Mya and Lyla's Story

     We found out we were expecting early June. I scheduled a doctor's appointment for the next week hoping to find out how far along I was, that is not all we found out! While getting my first ultrasound the woman played the baby's heartbeat, she kept staring at the screen not saying any words so I asked if that is indeed the heartbeat. She told me yes it is...and here is the other one. I began laughing while my fiancé asked if she was joking or not, she informed us that she does not joke about twins. She kept looking at the screen after we heard each heartbeat and then told us the doctor would want to speak with us.

     The doctor came in and proceeded to tell us that they did not see a membrane dividing the twins and there is a small chance they could be monoamniotic, but majority of the time they are able to find a membrane later on.  I went home to Google "monoamniotic twins" (big mistake) and really scared myself.  All I was able to find is that this occurs in about 1 of every 60,000 twin births and that my babies only have a 50 to 60% chance of survival.  I knew the girls were monoamniotic but Chris kept trying to make me feel better by insisting that they will find a membrane. Our next appointment we were able to find out the gender of our babies but also our last chance to search for that membrane.  I was ecstatic to find out we were having girls but that was quickly trampled when we were ensured that there was no membrane making my pregnancy extremely high risk.

     Our next step was to make a plan because that doctor could not handle such a high risk pregnancy.  After seeing a few doctors, all telling me to not get too attached because there is a 50% chance I will not get to have my girls, I settled on a doctor in Pennsylvania.  We made a plan to go inpatient at 26 weeks  and to be monitored 3x daily for an hour.  Getting to 26 weeks was extremely difficult.  I was skeptical about having a baby shower because I was afraid of my girls not making it. I was afraid to sleep fearing I would wake up and not feel any movement.

     Finally 26 weeks came and I was ready to be admitted. Being inpatient was hard to say the least.  Chris was finishing school so he could not be there as much as he would have liked which was hard for me. I cried every night I was in the hospital, I felt isolated from the world and everyone was going on about their life without me. I especially hated getting my IV switched every other day. One member of my family would visit every day and that was what I would look forward to every day.

     I had one major scare during my late night monitoring where Baby B's heart dropped into the 70s for a few seconds. I was so scared and pushed my call button 100 times. The ultra sound tech came running in and could not find my baby's heartbeat, finally my doctor pushed him out of the way and found it. Words cannot describe my relief.  I was given oxygen and they kept me strapped up all night. Between the straps being so tight, my tears and my fear I did not get one minute of sleep that night. A few weeks went by with no major issues and other than being in a hospital for five weeks I was doing well.

     My doctor gave me the option of delivering at 34 weeks or 32 and I did not want to take any risks so I chose 32. Thanksgiving rolled around and Chris was finally able to stay for a while. November 26, 2013 I was on my last monitoring session of the day when Baby B's heart dropped into the 70s. I was given oxygen and my doctor told me he was just going to keep me on the monitor for a while longer and told the nurse to give me another round of steroids.  Her heart rate went back up but I would not take my eyes off of that screen. Twenty minutes later her heart rate dropped again, this time to the 50's.

     My doctor ran into my room and asked "Can I deliver your babies today?" I was so scared I could not even speak. I looked at Chris and he responded "Let's Go!" Everything after that happened so quickly. I was rushed into a bright room and Chris was told to stay behind. They put me on the operating table and everyone was scrambling around me. My doctor was yelling that the anesthesiologist was taking too long and getting his instruments ready which did not help my nerves, finally it was time to put me under.

 

Mya and Lyla

     I woke up asking the nurses if my girls were ok and if they had hair, she responded yes to both questions. I was sent to recovery and was dying to meet my angels. When I saw my girls for the first time it was like a dream. My girls, my sweet babies who I had been told might not make it were finally here. Lyla weighed 2lbs 14 oz and Mya was 2lbs 15 oz. Their cords were not only tangled but Lyla's wrapped around Mya's neck. After four days we were finally able to hold Mya and the next day Lyla! I thought being inpatient was hard, but that was nothing compared to leaving without my girls every day which never got easier.

   I visited my girls every day sometimes up to 5 hours a day. The girls spent about 5 weeks in the NICU with only a few minor setbacks. Lyla came home January 11 and Mya the following day. My girls are 6 months old now and are absolutely perfect.  I love them more than I knew I could. I still stare at them in disbelief the same way I did when the night they were born.

