My husband and I were quite fortunate in that we got pregnant fast. Without any fertility treatments.
Our first ultrasound was nerve-wracking, the tech looked concerned while watching the screen and immediately I was nervous and expecting the worst. She then turned on the TV so we could see and she said “here is one heartbeat, and here is the second.” I’m sure my eyes were huge. Yanick kept saying “cool!” while I had tears streaming down my face because I had about every emotion possible. I asked if there was a third one hiding at all and she said no.
I was 9 weeks pregnant. With twins. She told us it looks like two sacs so likely fraternal.
We drove home in complete shock.
My doctor phoned the next day and said the early ultrasound can be difficult to see things and recommended I get another ultrasound in two weeks. She also said sometimes people get pregnant with twins and one isn’t viable and may not survive. We had another ultrasound scheduled for when we would be 12 weeks. Felt like an eternity. And with my doctor prefacing the potential loss of one I felt we shouldn’t say anything just yet and wait for the safety of 13 weeks. I began to google everything about twins and already I was learning so much. Twins can have one or two placentas, one or two sacs, they can be identical, fraternal, conjoined, mirrored. It was fascinating. Who doesn’t find twins fascinating?
Our next ultrasound came and we breathed a sigh of relief that both still had heartbeats (and looked oh so cute on the screen).
The next day my doctor called and said that things looked good but one was smaller than the other so she was referring me to a clinic called the Maternal Fetal Medicine Clinic (MFM) in Edmonton, Alberta.
We were excited to share the news since we were days away from the end of 13 weeks. We told our parents and siblings first. It was fun, many of them said they had a hunch, but no one knew about the twin part so there still was a surprise for them.
The next week I went to the MFM at the Royal Alexandra Hospital. It was a very long wait before getting the ultrasound. I assumed Yan couldn’t come to the appointment because of Covid rules at the hospital. When I got there, I discovered he could’ve come and was sad he would miss an ultrasound. Once in the appointment, I was so excited to see the little tadpoles on the screen. At the end of the ultrasound this time a doctor came in to discuss with me the results, rather than waiting for your doctor to phone the following day.
The doctor told me that one was smaller than the other. A was actually quite large and B was quite small. This could be for a variety of reasons: genetic disorder, Down Syndrome, heart or brain issue, or a developmental issue. In the end, she said it could also just be that the baby is smaller and everything is fine, but by this point, I was terrified. She asked if I wanted to get genetic testing done. This could be Chorionic Villus Sampling (CVS) where they take a sample of the placenta through the cervix. Amniocentesis is where they put a needle into the belly and take a sample of fluid. Both of those procedures had a risk, we could lose one, or both. There was a blood test that essentially has no risks but was slightly less accurate, because of the twin aspect. It was a tremendous amount of information to process. I was terrified, alone, and unsure about what to do. They told me to have a seat in the hall and they would see if a genetic counsellor was available to tell me more information. I sat quietly crying in the hall. I tried to text Yan as much information as I could, I didn’t want to phone and have people hear and I also didn’t want to audibly cry. A geneticist came and brought me to her office. She asked what I took away from the conversation I had just had. Through tears, I repeated the findings, options, and risks. She asked if I wanted to phone Yan and put him on speakerphone and I was relieved to feel slightly less alone. We decided to not make any quick decisions. CVS would have to be done within a couple of days if we wanted as it can only be done within a certain window of pregnancy. They also said we could do “selective termination” and stop one or both heartbeats. That part in particular made me feel the saddest.
I remember walking to my car and having a complete meltdown. This was absolutely not what I had imagined. We had gone from being over the moon excited to truly terrified and confused. I called my Mom and told her what happened, my Mom is an Emergency Room Nurse. She’s tough, and this was the first time I could hear fear in her voice.
The following day I phoned the genetic counsellor and said I had been looking online and found something called twin to twin transfusion where one baby is smaller than the other and asked if that could be the issue. She said no, because I had dichorionic, diamniotic twins (two placentas, two sacs). I told her we decided the blood test was the best option. I’m usually a pretty optimistic person, and this was a safe option to give us some insight about the situation.
The blood test had to be taken at the hospital as it was sent to a certain lab. In the waiting room, there was a woman with twins (could’ve been a mom or babysitter). The boys were maybe 2 years old and wild. They were running in opposite directions and licking the windows. I remember thinking that could be me….
A couple of days later the blood test came back and the genetic counsellor told me there were no genetic issues found. I said “what a relief” and she said “well the test is only 99.9% accurate” and I thought how optimistic of her....
I figured we were in the clear. They told us at the clinic that they would follow us throughout the pregnancy. We learned that this was the high-risk pregnancy clinic for Edmonton and Northern Alberta. And it was needed by way more than I imagined. The waiting room was always full and the wait times were hours long.
