Let’s back up a bit.

Here’s a synopsis of our gaggle to date: We have Sam, our almost-3-year-old boy. Currently, Sam loves trucks, Cheerios, and crying for his daddy whenever mom tries to do things with him. We also have two pitbulls, Overo (Ovie) (7 years old) and Patches (4 years old). Ovie was the first to join our gaggle, but after a year or so, he seemed like he needed a friend, so we got Patches. It turns out that Patches is a total bossy bitch, not the big spoon that Ovie was hoping for, so it took some time before our house didn’t feel like total chaos. Patches has calmed down over the years, and Ovie and Patches actually seem like friends now. Patches is actually a very sweet dog, and she’s the best snuggle buddy around, but she struggles with allergy issues (we now give her allergy injections every 3 weeks) and sometimes when her allergies flare up, she gets less patient. This was particularly difficult last year when Sam was in a phase where he liked to hit the dogs with large sticks. We’ve worked tirelessly to train her and Sam, and get Patches the veterinary help she needs so that she is the nice doggie that she wants to be. She’s been doing great lately! Time to add more to the gaggle!

Sometime last year, we decided that we wanted to grow our family, by one person. A 4-person family is great. You can fit at a normal dinner table, air travel seems manageable, and the kiddos can even share a room.

In late February, I found out that I was pregnant. The normal first trimester worries circulated in my brain, but nothing too crazy. “How will we shuffle 2 kids around? That sounds logistically inefficient.” “Maybe they can share a room so we can keep the guest room as is.” “I hope there’s nothing wrong with this baby.” “I hope I don’t have a miscarriage.”

Fast forward to late March when we had our first doctor’s appointment. I made my first appointment with a PA because I’d seen her before, I liked her, and I figured it didn’t really matter for the first visit. I mention to her that I have felt so much more tired and nauseous this go around. She starts to do the ultrasound and gets quiet for a moment. “Umm.. I see two heart beats.” Erin and I stare at each other in silence. Uhh.. what?? She mentions that they are very close together, and it looks like they are probably sharing a placenta. She suggests another ultrasound the following week, when the babies are a bit bigger, so they can look around more and see what’s going on.

For the next week and a half, the following thoughts occur:

• “How am I going to walk the dogs?” This was my first thought. What combination of strollers can I use to push three kids around while also wrangling my two pitbulls?
• “We need a new house” This was Erin’s first though. Erin starts exploring if we can buy some cheap land for sale in Lake Forest Park and build a house
• “Sam had placenta issues. Does that mean these babies will have them too, especially if they are sharing one?”
• “This was not the life we had planned. We need all new cars.”
• “OMG twins! How are we going to do this with our existing toddler and two pitbulls?”
• “They were so close together. I hope they aren’t conjoined. Or mono/mono.” No, that’s so rare. They’ll be fine.
• “Should I stop working?”… thinks.. “Definitely NO! I need and want to keep working. I love what I do.” 
• “How will we give Sam enough attention?”
• “How the f*** are we going to pay for all this? What combos of childcare can we consider? We don’t want to disrupt Sam’s life too much, so we’d like to keep him in his daycare/preschool. That means paying for a nanny or 2 infant daycares on top of Sam’s daycare. That’s $6k/month easily. I guess we just get a nanny and put less in our 401ks for awhile.” I have still not done this math.
• “Of course that $100k land for sale was too good to be true.” About 85% of it is protected wetlands, and there’s no access to that buildable land from the street. It was fun to dream about building a house.
• “I guess our house is fine for now.”
• “How will we make sure to give the twins their own identities?” 
• “We can do this.”

Fast forward a week and a half. We go in for the ultrasound, but the quality is not very good, and the twins don’t seem to be in a very good position. They never get a good shot of both of them side by side. 

