Mono/Di Twins

There's so much information out there about "twins" in general, but I am searching for real life delivery and NICU stories from mono/di mommas. I just want to know what is reasonable to expect for my delivery and after. So, here's the main things I'm wondering and would love to hear your stories.

How far along were you when you gave birth to your mono/di twins? My Doc is not allowing me to go beyond 35 weeks...is this normal? The peri says there is an unexplained twin death that can occur with no warning after that.

If you gave birth prior to 34/35 weeks, what type of issues did you face afterwards? How long were your babies in the NICU? What precautions (ie steroid shots) did your doc put in place in anticipation of their birth?

If you gave birth after 34/35 weeks, did your babies stay in the NICU? Was there any TTTS involved?

Also, did you want a vag or c/s and what did you actually end up having? If not what you wanted, then what were the factors that changed your decision?

I'm just so confused and want what is best for my babies. I'm meeting with their pediatrician tomorrow to talk about all of this as well, but really want some real life stories from moms who have BTDT.

Thank you in advance,
Danielle

 

Hi! Congratulations on your twins!

How far along were you when you gave birth to your mono/di twins? My Doc is not allowing me to go beyond 35 weeks...is this normal? The peri says there is an unexplained twin death that can occur with no warning after that. I had my mono/di twin girls at exactly 37 weeks. During my pregnancy, I became aware of the research study showing the risk your doctor is referring to by doing research of my own on mono/di twins. My OB, and even my high risk doctors, were not aware of this particular study until I printed it out and brought it to their attention. The high risk doctors were pretty quick to kind of disregard it, but I was still really concerned. Initially, I intended to push for delivery at 35 weeks, but we came to a compromise whereby starting at 35 weeks, I started going in every other day for NST's, and as long as everything looked good, I would (and did) continue to 37 weeks.

If you gave birth after 34/35 weeks, did your babies stay in the NICU? Was there any TTTS involved? My girls did not have any TTTS, and did not require any NICU time.

Also, did you want a vag or c/s and what did you actually end up having? If not what you wanted, then what were the factors that changed your decision? We were scheduled for an induction since both babies had been head down, but baby B turned transverse the day before, so I ended up with a c-section. I 100% would have wanted and preferred a vaginal delivery. I unfortunately ended up with a very difficult recovery from my c-section and some complications that had me back in the hospital for 10 days after their birth. (Luckily, I was still able to have them with me!) My OB has previously delivered a number of sets of twins where the 2nd twin was breech by doing a breech extraction, and has had no problems doing so. However, the high risk OB's who I saw for all of my ultrasounds, were aware of a study still in progress that was showing statistically significant risk to a second twin with a breech delivery, so even though my OB had a very hard time recommending and doing a c-section on me just because of my twin B's position, he still did it based on that new study. I agreed with the decision, but had my girls both stayed head down, I absolutely would have gone for the vaginal delivery. I had read about concerns with acute TTTS with vaginal delivery of mono/di twins and asked both my regular OB and my high risk office about it and both said they had never seen it happen. My high risk office was a huge and really busy practice.

I'm just so confused and want what is best for my babies. I'm meeting with their pediatrician tomorrow to talk about all of this as well, but really want some real life stories from moms who have BTDT.[/i] I just wanted to also say that I understand 100% how you're feeling and thinking about all of this! I went through the same thing with all the research and different opinions out there. Make sure you are getting the monitoring that you feel comfortable with for you and your babies. For me, that was a full growth scan ultrasound every 4 weeks, with just an extra cervical check/amniotic fluid check/heart rate check ultrasound every 2 weeks...so the babies and I were being visually checked on by ultrasound every other week. I was having no part of having any acute TTTS sneak up on us! Both of the offices thought that the once monthly ultrasounds would have been sufficient, but I was not convinced or comfortable with that, and they were happy to provide the additional "quick" ultrasounds in between...and my insurance company never had an issue with covering them.