The next couple of appointments were relatively similar. They would ultrasound the babies, a doctor would come in and tell us one baby is larger and one is smaller and ask if we wanted to do a selective reduction on one or both. They would also say there is a chance one may not survive. It was very bizarre. One Ultrasound Tech we met said “your body isn’t meant to be pregnant with more than one baby at a time, so think of it like you have a litter and one is a runt” which I still think is funny, but I am sure some people wouldn’t appreciate the comment. They also told us that reduction (or termination/abortion) would be an option for us until the 24th-week 6th day.
Throughout this phase of the pregnancy, I kept hoping we would get to 25 weeks because they would stop offering termination. And, at 25 weeks, we were so happy to be in the clear.
Another aspect of pregnancy we learned about is that if a placenta isn’t doing a good job (isn’t providing enough nutrients/blood/oxygen) or if the umbilical cord is also not pumping the blood well enough, they can deliver early and intervene outside the womb. This would mean having a premature baby that goes to the Neonatal Intensive Care Unit (NICU) where they may need a C-PAP machine to help them breathe and a feeding tube. We were fortunate to have a Zoom meeting with a NICU Doctor who did an amazing job of teaching us about premie babies. He gave us scary statistics. Babies born at 25 weeks were at risk of having blindness, deafness, cognitive issues, and gross motor issues. He shared survival rates and how the NICU works. He called the babies “little chickens” and it was evident that he cared deeply for the babies and their families. I was amazed at how he wanted to learn about Yan and me and our concerns.
They told us if the small baby gets to 500 grams (just over one pound) they would consider early delivery. But if the baby doesn’t get to 500 grams and stops growing there isn’t anything they can do. They also told us we should start thinking about what we would do if our small Baby B was in distress. Our options were: to deliver both and accept risks associated with prematurity. Let B pass away and continue on with the pregnancy, essentially giving A more time to grow in the womb and better outcomes.
Let B die to help A, risk A’s life for B. These were impossible decisions.
At this point, ultrasounds were weekly and we’d either hear fantastic news or dreadful news. It was tough. We were helpless.
In the span of a week, we went from passing the 24-week mark, learning about the NICU, preparing for early birth, and passing the 500-gram rule (we later learned from the NICU Doctor that they go by gestational age and not weight), and deciding on what we’d do if something happened to B. We decided we would deliver early and try to save them both. Not an easy decision but I couldn’t let B die after all we’d been through.
Then back at the MFM we go for yet another ultrasound. This time we had Dr. Chandra come in and told us she found that A had more fluid than usual. After virtually every appointment revolving around Baby B, we were confused as to why we were talking about A. She mentioned that it almost looked like Twin to Twin Transfusion Syndrome but she was confused because that can’t happen in our twin type (remember one or two placentas-we were told we had 2). She wanted me to get an echo (an ultrasound) to check the babies’ heartbeats and an MRI. She also said she wanted to consult her colleagues in Toronto for a second opinion. We spent the day at the hospital. At the end, we saw Dr. Chandra again and she told us there is a chance they are identical, I then realized because they knew the sex of the babies and were thinking that there was a chance of them being identical that they MUST be the same sex. I thought this was the most exciting news. I assumed they would be boy-girl twins the entire pregnancy. She said the Toronto team wanted to see us and we should go as soon as possible. This was Friday at 7 pm. She said the procedure is relatively safe, and not doing it would give the babies a 10% survival rate. She said this is very unusual with the situation and they are basically the experts in Toronto.
We headed home, packed up, and were on the red-eye to Toronto. She told me to fast after midnight in case the procedure happened Friday. We landed in the morning and went straight to the hospital. A doctor did an ultrasound and brought in another doctor, both said they didn’t know what was happening and weren’t sure if this was in fact Twin to Twin. They wanted to ultrasound again in two days and get more testing. They gave me a steroid shot in case I had to deliver early as it helps develop the lungs more before premature birth. We stayed in a hotel room for a few nights waiting for more tests and hopefully answers. Over the next four days, we had more ultrasounds and an echo done. By this point my stomach was quite swollen, I assumed it was a normal part of pregnancy, but it wasn’t. I couldn’t get in or out of vehicles, I couldn’t get out of bed without help. On top of being physically uncomfortable, we were unimaginably worried and stressed. Doctors were not sure what was happening. Up until this point, we were told that there were two placentas and two sacs, but now they said they couldn’t really tell if there were one or two placentas. Being unable to tell this was important as Twin to Twin can only happen when there is one placenta. They did tell us however that nature isn’t always perfect and they had seen twice before someone with two placentas that fused together and required the procedure.
