July 15, 2025 • 25 mins
When Marni's IVF embryo spontaneously split at 13 weeks, she was excited to be bringing not one but two babies into the world. But over half way through her pregnancy her doctors discovered one of the rarest twin complications - TAPS.
In today's emotional episode, Marni shares how TAPS turned her pregnancy into a fight for survival, with one twin slowly losing blood while the other's blood became dangerously thick. Marni takes us through the incredible medical interventions that followed—two groundbreaking in-utero procedures at 29 and 32 weeks. When an E. coli infection threatened their survival, Billie and Poppy arrived via emergency caesarean at 33 weeks, beginning a 27-day NICU journey that would test every ounce of Marni's strength.
Diary Of A Birth features mums sharing their heartfelt stories of bringing life into the world. Share your birth story at podcast@mamamia.com.au or send a voice note here.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:21):
You're listening to a Mama Mia podcast.
Speaker 2 (00:25):
Mamma Mia acknowledges the traditional owners of land and waters
that this podcast is recorded on. We pay our respects
to elders past, present and emerging, and feel privileged to
continue the sharing of birth stories and knowledge that has
been a fundamental part of Indigenous culture. Hi.
Speaker 3 (00:47):
I'm Cassanya Lukich and this is diary of a birth.
When Marnie Cochrane fell pregnant through IVF at forty two,
she thought the hardest part of her fertility journey was
behind her. But she was in for a big surprise.
Her single embryo transfer turned into identical twin girls. Then
(01:07):
a routine scan at twenty two weeks revealed a complication
that would change everything.
Speaker 4 (01:13):
Everything had been fine prior with the scans in between
thirteen and twenty two weeks. And when I walked in
that day to the hospital, you know that were scanning
me and everything seemed normal. At the end of the scan,
they said, oh, look, we're just going to bring in
a doctor, and you know, we waited for what seemed
like forever.
Speaker 3 (01:31):
In today's episode, Marnei shares her extraordinary story of navigating
one of the rarest twin complications taps, where one twin
becomes dangerously anemic while the other develops too many red
blood cells.
Speaker 1 (01:46):
So let's meet today's marm.
Speaker 4 (01:48):
My name's Many and this is the diary of my
birth with my twins, Billy and Poppy.
Speaker 3 (01:56):
You know, your journey to getting pregnant obviously took a
little bit of time. But what was your life like
before you fell pregnant with the twins.
Speaker 4 (02:06):
I have been with my husband for a really long time,
so we had been together, I think for about six
years before we settled on the Gold Coast and bought
our first townhouse together, and we had plan to get
pregnant pretty soon.
Speaker 5 (02:23):
And yeah, it.
Speaker 4 (02:25):
Took obviously many years, but in that time, I guess
we just spent a lot of time together.
Speaker 5 (02:31):
He's fantastic.
Speaker 4 (02:33):
We have adopted five birds, and we eventually upgraded to
a bigger house on the Gold Coast. We hoped for
a child and for the birds as well, so somewhere
a little bit bigger that would house the birds and
us and hopefully a child.
Speaker 1 (02:51):
Yeah, when you got pregnant, you went through IVF. They
just put one embryo in and lo and behold.
Speaker 4 (03:00):
Yes, Well we didn't actually find that out until about
thirteen weeks. So the IVF journey I was so nervous
about that. I really was quite reluctant to do it.
But we needed it obviously as I got older. But
we had a bit of a triple whammy. So my
age was against me. I had suspected endo and also
(03:23):
my husband has a male fertility issue as well.
Speaker 5 (03:27):
Like everything was against us.
Speaker 4 (03:29):
And yeah, so we found a newer specialist and it
went like a dream, like they got more eggs than
they thought they would get.
Speaker 5 (03:37):
They told me maybe three, like zero to three. We
got five.
Speaker 4 (03:41):
I think they expected maybe one to fertilize out of those,
and we got three embryos out of that, and then
they implanted one and at first we thought it was
just one child. So I'd had a couple of scans
at seven weeks and then at eleven weeks and the
child was developing quite nicely. But yeah, we found out
(04:04):
at thirteen weeks that that embryo had actually split and
we were pregnant with identical twins.
Speaker 1 (04:10):
Was it that the embryo split quite late in the process.
Is that why they wouldn't see it? Or was baby
be hiding.
