The Second but Last Trimester
After learning that we were having identical twins which were not sharing the same amniotic sac, we nearly skipped out of the doctor’s office with glee. Morning sickness was tolerable and overall I felt pretty good. This continued for the next 4 weeks or so.
Despite dodging the “monoamniotic twin” scenario, identical twins get an extra dose of precaution with a second OBGYN to monitor the pregnancy. Around the 14th week, we began seeing a high-risk pregnancy doctor, also known as a maternal fetal medicine doctor (MFM). At one of the first appointments, we had a blood test done to detect genetic disorders and from those results we learned our twins were boys. We were so excited and almost immediately decided Twin A would be Jack and Twin B would be Charles or “Charlie”.
I’m not completely sure what week it was but very shortly after (around week 16-17), our regular OB noticed that Twin B was growing a few days behind Twin A. It was another “nothing to worry about” moment and we continued on. The next week’s MFM appointment revealed that Twin B was now even more behind. And so it began. Each week (sometimes twice a week) we were seeing the MFM who would measure the twins and discover that Charlie was continually falling behind in his growth.
Initially the diagnosis appeared to be “Twin to Twin Transfusion”. Ok, I’ll explain a little medical stuff as best as I can. Our identical twins shared one placenta. When this sharing happens, connections between arteries and veins are made in the placenta which passes blood back and forth between each twin. Often the connections are balanced but if there is an imbalance then one twin is pumping too much blood to the other twin, hence “transfusion”. The complication is nearly always fatal for the twins. The MFM, on two occasions, offered us the available solutions: wait and see, abort one or both babies, or surgery if we met specific criteria. We refused abortion both times because we firmly believe that God controls our lives and this would be a violation of God’s commands. So we either wait or do surgery. The criteria was very specific and each visit to the doctor appeared to bring us closer to the criteria needed. We had planned, tentatively, to be in Houston for Labor Day 2016 for this procedure. The success rate for at least one baby surviving was only 50%. The success rate for the babies surviving without treatment was incredibly smaller.
Time would pass and God would graciously keep us just outside the necessary dimensions. The Houston team of doctors would be consulted over and over but we would never be accepted as true “twin to twin” patients. Finally week 20 passed and all options for surgery were over. It was now just a waiting game.
The complication was officially labeled “selective intrauterine growth restriction” (sIUGR). With this specific complication, one we learned was only seen two times per year by our specialist, another complication develops. The umbilical cord for the smaller twin would begin to have issues carrying oxygen from the placenta to the baby. Early on, Charlie’s blood flow would stall between heartbeats but still flow in the right direction. The best medical journals we found said that this would last 7 to 70 days until it began to flow backwards. Backwards blood flow is ominous; death or immediate delivery were the only results.
Day by day, we often had no idea what the fate of the twins would be. I could feel movement but could never identify which boy was moving. Every week we would quietly drive the hour to the specialist’s office and sit in the dark room for the sonogram. The technician (or often the doctor himself) would begin the scan and find Charlie to do an immediate heartbeat check. Each week Charlie would have grown, still 3 weeks smaller than he should be, and his heart would be beating just as well as Jack. We lost count of the times the doctor would look at us completely shocked. God was sustaining their lives.
As we began to approach the age of viability, the smallest age that a baby could survive premature, our doctor began to counsel us on statistics for survival and severe handicaps. The shared connections in their placenta meant that the fate of one twin in the womb would greatly impact the other twin. The conversations we had included the following:
- “We need to talk about the best plan to save Twin A.”
- “You need to decide if we plan to save one or both babies.”
- “You can deliver now but Twin B will be too small to survive.”
- “Do you have any support system for what you will be facing?”
We asked questions such as:
- “Can you tell me the range of neurological problems the baby will face?”
- “Can you compare the survival rate vs the risk of death in utero rate?”
- “What can be done to help improve their survival when born premature?”
It was a like a curtain closed over what we used to call “our lives”. It was a time of frivolous joy and fun. We had purchased the camper and taken Evelyn and Otto to see the ocean for the first time. Our trip to the mountains was planned and paid for. Now, we began to shut the doors, lay the white cloth over the furniture, leave our once home of easy living vacant. We asked to be relieved of ministry obligations and began the refund process of our planned vacation. Life, as we had previously known it, was over.
Options to improve the twins’ survival were incredibly small. Steroids to boost their lung development were given only at 24 weeks. Magnesium IV was done within 2 weeks of delivery (if you were lucky enough to time that correctly). One internet site said a high protein consumption would help. (I’ll never look again at a high protein Boost shake without hurling. I consumed 50g of protein every day in those shakes alone.)
At 24 weeks I received the 2 doses of steroid shots. This was also the first time the sonogram technician saw brief reverse blood flow for Charlie. It was far too early to deliver either twin. We waited. Two weeks later, the blood flow was occasionally reversing. We could deliver and save Jack but there was no hope for Charlie. We asked for another option. We were admitted to the hospital for a 48 hour magnesium IV to help stabilize the blood vessels in their brains. The side effects would be that I would feel all the symptoms of the flu, lose all muscle strength, and have to be woken every hour to ensure the dose was not too high and I stop breathing.
We were discharged on Halloween 2016 and instructed to see the doctor within an hour. The sonogram showed absolutely no reverse blood flow. It was a miracle by God. Two days later we would have another perfect blood flow report. Everything was fantastic. Until Cameron came down with a horrible stomach bug.
I left his weak and sickly self at home the next morning and drove with my mom to the MFM. The sonogram was quick and easy to determine, his blood flow was reversing 100% of the time. “I no longer can guarantee they will survive any more days. You must deliver. I’m so sorry it has happened.” The peace of God filled my heart but I will always remember the look on our doctor’s face as he said goodbye for the last time outside the exam room. He looked deeply saddened, completely aware of the future we didn’t see coming.
I picked up Cameron, who had miraculously recovered, and wept as we drove to the hospital. Hours later, I would sit upon the metal operating table. My arms were wrapped around my belly and all I could think was “My stomach is too small…far far too small.”
[to be continued…]