Mo-Mo Twins

Parents look forward to the birth of their children with anticipation and joy. There is a reason What to Expect When You’re Expecting, written by Heidi Murkoff, continues to be one of Amazon’s best sellers. This book is a must read for all first-time parents.

Amy and I were no different. We read this book when we were expecting Claire, and we reread it when we decided to have a second child. Sometimes though, not everything goes according to plan.

After getting a positive result on a home pregnancy test, Amy and I were excited for her ob-gyn appointment, where they would take the first ultrasound. They ushered us into the exam room and a nurse shortly came in to conduct the procedure. She applied the gel and began looking for the baby. She found it and gave us a quick glance of him on the monitor as we listened to his heartbeat. As she began taking measurements, she suddenly said, “Oh, it looks like there are two in here.”

Amy and I stared at each other in disbelief. Then, both our faces lit up with wide grins as we began to laugh at the curveball life had just thrown at us. The nurse continued to take measurements as we began to contemplate what this would mean for the pregnancy and our lives.

At some point, we noticed that the nurse was no longer smiling but had become focused on the ultrasound. She completed her tasks and indicated the doctor would be in shortly. After a few minutes, the doctor came in and congratulated us on expecting twins. She talked to Amy at length about how this pregnancy would be different than Amy’s first. After reviewing that, she mentioned that the ultrasound had failed to detect a membrane that would normally separate the twins.

Our mood turned serious in an instant.

“What does that mean?” we asked.

She explained that normally the babies are each contained in their own amniotic sac. An ultrasound would typically show the membrane of these two sacs that separate the babies. The doctor quickly added that this membrane is sometimes difficult to see early in the pregnancy and that we should not be alarmed that they could not find it. She said that we would do another ultrasound on our next visit, and there was nothing that we should do differently.

Reassured, we headed home to share our exciting news with family, friends, and neighbors. My mother was a twin, and I couldn’t wait to share the news with her. When we got her on the line and shared the news, we received a very subdued congratulations. Shortly thereafter, she asked if I had spoken to my sister lately. After hanging up, both Amy and I were bewildered at my mother’s subdued reaction.

It made total sense, though, after we called to share the news with my sister. Evidently, just prior to our call, my sister had also called Mom to tell her that she was expecting. My mom was in a total state of shock after getting the news that she would have three new grandchildren sometime in January!

Our life progressed normally for the next several weeks as Amy had bouts of nausea. Like the first pregnancy, she slept quite a bit, which left lots of quality time for me with Claire. We arrived optimistic at the next ob-gyn appointment.

The nurse began the ultrasound, and we became quiet as she found the twins and took measurements to chart their growth. As the procedure dragged on, both Amy and I were thinking the same thing. She’s not finding it.

Worry began to creep in the longer the procedure dragged on. Finally, she completed the ultrasound and told us the doctor would be in soon. Amy gripped my hand tight as we waited for the doctor in silence. The doctor eventually came in and shared the news we suspected. The ultrasound had not revealed a membrane. The doctor indicated that she wanted to look herself, so we started the procedure over again.

As she looked for the membrane, she turned the monitor toward us so we could also see as she pointed out each twin to us. After a good ten minutes, she also could not find any separating membrane. She explained that in rare cases where the egg splits late after the placenta has already formed, twins will sometimes, but very rarely, share the same amniotic sac. Those cases are referred to as monoamniotic twins, or Mo-Mo twins, and are only 1 percent of all twin pregnancies. Our doctor had never seen Mo-Mo twins in her practice until now. She did not hold back as she explained that this would be a high-risk pregnancy. The main danger would be cord entanglement as the babies grew larger in the later stages of the pregnancy.

She explained that sometimes the membrane can be very, very thin and not show up on a standard ultrasound when twins split late. Her plan for us would be to proceed normally. There was really no procedure or drug available that could help the situation. She recommended we see a perinatologist, a maternal-fetal medicine specialist in high-risk pregnancies, once Amy’s pregnancy reached twenty-four weeks. At that time, they could do a color flow doppler high resolution ultrasound to see how the twins were progressing and to look for the membrane again.

Our takeaway from the appointment was that there was nothing we nor the medical professionals could do in the immediate future. Amy latched onto that and was determined to control what she could. She would take especially good care of herself, eat healthy, exercise, and most of all, not let herself get mentally stressed by the situation.

Unfortunately, I often take the opposite approach. I want to learn everything I possibly can about the situation I am facing so that I can make the best decisions possible. I delved into learning everything I could about monoamniotic twins. In 1997, there was precious little information about the subject online and only two paragraphs devoted to the condition in a text I found at the Medical College of Wisconsin.

Most of the information I gathered was from other parents of expecting Mo-Mo twins. Their doctors, however, had varying approaches to their pregnancies. Before long, I became a central hub of email correspondence between parents seeking information just like me. Together with another parent, we started a chat room to document all the posts, discussions, and outcomes. At the time, we did not envision the chat room would become a central hub of information for parents for over twenty years.

The scariest bit of information I learned was that the mortality rate for Mo-Mo twins was extremely high, between 40 and 60 percent.

Amy was understanding of my attempts to learn more, but she stated very firmly that I was not to share any information with her. She wanted to stay focused on her health and on remaining positive. Despite her bravado, I know she was very worried, but I concluded that stress could only have a negative effect on her and the babies’ well-being, so as she requested, I kept the information I learned to myself.

Amy shined during the next couple of months. She remained upbeat and excited for the arrival of the twins. We moved Claire to a new bedroom and prepared the twins’ new room. We were able to obtain another crib from our friends who had twins previously, saving us some money.

Everything was going very smoothly as the time for our appointment with the perinatologist neared. The first week in October, Amy’s mother Judy came over to babysit Claire as we headed off to our big appointment. They ushered us into a specialized exam room with the color flow doppler machine. We both were nervous as the doctor came in and, after a short introduction, began the procedure. Amy and I attempted to chat with him to relieve some of our nervous tension, but the doctor politely asked us to remain quiet while he concentrated on the procedure.

It seemed like forever as he leaned in towards his monitor looking for the membrane. Amy squeezed my hand tight as the moments dragged on. Five minutes, then ten minutes, then fifteen minutes. Both Amy and I began to tense up. Finally, the doctor let out a huge sigh and sat back in his chair and stated simply, “I found it.”

Our faces lit up as he showed us the very thin membrane. He said we should return to our normal ob-gyn and that it looked like the twins were doing extremely well with no twin-to-twin transfusion syndrome (TTTS), where blood flows unequally between the twins.

Amy and I were all smiles as we walked to the car on that late afternoon in October. The sun was creeping toward the horizon as we got into the car. We took a moment to hug and release the emotions and stress of the past couple of months. We cried together for several minutes and then began to laugh before heading home to share the fantastic news with our families.

I’ve always admired Amy’s positivity, but never more so than those awful weeks of uncertainty and worry in 1997.