Speaker 4 (04:18):
So the first couple of scans I had wasn't like
a professional ultrasound place. It was with my utility specialist,
which is what they usually do just in the early weeks,
just to make sure that there's a heartbeat and that
you know, you go along and you do your.
Speaker 5 (04:31):
Nipped test and stuff like that.
Speaker 4 (04:33):
So they were really quite quick, and I think she
was just looking for a baby and a heartbeat and
didn't go looking for that second because we had one
embryo implanted. I was forty two. It was amazing that
I got pregnant first round at my age with one embryo.
So yeah, I just don't think she went looking for it.
Speaker 1 (04:54):
So your partner, Lee and you, when you find out
you're having twins, what was your reaction?
Speaker 4 (05:00):
Well, if I'm going to be really honest, the first
reaction was an internal screaming no. I guess A few
thoughts run through my mind. One was, oh my god,
how am I going to cope with twins? My finances
went through my head. Complications because I knew, like, we
did everything that they told us to do during the round,
so I knew that were identical twins, and so I
(05:23):
was scared for the risks, you know, to me to
the babies.
Speaker 5 (05:27):
So yeah, I was immediately.
Speaker 4 (05:29):
Fearful, but it's interesting what you do in that moment,
like lower scanning the one. All I wanted to find
out was if the other one was healthy. So I
just had that instinct to protect them and that they
were my babies, like immediately, even though I was like,
oh crap, what am I going to do? So but
(05:50):
once we started telling family members and workmates, you know,
that fear turned into excitement and we were just like,
oh my god, they're going to have a best friend
for life.
Speaker 1 (06:00):
How cool is that? And a connection for life?
Speaker 4 (06:03):
Absolutely yeah, And we'll never understand this. We'll never understand
this bond, but they will have it, and it was
just incredible.
Speaker 1 (06:11):
Unfortunately, at twenty two weeks you did find out that
there was a complication. Will you run us through that?
Speaker 6 (06:20):
Sure?
Speaker 4 (06:21):
So, because we found out quite late in the piece
that I was having twins and that they were identical
and that they shared a placenta, my referral to the
hospital was, I guess a.
Speaker 5 (06:31):
Little bit later than normal.
Speaker 4 (06:32):
So at twenty two weeks I walked into my maternal
fetal medicine scan. Everything had been fine prior with the
scans in between thirteen and twenty two weeks. And when
I walked in that day to the hospital, you know,
they were scanning me and everything seemed normal. And then
at the end of the scan, they said, oh, look,
we're just going to bring in the doctor. And you know,
(06:53):
we waited for what seemed like forever, and I've just
had no thought in my mind that anything was wrong,
even though I'd read the paperwork and the recommendations and
things like that. And yeah, they told us that they
suspected that the girls had twin anemia polypcythemia sequence or TAPS.
Speaker 1 (07:13):
So basically, one baby was anemic and one baby had
too much by.
Speaker 5 (07:18):
Red blood cells.
Speaker 4 (07:19):
Yeah, exactly, Yeah, Yeah, so yeah, bloodtoothin, blood tooth thick
they say, like lemonade and tomato sauce.
Speaker 5 (07:25):
That's the kind of consistency of the blood.
Speaker 1 (07:28):
Yeah, And what's the treatment for that? How do they
help you get to term?
Speaker 4 (07:33):
Yeah, it's a really difficult thing because one TAPS is
really quite newly discovered, like only in the last eighteen
years or so, so the best treatment still hasn't been
found out. So what they do is really individual to
each person. In our case, there were options that were
available to me and options that weren't. So in some cases,
(07:53):
they can do laser surgery to laser the tiny connections
in the BLAS center, doing in uterotransfusion, they can birth
the babies early, or they can just wait and see,
depending on that. So I had a bit of a combination.
They wanted to wait and see how the girls went
because in some cases they can adapt to their new
I guess environment in the womb. But it did progress
(08:18):
and did get worse, and that's where we had to
look to treatment.
Speaker 3 (08:22):
Yeah, so, as I understand it, you had a blood transfusion.
Speaker 1 (08:27):
Yes, how does that work in utero? Yeah?
Speaker 4 (08:30):
Sure, So this is very interesting, especially when it comes
to twins. So an in uterotransfusion for a normal anemic
singleton baby is quite common, but in twins it's really uncommon.
