Finding out we're having (high risk) twins! Pt. 3

July 17th, the day of our first meeting with the Maternal Fetal Medicine (MFM) specialist, finally rolled around. Our appointment wasn’t until 1:30pm and whenever we had appointments that weren’t first thing in the morning I would pass the hours by doing some anxiety cleaning. Anyone else do that? The dishes got done, counters wiped down, toilets cleaned, shower scrubbed, vacuum run, etc, etc. Nothing calms my nerves like busy hands. But the hours thankfully ticked by and we left for the the doctor’s office. We live in the city so we avoid driving whenever we can because parking is generally a nightmare or crazy expensive so we took the bus. We were pleasantly surprised that it only took us 10 minutes door to door.

Generally, to be seen by a MFM you have to have a referral from an OB or midwife. Being specialists, they don’t just see any old patients, only pregnancies deemed high risk or complicated. But because we were being seen by this particular doctor as a favor to my aunt, I didn’t have a referral! Each of our visits has contained an awkward exchange between the receptionists and myself that involves me fumbling to explain why I’m seeing Dr. Loy in the first place and usually ends with the receptionist recalling that I’m “that special case,”. So with a few chuckles, we made it through this exchange and after a little wait, we were being ushered back to the exam room.

The technician started our ultrasound and we joyously saw our wiggling not-so-little beans which were becoming more and more human each time we saw them! Everything appeared to be in order; strong heartbeats, growing appropriately, measuring right on track. Maybe it’s due to our first two failed pregnancies, maybe it’s just my temperament as a person, but the flood of relief at seeing thriving babies at each of our ultrasounds is indescribable. I always have a twinge of doubt in the back of my mind before each check-up that something could have gone wrong and we would be losing babies again. Check-up days always seem to carry the possibility of being either the most devastating or the most joyous days of my life. Luckily so far during this pregnancy, they’ve all been joyful days.

The babies' July 17th portraits. Baby A is stuntin' and Baby B is rocking the "face plant" as usual :)

After a short time with the technician, the MFM, Dr. Loy, joined us in the exam room. Being the first time he had ever met us, his first question was, “what is your primary concern today?” and although we had spent the last few weeks thinking (hoping) the babies were mono/di, we knew that wasn’t a certain diagnosis, which meant that our main question was whether or not a membrane separated our sweet fetuses. So with that in mind, Dr. Loy began his incredibly thorough investigation of my uterus and of our babies. And when I say incredibly thorough, I mean he scanned us for more than an hour. He took an overview of me and the babies, exploring some fibrous tissues that seemed to be fluttering around in my uterus that may have been indicating a membrane existing between the babies. He found the babies’ umbilical cords and traced them from their bellies to the insertion site in my placenta and then started at my placenta and worked back toward the babies’ bellies. He examined the space between the babies looking for indications that either they were separated or that they were too close to each other to have anything separating them. His time and attention meant the world to us.

Ultimately, Dr. Loy announced that he could not find a membrane between the babies and that in his professional opinion he would diagnose the babies as being MoMo and we got our first real idea of what that meant for us. The main concern that captured my attention was the possibility of fetal death, meaning that some sort of cord accident would happen and one or both of the babies would be without oxygen and vital nutrients and they would not be able to survive. I like numbers, so my first question was, “how likely is this to happen?” and he said he couldn’t be 100% positive without checking the research but he would venture to guess there would be around a 20% of a fatal cord accident.

That’s horrifying news but for some reason, I think our past experiences of miscarriage have hardened me a little bit to the idea of losing a baby. Losing them would no doubt be the single most devastating experience of my life but maybe you could say I wasn’t afraid of it. I would do just about anything to prevent this from happening but I also know that there is next to nothing you can do when it comes to influencing the course of fetal development. It’s a process that requires several million things to go off perfectly without a hitch and you just have to be incredibly thankful when the stars happen to align.  Mostly upon receiving this news we were just flooded with questions.

How do we manage this pregnancy going forward?

When are the babies most at risk?

Are they ever out of the woods?

Is there anything we can do to help them?

And we learned that the standard of care for MoMo twins involves inpatient management, meaning hospitalization for me, at 24 weeks gestation and delivery whenever a problem is detected or by 34 weeks gestation at the latest. For those that don’t know, 24 weeks gestation is when a fetus is considered viable, or capable of surviving outside the womb, so until then, they wouldn’t have me admitted to the hospital because even if a problem was detected, they wouldn’t be able to save the babies. So between then (I was 15 weeks at the time) and 24 weeks, I would come in every other week for an ultrasound and we would just keep an eye on the babies to make sure they were growing and that everything was developing exactly as it should be.

We left that appointment with only the very most basic information because I think it’s all our poor little brains could handle. We knew our babies were currently thriving but that there was a very real possibility of them not surviving. That’s all I could focus on at least. I think my husband’s perspective would be entirely different but at first, the possibility of losing them was my main focus. With a healthy dose of encouragement from my husband, my aunt, my mom, anyone I talked to in the days following that appointment, I developed a new mantra,

As far as we know my babies are perfect. Today, 1 day/5 days/10 days since my last ultrasound, I have no reason to believe that my babies haven’t continued to thrive, just as they have every single day of this pregnancy so far.

After this appointment we were only one step away from deciding on who our care providers would be. 10 days after this appointment, we would have our consultation with another MFM practice and it became clear pretty quickly who would be the right doctor for us. If there’s one thing I can recommend to other expectant mamas it would be to carefully and intentionally choose your care provider. It matters. And I’ll delve into that a little more after the next post when I tell you all the details of our second consult!

To be continued…