Saturday, April 7, 2012

BOGO Babies, or Getting Knocked Off My Low-Risk High Horse

Everyone loves a good pregnancy story, right?  I figure I should record it for posterity before it is overwritten in my memory banks by the actual birth.

I found and had three meetings with a wonderful CPM.  We decided to have just one ultrasound - my feeling being that if you are going to have a home birth, there's no harm in ruling out easily-spotted problems.  I was not going to find out the sex.  (I know ultrasounds aren't perfect, but I still feel that the risks of intervention are outweighed by the benefits of information in this case).  So on January 4, 2012, The Husband and I happily drove half an hour to the practice of the OB the midwife works with to have an anatomy ultrasound performed.

Back to the ultrasound room we went, lighthearted enough, even though I always get a little jittery before things like this.  I hopped up on the table, and the guy told me I needed to empty my bladder, and that it was the fullest one he had seen that day.  So I went and did so and hopped back up (I can't believe I was that nimble just four months ago).  Within about 30 seconds, he said, "How many babies were you planning on having?"

"Just the one," I said.

"Well, there are two in there."

I laughed, in a probably mildly unhinged manner, for a couple minutes, then had to be still so he could look at a few more things.  He couldn't do the full anatomy scan on both twins due to scheduling, but he checked their hearts, brains, and also identified the type of twinning.

Thence began a happy, but difficult, January.  I immediately, if sadly, ruled out home birth - just too risky, especially with monochorionic twins, even diamniotic ones.  (No, I didn't know the terms before, but here's the important thing:  they share one placenta but have their own amniotic sacs).  I picked an OB/midwife practice; it was terrible, and I cried at the first appointment.  I then switched practices and it has been great.

The first OB said some pretty terrible things.  Like:  no option of a vaginal delivery unless both twins were vertex; he would induce me when I got to 38 weeks; oh, and in the ever-so-likely even of a c-section, would I like them to tie my tubes "while they were in there?"  Hence the weeping.  My OB now?  Vaginal delivery as long as the presenting twin is vertex (and they are about the same size, not distressed, not preterm, and other reasonable stipulations); no one will say "induction" unless I go to 41 weeks (pretty unlikely); and, in general, a c-section is not the preferred method of delivery.

I had a very hard time admitting I am a high risk pregnancy.  Unfortunately, there's simply no getting around it; monochorionic twins ARE high risk.  They die in utero more often than singletons, whether it's early or late in the pregnancy, even more often than dichorionic twins (twins that do not share a placenta).  They can have Twin-to-Twin Transfusion Syndrome (TTTS), where their mingled circulation can cause one twin to have too much blood, urine, and amniotic fluid while the other has too little of those things.  Placental abruption is more of a danger during delivery.  Heart defects are more likely.  Preterm delivery, and especially very preterm (before 34 weeks) is more frequent.  Going past 40 weeks appears to be more risky with twins than it is with singletons as well.

Having said all that:  I'm happy to say I am being treated as normally as possible, while being monitored very closely.  My midwives (CNMs) have been amazing and are respectful of my general hippie-ness.  I even detect a touch of excitement from them!  Their plan of action has so far included: an in-depth ultrasound that checked for uneven blood flow, heart problems, and a bazillion other things (it took over an hour, and I nearly passed out from being on my back, but at least now I have an iron-clad reason not to be on my back during labor!); twice-weekly non-stress tests staring at 32 weeks; once-weekly biophysical profiles starting at 34 weeks; and growth ultrasounds at each midwife appointment going forward to verify that growth is equal and not slowing too much.  (Unequal growth is a very obvious sign of the previously mentioned TTTS).  Is this a lot of stuff going on from now until birth?  Absolutely, but it's "stuff" that actually improves outcomes, and that's all I ask.  Poke me, prod me, strap three monitors to me twice a week, but improve my chances of having healthy babies!

So, here I am, 34 weeks pregnant with monochorionic/diamniotic girls who are creeping up on 5 pounds each.  Yes, I am uncomfortable, huge about the belly, tired, and I sleep alone because I get up all the time due to a full bladder, heartburn, hunger, or some combination thereof, but I'm awfully close to bringing some kick-ass healthy twins into this world, as close to "the old fashioned way" as possible.  I am controlling what I can, which is mostly what I eat and how much I rest.  I still think those things, especially the eating, are incredibly important.

I realize that I've left out all my feelings about the actual having of two babies thing.  In short, the idea of going from one kid to three so quickly was an incredible shock, but we have mostly processed it.  I don't think we will fully comprehend it until they are here.  But just know... it could happen to you!


  1. Oh, dear. I'm sorry you're subject to all the poking and prodding now, and the shock of a scenario that's so wildly different from what you planned. It sounds like you have two wonderfully healthy babies in there and are taking as much control as possible of your care, however, so it seems that all will work out well in the end.

    I'm in week 25 of an ultrasound-less pregnancy and am planning a homebirth myself. I'm not worried about ultrasound because I'm so fantastically "low-risk," but I feel so very massive this time around that I keep teasing the husband with the possibility that we could become parents to twins. Gulp. Suddenly that possibility seems a bit more real.

    Does your previous midwife feel she would have suspected twins on her own if you hadn't gone in for an ultrasound? I keep telling myself that midwives have such incredibly clinical skills that a good one would *totally* know if a mother were pregnant with multiples as the pregnancy advanced, because they would feel the position of the baby(ies), etc. Perhaps not so much? Eep!

  2. I am 100% positive my midwife would have suspected twins by early February at the latest. Up to my last appointment with her, around December 12, I was measuring normally, so she had no reason to look around for a second heartbeat. It was between then and January that I started measuring ahead of schedule. Any weird symptoms - being extra tired, really nauseous (I still didn't puke), getting bigger faster, etc. - I attributed to it being my second pregnancy/having a toddler to take care of. My weight gain was pretty normal, I think - I started out about 40 pounds lighter than with my daughter, so the weight gain is all different this time.

    I was measuring 3-4 weeks ahead in January; at this point it's more like 6 weeks.

    My husband started making twins jokes sometime around October. The joke's on him now! I had always assumed I would have twins (weird, I know), but after my daughter I forgot all about that adolescent daydream.

    But, again, I think you are right to believe your midwife would detect multiples sans ultrasound. Typically if they suspect multiples they will send you for one just to make sure.

    1. Ah, good. That's comforting!

      Wishing you the best!