"This can't be happening!" – The Riso Twins Story

My husband and I decided to start a family sometime in early 2008. Like any other naive couple about to embark on the journey to parenthood we figured it would be relatively easy. I mean, we spend most of our teenage years trying NOT to get pregnant so logically, once we threw caution to the wind it should happen fairly quick, right?.......WRONG! Here's where that title phrase made its debut appearance....."This can't be happening!" Unfortunately, it was.

So, after about a year of disappointment we sought the help of a reproductive specialist. After countless blood tests, MRI's, sonograms, surgery, numerous medications and several medical procedures we still weren't pregnant. After each failed cycle I kept thinking "this really can't be happening." The desire to become a mother had grown so strong that it took over my life. We decided to try IVF (in vitro fertilization). So, after one round and many tears I finally got my Second line! We were pregnant!  Blood tests all came back normal and my first sonogram confirmed one healthy baby….or so we thought.

Cut to 10 weeks pregnant. I went to my OB for a routine sonogram. Little did I know that on this day my life would be forever changed. He placed the wand on my belly and was quietly scanning around. Then, out of nowhere he said "I need to do an internal sono, I think I hear TWO heartbeats." My initial reaction was, yep, you guessed it, "This CAN'T be happening. My Baby has TWO hearts." haha. I honestly didn't think he meant twins. I mean, I saw the sono screen. There was only ONE sac and as far as I knew it was impossible for there to be more than one baby in them. So, the internal sono began and he confirmed what he originally thought...."it's twins" he said. But his voice wasn't enthusiastic...in fact his whole demeanor changed. He excused himself from the room and said he needed to make a phone call.

After he left my husband and I tried to wrap our heads around the news we just received. I was excited yet nervous because I knew something wasn't right. When he returned he explained that I was to leave his office and immediately make an appt with the maternal-fetal medicine specialist office. He basically said that he suspected I had what is called mono-chorionic, mono-amniotic twins. I was told the next doc would explain this further.

So, of course, I didn't what anyone in the 21st century would do...I "googled" it. As I began to read the various websites that popped up I couldn’t help but think, as you probably already guessed, "This can't be happening." Information flew across the screen in a blur. Phrases such as  "50% chance of survival, cord entanglement, and twin to twin transfusion syndrome" flooded my brain. It was all too much to process. I cried my eyes out for days, ok more like weeks. I emotionally detached myself from the pregnancy, which I regret today and will touch upon more later on. Friends and family were under strict orders NOT to purchase anything for the babies. A friend bought me a journal for me to write down my experiences and feelings....that journal remained blank....as I convinced myself not to do it because, well, I didn't want to remember anything if something was to go wrong (something else I totally regret today.)

Then, I decided to google "momo success stories" and again, information flew across the screen. Only this time, it was stories of other women who were in the same situation as me. Some pregnant still, some with babies in NICU, and other with older “momo” children. For the next few days, I browsed their stories and as I completed each one something in me changed. All of a sudden there was hope! I COULD be one of those women some day! So from there, I began to plan. Planned my inpatient stay, made a registry, ordered furniture and so on.

Unfortunately, at this point I began having problems unrelated to the momo diagnosis. I went into preterm labor and lost a lot of my cervix. At about 16 weeks pregnant I had a cerclage and was put on various medications to stop the contractions. I was admitted to the hospital twice for observation but allowed back home on strict bed-rest for the remainder of the journey. That was a nightmare in itself! It didn't end there.  Then, my AFP test results came back stating that the twins had a 1 in 5 chance of having a chromosomal abnormality; one that would result in death immediately after they were born. "Seriously now, this really can't be happening" was all I could think. I declined any further testing as I couldn't handle any more bad news and I knew that no-matter what, I was going to do my best to get them here safely even if it was only for a few minutes.

Finally, the day had come. It was early June when I officially turned 24 weeks pregnant. This was the beginning of the inpatient portion of my journey. The next almost 6 weeks are a blur. I am not going to lie it was hard. I was still on strict bed-rest so I was confined to a hospital bed all day. I didn't have my own room so parades of women would be brought in for a few days and eventually go home with their families or a bouncing new baby in their arms. Yet, there I laid, still weeks away from uncertainty. Visitors came and went as did most of the summer. I was on continuous monitoring so not only was a stuck on my back I had three different machines attached to me at all times (two for the babies, and one for my contractions.) The highlight of my days were the 10 minutes in which I was allowed to shower. In the end however, it was more than worth it.