Let's see...once I got to 30 or 32 weeks, I think, I started adding in the NST's as well. Starting around 33 or 34 weeks, I started going for NST's twice a week, but worked up to going EVERY day for the final week - week and a half because I was so concerned about that time period. Being monitored every day gave me the complete confidence to continue to 37 weeks, and the babies did so well!

Good luck!!

 

QUOTE(TwinsInFL @ Sep 8 2008, 12:09 PM) [snapback]969413[/snapback]
There's so much information out there about "twins" in general, but I am searching for real life delivery and NICU stories from mono/di mommas. I just want to know what is reasonable to expect for my delivery and after. So, here's the main things I'm wondering and would love to hear your stories.

How far along were you when you gave birth to your mono/di twins? My Doc is not allowing me to go beyond 35 weeks...is this normal? The peri says there is an unexplained twin death that can occur with no warning after that.

If you gave birth prior to 34/35 weeks, what type of issues did you face afterwards? How long were your babies in the NICU? What precautions (ie steroid shots) did your doc put in place in anticipation of their birth?

If you gave birth after 34/35 weeks, did your babies stay in the NICU? Was there any TTTS involved?

Also, did you want a vag or c/s and what did you actually end up having? If not what you wanted, then what were the factors that changed your decision?

I'm just so confused and want what is best for my babies. I'm meeting with their pediatrician tomorrow to talk about all of this as well, but really want some real life stories from moms who have BTDT.

Thank you in advance,
Danielle

Haven't had babies yet, but had to comment...

Wow, I wish I had your Dr.! I've read the studies,... there is a risk starting at 28 weeks, but what I've read is about 35 weeks is where the risk balances out with risks of prematurity... in fact, some recommend delivery as early as 32 weeks, but many articles based on that study think 34-35 weeks is good...

Uncomplicated Monochorionic Diamniotic Twins and the Timing of Delivery
http://www.pubmedcentral.nih.gov/articlere...i?artid=1160585

High Risk of Unexpected Late Fetal Death in Monochorionic Twins Despite Intensive Ultrasound Surveillance: A Cohort Study
http://www.pubmedcentral.nih.gov/articlere...i?artid=1160580

though I don't think all Drs. subscribe to that, or some (like mine) thinks the risks after birth outweigh the risk before 37 weeks... my Dr. said 37 weeks at the latest for our mono/di boys, but I'm nervous about it being that late.... also nervous because we probably have to switch perinatologists due to distance, and I heard Standard for Kaiser for all twins is 38 weeks, not 37 weeks.... so hoping we don't have a Dr. that wants to deliver even later... (I'm actually pretty scared about this- kinda the opposite of what you are worried about)

 

QUOTE(TwinsInFL @ Sep 8 2008, 11:09 AM) [snapback]969413[/snapback]
There's so much information out there about "twins" in general, but I am searching for real life delivery and NICU stories from mono/di mommas. I just want to know what is reasonable to expect for my delivery and after. So, here's the main things I'm wondering and would love to hear your stories.

How far along were you when you gave birth to your mono/di twins? My Doc is not allowing me to go beyond 35 weeks...is this normal? The peri says there is an unexplained twin death that can occur with no warning after that.

i went into labour on my own at 34w1d after 6 weeks of bedrest. my OB had said she was not willing to let me go past 36 weeks for the same reason your peri mentioned - although, my OB was very manipulative & instead of just stating the facts about the risks kept telling me horror stories of families that lost one twin at the end of their pregnancy. that really ticked me off.

If you gave birth prior to 34/35 weeks, what type of issues did you face afterwards?

i didn't give birth prior to 34 weeks but i was pretty close. our girls had very few issues. Danika needed to be on pressurized oxygen for about 18 hours after birth because she was having trouble breathing, then she was on nasal prongs for an additional 3 or 4 days. she was also on an IV for about a week. Riley didn't have any breathing problems but she did have trouble controlling her temperature so she was in an incubator for about 3 days. Danika also had jaundice so she needed to be under billi lights for a couple of days. both girls needed gavage tubes for about the first week until they were strong enough to do all their feeds from a bottle or to nurse.

