Pregnant at DEFCON 4

Part 1

But first, something cute that Chiara said:  This morning we were talking about her transition to the next classroom, "the Busy Bees."  (Right now she's in the "Wobblies").  She asked, "How come I'm big enough instead of I'm small enough?"  Good question.  I'll have to get back to you on that one.

OK - so the quick recap is we’re going to have twin boys.  Maybe one day I’ll tell the boys that when the midwife said, “Oh, wait.  There are two,” I had tears of joy, but let’s face it, at the time they were tears of grief.  Grief for the life I was about to lose: mine.  GREs – don’t need to study for that anymore.  Grad school is out for 2010.  And 2011.  And 2012.  Maybe even 2018.  My cute little black Jetta?  That’s got to go.  Now we’ll need some kind of behemoth vehicle that gets 8 miles to the gallon. I will never take another yoga class or go on another retreat.  I will have to stop volunteering for the Greater Good Center.  And of course, I will never sleep for five consecutive hours ever again.  Ever. 

It felt like a prison sentence.  But all that was about to change over the next week.

No pretty segue here, but what we went through in the first half of 2009 was really a drag, and I have to say, I was a little bit angry at the doctors we saw during that time.  When I was pregnant with Chiara (2006), I felt like I really had to seek out positive information about healthy pregnancy.  The midwives were great to that end, but I felt like the doctors treated pregnancy (literally) like a medical condition rather than a natural occurrence.  We were constantly being given the worst case scenario rather than positive preventive health information, as if they were secretly hoping for dramatic and dangerous flare-ups so they would have a more exciting and more involved role in the birth of my daughter.  I know I’m being slightly unfair.  But only slightly.  It’s like that terrible book: What to Expect When You’re Expecting.  Have you ever flipped through that?  It’s like, 800 pages of stuff I most definitely don’t want to “expect,” like gestational diabetes and preeclampsia and my favorite, cramps in my feet from “pointing my toes.”  Oh yes, pregnant women should never point their toes. 

(There are a lot of really cool cognitive science discussions we could have about this, because after all, these books and the doctors’ consensus is really just a manifestation of our cultural concept of health and the role of medicine.  It’s not based on any “truths” that are handed down from the heavens.  It’s all brains, baby.  But I’ll have to address all that in the book.)

Flash forward to spring 2009: because my pregnancy with Chiara had been so picture perfect, it was really hard for me to take the doctors at their word when they started with their gloom and doom observations: this ambiguous measurement could mean a neural tube problem.  That fuzzy gray picture could mean a heart defect.  This blood test, compared to all the other blood tests from 39 year old Mexican-American moms-to-be was probably indicative of some genetic problem. 

Then, just a few days after graduation, and almost halfway through the pregnancy, we lost the baby.  The whole time a part of me had felt that something was wrong with my baby.  At the same time, I was angry and defensive that the doctors also thought that something was wrong with my baby.  Of course, in the final analysis, the doctors were right; something was wrong with my baby.  But the whole time they hedged their bets: maybe it was indicative of a heart defect.  Probably the neural tube would close.  For us it was like this awful waiting game, always hoping for the best case and then ending up with the worst.

So this time, with the experience of the spring behind us, we said, no screenings, no hedges.  This time we want the diagnostic tests.  And we want them now.

That’s what led us to opt for CVS (a genetic diagnostic test) at the earliest opportunity—11 weeks—and that’s how we found out 5-8 weeks sooner than we would have otherwise, that our twins are monoamniotic and monochronionic, i.e., sharing a placenta and sharing an amniotic sac.

At first we thought it was the coolest thing ever.  (Because identicals are way more in demand for twin studies experiments than fraternals.  Duh).  We saw the twins on the high resolution ultrasound, facing each other, mirroring each other, either playing patty-cake or already beating the crap out of each other.  It was awesome.  Not awesome like surfer-awesome, awesome like feeling-full-of-awe-awesome.

But clearly the doctor thought it was neither cool nor awesome.  And clearly he was not prepared to tell us what he had to tell us.  He stumbled and stuttered and frowned and instead of doing the CVS procedure, booked us an appointment for the next day with the head of the Maternal & Fetal Medicine clinic.  We went home dazed and confused with his words: “Some couples in your situation choose to terminate” hanging in our heads.

Suddenly I couldn’t care less about my Jetta, or my yoga or my sleep.  I just wanted my babies to live.

The first thing I did when we got home was call my friend Ang, whom I know through my friend, Gary, and of course being Gary’s friend is how Ang got twins.  I knew her twins were born prematurely, but I didn’t know the half of it.  Her babies were born at 25 weeks, and what she, her husband and the babies went through was nothing short of heroic.  And here she was, a year later, laughing and talking on the phone to me, feeding one twin and holding the other and reassuring me that miracles do happen daily in the NICU (neonatal intensive care unit).

