First Trimester: The
Shock
I had confirmed my pregnancy with my doctor at around 4
weeks through blood tests for HCG (the pregnancy hormone). They give you one
test and then a second 48 hours later with the doctor looking to see if the HCG
has doubled. Given how far along I was, the doctor told me she expected to see
the hormone level at around 150 and double to 300. I had 400 on my first test
and it went up to 1,400 in 48 hours. I asked if this was bad and the answer was
not at all you just have a really strong pregnancy! I remember telling Pat and
him joking, “What if it’s twins?”.
Patrick and I had gone to the OBGYN to confirm our pregnancy
at 6 weeks. During that visit, we had received an ultrasound where we saw one
yolk sac and one small flickering heart on the screen. The doctor was able to
find a strong heartbeat, which he commented that none of his colleagues would
believe he was actually able to find one so soon! We were thrilled, even though
it was only 6 weeks everything was looking so strong and perfect.
At 7 weeks I was hit with REALLY strong morning sickness
that made it difficult to get out of bed, operate like a normal human, watch
any screens, or just literally move. It was like the worst hangover of your
life x 10 (and non-stop!). Given how high my HCG was getting at the beginning the
doctor didn’t seem surprised since high hormones can cause nausea. Since it was
so severe though they wanted me to come in to make sure everything was okay. I
went to the appointment by myself because I figured there was no point in
having Pat miss work for just a simple morning sickness check-up.
At the appointment I was given a prescription for morning
sickness. The doctor said since I was there anyways they might as well give a
quick ultra-sound check. The doctor said, “Do you know you’re having twins?”
But it wasn’t said in an excited manner or in the way one tells people good
news, I know that’s hard to describe but it’s the best way I can put it. I
said, “No I’m not!” She said, “Oh you definitely are, look there is two
flickering heart beats.” I look at the screen and I see exactly what she’s
talking about, except that the two babies (at this point they look like little
bean blobs) seem to be right on top of each other or attached. I ask, “Are they
conjoined or something?” Her response, “That’s what I’m not sure of, I’ve
already paged our ultrasound specialist.” Someone walks into the room and tells
the doctor that the specialist is in an appointment and the doctor responds, “Tell
her it’s an emergency and she needs to leave the appointment asap.” At this
point I’m full on BAWLING tears, I just can’t help it- I’m so scared and I have
no idea what’s going on. My husband isn’t there and I ask the nurse to hold my
hand while the specialist rushed in and starts looking at the screen with the
doctor.
After looking for quite some time at the ultrasounds images;
my doctor tells me that while it’s very early she’s pretty confident they are
monochorionic-monoamniotic twins (also known as Mono-Mono or MoMo twins),
because there were clearly two babies but they were very close with only one
yolk sac. She explained that mono-mono means that my twins share a placenta and
are in the same amniotic sac, unlike most twins that each have their own. About
300 women in the United States get diagnosed with this a year and you have
about a 1 in 30,000 chance of it occurring. It’s not hereditary and it is completely
random; a MoMo pregnancy is considered a medical abnormality.
The main issue is that even if both twins are perfectly
health, since they are in the same amniotic sac they can tangle their cords or
even squeeze each other’s- making it a very precarious situation that you have
literally no control over. Once they are considered to be able to be viable in
a NICU setting (usually around 24-26 weeks), you get moved to be inpatient at a
hospital for daily monitoring with the typical goal of making it to around
32-34 weeks for a mandatory C-section (normal gestation is 40 weeks). Making it
to 24 weeks is completely in the hands of a higher power, so going inpatient is
considered to be a big goal and huge blessing.
The doctor said that after performing a doppler to check
their blood flow they didn’t appear to be sharing any, which meant they weren’t
conjoined. They wouldn’t be able to confirm that though until they got bigger.
I asked her how many times she had seen mono-mono in her career, she said
never.
At this point you begin to be in limbo. Since MoMo is considered
a high-risk pregnancy you need to be transferred over to a Maternal Fetal
Specialist. But the MFM wouldn’t take me until 12 weeks because MoMo’s only
have around a 50% chance of making it until then and really in between there
isn’t anything they or I can do. Luckily, my regular OBGYN wanted to make sure
to see me once a week between 7 and 12 weeks to ensure fetal heartbeats and
separate blood flow. I thank her for this. Not every doctor would want to see
patients weekly in the first trimester, but it brought me an incredible sense
of peace. By week 9 it was also able to be confirmed that they were not
conjoined.
I think the first trimester is one of the hardest in a MoMo
pregnancy. It’s filled with a lot of shock, fear, and grief for the normal
pregnancy you wish you had. Pair this with horrendous morning sickness and I
was one hot mess! I recommend making sure to stay in touch with close friends,
your partner, trustworthy people, and even seeing a therapist to help you
process this very intense pregnancy. Fear can rob you of the joy of pregnancy
but you don’t let it have to.
Second Trimester: The
Wait
The good old fashion wait! This can be one of the toughest
parts of the MoMo pregnancy because you literally have no control over what
happens. As humans we love to have at least the appearance of control- this
pregnancy offers none. My doctors said at 14 weeks they’d love to already have
me inpatient to make sure and know what’s going on minute by minute with the
babies. The problem is that before viability (24 weeks in most NICUs) if
something is going wrong with the babies, there is nothing the doctors can do
as far as medical interventions that would require them to be out of the womb-
like cord entanglement. So the second trimester is really a big ol’ sit, wait,
and have faith that you’ll make it to viability.
