Rating: 
Summary: Lacks info, badly organized, much incorrect info
Review: When you find out you're expecting twins, you're bound to have questions. How likely are they to be premature? Will I need bedrest? How likely is a vaginal delivery? An unmedicated birth? How much weight will/should I gain? Most important of all: What can _I_ do to give the babies the best chance of going to term and being healthy?Later you become curious about all aspects of twinning, including some you may never have thought of before: How do conjoined ("Siamese") twins occur? How is twinning inherited, and do twins really "skip a generation?" Can you tell from the ultrasound whether twins are identical or fraternal? What are the odds of identical vs. fraternal twins? Unfortunately, not _one_ of the questions I list above is (in my opinion) adequately addressed by Agnew et al. Space forbids going through all the questions...Unfortunately, induction of labor is not otherwise discussed, despite the fact that many practitioners routinely induce labor at 38 weeks for twins, and even in cases where it is not a general policy, the higher incidence of hypertension and gestational diabetes in mothers of twins probably renders induction more frequent...No exact statistics are given on the following important topics: --percentage of identical vs. fraternal twins --percentage of twins with very low birth weight, low birth weight, or normal weight --similarly, percentage of twins who are very premature, somewhat premature, or full term.. --percentage of twins in good positions for vaginal delivery, and percentage actually delivered by C-section in the U.S. --percentage of mothers on bedrest, tocolytic drugs, or other therapy to stop preterm labor. There is no mention of the new test for fibronectin, used to detect a protein that occurs in the cervical area in the weeks before labor...Very little information is presented on appropriate nutrition and weight gain for twin pregnancies. An average total weight gain "in the realm of thirty-five to forty-five pounds" is noted (p. 30) but no recommendations are made. The only nutritional table (p. 28) is simply the official RDAs for pregnant and nonpregnant women, with _no_ alterations noted for the extra needs of a twin pregnancy, not even the ones previously mentioned in the text, such as extra calcium, or the no-brainers, such as extra calories. (As a matter of fact, I did finally find a recommendation to increase caloric intake to one and a half times that of the singleton level [p. 43], but it was not in the formal section on nutrition, nor was this information accessible through the index, as far as I could make out.) The correlation between higher maternal weight gain and better birth outcomes, which has been clearly established for twin pregnancies (see "Weight Gain in Twin Pregnancies," in _Nutrition During Pregnancy_, Institute of Medicine, Washington, D.C.: National Academy Press, 1990), is apparently not important enough to mention...Of the breastfeeding mothers profiled, one said "I nursed at first because I really felt I had to, but it got a whole lot easier when I made a decision to switch to formula" (p. 206), and another, who said "I loved nursing and it seemed to go well for us" (p. 155), had to quit nursing in order to take medication for severe postpartum depression. Although both scenarios are realistic possibilities, the lack of any better role model leaves the reader with the overwhelming impression that breastfeeding twins is not worth the hassle, surely the opposite of what the authors would say they wished. Similarly, in the "roundtable discussions" that are such a feature of this book, the couples taking part all had bedrest pregnancies, none mentions a vaginal delivery -- except one who had a section for the second twin -- and none mentions going to term, adding to the general impression that twin pregnancy and birth _cannot_ proceed normally. I am afraid that many expectant parents of twins will buy this book because it is the newest on the topic (though the only "up-to-date" aspect of the book is the 10-page list of resources in the appendix...), and because, as advertised on the cover, it is "The only major book on twins written by physicians" Though the medical information given on most topics is far less accurate and less complete than that provided by Elizabeth Noble, whose _Having Twins_, rev. 1991, remains the classic in this field.
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