On the fifth day of being in Toronto we had another ultrasound. In Edmonton, Yanick was able to attend these, in Toronto however, covid rules were more strict and I had to go to appointments alone.
At the Ultrasound, I met Dr. Greg Ryan, who was the top doctor for TTTS. He looked at my ultrasound and wanted to look for himself. While scanning me he kept saying “this is a puzzle” which was a bit unsettling. After scanning he said, “you need the laser” and the fear set in.
He brought up a slideshow about TTTS and told me to facetime my husband so we could both learn about it. He explained that 10-15% of identical twin pregnancies will experience TTTS, and if untreated there is a 90% chance both babies will not survive. The placenta has vessel connections that are essentially one direction and one baby results in fluid, blood, and nutrients while the other is considered the donor and has little blood, fluid, and nutrients. The procedure involved uses a laser to stop the connections. I would be awake but drugged to not feel anything, and again, because of covid, Yanick couldn’t come. Usually, spouses are in the room. I would stay overnight in the hospital for monitoring and there is a very quick recovery time. The procedure was risky, and there was a chance of losing one or both babies. I believe it was 40-60% both would make it, and the doctor added that since we were on week 25, if there were signs of distress the babies could be delivered, and then we would have very premature babies, and the risks associated with that. The goal was to a) go in with the needle/camera to see if it was in fact Twin to twin, b) laser the connections, c) not break the sac d) keep both babies alive. He also mentioned that every surgery/risk includes a risk to the moms. He left the room and told me to talk with my husband and decide what we want to do. It seemed quite obvious that the stats were leaning toward the procedure but it was still a very difficult choice. We also didn’t realize just how close we were to losing the babies. I had to sign a consent form and he told me the procedure would be the next day. I returned to the hotel and completely broke down. I wrote a letter to the babies because I thought it would make me feel better. I told Yan many times “we are leaving here with two babies” and we tried to get rest before the procedure.
At the hospital the next day the staff was very kind, nurses prepped me and I walked into the room and lay on the bed. They placed a curtain from my chest up so I couldn’t see what was happening. I felt the drugs working and I listened to the doctor talk through the surgery. He would say things like “there’s one” and I would feel a sensation similar to popcorn popping in my belly. I continued to ask for more drugs from the anesthesiologist. I believe the procedure was about an hour. In the end, Dr. Ryan asked if I wanted to see the babies and I said yes. On the monitor, it almost looked computerized. I could see the head of the baby and the details were incredible. The camera moved down and I discovered that they were girls! I said “they’re girls?!” and the doctor said “maybe you won’t remember this” he then showed the legs and feet of the baby and I saw little toes and toenails. I said “she has my toenails” and a few nurses laughed.
The procedure ended and the nurses took me to recover. They brought me to the bathroom and a nurse supervised me while I went pee. I told her it was like we were friends at the bar. The drugs were great.
I slept the night in the hospital, they checked the babies with a non-stress test a few times and they did well every time. In the morning Dr. Ryan checked me with an ultrasound and essentially said I was cured and could carry on with the pregnancy to 36 weeks rather than delivering very early. It felt so incredible to have found the answer and the problem was solved. I was anxious to return home. We had to stay an additional night and then after another positive ultrasound we were allowed to fly home.
It was an emotional experience. When we returned home we had to continue to be closely monitored but the next couple of weeks went well and each ultrasound showed promising results. We went to the MFM 2-3 times a week for weeks 25-31. With each week we knew that the babies' chances of being born with serious or life-threatening issues were declining. Each week was a huge accomplishment.
At 31 weeks, they started to notice blood flow was beginning to get worse and we were told to prepare for a possible delivery soon.
At 32 weeks we were told “you aren’t going to get any more weeks out of this pregnancy so you’ll deliver today or tomorrow depending on the OR”
At 4:50 and 4:51 our baby girls were born by C-Section.
We spent about 2 weeks at the NICU in one hospital and then were transferred to a less intense NICU with private twin rooms. Four more weeks and Cleo was discharged, Margo needed a hernia surgery and was required to be transferred to the third NICU. She did so well and after 8 weeks, and 3 days before their official due date, we were home.
After the delivery, my placenta was sent to Toronto to be studied and they discovered I had partially one, partially two placentas, which they've only known about two other times in literature. And after being told in our pregnancy we were having fraternal twins, we ended up with identical twins. We're forever grateful for the medical teams that got us through pregnancy, delivery, and the NICU.
Now that we are through the first year, I have joined the Edmonton Twin and Triplet Club as the Program Director and will be teaching future Twin/triplet parents what to expect in our Managing Multiples Program!