How long were your babies in the NICU?

our girls were in for 13 days. the second week was almost entirely about putting on weight as most of their medical issues had been dealt with in the first week.

What precautions (ie steroid shots) did your doc put in place in anticipation of their birth?

i had steroid shots at 27 weeks to help the girls' lungs develop because at my routine ultrasound my cervix had thinned from about 4cm to under 2cm. that was also when i was put on bedrest. other than that we were given a lot of reading material about premies & the NICU to prepare ourselves. some of it was helpful, some of it was just unnecessarily frightening.

If you gave birth after 34/35 weeks, did your babies stay in the NICU?

yup, for 13 days.

Was there any TTTS involved?

TTTS was never diagnosed although we did have some indications of it & i had to go for weekly (sometimes twice a week) ultrasounds from about 27 weeks on. basically we had growth discordance (Danika, baby B, was bigger) and polyhydramios (sp?) (again, Danika - she had about twice as much amniotic fluid as Riley). however, Riley's amniotic fluid wasn't low, nor was her weight so Danika wasn't necessarily taking from her, she just had a lot more of everything for some reason. they kept a close watch on both girls bladders & abdomens but it didn't develop into anything.

Also, did you want a vag or c/s and what did you actually end up having? If not what you wanted, then what were the factors that changed your decision?

i wanted a vag delivery & that's what i had for both babies. this was against the advice of my OB, however, the OB on call at the hospital when i went in to deliver the girls was not uncomfortable with me attempting a vag delivery. this just proved to me that when it comes to vag vs c-section, short of a clear cut life threatening situation that makes a c-section necessary, everything else is personal preference of the doctor. my OB & i did not get along (for some perspective). at any rate, during pushing both girls heart rates dropped a bit & i had to push very quickly & effectively to avoid an emergency c-section. they did use a small hand held suction cup called a Kiwi to help Danika out as she was having even more trouble with her heart beat. i did not have an epidural as there wasn't time for me to get one & i think that helped me with the pushing, although if i had had to go for an emergency c-section it would have meant general anathesia & i likely wouldn't have been able to see my girls for a long time after the birth.

I'm just so confused and want what is best for my babies.

take in all the information & then sit & listen to your heart, your head, and your gut. you DO want whats best for your babies & your instincts will not steer you wrong. do not let fear lead your choice & don't rush into any decisions. you will know the right thing to do when it's needed. :hug:

I'm meeting with their pediatrician tomorrow to talk about all of this as well, but really want some real life stories from moms who have BTDT.

Thank you in advance,
Danielle

 

How far along were you when you gave birth to your mono/di twins? My Doc is not allowing me to go beyond 35 weeks...is this normal? The peri says there is an unexplained twin death that can occur with no warning after that.

The whole time I was pregnant I was expecting to go between 33 and 35 weeks, but never did. At my 37 week visit, there was a 1 lb difference between the babies weights based on the measurements (No TTS, but I was induced just in case) - and I wasn't dilated at all!, so I was induced at 37.5 weeks. I did not/refused to have a c section (unless of course a baby was in distress, which didn't happen). You have to be strong if you don't want a c-section. Many docs try to convince you this is the right thing to do.

Since I wasn't dilated I had to do all these cervical ripening things (not painful just took time). The delivery was fine. Here would be the part I would give advice on. I had an epidural. This was fine for the first baby. After the first baby it started to wear off and I got scared. I had them do it again and I was totally numb for the second baby, my contractions slowed down and there was 2 hours between my boys!! My second baby had to be vacuumed because I couldn't feel anything to push. He came out not breathing (cord wrapped around him) - but was breathing very quickly (no issues). It is scary sometimes. but here is my advice:

1) better to feel a little pain then overdo your epidural cocktail!!
2) make sure you and your doc are on the same page (c-section or no) - if it is different find a new doc. I did.
3) make sure your doc has delivered mono/di twins - my first had only delivered fraternal twins - again they may know what to look for, but I wanted a doc with experience that knew what to look for.

How long were your babies in the NICU?

