In a message dated 10/19/2003 9:44:16 PM Eastern Daylight Time, [log in to unmask] writes:

> Since I am a mom of twins myself, I get more than my share of twin moms
> calling me for bfeeding help.  I am so tired of hearing from moms whose "doctor has
> decided to induce early for mom's comfort and because, 
> well, those babies are
> big enough now anyway."  Ugh. 


Due to the very problems you cite re: breastfeeding after delivery at 36 weeks, this meta-analysis may be of interest...

<< From The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd. All rights reserved. 
 
Elective delivery of women with a twin pregnancy from 37 weeks' gestation (Cochrane Review)
Dodd JM, Crowther CA

ABSTRACT 
A substantive amendment to this systematic review was last made on 21 January 2002. Cochrane reviews are regularly checked and updated if necessary.

Background: The optimal timing of birth for women with an otherwise uncomplicated twin pregnancy at term is uncertain, with clinical support for both elective delivery at 37 weeks, as well as expectant management (awaiting the spontaneous onset of labour).

Objectives: To assess a policy of elective delivery from 37 weeks' gestation compared with an expectant approach for women with an otherwise uncomplicated twin pregnancy.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (searched 8 July 2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002) and PubMed (January 1966 to 8 July 2002).

Selection criteria: Randomized controlled trials with reported data which compared outcomes in mothers and babies who underwent elective delivery from 37 weeks' gestation in a twin pregnancy with outcomes in controls who were managed expectantly.

Data collection and analysis: Two reviewers independently assessed trial quality and extracted data. Outcomes listed were collected from the identified trial.

Main results: A single randomised controlled trial comparing elective induction of labour at 37 weeks for women with a twin pregnancy with expectant management was identified. A total of 36 women were recruited to the trial with 17 women allocated to the induction of labour group and 19 women to the expectant management group. For primary outcomes, there were no statistically significant differences between elective induction of labour and expectant management with regards to all caesarean births (relative risk (RR) 0.56, 95% confidence interval (CI) 0.16 to 1.90), caesarean birth for fetal distress (RR 0.37, 95% CI 0.02 to 8.53), or perinatal death (RR not estimable). For secondary outcomes, there were no statistically significant differences between the two interventions with regards to haemorrhage requiring blood transfusion (RR 0.37, 95% CI 0.02 to 8.53), meconium stained liquor (RR 0.10, 95% CI 0.01 to 1.77), Apgar score of less than seven at five minutes (RR not estimable), and infant birth weight less than 2500 grams (RR 0.95, 95% CI 0.49 to 1.82). 

Reviewers' conclusions: The small trial identified was underpowered to detect the outcome measures of interest. Consequently, there are insufficient data available to support a practice of elective delivery from 37 weeks gestation for women with an otherwise uncomplicated twin pregnancy at term. 

Citation: Dodd JM, Crowther CA. Elective delivery of women with a twin pregnancy from 37 weeks' gestation (Cochrane Methodology Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd. >>