Coming to Terms...

Identical twins aka Monozygotic twins.  

     What does that mean?  

1. Monochorionic-diamniotic twins are identical twins who share a placenta but not an amniotic sac. 

2. How does this happen?

3. To form identical or monozygotic twins, one fertilized egg (ovum) splits and develops into two babies with exactly the same genetic information. 
4. To create our type of twin the fertilized egg must split between days 4-8 after fertilization (it's like they were fighting already!) and then they embedded themselves in my cozy little uterine wall and began to grow together but separately.  They are aware of each other and can hit and kick each other just as siblings love to do, they're just getting an earlier start than most.
5. I forgot to mention in my original post that from the first ultrasound they measured a week behind so my due date was moved to January 21.  Not that it really matters because it's identical twins and identical twins don't go to 40 weeks they go 37 max.  
6. At 12 weeks we feel comfortable enough to tell the world and we had a big sister who was bursting at the seams with the news!  She had known about the twins from the first night that we knew about the twins and she had kept it somewhat secret.  We made the cute little announcement at the beach to post to Facebook and of course it got a ton of likes and comments because babies are exciting but TWO new babies gets everyone all tickled.  The "world" was on cloud nine with us.  
7. August 5 at 16 weeks we went in for our bi-weekly sonogram and they measured tummies, heads, hearts, blood flow in cords, fluid levels and told us the sex.  Now remember we were really rooting for some more testosterone for our household.  Cue favorite dog getting run over right before our eyes kind of sadness - two more girls coming our way.  I was secretly okay with it because I know what to do with girls but would be taking a huge learning curve with dirt and bugs and whatever other weird things little boys come up with.  Back to the largest section in department stores dedicated to pink and purple lacy, sparkly, floral, unicorn and kitten things.  In the world of sugar and spice and everything nice for another eighteen years.  Plus, you feel a little less guilty for wanting to match your girls in almost every outfit.  Yep, just like nine years ago I was okay with it.  Daddy on the other hand couldn't help but feel some natural disappointment.  I'm brought out of my pink haze by the sound of the fire alarm going off in the MFM's building.  The doctor quickly says "We're concerned about fluid levels in Baby A.  We would like you to come next week.  Do you have any questions?"  Well the FIRE ALARM is blaring so no questions could be formulated in my brain.  They call the next day to set the appointment for August 12 at noon.
8. There are some things you should never do alone.  One is when someone who is a high risk baby doctor says she is concerned about one of your babies is to go see her alone.  But I didn't have the dread feeling so I went by myself.  It was horrible.  Baby B was having a party in her swimming pool like she always does and Baby A, well, she didn't move.  She had turned facing my back and never even flinched.  The only thing I can equate that to is a dead goldfish in a bowl only back up instead of belly up.  My baby, the twin I never knew I wanted, wasn't moving but luckily she had a heartbeat.  A good strong heartbeat.  But time was not something to be played around with.  Dr. Connor's looks at me, who is putting on the bravest strongest face that I only pull out when I am feeling defeated, and says the words I have been dreading since we went MoDi, "We believe your babies have developed twin to twin transfusion.  We are sending you to Charlotte to Dr. Stephenson who is a fetal surgeon and she will do another scan and talk to you about your options".  I stumble out an "Okay.  Yes I understand.  Yes I've done some research".  I keep that face on until I get to my car and I call my husband and my cousin and I let the tears fall.  The MFM office beeps in and says "Dr. Stephenson wants you in her office at 7 am tomorrow morning."  I say "I will be there".  Obviously 7 am is early which means they're concerned which has me even more concerned.  
9. August 13 my husband and I make the hour and half drive to Charlotte and settle in for what is a long sonogram.  More measuring of two heads, two hearts, two bellys, two cords, two this and two that.  Little to no words are being said by anyone in the room.  Baby A is still facing my back and still not moving but hanging in there with a heartbeat.  You see, when a babies fluid environment gets to a certain low point they start using their energy wisely.  She was using her energy just to literally survive.  We then consult with Dr. Stephenson and she explains twin to twin transfusion.  

