Ultrasound, April 14, 2011

I’m happy to report that positioning for the twins has improved 75% in the last 2 ½ weeks. They were double breech, an automatic c-section combo. Now Twin B is hanging out head down in the back, while Twin A sprawls sideways in front of her like a backslash. People who have noticed me looking especially stickie-outie in the last two weeks can understand: we take up more room front to back when the three of us are in single file. I’m sure somebody, probably A the quirky one, got tired one night of me tossing and turning from left side to right side in an endless ricochet and decided that nobody really had to have the bottom bunk. It’s still a combo that is delivered by c-section, but it is definitely a step in the right direction. If Twin A gets tired of Twin B’s toes tickling her ear, she may decide to give the head-down lifestyle a try.

Our biggest good news is that a normal 24-week scan for mono-di twins is a huge milestone. It means the placenta and dual umbilical cords formed correctly and we are past worrying about TTTS. The tech took Doppler readings of my heartbeat through the cord veins and arteries and the blood supply looks equal. Great news! The only disappointing thing about our 24-week scan was: No Pictures! I came home, empty-handed, to Craig wanting to see more little black-and-white renditions of hands and feet, soft palates and bases of spines. The reason we didn’t get a photo booth keepsake to commemorate this scan was that though two babies still flashed by on the screen and the tech did record their heartbeats, this scan didn’t measure the babies.

Years from now, we will NOT look lovingly down at the photo album and say “Awww, look! There’s my placenta. How adorable is that!” or “Yes, I remember when my cervix was long and closed!” I don’t even WANT a picture of any of it. Truth be told, I think that placentas and umbilical cords are slimy and disgusting, and the thought of having a few inside of me engages my yuck factor. I was too drugged to notice the delivery of the placenta after I had Devon, which was fine with me, and when Craig (ever the biologist) launched into a description of it ("I was amazed at how HUGE it was, Krista. Like a PIE PLATE! And it had all these blood vessels snaking around it like red and blue--") in recovery I had to cut him off.

Another odd fact about pictures is that in the past week the mysterious entity http://2.bp.blogspot.com has ripped the sonogram pics off my blog and posted them on Google Images. I spent the morning trying to change the security settings to keep my twins from being carelessly disseminated through the ether without my permission. No luck, thus far. I feel that being the owner of said blog and fetuses gives me enough of a copyright that I can expect that my images not end up on somebody’s powerpoint. I’ve heard about this happening. Moms post sweet baby pictures on Facebook and see their babies selling cereal in an Internet ad a few weeks later. People post pictures of their diet progress on a weight loss blog and end up on a makeover site, with their pictures used as "Before" shots and models comprising the "After" pictures. Didn’t think it would happen to my twins, but it could be worse. I’m glad I didn’t upload any pictures of my placenta.

Ultrasound, March 28, 2011

Most same-gender twins have genetic testing at birth to determine if they are identical or fraternal (boy-girl twins are obviously not—think about that one for a while). How does the doctor already know that our girls are identical?

Twin A and B are mono-di twins, short for monochorionic-diamniotic. They split from a single egg three to seven days after conception. Each twin has her own umbilical cord and amniotic sac, but they share a placenta. It’s hard to tell when you’re looking at it on a fuzzy gray screen, but the whole thing looks like one of those cherries that is really two developed on the same stem but stuck firmly together.

Mono-di twins have a 1 in 7 risk of a condition called Twin-to-Twin Transfusion syndrome, a really scary complication where the blood vessels in the cord filter all the blood supply into one twin and then the other. One twin swells up and develops heart problems from all the extra pumping, and the other one shrivels up like a raisin because it can’t get enough blood. This condition is usually apparent by 18-25 weeks, so that explains the extra scrutiny. Thankfully, the girls measured about 20 weeks today and there wasn’t any difference in amniotic fluid, the first sign of TTTS.

We’ve been fielding questions about twins in the family since our discovery ultrasound two weeks ago. No, neither of us have twins in our lineage, but this makes sense. Family genetics can produce only fraternal twins, which are caused by more than one egg released at once. Fraternal twins are also the only kind produced by taking fertility drugs to induce hyperovulation, one reason why it seems like there are many more sets of twins than there used to be. Higher maternal age is another factor in increased chance of fraternal twins, but there is no way to predict or increase the likelihood of the spontaneous dividing of a single pregnancy that causes a set of identical twins, a 1 in 250 chance for everyone, no matter what.

