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Tag Archives: identical twins

This shit is hard.

12 Monday Mar 2018

Posted by frannyritchie in babies, Early Days, Parenthood

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babies, identical twins, Parenthood, parenting, twins

Before I had kids, I read a blog post about a woman who had three kids (singletons, its worth noting) and she talked about how intimidated she was by the prospect of taking all three out by herself. And I thought, in my infinite childfree wisdom, ‘why would you have three kids if you couldn’t cope with it?’

And then in the midst of the UK version of Snowmageddon last week (it snowed, like, a quarter of an inch. Everybody freak out), nursery was closed, I was home with three kids, and I just…couldn’t. In the end, a very kind friend brought her kids over because their nursery was closed too, and I had to admit that I couldn’t handle the prospect of hauling three kids out for a playdate at 4 pm. Or maybe, more broadly, I was kind of at my threshold, in terms of my ability to successfully parent three children at the same time.

Lately I’ve been making a real effort to parent more intensively, especially with the littles (I’m less worried about Theo. He had three years as an only kid). I’m trying to stay off my phone, verbalise more, focus on each girl individually, be a more present parent in general. And I’ve been proud of myself, because I’m succeeding. Bu I saw something on Facebook a couple months ago that really resonated with me. It was a meme that said ‘I’ve been dieting ALL DAY, am I skinny yet?!’

That’s how I feel about parenting babies. I can do a bang-up job for about thirty minutes at a time, and then what I want most in the world is to dick around on my phone. Or drink coffee in silence. Or fold laundry. I want to do anything but sing ‘zoom zoom we’re going to the moon’ for the 37th time that morning.

I also vividly remember watching ‘Master of None’ when I first brought the girls home (pre-Aziz Ansari sexual harassment drams). At one point in the show, the central character is feeling lovelorn and confused and he goes for a walk around New York. I saw him do that and thought ‘Efffffffff YOU! You just leave the house whenever you want. What’s that like?’

There is a reason that babies generally come in ones and parents usually come in twos (at least to start). The reason is: babies are a crap-ton of work, and multiple babies are more than double that. It is relentless and hard, and man oh man do I love my kids, but I would also love to see a little less of them.

So, to the mum of three on the internet whom I judged when I was pregnant, I apologise. I still think having three on purpose is kind of nuts, but I understand how great they are once they’re here, and I also understand how, some days, leaving the house just isn’t happening.

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Identical Vs Fraternal Twins

05 Friday Jan 2018

Posted by frannyritchie in babies, pregnancy

≈ 1 Comment

Tags

di-di, fraternal twins, high risk pregnancy, identical twins, mono-di, multiples, pregnancy, turners syndrome, twins

The thing that struck me about having twins – particularly high-risk twins, since that comes with so many more scans and doctors appointments – is that the whole thing is very, well, mammalian. There are different types of twins, characterised by different placentas and amniotic sacs, and there is a surprising amount of confusion among the non-twin-bearing public about how they work.

So I’ve written a quick guide, and include the usual disclaimer about how I’m not a medical professional, just someone who is surprised by the degree to which people are confused about the biology of twins who’s done a lot of googling.

First, there are fraternal twins. Fraternal twins occur once in about every 80 pregnancies, although the number is going up as maternal age rises and fertility treatments increase the incidence of multiples. Vanishing twin syndrome, in which one pregnancy isn’t viable and just sort of…fizzles….only happens with fraternals.

In fraternal pregnancies, there are two separate placentas with two separate amniotic sacs. They are concurrent pregnancies, but there are no links between the babies in utero; they just happen to be two babies born on the same day. Fraternal twins can be girl-girl, boy-girl or boy-boy, and while many pairs of siblings may look alike, they are no more genetically similar than any other pairs of siblings. There is a genetic component, however: a woman’s likelihood of becoming pregnant with fraternal twins is passed down the maternal line (i.e. mother to daughter), because it relies on a woman’s likelihood of releasing two eggs in any given cycle (though, as mentioned above, there are a number of other relevant factors as well).

The natural world is full of fraternal twins. Every animal that has a litter is, in essence, having fraternal twins.

Identical twins occur once in about every 400 pregnancies, but are (I suspect) less prevalent in the general population because there are some common complications that make fewer identical-twin pregnancies viable. Within the umbrella of ‘identical twin’ there are three separate types of pregnancies:

