertain situation.

If you had to pick the most important lesson you want the reader to take with them, what would it be?

I believe every woman expecting multiples should read the chapter about nutrition and exercise. As doctors we often focus too much on treating problems once they have happened and not enough on preventing problems in the first place. In my research I came across a study, still used in some parts of the country, that demonstrated that women expecting multiples could reduce their risk of preterm labor and of having low birthweight babies by 25-30% just by eating correctly and focusing on the right amount of activity. I wrote an entire chapter devoted to the calorie and nutrient requirements needed to make that happen. I also focused on how reducing one's level of exertion can delay the need for bed rest, and why some professions (teachers, doctors, and speakers) are at surprisingly higher risk than others for preterm labor.

I also wish more people knew about Postpartum Depression. Women who have high-risk pregnancies are at greater risk for depression as a complication of their pregnancies, and some go through years of misery without a correct diagnosis. I have put a list of symptoms in the book for family members to read and have a whole section on the diagnosis and treatment of the condition. What many don't know is that their babies' mental and emotional development can be permanently harmed if mom is not treated.

Talk more about the nutritional guidelines.

A landmark study showed that a woman can reduce her risk of preterm labor and of delivering babies that are low birth weight (below 5-1/2 pounds) simply by changing the way she eats. A woman expecting twins should plan on a 40-45 pound weight gain by eating about 500 more calories per day per baby. A woman expecting triplets should shoot for about 50 extra pounds by doing the same thing. That translates into about 3000 calories daily for twins, about 3500 for triplets. The type of nutrition she eats is important, too. Specific micronutrients are essential for helping the babies during the pregnancy. Other nutrients have been shown to prevent twin-twin transfusion syndrome, an uncommon complication of certain types of multiple pregnancy.

Is there anything else you'd like the reader to know?

I want the reader to know that she has more control over her body than she may think, even in uncertain circumstances. I hope she learns from the book that finding humor in pregnancy is still possible, perhaps is even more likely to happen because of the bizarre experiences she may have. I wish her to see the sisterhood around her, waiting to help her laugh and get through the craziness. And I want her to know that when all is said and done, she will be herself again, just wonderfully changed by the special situation that is a multiple pregnancy.