The first thing I wanted to know about my very special girls at this ultrasound was their position. Right now they are both breech (imagine me with two hamster-sized fetuses perched upright on my lap). Now that they have their heads together, I hope they can figure out a way to go head down, because I am really hoping for a natural birth. There are complicated formulas for positioning combinations in a twin delivery, but my best chance of not getting popped like a beach ball in front of a hundred interns taking notes (UK is a teaching hospital) is for them both to be bottoms up at term.

We were also hoping for some cute two-heads-together or four-little-feet pictures, but our twins were not in a photogenic mood. The main reason the scan took over an hour was their constant movement. The tech would isolate a foot, prepare to measure it, and it would disappear. She could move the camera a bit, but the first foot that came into view might not be the right one of the four squirming feet she had to keep straight.



We did, however, get a “Power to the Babies!” sign from Twin B, busy executing a barrel roll.



Devon’s favorite postpartum gesture was to make a punctuating grunt and stab a fist emphatically in the air, like he was saying “Power to the Babies!” I think Twin B was just reminding us who was in charge.

Ultrasound, March 10, 2011

I could tell that something was different in the ultrasound room. On the screen I saw my baby for a moment, a rib cage, a snub nose in profile, then the image suddenly dissolved, and then reappeared again, only… upside down? I didn’t remember that trick from Devon’s 20 week sonogram, which wasn’t all that long ago (November 2010). Then the sonogram tech started rapidly swirling the camera around on my stomach in a figure eight-like motion and I thought of Mr. Potato Head when you open the door in his back and see all his spare parts tangled up inside. A knee and an ear? A foot and two hands? Three feet and a chin? Was there something wrong with my baby? Could it be fixed? What would they do with all the extra body parts… donate them?

“So… what number scan is this for you?” asked the tech.

“The first.” I thought I was two months late when I finally saw a dark blue cross on the end of the stick, but it was hard to tell. The monthly visitor had barely started visiting me again anyway because I was still nursing Devon, then 9 months. Since it was Christmas week, I had to wait until the doctor’s offices opened again to make an appointment, and they couldn’t see me until late January. When they said they could get me in for an ultrasound at 16 weeks, I declined. Since my husband is just finishing grad school, we have Humana Student Health insurance (Need health care? Flip a coin. Heads we’ll cover it. Tails we won’t!).

The kaleidoscope of baby shapes continued to move on the screen and then came to rest for a moment. “Well, I have a surprise for you. There’s more than one in there!”

I gasped and looked over at my husband, who was holding almost one-year-old Devon tightly and grinning like we had just won the fertility lottery. “I knew it!” I wheezed. But did I really? What I had was more a vague sense that this pregnancy was different, and they say that every one is. I had several dreams of Devon and he was always a boy, so I’d been going to bed every night waiting for gender clues in my dreams. So far, I dreamed of food: burritos, cheeseburgers, cake, terryaki chicken bowl. I was definitely sicker with this pregnancy, and I had already stopped riding the stationary bike because of a tight abdominal sensation I was experiencing, reminiscent of two stakes being wedged between my rib cage and my pelvis, one on each side.



As it turns out, the stakes are identical twin girls. Twin A is currently breech and seems to be the more active one, using my bladder as a stairmaster in the evenings.



Twin B is currently head down, and seems quieter. I can occasionally feel her fingering my intestines like the strings of a harp.



I triumphantly told the ultrasound tech that this was why I was big for 20 weeks, and her response was that my due date was also off. Measuring at 16 weeks and 17 weeks, my twins are due August 21st, not July 28th as we thought. So Devon will probably still be a big brother by 16 months, because twins are often early. And being moved back four weeks in my pregnancy didn’t help any size estimates either. I’m kind of like global warming: it’s a vague problem that everyone seems worried about, but we all have no idea how bad it’s going to be.



So, Devon turned one last week, and Craig finishes grad school in August of this year, and whatever job we find will probably include moving again. I’d spent weeks picturing us driving off in our car with one newborn, one toddler, and one tabby in the back seat of our compact car. At the moment, we’re not sure how we can accommodate three babies under two and a tabby cat in our compact Chevy Malibu, but it’s not a bad problem to have.