Now, It was August 4th and my husband had brought me a Burger King chicken sandwich just as he did every Monday night, as it was my guilty pleasure! I was enjoying my dinner when my OB busted through the door with a bunch of nurses and residents.  "What is the matter with you?" he said. "Why didn't you buzz us?" I was so confused. I didn't need them...or so I thought. "Your contractions are 2 minutes apart and the babies heart rates are struggling with every contraction. It's time to get them out he said. Up to labor and delivery you go." I had no idea how to feel. I was so excited, relieved, anxious, and scared. I was only 31 weeks 6 days. I had no idea what to expect and we still didn't know if they were genetically normal. So up to L&D I went. I was prepped for surgery while I called my parents and told them the time had finally come. As I sit here and type this I can't help but tear up as this was a day that I truly never expected to see.

The only way I can describe the whole birth is surreal. As soon as the OB pulled out the boys I remember yelling over the curtain, "Are they O.K?" I will never forget his response...."Yep, they are fine and have all 20 fingers and toes!" It was at this point when I heard a little voice begin to cry and thought to myself, "This can't be happening!" Except this time, it was a happy phrase. It WAS happening. I was in such disbelief. I got to kiss them both on their heads before they were whisked away to the NICU. I couldn't believe it, they were SAFE! I knew the next few weeks would be hard as well but I didn't care...I was a MOM!

Carson Joseph was born weighing in at 4pds 1ounce and 16 ½ inches long.

Mason John was born at 3pds 15 ounces and 16 ½ inches long.

The next few weeks consisted of me recovering, preparing the nursery, going back and forth to visit the twins, and finally having a baby shower....or as I called it, my "welcome to the world Carson & Mason party"; A much more appropriate title in my opinion.

The NICU journey for us was rather uneventful.  The boys suffered from the basic preemie issues such as breathing and eating. They were both jaundice and contracted a minor infection while there but it was easily treated with antibiotics.  Below are some pictures from our journey. 

(Above are pictures of the boys first week of life. Both are intubated here.  Mason is the top picture and Carson is the bottom picture. )

After four of the longest weeks of my life the boys came home and completed our little family. They were the tiniest little angels! Shortly thereafter we were hit with the realization that they were both colic with severe acid reflux...but that's a story for another time and another blog ; ). 

(Above is the boys very first picture together on the day they can home from NICU. Those are preemie onesies on them and they still look huge. Now I look at preemie clothes and cant remember them ever being that Tiny!)

That brings us to today. My boys are happy and healthy at almost 19 months old. They are up to date on all of their milestones and gaining weight like it’s their job! They are definitely all boy; running everywhere and climbing on everything. Being a multiple mom is hard but worth every single second!

So, for all the expecting momo mommies out there hang in there. Miracles CAN happen. Don't focus on the future what-ifs, focus on the now. Read to the babies, sing to them, make a registry, paint a nursery, buy some cute baby clothes, because when things DO turn out well in the end you will regret not doing it. Stay strong and always remember "Worry does not empty tomorrow of it's sorry; it empties today of it's strength."

What are Monoamniotic Twins?? (Wikipedia)

Source ~ Wikipedia:  http://en.wikipedia.org/wiki/Monoamniotic_twins

Monoamniotic twins

Monoamniotic twins are identical twins that share same amniotic sac within their mother’s uterus.^[1] Monoamniotic twins are always identical, and always monochorionic as well (sharing the same placenta), and are sometimes termed Monoamniotic-Monochorionic^[1] They also share the placenta, but have two separate umbilical cords. Monozygotic twins develop when an embryo does not split until after formation of the amniotic sac,^[1] at about 9 days after fertilization.^[2] Monoamniotic triplets or other monoamniotic multiples^[3] are possible, but extremely rare.^[1] Other obscure possibilities include multiples sets where monoamniotic twins are part of a larger gestation such as triplets, quadruplets, or more. ("MoMo") twins.

