That Explains It

I'm starting this blog so that when I go on hospital bed rest for 2 months, my friends' Facebook feeds aren't blown up with endless "I hate hospital food, mumble, mumble."/"Won Monopoly again." status updates. And for the several hundreds of women impacted by a monoamniotic monochorionic (a.k.a. mono-mono, MoMo, or MCMA) pregnancy that lurk the internet for something to read that they can relate to other than stark medical journals.

What does it mean to have conceived monoamniotic monochorionic babies? It means you have been chosen to endure a challenge so heart-wrenching that no matter the outcome, it will alter your life dramatically.

It means you have become pregnant! Your one embryo (yes, warning, sciencey words) is on its way to doing what its been doing since the dawn of time. Cool. But in a mono-mono case, about a week or even two weeks later, that eggling decided hey, it'd be even cooler if I had someone to pass the time with in here, so I'm going to split into two people now.

In a nutshell, fraternal twins are two completely separate eggs from the get-go, and they are SOMETIMES hereditary because if a woman hyper-ovulates (releases more than one egg each cycle), this is something that can be passed onto to her daughters, and her sons can be a carrier of it to his daughters. Fraternal multiples, while a grueling pregnancy I am sure, is a fairly low-risk pregnancy unless you have other health issues going on too.

Identical multiples are not so much black and white, but shades of grey. They are not hereditary because they are in fact a spontaneous act at random with which no scientific explanation is possible. (See, it's getting interesting. Stay with me.) Many people know there are fraternal or identical twins (or triplets, etc.) but many do not understand that there are different kinds within the identical realm, too. The risk that the pregnancy will inherit is dependent on the timeframe in which the embryo (yes, sciencey words) decides to split.

Mono-mono multiples are the most rare kind to conceive aside from conjoined. A MoMo pair (or trio!) has only split once, leaving them to share the same placenta and the same sac in the womb. (Ew, sac? Womb? Sorry, there's no other way to say it.)

The risk of cord entanglement is the main reason this pregnancy is so high risk. It is inevitable and can happen at varying degrees--as well as occur at any given time. Tangles are worrisome; true knots and compression of said tangles are the real danger.

Twin-to-twin Transfusion Syndrome (TTTS) is also another possible danger that occurs about 15% of the time; in layman's terms since they are sharing a placenta, one of the twins could begin to receive less nourishment, causing the other to receive an overload of nourishment. Treatments are available if the case is mild.

If you have been diagnosed with MoMos, your doctors will be watching you very carefully with frequent ultrasounds to follow any and all of the possibilities of the aforementioned dangers. They are looking for normal progress of babies (as they would with any fetus), looking to make sure the size discrepancy between the two does not exceed 20%, the blood flow to the heart, brain, body, and most importantly--cord flow and heart rates.

But what about some tidbits with bulletpoints instead of paragraphs?

Okay.

• Mono-mono twins occur about 1 in 60,000 pregnancies. Mono-mono triplets are possible, but even more rare.

• Mono-mono twins are identical, meaning they will be the same gender

• A stat that floats around the internet therefore it must be true, is that 75% of MoMo pairs are girls (but don't stock up on pink crap just yet...plenty discover manly bits at their anatomy scans.)

• Specialists in the States strongly encourage MoMo moms-to-be to go in for an inpatient hospital stay starting between 24-28 weeks gestation up until they give birth.

• They must always be born through cesarean section. The chance of survival the natural way is extremely grim.

• Most specialists set a goal of a planned C-Section between gestational weeks 30-34. It is my understanding that after week 32, it is a bit of a gamble due to the possibility of cord compression (because there is a high chance that they are tangled). Also, the placenta begins to start to slow down, so since the two are sharing it, it may be safer to go ahead and retrieve them. As the patient, if everything is going smoothly, you DO have a say as to whether you want to take the gamble after 32 weeks or not.