Then I emailed my friend, Kara.  Kara, in spite of not knowing who Gary is, had her twins six years ago.  Her quest for substantial literature on twin pregnancies led her to edit a book on the subject.  (She is also a journalist, so check it out: http://karathom.com)

Then we did something we knew shouldn’t do: we Googled “monoamniotic/monochronionic.”  And we read a lot of things we wished we hadn’t read about.  So much so that I won’t even give examples.  But when we went to the doctor’s office the next day, we were prepared for what he might tell us.

He confirmed that:

This is not going to be the birth that I had with Chiara: with midwives and birthing tubs.  This is going to be a high-tech birth.

By far the highest risk to monoamniotic/monochronionic twins (or “MoMos”) is cord entanglement.  Meaning that, as the babies get bigger, the umbilical cords can get crimped or twisted and there isn’t enough room for the babies to unwind themselves.  For this reason, MoMo twins are always “taken” early by C-section, usually at 32 weeks.

Because cord entanglement issues can happen earlier, the protocol at many hospitals is to admit MoMo moms at 28 weeks for 24/7 monitoring.

The other big problem that can happen with MoMos is uneven nourishment.  They share a placenta, and it can happen that one twin (for various reasons) doesn’t get enough sustenance.  This is visible in the ultrasound; one twin gets bigger, the other one doesn’t.  As long as the twins are “viable” (25 weeks or older), the doctors can take them via C-section, and save both babies.

Twin-to-twin Transfusion Syndrome (TTTS) is another problem that can happen with twins that share a placenta (is less common when they share an amniotic sac).  It has to do with how the blood vessels grow and attach, but it amounts to the same end as uneven placenta sharing (see above).

There’s nothing the doctors can help us with if something happens before 25 weeks.  And if one twin is sick or undernourished, there’s no way to save just the healthy twin.  If something happens before 25 weeks, we’ll lose them both.

Between 25 and 28 weeks, the twins will be “viable” but then they’re considered micro-preemies.  There are added risks to the respiratory, neurological, and digestive systems and it’s the outcome that some doctors are least comfortable with, because some of these early problems can turn into life-long disabilities.

Part 2

The specialist we saw on this day was really nice.  He let us know that our situation was serious, but he also let us know that we were in good hands.  He didn’t mention anything about what “some couples in our situation choose to do,” didn’t give any numbers or statistics regarding our chances for healthy babies (we already knew that they are slightly better than chance), and didn’t say the words “dead baby” once.  Not once. 

(There was one odd moment before we were called in to see him.  The nurse informed us that he had just been called to a birth.  Could we wait?  Oh, then it might be while, Matt commented.  It might, responded the nurse, but not longer than 25 – 30 minutes.  Matt and I looked at each other.  Welcome to the Land of High Tech Birth.  Sure enough, we were called into his office 27 minutes later.  We would have never known that he had just come from a birth.  He was in his shirt and tie and didn’t even look out of breath.  That was weird.  I mean, just the round trip elevator ride must have taken 6 minutes.  I couldn’t help but picture the scene from Monty Python’s Meaning of Life in which John Cleese is a doctor in the hospital looking for the machine that goes “ping!”  A woman is on her back about to give birth.  The babe is born and then it and all the machines are whisked away and mom is left in the dark on a gurney in a completely empty room.  That’s my picture of High Tech Birth). 

Anyway . . .

The doctor also outlined some thing we’ve got going for us:

1.     I’ve already carried a baby to term and had a healthy birth under ideal conditions, without complications.

2.     I have a very low-stress job.  Basically, it consists of making sure that Chiara gets to daycare some time before 11 am and that any clothes in the washer get moved to the dryer within 48 hours.  Oh – and I have to make sure that the mail gets from the bottom of the stairs to the top of the stairs.

3.     I have a great support system (Matt & our families).

It took awhile for this information to sink in.  It was like the end of the movie A Christmas Story where the narrator outlines all the leftovers they won’t have now that the Bumpus’ dogs got to the turkey first.  No turkey sandwiches!  No turkey stew!  No letting nature take its course!  No staying home with my daughter in the weeks before the twins come!  No coming home with the babies!  No colostrum as their first meal!  (In fact, one month in the NICU for the peas could mean no breastfeeding, period.)