10. Twin-Twin Transfusion Syndrome (TTTS)

11. is a condition unique to monochorionic twins. This type of twin gestation has two fetuses that share one placenta. Since the fetuses share one placenta, they have vascular connections through the placenta. In TTTS, the fetuses are not sharing the placenta equally. Instead, one fetus receives more of the placental blood supply than the other.

1. Therefore, one fetus (the "recipient") receives too much blood and can become "volume overloaded". This increased volume results in increased fetal urination. While the other fetus (the "donor"), receives less of the placental blood volume and is "dehydrated" and does not urinate very much.

1. The differences in fetal urination are what result in different levels of amniotic fluid volume. If this condition is left untreated, there is an estimated 80 to 100 percent mortality

We listen and nod.  Listen and nod.  Then she talks about stages.

• Stage I is an early stage in TTTS that reveals only a discrepancy in the amniotic fluid between the fetuses. One fetus can have "polyhydramnios" or too much amniotic fluid, while the other has "oligohydramnios" or too little amniotic fluid
• Stage II is when the bladder can no longer be sonographically appreciated in the donor fetus. The bladder is present but is empty, so on ultrasound we cannot visualize this structure

• Stage III is when we note changes in blood flow through the arterial or venous systems of either fetus. The Fetal Care Center of Cincinnati has broken stage III into three groups depending on cardiac function of the recipient fetus based on mild (a), moderate (b) or severe (c) cardiac changes

• Stage IV is when the recipient fetus becomes so volume overloaded that there is ultrasound evidence of severe cardiac compromise such that the fetus is hydropic and swollen

• Stage V is when there is a demise of one fetus

Our girls are stage IIIb.  Something has to be done.  The weekend was coming and like I said before time was not our friend at this point.  She gives us a moment to talk it over.  We look at each in complete agreement that we will do whatever it takes to at least bring one baby into the world.  Surgery was scheduled for the next day at noon.

To Be Continued...

Surprise of a Lifetime!...

We have lived pretty contently as a family of three for the past almost nine years and before that a family of two for almost two years.  Our first child, a beautiful daughter with a free spirit and a knack for going from zero to diva faster than you can blink.  The day she was born was the greatest day in my memory and then we brought her home.  Within days I was ready to take her back and request a full refund!  She had colic, a milk allergy and reflux.  She cried and cried and cried and just when you thought she might be done she would cry some more.  And in those rare moments she wasn't crying it was only because she was taking the time to decorate me in spit-up.  She left me feeling helpless.  Her father and I were only twenty-two and while I had been around babies he was clueless!  Married single parent syndrome set in and yikes was that first year hard!  Needless to say we both agreed it would take some time to even think about having any more children.  She broke us.  She broke us bad.

Fast forward to a few months shy of our first born princess' ninth birthday and we start slightly discussing the possibility of expanding the family.  After all things are going pretty well.  I got hired on with our local government working with a wonderful and exceptionally supportive team.  My benefits, insurance and retirement are darn near dreamy.  We were getting close to the end stages of finally getting our dream home built.  Life is good.  And when you feel like you're finally doing something right that's when crazy things like "let's have a baby" start coming up.  So we had minimal discussions and I had some talks with the Lord about if it be His will than we will be blessed with another (hopefully more calm) baby - preferably a boy.

May 15, 2015 I realize that I'm late with no monthly symptoms and I have one test that has been gathering dust in the bathroom drawer I should pee on it for kicks and giggles, so I do.  Those lines showed up so fast it was almost magical.  I managed not to freak out like my twenty-one year old self did way back when I saw pink lines the first time.  I calmly walked myself into the bedroom where my handsome husband was half awake and told him the news.  He was as excited as a half awake person could be but he also managed not to freak out like the younger version of himself did - I felt so grown up.  I made an appointment with my family doctor that we've gone to for years now to confirm and sure enough she saw what I saw and due date should be around 1/15/16.  I was so excited!  We decided to keep it to ourselves because we knew this would be it for us and we wanted to keep it special for a little while.