My babies were never in the NICU and are both doing great! I wouldn't let them scare you into going earlier if you don't need to b/c it is hard once they are born and the smaller they are/the harder it can be. Again, same thing with the c-section. I didn't have one, but I separated my pubic synphasis (sp?). I had to walk with a cane for 2 weeks and that was hard - this had nothing to do with the delivery, it happens due to carrying the extra weight of 2 babies sometimes. Point is: it is hard enough to care for 2 babies without having additional recovery yourself.

What precautions (ie steroid shots) did your doc put in place in anticipation of their birth?

I did not have any shots. I went to a High risk mono/di specialist and she thought this was not necessary unless she saw some problems with the pregnancy. I was on modified bedrest for the last month and I took it seriously, which is why I think I made it to 37.5 weeks. I even fell down the stairs at 28 weeks and the boys were totally fine and I never had any problems (lucky!!)

Overall, there is still a 1lb difference between my boys today and they are 4.5 months old. Don't let all the stuff you read scare you. Eat right, slow down when you feel tired, trust your instincts - just like other MOTs said. There were days I felt like I should just stay home and I did. Other days I felt fine and could do anything, but I just let my body guide me and if things didn't feel "right" I rested and/or called my doctor. I think that is the best advice I can give you.

Best wishes!
Sarah

 

Here is how it went for us:

We were at Stanford Medical Center in California when the twins were found at my 19 week u/s. The girls had TTTS so I was immediately (as in that hour) transferred to a perinatologist and she was my only doctor. She worked with an OB who did our u/s every week and also ended up delivering the babies. Like I mentioned, I had u/s every week to watch the TTTS, they measured the babies' growth every two weeks, and I ended up with two amnioreductions (basically an amnio where they take out jars of fluid - it's a treatment for TTTS). One of those amnioreductions occurred a couple of hours after that first 19 wk u/s and then the next was at 25 weeks. I had the steroid shots before that one because of the risk going into labor.

The girls made it all the way to 35 weeks before they had to be delivered. They came out at 35.3 weeks. Sierra was our smaller baby and she was perfectly healthy. She had to spend 7 days in the Special Care Nursery until she proved she was eating and growing well. She took a 1 hour trip to the NICU soon after birth but her issue had stabilized as soon as she got there so she was sent back to Special Care. I always say she just wanted to go to the NICU so she could get one of the handmade hats & blankets that they hand out up there.

Ainsley was 5.5 lbs and she had immature lungs at birth. She was in the NICU for 9 days due to this respiratory distress syndrome and received various treatments for her difficulties. She also got a plasma transfusion since her blood was thick from being the recipient twin of the TTTS.

When I heard I was having twins, I automatically assumed we had to get a c-section. My peri told me that wasn't so and that we could try for a vaginal delivery as long as Baby A was head down. The girls stayed vertex (A) and breech (b) pretty much the entire pregnancy so I was induced at 35.2 weeks when it was determined that we needed to deliver. My body was not ready for delivery at that point though and I never dilated past 2.5. Thankfully, my doctors didn't subscribe to the "lack of progress" idea and were willing to wait as long as the babies and I all looked well. Eventually, I came down with HELLP syndrome (high blood pressure, low platelets, elevated liver enzymes) and we had to do a semi-emergency c-section before it got worse.

Since my c-section was actually really necessary, I don't feel bad about it at all. I would never want to go through it again and would have loved to deliver the twins vaginally but my body did not like being induced so early and it wasn't doing well carrying two babies. I had a VBAC with my singleton and it was way nicer than the c-section.

LOL, I was about to link a couple of studies for you but see a pp beat me to it. Good luck with your pregnancy and delivery!

