Initial Stages of Planning - 15 weeks

It's very early to set anything in stone, but our initial plan is home monitoring to begin between 24 - 26 weeks.  In addition to home monitoring I will go in several times a week for ultrasounds.  My peri is agreeable for me to continue home monitoring to 30 weeks if the babies look great.  At that point I would be admitted into the hospital for 24/7 inpatient monitoring.  

During our initial planning we did not discuss delivery.  Delivery for mom twins is typically between 32-34 weeks.  I would love to aim for more towards 35 weeks, but there is not guarantee that I will make it that far.  The bigger the babies get the more danger they are face in compressing their cords so that's typically the reason for 32-234 weeks delivery. 

Here are the twins at 15 weeks facing each other.  TOO CUTE!

The Shock & Reality

Now that you know the nuts and bolts, how are I am feeling?  Initially, I was in a 100% state of shock.  Shock that I have been blessed with twins and shocked that learning the difficulties I face in this pregnancy.  The pregnancy of my 1st born was very smooth.  Minor problem here and there, but nothing that prevented me from carrying to term or enjoying my pregnancy.

I cried for several days straight.  Crying for the a loss of innocence and enjoyment of my pregnancy, crying for what might happen, crying for cryings sake.  I was pretty devastated and scared.

I spent hours online learning all I could.  Reading as many studies as I could, learning from others experiences they shared on online forums, and soaking every piece of information I could

I had a follow-up appointment with the perinatologist two weeks later and was in a much better place about the twins and my pregnancy.  I had a whole host of questions for him.  It was the first time I didn't feel fatalistic about the pregnancy and really felt like everything would be ok.  That the twins would be ok.  That I and my family would be ok.

Mourning the loss of Natural Childbirth

Maybe that's a bit dramatic way to say it, but I am really sad (really sad) about having to have a c-section. Of course this is not at all how I imagined this birth being. I was considering a home birth. My first son was born via vaginal delivery in a hospital with no complications. I got to hold him and breastfeed him immediately.

I know its what's best for my babies, but I have no idea how to start to let go of this disappointment. It's not even the actual birth itself, it's the recovery time. How can I mother two newborn twins and a 3 1/2 year old while recovering from a c-section?

I feel selfish for even feeling this way, but I do. And of course, everytime I begin to think about them in the NICU I just start crying. The loss of that bonding time, the potential difficulties of breastfeeding. I'm just scared and sad.

I have a great team of women around me. My midwife is going to see me concurrently with my peri and ob. On staff with the midwife is lactation consultant who has experience in this area. I am just scared and mourning the loss of the ideal.

Monoamniotic Monochorionic - Nuts & Bolts of MoMo Twins

At our first visit with the perinatologist we learned that as my OB suspected, our twins did not have a separating membrane. They are monoamniotic monochorionic (MoMo Twins).  MoMo Twins are pretty rare counting for 1 in 25,000 to 1 in 60,000 births.  If there was no doubt before, they are special!

What are MoMo Twins?

MoMo twins are by definition identical.  Identical twins are formed when a single fertilized egg splits in the womb.  If the egg splits prior to the placenta being formed each embryo has its own placenta, chorionic sac, and amniotic sac.  If the split occurs after the placenta has begun to form (typically 7-9 after conception) the twins begins to form in the same placenta and sacs. 

Identical Twins

 Monoamniotic Monochorionic Twins

Why are MoMos special?

Besides being a rare occurrence (less than 5% of identical twins pregnancies), momo twins are at risk for health complications due to the close proximity of their umbilical cords in the amniotic sac.  

What are the concerns for the twins?

Momo twins are at risk for cord entanglement, cord compression, and twin to twin transfusion.  

Cord Entanglement - Because the twins have no membrane separating them their umbilical cords can be easily tangled.  Actually, most MoMo twins cords are tangled at some point in during the pregnancy, but severe entanglement can cause fatal complications

Cord Compression - Without a membrane separating them as the twins move around in their sacs, one can compress the other's cords cutting off nutrients and blood flow.

Twin to Twin Transfusion - This occurs when one twin receives the majority of the nourishment in the womb causing the other undernourished and sickly.  

What can be done to help ensure a healthy babies and mom?

First recognizing that carrying multiples is different from carrying a singleton.  May seem obvious, but the needs are different and not always proportional.  Secondly, very little until viability (24 - 26 weeks).  Intensive monitoring of fetal movement, blood flow between the cords and development prior to viability and then increasing post viability.

How does this affect your pregnancy?

My pregnancy is officially considered high risk.  I see my doctor's on average of every 2-3 weeks during the 1st part of pregnancy increasing to 2-3 times a week as my pregnancy progresses.  I get to see the twins often with ultrasounds at every appointment.  Once the twins reach viability I will start with home monitoring 2-3 times a day and multiple weekly ultrasounds to monitor blood flow and development.  At some point yet to be determined, I will enter the hospital for 24/7 monitoring.

What about delivery?

MoMo twins are typically born between 32-34 weeks barring any complications.  Due to cord entanglement they are born via c-section.  Due to their premature arrival, most spend  period time in the Neonatal Intensive Care Unit (NICU).

Surprise!

Although I hired midwives for my care, I had forgotten to cancel my next appointment with my OBGYN. Being to late to cancel the appointment I decided to go ahead and go. What was the harm?

Since this was just a routine appointment, I told my husband there was no need for him to come. When the doctor tried to hear the heartbeat with the doppler she got a strong heartbeat, but baby was moving to much to get a good read. She decided to do an ultrasound just to make sure everything was ok.

In the initial ultrasound she was getting a "shadow," not abnormal for an external reading at this stage of the pregnancy.  She opted for an internal ultrasound which immediately looked to me like their might be two heads. I wasn't sure, after all I am not technician trained to read these things. She moved the screen closer and out of my view (clearly, while she did not say anything, she saw what I saw). After a few seconds of her not saying anything I asked if everything was ok, she said yes, but I have news, there are two!

I was out of breath, but oddly not surprised. I kept asking if she was sure and promptly asked her to hand me my phone so I could call my husband. I took a picture of the ultrasound screen and emailed it to him. I called and had him look at the email as I gave him the news. He was pretty shocked and of course since I was not done with my appointment I had to make the phone call quick.

Staring at the ultrasound was amazing. One baby was in the fetal position that you are used to seeing in the ultrasounds, but the other looked as if it were hugging the first one with its arm wrapped around the other and its leg in a spoon like position. What an incredibly site!

My OB expressed a very small concern that there was not a membrane separating the babies. Not being an expert on assessing multiples, she referred me to a perinatologist who specializes in high risk pregnancies and has more in depth equipment to asses the babies.

1st and 2nd Ultrasounds & Healthcare Decisions

Yay, the first ultrasound at 5 weeks looks great and the follow up ultrasound at 9 weeks we can see the heartbeat. Looks like baby is growing great.

Seeing that the pregnancy was progressing well, I began exploring my birth options. My son who is now almost 3, was born via induction in a hospital. Born at 6 lbs, 13 oz there was no cause for concern. To this day he remains long and lean.

Based on my experience with my first son and other close friends birth experiences I wanted a different experience with this baby. My interest turned into a deeper passion, wanting to help educate and empower other woman on their birth options. I pursued certification as a birth doula through DONA .

Shortly after my nine week appointment I decided to hire midwives for my care and to attend my birth.

We're pregnant!

No missed period yet, but just starting "feeling" like I was pregnant. Low and behold I buy a home pregnancy test and it confirms that I am indeed pregnant. My due date is April 2, 2009.