Various types of chorionicity and amniosity (how the baby's sac looks) in monozygotic (one egg/identical) twins as a result of when the fertilized egg divides

Occurrence

Monoamniotic twins are rare, with an occurrence of 1 in 35,000 to 1 in 60,000 pregnancies,^[1] corresponding to about 1% of twin pregnancies.^[3]

Complications

The survival rate for monoamniotic twins has been shown to be as high as 81%^[4] to 95%^[5] in 2009 with aggressive fetal monitoring, although previously reported as being between 50%^[1] to 60%.^[3]. Causes of mortality and morbidity include:

• Cord entanglement: The close proximity and absence of amniotic membrane separating the two umbilical cords makes it particularly easy for the twins to become entangled in each other’s cords, hindering fetal movement and development.^[3] Additionally, entanglement may cause one twin to become stuck in the birth canal during labor and expulsion.^[1] Cord entanglement happens to some degree in almost every monoamniotic pregnancy.^[1]
• Cord compression: One twin may compress the other’s umbilical cord, potentially stopping the flow of nutrients and blood and resulting in fetal death.^{[1] [3]}
• Twin-to-twin transfusion syndrome (TTTS): One twin receives the majority of the nourishment, causing the other twin to become undernourished. TTTS is much more difficult to diagnose in monoamniotic twins than diamniotic ones, since the standard method otherwise is to compare the fluid in the sacs. Rather, TTTS diagnosis in monoamniotic twins relies on comparing the physical development of the twins.^[1]

Diagnosis

Ultrasound is the only way to detect MoMo twins before birth.^[3] It can show the lack of a membrane between the twins after a couple of weeks' gestation, when the membrane would be visible if present.^[3]
Further ultrasounds with high resolution doppler imaging and non-stress tests help to assess the situation and identify potential cord problems.^[3]
There is a correlation between having a single yolk sac and having a single amniotic sac.^[1] However, it is difficult to detect the number of yolk sacs, because the yolk sac disappears during embryogenesis.^[1]
Cord entanglement and compression generally progress slowly, allowing parents and medical caregivers to make decisions carefully.^[3]

Treatment

Only a few treatments can give any improvements.
Sulindac has been used experimentally in some monoamniotic twins, lowering the amount of amniotic fluid and thereby inhibiting fetal movement. This is believed to lower the risk of cord entanglement and compression. However, the potential side effects of the drug have been insufficiently investigated.^{[1] [3]}
Regular and aggressive fetal monitoring is recommended for cases of monoamniotic twins to look for cord entanglement beginning after viability. Many women enter inpatient care, with continuous monitoring,^[1] preferably in the care of a perinatologist, an obstetrician that specialises in high risk pregnancies.^[3]
All monoamniotic twins are delivered prematurely by cesarean section, since the risk of cord entanglement and/or cord compression becomes too great in the third trimester. The cesarean is usually performed at 32, 34 or 36 weeks.^[3] Many monoamniotic twins experience life-threatening complications as early as 26 weeks, motivating immediate delivery. However, delivery around 26 weeks is associated with life-threatening complications of preterm birth.^[1] Steroids may be administered to stimulate the babies' lung development^[3] and decrease the risk of infant respiratory distress syndrome. Natural birth rather than cesarean section causes cord prolapse, with the first baby delivered pulling the placenta shared with the baby being left inside.

See also

• Monochorionic twins
• Identical twins

References

1. ^ ^{a b c d e f g h i j k l m n o} Pregnancy-Info -- > Monoamniotic Twins Retrieved on July 9, 2009
2. ^ Shulman, Lee S.; Vugt, John M. G. van (2006). Prenatal medicine. Washington, DC: Taylor & Francis. pp. Page 447. ISBN 0-8247-2844-0. 
3. ^ ^{a b c d e f g h i j k l m} MoMo Twins; Monochorionic Monoamniotic Twins By Pamela Prindle Fierro, About.com. Retrieved on July 9, 2009
4. ^ Hack KE, Derks JB, Schaap AH, Lopriore E, Elias SG, Arabin B, et al. Perinatal Outcome of Monoamniotic Twin Pregnancies. Obstet Gynecol. 2009;113(2, Part 1):353-60 http://journals.lww.com/greenjournal/Abstract/2009/02000/Perinatal_Outcome_of_Monoamniotic_Twin_Pregnancies.17.aspx
5. ^ Baxi LV, Walsh CA. Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes. The Journal of Maternal-Fetal & Neonatal Medicine. 2009. http://www.informaworld.com/openurl?genre=article&issn=1476%2d7058&issue=preprint&spage=1&doi=10%2e1080%2f14767050903214590&date=2009&atitle=Monoamniotic%20twins%20in%20contemporary%20practice%3a%20a%20single%2dcenter%20study%20of%20perinatal%20outcomes&aulast=Baxi&aufirst=Laxmi&auinit=V%2e