  1. Dichorionic-dizygotic: two placentas, two amniotic sacs. On an ultrasound, this pregnancy will look exactly like a fraternal pregnancy; in fact, some people do not know until they have genetic testing whether they have identical or fraternal twins even after birth (not all identical twins look alike. Mine don’t!)
  2. Monochorionic,-dizygotic: one placenta, two amniotic sacs. The placenta is divided into two sections, serving each twin individually, but the line can only be distinguished post-partum. This is the most common type of twin pregnancy and occurs in roughly 92% of identical twin pregnancies (though I have also seen reputable websites that claim its more like 60%. Since not all di-di twins will be confirmed as identical there is probably some wiggle room here).
    There are also blood vessels connecting the twins across the sacs; despite the roughly hojillion ultrasounds we had, I was never 100% clear on how that works. In twin-to-twin transfusion syndrome (TTTS), one of the more common and serious complications, the babies’ blood vessels are connected, and one twin receives more blood than the other (donor) twin. Selective intrauterine growth restriction, which is what my girls had, is a similar condition in which one twin has a larger allotment of placenta than the other. Most identical twins are different sizes at birth; sIUGR is diagnosed when one of the fetuses is below a certain percentile (I believe its 10th percentile but I couldn’t confirm that with a quick Google so I’m just going to go with it)
    TTTS affects about 15% of identical twin pregnancies and sIUGR about 10%. If you’re really unlucky, you can have both simultaneously; one does not preclude the other, though the differences between the two disorders are only subtle. Both are not possible in pregnancies without a shared placenta, so do not affect fraternal or di-di pregnancies.
  3. Monochorionic-monozygotic: there is a single placenta and a single sac. This occurs in about 2% of twin pregnancies and is super high-risk. Best practice as of 2017 calls for women with mo-mo pregnancies to be put on bed rest at 25 weeks and deliver at 32. The reason is that there is a risk of the umbilical blood vessels getting tangled within the single sac, which can have really awful, tragic outcomes. Mo-mo pregnancies are also at an even higher risk for TTTS and sIUGR, although I’m not sure why.

The type of twin pregnancy is determined by when the egg splits: if it happens early, you get a di-di pregnancy; if it happens late, mo-mo. Everything in between is mono-di. What surprised me is the definition of ‘early’ vs ‘late’: any egg that splits more than 13 days after conception will result in conjoined twins. Eight-13 days = mono-mono and a split between five and eight days results in mono-di.

One note about identicals: in very rare cases, they can be different sexes if one of the babies has Turner Syndrome and the other does not. Turner Syndrome occurs in 1 in every 2,500 births, but its incidence in twins is extremely small – like, five documented cases ever. Still, I was floored to find out there is any instance in which identical twins can have different sexes.

You may think you don’t know enough identical twins for the 1/400 number to sound right; this is because (I think) there have been dramatic advances in maternal/fetal care for twins in the last decade or so, as well as major improvements in neonatology, which is a fast-moving field. In most cases, the treatment for complications is premature delivery, which on average has much better outcomes now than it did thirty years ago (which is not to say there aren’t lots of healthy humans who were born prematurely out in the world, though there is not great data about how they fare in old age).

When we told my parents we were having identical twins, they said ‘but how do you know?’ and the answer is, there was only one placenta, so it was definitely identical. There is no way to increase your chance of having identicals; it just happens sometimes.

 

 

 

Now that I’m a Mum of Three

19 Monday Jun 2017

Posted by frannyritchie in babies, Early Days, pregnancy

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Tags

bonding, Family, high risk pregnancy, identical twins, pregnancy, three kids, twin

Didn’t plan on having a litter.

 

When my first child was born, I remember walking dreamily around the hospital room telling a friend that I couldn’t believe something so perfect had come out of me. Objectively, this was not true – kid was a weird looking baby. He was super scrawny, and the first time my sister saw him, she squeaked ‘he looks like an alien!’

(she wasn’t wrong)

Maybe because of the persistent anxiety that defined this pregnancy, or because they were whisked away in incubators while I still felt too shaky from the c-section to touch them, or because two babies is a lot of baby – I didn’t have that this time. I have felt fierce, and protective, and grateful, and scared. But a couple days ago, I looked at my two daughters and said to them ‘I love you so much!’ and was surprised to realise that it was the first time the phrase had come naturally to me.

I learned I was having twins ten months ago, and today, I still struggle to believe that I have three kids – even with all three of them in front of me, it doesn’t seem real. I am still recalibrating my life as a parent – this isn’t the family I imagined, and the third kid is the hardest part. And to be clear, are all the third kid: Theo, when he runs into the bedroom at 6:30 on the nose to ask if he can watch Paw Patrol; Daphne, when she screams because she’s starving but the boob is RIGHT THERE; Fiona, when…well, she’s actually a pretty chilled out baby but she definitely has her moments. I want all three of these kids, but I didn’t want three kids, and I’m still mourning the vision I had for my family, even as I feel myself falling more and more in love with what I actually have.

 

So let me tell you about this horrific pregnancy I just had.

30 Tuesday May 2017

Posted by frannyritchie in pregnancy

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Tags

31 weekers, high risk pregnancy, identical twins, little squishes, preemies, pregnancy, premature, premature babies, scary pregnancy, sIUGR, twins

It turns out I have a lot more to say about parenting in the abstract – having branded myself, officially, as a Mummy Blogger (ugh) I’m all of a sudden at a loss for words.