 

I have not had mine yet, but I have never heard of any doctor wanting to take them at 35 weeks. My doctor wont induce me until 38 weeks. I get an ultra sound 3 times a week and NSTs 2 times a week so I feel pretty comfortable with them staying in as long as they can (well I am not comfortable, but you know what I mean LOL). I have never had low fluid levels and the boys have never been more than 3oz different in weight. The only thing that worries me is my placenta started to calcify kind of early, but I am only at a stage 2 now and they don't seem too worried about it. This is the hardest thing about twins: every doctor feels differently about everything!! For example my doctor is the only doctor in our area that will perform a vaginal delivery on twins period. I have been blessed to have a very uneventful pregnancy so I have never had major concern about my boys being mono/di, but I know it can be very scary. Oh and as said in PP my doctor has never seen TTTS happen at birth either. Good luck! Hope you have a great birth story!!

 

How far along were you when you gave birth to your mono/di twins? I was 38w4d when I delivered them. 5lb2oz and 6lb1oz. (both less than 3rd percentile for their gestation)

If you gave birth after 34/35 weeks, did your babies stay in the NICU? My smaller baby was in the special care nursery for 8-9 hours on oxygen. Then she was in the room with me.

Was there any TTTS involved? Yes. We were diagnosed with TTTS at 18 weeks. At 16 weeks I had an u/s because we still hadn't seen the membrane between them, and they saw a 20% difference in size. At 18 weeks I saw a peri, and my smaller baby had NO fluid (was shrink wrapped in her sac) and absent end diastolic flow in her cord. My bigger baby (recipient) had only normal fluid, so we didn't qualify for laser surgery (which I would have gotten in an instant). I was put on bedrest at 17 weeks, and stayed there until delivery (that's 21 weeks, for those counting). I drank 3 high protein boost drinks a day, ate plenty and drank plenty. I was monitored weekly with u/s BPP's at my peri's office. Within 2-3 weeks, my TTTS stabilized, and everything returned mostly to normal. It stayed that way until delivery - but I was monitored frequently. I will never underestimate the power of bedrest, protein drinks and positive thought again. Seriously, my peri was shocked that we turned around. My donor baby also had a 2 vessel cord and velamentous cord insertion, so that was an issue with her size and TTTS too. She stopped growing at the end, so it was time to deliver.

Also, did you want a vag or c/s and what did you actually end up having? If not what you wanted, then what were the factors that changed your decision? Before the TTTS, I wanted vaginal. After we got diagnosed, I could have cared less. I didn't want the risks of acute TTTS especially because we were already dealing with it. Turns out, it was out of my hands, because both babies were breech. So, c-section it was! My donor had an apgar of 3, so I'm very glad we went that route.

Hope that helps. PM me anytime - I do believe that TTTS can be treated, and frequent monitoring is key. If you're not being frequently monitored (bi-weekly by u/s) then I would urge you to do so, especially at this gestation through 26 weeks (when laser treatments are possible).

Jenny

 

My dd had mo/di twins. They were born via scheduled c/s at 36w 1d weighing 5.10 and 5.14. The c/s was the preferred method of deliver by both her peri and her ob. DD was fine with it. They spent no time in the NICU. She was monitored every other Friday for her entire pregnancy for signs of TTTS and thankfully that was never an issue...
She only had one NST at 34 weeks and did not have the steroid shots.

 

I was 35 weeks 4 days when my boys were delivered. It was via c section because my ob doesn't do VBAC's (they were both breech, so it would have been a c seciton regardless.) My scheduled c section was at 39 weeks, but we knew I probably wouldn't go that far as most twins don't, but I went as long as I could. She never mentioned having to deliver before 35 weeks because they were mono/di. Finn (baby B) had to be transfered to a NICU 40 minutes away because of respiratory issues. He spent a week there. We were monitored very closely. Starting at 18 weeks we had u/s every 2 weeks at the MFM office, but never had any signs of TTTS though they think they may have had a bit at the end because Van (twin A) had a low red blood cell count and was VERY pale and Finn had a very high red blood cell count and was VERY red. Try not to worry- it sounds like you're in very capable hands! Congratulations on your twins and good luck!

 

How far along were you when you gave birth to your mono/di twins? My Doc is not allowing me to go beyond 35 weeks...is this normal? The peri says there is an unexplained twin death that can occur with no warning after that.

my docs were going to induce me at 36 - but my water broke ar 35.1, they were concerned about acute TTTS even though we had no signs of it.