My personal advice if you have just been diagnosed with a mono-mono pregnancy is to:

• Find an obstetrician that specializes in high risk pregnancies as well as multiples
• Find a maternal fetal medicine specialist (MFM)
• Make sure you are covered or at least partially covered medically by insurance
• Do not miss a single appointment or ultrasound unless an emergency arises and you need to reschedule
• Do not use Google to find the answers you need. Talk to your specialists. They have chosen an entire career towards taking care of you and educating you. Make a list of all questions so you do not forget when you see them.
• Explain the gravity of the situation to your friends and family. No one should go through this alone.
• See a nutritionist, or at the very least make sure you are getting an outrageous amount of protein in your diet. This can be accomplished even if you are a vegetarian.
• Hold off on all purchases until you are well into your second trimester/approaching your third trimester. Many MoMo families decide to hold off until the babies are safe and snug in the NICU. It is a personal choice.
• Educate yourself and then let it go. It's out of your hands. Every new doctor I've met was dying to inform me of all the risks, but once I had heard the full scope twice, from then on every new face I was introduced to was told, "Yes, I understand all the risks and I want to continue with my pregnancy. Thank you." That's all it took, they were very sweet and dropped it immediately. Once they know you are in-it to win-it they will move on to how to best take care of you.

Now that you get it, you might want to know what is my story. I'm in my 6th month of pregnancy, so let me back track. A few months after having our first born, we decided to try for another baby. My husband is a twin himself, and we figured it would be nice to have them close in age. We talked so many times about how it would be nice to have twins, an "instant family". For five months, I selfished prayed for twins every night. Once my doctor told me "You're pregnant, my love!" we both knew in our hearts it was twins.

The first month: I had one ultrasound and they couldn't really see anything because I was not that far along. Beta levels have to reach a certain amount before it is visible on a screen. Two sonogram technicians whispered to each other about seeing two things, maybe one was a baby and the other was a polyp (very small tissue growth).

The second month: I had a couple blood tests done to observe my beta levels, and they jumped sky high. This can be indicative of multiples but can also be normal for a singleton. At any rate, it meant the pregnancy was progressing in a healthy fashion. I was still unsettled from my first ultrasound (polyp??) so I brought my husband along with me. Clear as day--twins! But the technician was silent and went to fetch a doctor--never a good sign. She came in and announced they were twins, but they were sharing a placenta and a sac. She went on to say how rare it is and the chance of survival is about 50% and most doctors do not feel comfortable delivering them past 30-32 weeks. She went on to encourage me to terminate the pregnancy to save us the hardship. She left on the note of mentioning since identical twins are technically a malfunction in the development of an embryo, the body will probably miscarry them anyway. Through my tears this doctor was informed that there was no way I could discard two beating hearts. We left and it was downpouring. We spent the busride soaked and reading about the risks and stats on Wikipedia and success stories on blogs. Those success stories on blogs were what gave us hope; not the doctor. We clutched to those before and after pictures of a MoMo twins' journey from a snapshot of their NICU days to a picture of them as thriving young children. I hope to give the same peace to another couple. Without reading those posts or our families' unwavering support (hi! we love you!!), I don't know how we would have gotten through those dark, early days.

The third month: Severe nausea everyday continued to go strong. Switched to a new team of specialists. Ultrasounds showed two heart beats each time, what a relief.

The fourth month: Nausea continued. The ultrasound tech discovered Baby B has a 2 vessel umbilical cord--another rarity. Most babies have a 3 vessel cord. Baby A has the normal 3. Baby B is missing that second artery though. The main problem with lacking that artery means the baby could develop at a much lower weight. Their cords have begun to tangle. Can feel them moving around.

The fifth month: Hi, nausea. Glad you could make it. Every, single, day. The babies' cords have become so entangled in a ball, it is referred to as "a bunch of grapes". The fetal echocardiograph goes smoothly except since it is done early, they need to do another to get all the imaging they need to study the development of their hearts. They have good cord flow, and we focus on that. We discover they are GIRLS! I could feel them starting to get stronger at their ballet moves in there.

The sixth month: Nausea is not only every day, but coming in waves now even when I take my medicine. They are weighing in over a pound a piece and looking healthy. I will have my second fetal echocardiograph to get the rest of their hearts' imaging. Feeling lots of movements; others can see and feel them move from the outside. Able to discern their facial features during ultrasounds (so exciting!). Feeling so blessed to be getting this far. I will be admitted to the hospital for inpatient care around my 26 week mark, just over a week from now.

And now you have been brought up to speed...