And Here’s Another Baby!: Tales of an over-forty twin pregnancy, part two.

We’re pregnant.

These were the words that Ned/Thor/Gunnar and I uttered to ourselves for a week after we got a positive pregnancy test. Over and over and over. By the time we were headed to the ultrasound appointment, I had rearranged bedrooms and furniture in my head a hundred times. I could do this. We could do this. Everything would be okay.

The ultrasound tech was young, and perky. She was chatting with us about our situation, and one or both of us mentioned that this pregnancy was not planned. As she was busy clicking and looking at the screen she said, “You weren’t trying at all?”

NTG gave her a solid, “Nuuuh-ooo. No, no, no, no.”

A few more clicks and she said, “Um, Dad? You may want to sit down for this.” NTG’s head jerked upward, and we looked at each other. “Why?” we asked in unison.

She turned the little monitor towards us and on it, was a little peanut, heartbeat flickering away. The tech said, “Here’s baby,” and she waited a few seconds before she moved the wand on my stomach upward. “And here’s another baby!”

Wait.

What?

Everything stopped.

NTG, I believe, was shaking his head. The tech, delighted that she had discovered twins, because it only happened a few times before, pattered on and on next to me. I felt the dread and awe come over me all at once. As I looked at these two little beings on the screen, I instantly knew they would be healthy and strong. They were here already, after all. Blinked right into existence in my abdomen.

And then she said something else. Almost casually, “So it seems they’re in the same sac, so the midwife practice will give you an OB recommendation, and that doctor will refer you to a Maternal Fetal Medicine specialist.”

I’m pretty sure I said, “Oh. Okay.” I already was aware that a twin pregnancy would boot us out of the midwife practice. I didn’t yet know what was to come.

Stunned, we left the office. Walked out the door. Piled into NTG’s new car. The entire 50-minute ride home, NTG was ratting off exclamations: This is two more college tuitions! Ohmygod, what if they’re girls? That’s TWO weddings! We have to get a bigger car!

I wasn’t thinking in practicality. I was just feeling. And my feelings were that I was in trouble. I was in over my head. I was used to being excessive; it’s part of my personality. This? TWINS? This was too much.

Then I got home and Googled: “Twins in same sac.”

My heart stopped. Twins in the same sac, or monoamniotic-monochorionic twins, are a rare case of twins in which the fetuses share the same sac and amniotic fluid and the same placenta. Basically, when an egg divides and becomes two embryos, if it doesn’t divide all the way, this is what can happen: babies that share a placenta, babies that share amniotic fluid and the placenta, and babies that are conjoined. This handy diagram simplifies it for us. https://en.wikipedia.org/wiki/Monoamniotic_twins#/media/File:Placentation.svg

Now, if you are pregnant and have been to your first ultrasound and are told you have mono/mono twins, and you are reading this: DO NOT PANIC. Yes, this type of twins comes with great risk, but it is extremely rare, and in most cases a subsequent ultrasound will find the babies are in two separate sacs. That little tidbit of information took me a good half hour and ten articles on the internet to find, and was confirmed by a healthcare professional the next day.

I then chose an OB based on my midwife’s recommendation and made an appointment for the next week. NTG came with me, and the first thing she did was recommend an MFM (Maternal Fetal Medicine) practice and told me to call and make an appointment for an ultrasound. I had to tell them yes, I was less than 12 weeks, but we needed to find the membrane and confirm if they were mono-mono twins. And it needed to happen as soon as possible.

This was the scary part. See, the biggest risk to mono-mono twins is cord entanglement. There are a few things that can be done about risks with a shared placenta, but if the cords become entangled, there’s nothing to do but pray and wait it out. It means one or both of the fetuses might not make it.

And it meant if they were mono-mono, we’d have to decide if we wanted to go through all of that, or terminate the pregnancy.

I know. It was heavy. In that week before that first ultrasound with the MFMs, it was all I could think about. I kept telling NTG I couldn’t imagine this was their fate. I mean, they’re here. They exist. Why would that happen only for them to not make it?

The day of the ultrasound, once I was checked in and on the table, the very first thing the tech did when she put that wand on my belly was look for that membrane. And bam! There it was. We ruled out mono-mono twins in an instant.

After the technician was done, I met with my first MFM doctor, whose name was Erin, and she was no nonsense. She told me that we weren’t quite out of the woods yet. The twins were each in their own sacs, but they shared a placenta, which made them monochorionic-diamniotic twins. It meant they were at risk for several things:

1. They could have a uneven placement in real estate on the placenta, meaning that one twin got more space than the other, and therefore one would develop just fine and the other would fall behind.
2. They could have an imbalance in the amniotic fluid, which means one twin would get more than the other.
3. The veins that attach to the placenta could grow into one another, in which then one twin would be “feeding” the other, and therefore have a lag behind in development.

Two of these are treatable. The first one is not (again, pray and wait).

So we prayed. And waited. I didn’t want to tell anyone until we had hit another milestone and could see they were developing. And we sat on this news: surprise pregnancy, twins, high-risk, for months.

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