If you gave birth after 34/35 weeks, did your babies stay in the NICU? Was there any TTTS involved?

9 days in NICU feeding/growing


Also, did you want a vag or c/s and what did you actually end up having? If not what you wanted, then what were the factors that changed your decision?

wanted c/s at first because i was scared of ending up with one of each, but my doc convinced me to go vag as long as baby a was larger and head down. she was larger and head down, and baby b was smaller and breech. i delivered them vaginally 5 min apart - barely tore only needed one stitch.

i would say go for vaginal if possible - just to avoid surgery - but if baby a is transverse or breech its pretty much out of your hands - which is fine also. one thing i was happy i was prepared for was a post partum hemmorhage. during the last few mos pf my pg my doc kept saying that i was at high risk for that due to my uterus being so over stretched, so when it happened i was like -oh yeah this is what she was talking about. it was scary for my husband but i just got sleepy and two units of blood later i was feeling the best i had in 8 mos! i am not telling you this to scare you, just so you know that it can happen but they are most likely ready for it and will fix you up real nice.
good luck!

 

i have mono/di twins. my doc said we'd go to 38 weeks, but wouldn't stop labor at 34 weeks. (if that makes sense) at 29 weeks i got my steroid shots. at 30 weeks i started going in twice a week for NST's and once a week for U/S's. at my 36 week appt my doc said she'd like to induce at 37 weeks. i'm GUESSING this was because the babies didn't grow much (if at all) that last week. (they ran out of room, perhaps? and i believe that's when it can become dangerous. i could be wrong... ) . i chose a c/s from teh beginning, but 2 weeks before delivery, i decided to try vaginal. i pushed for 3 1/2 hours and nothing. so we did a c/s (cuz i was tired of pushing and baby A was stuck under my pubic bone), and my recovery went wonderfully. my girls didn't have TTTS, nor did they have any nicu time. actually, ivana was, surprisingly to everyone, very alert for a newborn. (and she's now a very calculating little girl ) their birth weights are in my sig, btw

both of my babies were head down, and everyone was trying to talk me into doing vaginal. i had to make that decision myself. so i did, and i'm proud that i tried, but i'm glad i got a c/s in the end. my doc said i coulda pushed for 5 more hours and nothing would have happened because ivana was literally just stuck (and too high for the vacuum).

good luck to you! and just relax and enjoy your pregnancy!

 

Thank you so much to everyone for the information. It's really helpful to hear true stories from moms who have been in my shoes. I'm glad all of your little ones are doing so well and hope our girls will follow their example! :itwins:

 

How far along were you when you gave birth to your mono/di twins? My Doc is not allowing me to go beyond 35 weeks...is this normal? The peri says there is an unexplained twin death that can occur with no warning after that.

I was 34 weeks, 5 days. I went into labor that couldn't be stopped. And I was sched for a C the week after. I agree, I think they need to get mono/di twins out sooner rather than later.

If you gave birth prior to 34/35 weeks, what type of issues did you face afterwards? How long were your babies in the NICU? What precautions (ie steroid shots) did your doc put in place in anticipation of their birth?

I had no problems, and the girls were in the NICU only as growers/feeders. I don't remember getting a steroid shot. It happened so fast.

If you gave birth after 34/35 weeks, did your babies stay in the NICU? Was there any TTTS involved?

They were in the NICU for 3 weeks. They wanted the girls to be at least 4 lbs. There was no TTTS

Also, did you want a vag or c/s and what did you actually end up having? If not what you wanted, then what were the factors that changed your decision?

I knew I was going to have a C, the lower girl kept flipflopping, I had a C the last time, and really didn't care to push out 2 babies. Plus I was at risk for an abrupted placenta; that was what I had last time.

I'm just so confused and want what is best for my babies. I'm meeting with their pediatrician tomorrow to talk about all of this as well, but really want some real life stories from moms who have BTDT.