You guys, I am never at a loss for words.

So I decided to go for it. 


The girls at about three weeks old (34 weeks gestation)

I’m writing this because even three months removed from the actual pregnancy, it looms over me, as I imagine it does for other women (and men, and people) who have dealt with a scary or high-risk pregnancy. I would have loved to read my story six months ago and I would love for it to be a source of strength for families at a different stage of their own experience.

Lucky you, though, I decided to save miscarriage and the NICU for another day.

In February I gave birth to two extremely tiny identical twin girls, Fiona (at 1.3 kilos or 2.9 lbs) and Daphne, who weighed in at 820 g (1.8 lbs). They were 31 weeks gestation and had suffered from selective intrauterine growth restriction, or sIUGR. Both were small for 31 weeks, but Daphne was barely on the charts – she was somewhere near the 0.1 percentile, whereas Fiona was somewhere around the 9th or 10th percentile. That is also small enough to be considered growth-restricted, and the NICU consultants told me she was probably also somewhat compromised in utero.

We were diagnosed with sIUGR at about 16 weeks and had weekly ultrasounds to monitor growth and, more importantly, blood flow in the umbilical arteries. The gist of sIUGR is that one baby has a larger share of the placenta than the other, but it is also common for the smaller baby to have a narrower umbilical artery and/or a bad connection between the artery and the placenta. In Daphne’s case, she had a cocktail. She had All The Things. It wasn’t a great situation. Once diagnosed, we had a target C section date of 32 weeks, though I held out hope that we could make it to 34 if we were lucky.

Every week, we would watch the blood flow in the umbilical artery to make sure, essentially, that blood wasn’t backwashing into the artery between heartbeats. When that happens, intervention often follows fairly swiftly.

Things were going pretty well, actually, until the 23rd of December, when I had a bleed. I was 23+6. As my legs shook and the midwife put in an IV, the doctor stood above my bed and said ‘I don’t think we will deliver these babies tonight, but that is just a feeling.’

They never figured out what it was, but after about three hours the bleeding just….slowed, and eventually stopped. I spent the night in Labour & Delivery drinking water, staring at the blue computer monitor, and schlepping back and forth to the toilet. When a nurse in green scrubs brought me tea and toast the following morning, I sat with the tray in front of me and sobbed.

The following week, there was backwash in the umbilical artery and it was time to consider laser ablation surgery. The procedure was effectively a selective reduction. While in rare cases, the smaller twin thrives after connections to the bigger twin are severed, in most cases, the little one doesn’t make it; instead, the larger one gets more time in utero and a substantially mitigated chance of profound disability. Our little one – already named Daphne – was so little that we had to assess her chances of survival at about three weeks behind her gestational date. So when she was 28 weeks, we looked at statistics for 25 weekers.

At 25+4, we went to London to meet with a specialist. The procedure is not performed past 26 weeks so it was absolutely our last chance. We knew the moment might come but it was an agonizing weekend. There was a very real possibility that, without intervention, neither girl would make it. But there was an equally real possibility that both girls would be just fine. There was no right answer, but we went to London having decided that the procedure was the best thing for our family. I was so sure we were going to do it that I had already contacted grief counseling services at our local hospital.

And then, magically, everything looked fine.

My husband had by this point taken to carrying around a thick stack of scholarly articles covered in pink highlighter, and I had taken a case-study approach – I had scoured the internet for similar stories. So it was both alarming and gratifying to see a team of six medical professionals from around the world clustered around the ultrasound machine, all trying to figure out what the fuck was happening in my uterus. Spoiler alert: they decided that 32 weeks was still a reasonable goal, and that 33 was not unimaginable, and sent us on our way. We got Japanese food and almost missed our train.

I’ve tried to be succinct here, so I will skip the part about how I had another bleed, spent another weekend in hospital, got put on monitoring, and then ultimately delivered due to complications entirely unrelated to sIUGR (high blood pressure and reduced foetal movement).

We delivered at 31 weeks via emergency c section, and our girls spent 9 and 10 weeks in the NICU respectively. Despite the fact that that is a helluva long time, they had relatively straightforward experiences, or at least it could have been much worse.

Today the girls are 15 weeks old, or 6 weeks and 2 days, adjusted. Both have begun to smile but prefer to look quizzical, gifting me infrequent but radiant open-mouthed grins. They have largely held their growth curves but I am optimistic that they will nudge up a few percentiles in the next few months. In short: it all sucked but we appear to be coming out the other side. At this point, my day-to-day experience of these babies is like any other woman with six week twins, and the most amazing thing is how quickly the NICU has faded behind us.

If you are a stranger on the internet in the throes of a scary pregnancy, and I can be of use, please let me know.

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