So what they actually had to do was transfuse adult
donor blood to my anemic baby and take out small
(08:54):
amounts of blood out of the polycyphemic baby and replace
that with warm saline. So it was a very scary
procedure and the way they do it. So I had
an anterior placenta. It was right in front, so easy
access to the placenta and umbilical cords. And they go
in with a big needle, one by one and they
(09:16):
go into the placenta and then the umbilical cord and
they that's when they transfuse the blood. And then obviously
they go into the next baby, big needle through the
plazender and the umbilical cord and take out small amounts
of blood and replace that with warm, salty water.
Speaker 1 (09:33):
And were you awake for this procedure?
Speaker 5 (09:36):
Yeah, so the first.
Speaker 4 (09:37):
One at twenty eight weeks, that one was actually just
done in an ultrasound room. They set up a sterile
environment and they actually have blood testing on site, so
there's a formula attached to it as well. They find
out how much blood they need and the doctors calculate
all that. But yeah, I was awake, felt everything. There's
only a local anesthetic on your belly, yep, just to
(10:01):
numb where the injection site or the needles go in.
And I had like a little bit of medication to
I guess keep me calm, and medications to stop the
uterus contracting and things like that.
Speaker 5 (10:13):
But I could see and feel everything.
Speaker 4 (10:15):
So they had the ultrasound screen up so I could see,
you know, I just wanted to check that the baby
girls were still moving and hearts were still beating and
things like that.
Speaker 5 (10:24):
And Lee happened to be there with me during that one.
Speaker 4 (10:28):
I mean, it was very scary and surreal just to
think about it, Like when I think about myself in
that ultrasound chair looking at the screen. Yeah, it's just
it's amazing what they can do. A bit at the
same time, you're thinking, oh my god, is this my life?
Speaker 1 (10:42):
So yeah, I mean it's one thing to be pregnant
after you know, years of infertility. It's enough to be
pregnant with twins, and it's another thing on top of
that when there's complications. Definitely, So in terms.
Speaker 3 (10:57):
Of like your mental health and how you were coping.
Speaker 1 (11:01):
Yeah, how was that time for you?
Speaker 5 (11:04):
Yeah? It was very hard.
Speaker 4 (11:06):
I mean, the thought of having something wrong with your
babies in utero. Like I think the first thing I
went to was, you know, what did I do? You know, like,
this must be my fault. It must be something I ate,
something I did in my you know, like pre pregnant life.
You know, you think of all the things things and
mum guilt sets in really quickly, But really I just
(11:30):
had to turn to the focus of putting my trust
in the doctors. We have such an incredible medical system,
especially in Queensland, and access to the brilliant doctors at
Martyr Hospital in Brisbane. It's incredible, Like the doctors up
there are just world class and what they do is
just unbelievable. So I did really feel like I was
(11:50):
in good hands. I just had to trust that, yeah,
that we would be okay. It was definitely hard. There
were a lot of tears and I just had to
lean on my supports.
Speaker 5 (12:01):
Like I had to.
Speaker 4 (12:02):
Like, there weren't many people going through what I was
going through.
Speaker 5 (12:05):
It's so rare.
Speaker 4 (12:06):
It only happens in like three to five percent of
identical twin pregnancies, so yeah, it's it's extremely rare. There's
not a lot of people you can reach out to.
But like I had my family and then I also
had a tach support for them who were just wonderful.
So yeah, sought some help online as well. You know
what questions to ask and you know what's it like
(12:27):
and can anyone tell me if they've had any UTEROI
transfusion before, so really just reaching out to all the
resources I could to help get me by.
Speaker 5 (12:35):
It was just really like survival mode, to be honest.
Speaker 3 (12:38):
I imagine that there was a discussion of how far
into the pregnancy they would like you to get, and
I imagine that they were suggesting.
Speaker 1 (12:50):
A c section because you were higher risk.
Speaker 3 (12:53):
Did they have a goal for you and can you
tell us a little bit about going into labor?
Speaker 1 (12:59):
Sure?
Speaker 4 (13:00):
So, yes, the goal, and in most cases with taps
is thirty two weeks. Getting to thirty two weeks usually
the placenta is not happy by the end of thirty
two weeks and it's a good idea to birth them
because it gets riskier. There's no more treatment that can
be done at that stage. So the aim for me
was to get to thirty two weeks. Unfortunately, at thirty
(13:21):
two weeks I went to my local hospital. They didn't
have any nick Cure special care beds available for the girls,
so they turned me back around, referred me back to
the martyr and said, let's see what they think they
should do with you, and they suggested another transfusion, which
we did at thirty two weeks.