Something else that changes in the second trimester is that
you’ll start having A LOT more doctors’ visits. You’ll always have your MFM
appointments, but MFMs tend to not deliver and work in tandem with an OB. So
you’ll have your MFM appointments and your OB appointments. In the second
trimester I was getting an ultrasound almost every week to check in on the
babies. On top of that you’ll have extra special ultrasounds that come with
most high risk pregnancies such as the echocardiograms on the babies, extra
brain screenings, and the option of having a multitude of different blood
tests. MoMos tend to come with abnormalities so the doctor’s like to stay on
top of screenings to ensure that when they get placed in the NICU, the team
will be prepared as possible for their needs.
If you have a large MFM/OB team at a large research hospital
like I do, you’re going to see that each doctor has a differing opinion of what’s
best for a MoMo pregnancy. This is because that while research has shown that
inpatient monitoring after viability is best, there is not enough data to give
a conclusion on the amount or type of monitoring. This leads to varying
opinions by professionals depending on how conservative their style is. One of
the most important things you can ask any of your doctors is, “How many mono-mono
twins have you delivered?” This tells you a lot about their experience and from
there you can ask further questions regarding their style of dealing with MoMo pregnancies.
I’m on a MoMo mom facebook group and recently someone at 16
weeks was told by their doctor that there was cord entanglement. A lot of
people commented that this was totally unnecessary of the doctor to tell the patient
because it’s inevitable with MoMos and will only cause the mom distress over something
they have no control over. If you have MoMos ask your doctor to please not tell
you if they are seeing cord entanglement unless it’s severe. What’s more important
is that blood flow in the cords is good (ask to be kept updated on that!).
At 18 weeks we were told that both babies had a small whole
in their heart with one have a small leak. The doctor told us it was nothing to
worry about and would most likely resolve itself throughout the pregnancy. But
HELLO it’s hard not to freak, right? I got my second scan at 26 weeks and one
baby has no whole and the other still has a small whole but now with no leak.
The moral of this story is that this pregnancy comes with a lot of screening
that most regular pregnancies just don’t get. That means they’re going to catch
things that otherwise wouldn’t be caught in normal pregnancy and usually it’s
issues that can self-resolve. If a doctor doesn’t really seem concerned with something,
there’s no need for you to be either.
Now, a lot of MoMo moms decide not to have any kind of baby
shower because they are too nervous about the pregnancy. At first I also did
not want to have a shower or even set up a nursery. I thought if something happened,
then memories of the shower would just make me too sad. I then had someone tell
me, “If you lose the twins, will you actually regret having a shower to
celebrate the pregnancy?” My answer was no; it wouldn’t make a difference. Your
answer might be different. As hard as this pregnancy is though, I really do
recommend trying to celebrate the pregnancy as much as possible. Even still, I
held back a lot from telling people about our MoMo status. I didn’t make that
public knowledge until I was inpatient as I felt too nervous making that
journey a point of attention. All of this though is a personal decision and
style- I don’t think there’s a right answer and do what’s best for you!
Third Trimester: The
Long Hospital Stay
Okay, so I’m currently in this phase right now so this part
of the blog can’t be as conclusive as I’d like it to be. I can say though that
I’ve been here for three weeks and have a pretty solid grasp of how things
work. If you have a MoMo pregnancy and are reading this, you may have a very
similar schedule. As mentioned above though, because there is no conclusive
research on us in regards to inpatient monitoring (NST- No Stress Test), the experience can
differentiate from hospital to hospital.
From what I see in my MoMo mom group, my time in inpatient
is pretty common. When I was first here I was monitored three times a day for
20 continuous minutes as a time. These 20 have to be a solid 20 minutes of
having both babies on the monitor at the same time, so while it can be 20
minutes- it’s usually an hour. Getting monitored means that you lie your bed
while they have a round sensor placed on each of the babies with an additional
one to measure your contractions; all affixed with stretchy bands. When you’re
first admitted the babies are usually small and therefore move around a ton.
Thus, the stretchy band is pointless and you’ll just have to have your nurse
chase them arounds your tummy to get a solid read. It becomes so much easier as
they get bigger!
By the end of the second week though I was feeling like I
wanted to get monitored more. The doctors didn’t seem to think it would make
too much of a difference but told me if I wanted to move to four times a day,
they would be more than fine with that. That very day I asked for more
monitoring they caught some decelerations of the baby’s heart rate &
contracting that they found concerning so I got bumped up to the Labor &
Delivery floor. The issue with the antepartum floor is that they can only
monitor for up to two hours at a time and they wanted me on for a longer
duration. The L&D floor has the one-on-one staff needed for continuous monitoring,
so they felt it was better for me there. The boys ended up chilling out and I
was able to return back to my normal room after about 24 hours.
For a week I kept ping-ponging from my antepartum floor to
the L & D floor to the point the doctors felt like I should really just be
on the L & D floor permanently. They didn’t think they’d need to deliver me
soon but wanted the capability of longer monitoring if need be. So currently at
29 weeks I’m a resident of the L & D floor but generally on a
four times a day monitoring session about an hour each. While I like that I get
the capability of longer monitoring sessions, L & D is a different vibe
from the antepartum floor. It’s a much more intense environment and the staff
is generally not used to have long-term patients. BUT, L & D has a
beautiful view of the water- so I can’t complain too much!
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