Then: rolling up our sleeves.  One month in the hospital?  Then we’d better transfer to a facility with a Level 3 NICU that’s closer to home.  Better ask some grandmas to come early to help out.  Better check out the fine print on the health insurance plan.  Better find out the hospital’s visiting hours’ policy.  Better find out if they have a hospital grade breast pump for the preemie moms.  Better find out if they have WiFi.

We left the doctor’s office thinking, “OK – bring it on!  Let’s grow these babies!”  A week later we came back for our CVS procedure.  A week after that we got our results (everything is AOK fine) and that, dear readers, is how we know they’re boys.  (Did I mention that 75% of all MoMo twins are girls?  Where’s our lottery ticket?  We’re playing with 1 in 100,000 odds here.)

Coming up next: the quest for 5 pound preemies.

© 2010 Janine Kovac 

One small step into the blogosphere . . .

The Pod Blog

So we decided to jump on the blogwagon.  Not just because our daughter is so adorable we wanted to have a forum to tell people about it (like, “Christmas is so far away, we’ll need a plane to get there”), but because in the foreseeable future we imagine we will have a lot of different kinds of news that we imagine a lot of people would like to know and that’s a lot of phone calls.  Nine, if you just count our immediate family.  And if we just send out of few facts, and you use the Google machine on the Interweb, you’ll find out a lot of scary sounding things indeed.  Better to get it straight from us.

Here’s the short story: we’re pregnant.  Twins.  Identical.  Boys.  Due in April, but we’ll get them in February.

We’ve told enough people and been asked enough questions that we’ve realized that we might actually need a FAQ section.  So here goes.

Do twins run in either family?

No.  But that only applies to fraternal twins, anyway.  And if you think real hard about it, can only be carried down through the mother’s side.  (Quick biology refresher: fraternal == two fertilized eggs, kids are no more similar than other siblings; identical == one fertilized egg that splits, kids have the same genetic material).

Other fraternal fun facts: there are, like, TONS more twins now in the United States than just a scant 30 years ago, by like, some really high percentage that I am too lazy to look up right now.  Some fraternal twins, of course, are due to techniques like IVF and even Clomid, but for some bizarre reason, older women who have already had a baby are more likely to have fraternal twins if they conceive again in their 40s.  (That’s a nasty little trick, isn’t it?) 

So how do you get identical twins?

Nobody knows.  Identical twins are just a fluke.  Or in fancy medical language, an anomaly.  One perinatalogist actually called it a birth defect (because “it’s not supposed to happen.”  She continued: “Let’s hope this is the only birth defect.”)  This is the same one who used the words “dead baby” during our consultation.  I don’t remember the rest of the sentence because I was so shocked.  I hadn’t heard those words spoken together since my brother went through his “dead baby” joke phase in eighth grade.  Don’t worry.  We got her back.  Stuck a “kick me” post-it on the back of her scrubs. 

So nobody knows why a fertilized egg suddenly splits, although I do recall having a serious bout of hiccups in late July.  It could also be that I’m Gary’s friend.  Gary has FIVE friends who have had twins in the last two years.  (Needless to say, Gary’s wife is a leetle worried.)  Of course he told me this AFTER we told him about the twins.  Thanks, Gary.

How do you know they’re identical?

This is a question you would only ask if you’re up on your twin reading.  It’s like this: all fraternal twins have their own little sacs to grow in.  (Placentae).  And in the identical case, if they split early, they will also get their own placenta.  And nobody will know whether or not they are identical (if they are the same sex) until after they are born.  Since fraternals can look alike, too, in some cases, there’s really no way to know without a DNA test.

On the other hand, if the egg splits late, the babies will share a placenta.  And if the egg splits really late, there’s a one in 25,000 chance that the babies will share both a placenta and an amniotic sac (or as the midwives call it, the “bag of waters.”  Awesome.  It’s like the first line of a haiku, isn’t it).  Anyway, so I burped instead of buying a lottery ticket and we blew our lottery odds on two peas in a pod.

This means that our babies will have skin to skin contact in the womb.  Which is pretty cool.  It also means that I just went from the ho-hum ordinary “40 years old and merely high risk” to, as I told Aunt Rita, “DEFCON 4 High Risk” and listening to Dr. Bedside Manner and her “Dead Baby Birth Defect” speech.

But before we delve into all the scary stuff that Dr. Bedside Manner and her staff told us, (no, I will not call her Dr. BM, that is just too infantile), let’s end our first post with a little twin haiku.  This haiku is dedicated to Greg, because I know he likes haikus although I don’t know how he feels about amniotic sacs.  It’s called, “Hiccup Hiccup Oh!”

Hiccup Hiccup Oh!

One bag of waters

Not a lot of room in here

Will you be my twin?

© 2010 Janine Kovac