Pregnancy is a journey in and of itself, sometimes feeling unending (Will I ever eat without throwing up again? What did it feel like to go more than 2 hours without peeing?) and sometimes feeling too fast (ahhhh! The nursery isn't set up yet! I can't have a baby, I haven't practiced my breathing techniques enough!).
Nausea, exhaustion, backaches, restless sleep, swelling...every pregnant mama has a high chance of experiencing any or all of those, no matter how many babies they are growing. Twin pregnancies are just like singleton pregnancies. Well, except when they're not.
There are 3 types of twin pregnancies, relating to how many placentas and amniotic sacs there are. The amniotic sac is the bag of fluid that the baby lives in, and the placenta is the nutrient supply that the umbilical cord attaches to.
If the babies are each growing inside their own amniotic sac and each have a separate placenta, they are called dichorionic/diamniotic. These are the lowest risk. With separate amniotic sacs but a shared placenta, it is a monochorionic/diamniotic pregnancy (medium risk), and when the twins are cozied up together in a shared sac and have a single placenta, it is mono/mono (or MoMo for short). With MoMo twins, there are risks of cord entanglement, among other things. Our twins were Mono/Di, so they were medium risk. The biggest concern was the possibility of twin-to-twin transfusion syndrome (TTTS), which means that one twin starts taking too much of the blood from the shared supply, and the other twin doesn't get enough. This causes big problems for both the blood "donor" and the "recipient" twin.
Because of the TTTS risk, I went every other week for an ultrasound so they could check for concordant growth and similar fluid levels in each amniotic sac. "Everything looks great" the technicians always told me. I didn't love going to the doctor so frequently (especially during a pandemic...) but I was grateful for the regular confirmation that the twins were growing and doing well. I also saw the maternal fetal specialist, as well as a regular OB occasionally, and between all those appointments (and sporadic one-off things like a fetal echocardiogram or the glucose tests), I became good friends with the staff. I knew all the ultrasound technicians by name, how they had gotten into medicine, and how many kids they had of their own. We talked about my IVF journey, how my 8yo was handling the news of baby brothers, and the progress of the house hunt.
Early in the pregnancy I had some unexpected bleeding and cramping that continued through the night, and after only 3 hours of sleep I rushed into the office first thing in the morning to see what was wrong.
Nothing, they determined.
The twins looked healthy (good size, heartbeats, wiggling around), in no distress, and there was no findable cause for the bleeding. I felt a mixture of great relief that my babies were fine, and confusion/frustration that if there was no problem to solve, why had I gone through such stress? I bled and cramped off and on over the next few days, and I kept a careful eye on it. It was a physically demanding week at work (I'm a stage manager and we were in tech rehearsals), and I seemed to bleed more when I was more active, so I did my best the rest of the week to delegate the heavy lifting to others on my team and listen to my body. At the next ultrasound a couple weeks later (the first of my bi-weekly TTTS scans), the twins still looked healthy. I didn't know what the bleeding had been from, but chalked it up to "sometimes bodies are weird" and moved on.
Later in my pregnancy it happened again. Off and on bleeding, nothing consistent or heavy but it just wouldn't go away and stay away. I called and talked to nurses, who told me what to watch for, and I watched. It wasn't bad enough this time to go in outside of my regularly-scheduled ultrasound, but I was thrilled when that appointment came around so I would know my babies were okay. The MFM doctor ordered a transvaginal ultrasound in addition to the regular one, just to make sure. They discovered a blood vessel in an unusual place, but decided it was probably maternal and since nothing other than the random spotting seemed out of sorts, sent me home with instructions to come back in if I spotted any more. At the end of a complex and very roller-coaster-y few weeks, and 2 more ultrasounds viewed by 3 different high-risk specialists, they determined that I had a condition called vasa previa and should be immediately hospitalized prior to a scheduled c-section. I was completely thrown for a loop and not at all pleased with this development!
The vasa previa only put one of the babies at risk, but affected the rest of the pregnancy and early delivery of both twins. To learn more about it, read How We Got Here part 3: The Problem Child.