The next morning  I called up the office where the OBGYN that delivered my first child now works because I mean we have history.  My first appointment is scheduled for June 5 at 9:30 in the morning which happened to also be my thirty-first birthday.  As the appointment day drew close my husband couldn't go with me.  You see he's a farmer and it had finally rained and he needed to be here planting.  It's our life I'm used to it.  So he tries to convince me to just go alone but I just knew something wasn't "right" about this pregnancy and I didn't want to hear any bad news alone.  So my best friend who had guessed I was pregnant a couple of weeks before because I had a horrible sinus infection and of course couldn't take anything worth taking to help, I asked her to go with me.  She of course said she would.  We head out to the big town of Albemarle and she had to witness yet again (she went to an appointment with me with my first and they surprised me with one) me getting a yearly exam and then we were getting a dating/heartbeat sonogram.  My how things had changed.  I didn't see my first baby until we were 18 weeks.  I walk into the ultrasound room so excited for my first birthday present and I confidently say to the tech "Tell me there's only one and there's a good heartbeat and I will be on my way".  She looks at me and I look at her and she says something along the lines of "I can't tell you that, there's definitely more than one".  I reply with a "Are you serious!?".  I mean what else would you possibly say in a moment like that?  It was then followed by a long string of "Oh My God!  Hollie did you hear that?  Oh My God.  This can't be real life." on repeat.  She proceeded to measure their  heartbeats and I continue to live in the land of "Oh my God".  Then she brings the OB back in and begins to explain to me that he believes from that sonogram that we are having what they call Monochorianic Monoamniotic (MoMo) twins.  The most dangerous type of twin to carry besides conjoined.  Mama bear automatically kicks in.  I ask him will they make it?  What are their chances?  What do we do?  They scheduled me to see a maternal fetal medicine specialist (MFM) and she will take a better look with a better machine and we can hope that she will discover a membrane separating these two little miracles.

I go home still not believing, even with photographic proof that we - the people who waited almost nine years to decide we were ready to have another baby - were having twins.  But it was like finding out we were having two blessings and being served their death sentence all in one day.  It was a lot to take in.  I take rest of the day off from work and jumped on Dr. Google.  I already knew there was going to be more doom and gloom than sunshine and roses.  I learned that the umbilical cords could tangle and stop flood blood flow for one baby or both and if one baby goes there was a slim chance of the other one making it.  I discovered that I would be expected to go inpatient at a hospital with a high rated NICU (which meant at least an hour or more from home) starting at 24 weeks and the absolute max I would be allowed to carry would be 32-34 weeks.  I was scared to move.  I felt like every movement I did make would cause them to tangle up and die.  It took awhile to sink in that there wasn't much I could do to stop my babies from moving.  I had to give it all up to God and pray for a miracle.  We also started sharing our news with close friends and family, after all we needed all the prayers we could get!

July 1 my first appointment with my MFM finally rolls around and my husband who is still under twin shock goes with me and BOOM!  there it is - "the miracle membrane".  My babies are officially separated in their own amniotic sacs.  They are now classified as Monochorionic Diamniotic twins.  Now a little twin lesson so this will be easier to understand.  All Monochoronic Monoamnitoic (MoMo) and all Monochoronic Diamniotic (MoDi) twins are "identical".  The term identical is a loose term because each child will have their own set of fingerprints and there will be subtle physical differences.  Each child is an individual with their own personality who just happens to have "identical" DNA.  We wrap up our sonogram with her with a "Congratulations and we will be seeing you every two weeks until delivery day" because MoDi twins come with a whole different set of concerns.  But from that point on we allow ourselves to feel some excitement again.

To Be Continued....