My doctor (who I had not yet seen) calls me the next day, Saturday morning. She mentions that the babies were touching in the ultrasound, and there are some concerns about them being conjoined. CONJOINED?!? She says she’s referring me to a maternal-fetal medicine (MFM) specialist. Of course, this call comes on Saturday morning, and the clinic is not open until Monday, so I spend the weekend worrying about having conjoined twins. Actually, a more proper description of my state over the weekend would be “freaking the F out.” Googling pictures of mono/mono and conjoined twin ultrasounds. Staring at the ultrasound photos I have. Reading about conjoined twins. Reading about mono/mono twins. Why would she tell me that on a Saturday? Did she even need to mention that she thinks they could be conjoined? Why not leave that information out until we see more? CONJOINED? The doctor says the clinic will call me on Monday to schedule, but I decide to take matters into my own hands.

First thing Monday morning, I call the MFM clinic, and I immediately start bawling when they tell me that the referral hasn’t been completed. I am losing my shit here, and it’s not even 8:30 on Monday morning. I call my doctor’s office again, make sure they submit the referral, and then wait for the referral to go through medical review. UGHHHH. In the meantime, I also make it clear to the MFM clinic that I’m going on a trip in a few days, and I want to be seen before I go so I can stop freaking the F out. They mention that they probably won’t be able to see me until the following week. I continue freaking out about my potential conjoined twins, in the midst of typical Monday work meetings.

The MFM clinic then calls back, later in the day on Monday, and says they found me an appointment for Tuesday at 9am!! Thank you thank you!! Yes yes yes, I will take it! What a relief!

So we go to the clinic on Tuesday morning to get another ultrasound and see the MFM. This ultrasound is higher quality, and we quickly notice that the twins are oriented in different positions compared to last time. OH THANK GOD. Likely not conjoined. They look kind of cute in there, like little sea otters chilling next to each other.

After the ultrasound, we meet the doctor and we officially learn more about what we are dealing with. No, she doesn’t think they are conjoined, but they won’t rule it out 100% yet until they see them side by side with space in between (I have already ruled this out, though, based on how differently they were positioned this time.)

We finally get the diagnosis: mono/mono twins. What does that mean? Most people don’t know that there are actually 3 types of identical twins, depending on when the embryo divides into two. If it divides before implantation, they are called di/di twins and have a similar path to fraternal twins. They have 2 placentas and 2 amniotic sacs. If the embryo divides after implantation within a few days, the twins develop into mo/di twins. These share the same placenta, but there is a membrane between them because they are in different amniotic sacs. Finally, there is a third type called mono/mono twins, which happens when the division happens later, around 8-13 days after implantation. These share everything — 1 placenta, 1 amniotic sac. There’s nothing in between them, and they are the highest risk of twin types (aside from conjoined twins, which occur when the zygote division happens really late).

Since there is nothing separating mono/mono twins, the primary risk they face is umbilical cord entanglement, which means the cords get tangled up and they can die. There are a host of other risks due to the shared placenta, like sometimes they don’t get an even amount of nutrients, but really the cord entanglement is the kicker. This is why the treatment plan is so aggressive. Around 24-26 weeks, I will be admitted to the hospital for intense, regular fetal monitoring and live there until the babies are born. The goal is to keep the babies in until 32-34 weeks, but they will always deliver them by 34 weeks because the risks of cord entanglement get too severe. The intense monitoring is to make sure cord entanglement isn’t happening. But otherwise I’m just chilling in the hospital, living there and hopefully working remotely so I don’t go crazy. Once the twins are born around 32-34 weeks, they will spend time in the NICU before they can come home. Phew, all that before you even get home with twins.

Our doctor is great. She spent so much time explaining all of this to us, and I am very confident that we are in great care. Even at University of Washington hospital, there are only about 4 of these cases per year. We won the biological lottery… but not sure if it’s the type of lottery you want to win? I guess we will see.

BUT they aren’t conjoined!! My relief made this new scary and difficult diagnosis so much easier to swallow. It makes me think about the levels of worry involved in pregnancy. Once you spend time at the very highest level, the lower levels don’t seem so bad. Throw anything at me, universe, I can take it, as long as it’s not conjoined twins.

So here we are. We have a long road ahead of us and a lot can still go (very) wrong, but we are relieved to be in good care, and to have a plan. We will do our best to take things day by day and give these babies the love and attention they need.