Speaker 5 (13:41):
Very very risky, but this time.
Speaker 4 (13:43):
It was in theater with an epidural, so I felt
a lot safer if something went wrong, they could just
birth the girls. Thankfully, it was very successful and they
sent me home the next morning and just said it
could be any time. If we get a couple of
days out of this, it'll be great, And I was like,
oh wow, Like reality just really set in. Then I
(14:04):
got to thirty three plus two and my waters broke.
So sitting on the couch on a Saturday night and
my waters broke and I went to hospital.
Speaker 5 (14:17):
Now, my local hospital still.
Speaker 4 (14:18):
Didn't have nick cure or special care beds, so I
stayed a couple of days there with antibiotics and there
was no labor progressing aside from the water's breaking.
Speaker 5 (14:27):
So they sent me up to Marta and.
Speaker 4 (14:30):
When I got there, we made it through one night.
The aim was to get me to thirty four weeks,
so that was the plan. I was like, we had
it in our minds Oka thirty four weeks, I was
thirty three plus six and I went for a well
being scan and everything seemed fine. That was at four
o'clock in the afternoon. At ten pm during a routine CTG,
(14:56):
my baby be had a very high heart rate.
Speaker 5 (15:00):
So they were like all of.
Speaker 4 (15:01):
A sudden, doctors and nurses swarming around me and said
it's time to get the girls out. So my husband
was still at home an hour away and didn't quite
make the birth.
Speaker 5 (15:13):
Oh no, yeah.
Speaker 4 (15:15):
I asked them to hold on, like cut, you just
hold on an hour until he gets here, but expecting
to birth the next day. He rushed up the motorway
but still didn't quite make it. But I found out
later that it was probably like a category one sea section.
They were like, these babies have to come now. It's
really bad, but I didn't realize like they made me
(15:36):
feel like, yes, it's an emergency, but everything's going to
be okay.
Speaker 1 (15:43):
Coming up.
Speaker 4 (15:44):
My husband arrived just as Poppy had been born, so
Billy was born first and she was the one whose
heart rate had caused the emergency sea section.
Speaker 1 (15:59):
So by yourself, were you scared?
Speaker 5 (16:02):
Absolutely?
Speaker 4 (16:03):
I burst into tears a minute that they told me
that the babies had to come right that minute. I
was frantic, like calling my husband. I just I couldn't breathe.
It was really awful. At one point when we got
when I got to theater and I had everyone around me,
and they asked you all the questions, what are we
doing today having a C section? I started to calm
(16:26):
down once I saw my medical team and I asked, someone,
can you put on my playlist? Because I had organized
a playlist and it was all my favorite songs. Forty
five minutes of my favorite songs. They said, yep, we
can absolutely do that. I was like, oh my god,
thank you so much, started crying again, and then one
of them put their hand on my shoulder and went, okay,
let's have a birthday party. And that's where I was like, Okay,
(16:49):
I feel well looked after now. So even though I
didn't have my husband, I had my music, I had
an incredible medical team, and I just really had to
be grateful for what I.
Speaker 5 (16:59):
Did have, not what I didn't have.
Speaker 4 (17:01):
So yeah, yeah, and I knew that the babies were
going to be safe as well.
Speaker 1 (17:06):
So the babies come out, did they go straight to
the niku?
Speaker 5 (17:09):
Yeah, So they showed the girls to me.
Speaker 4 (17:11):
Their cards had to be cut straight away and they
were whisked away. My husband arrived just as Poppy had
been born, So Billy was born first, and she was
the one whose heart rate had caused the emergency C section,
so she was born first, and then Poppy was born
and Lee just arrived, so he was able to follow
(17:32):
them up, which was amazing.
Speaker 1 (17:34):
Yeah that's good. That would have made you feel a
little bit calmer.
Speaker 5 (17:38):
Yeah. Yeah.
Speaker 4 (17:39):
All I could like at that point was about the babies,
and so he was like, do you mind if I
go up and I was like, yes, please go, yeah, go,
and he named them up there and everything.
Speaker 1 (17:50):
So, yeah, tell me about your first time holding them. Yeah.
Speaker 4 (17:55):
So I actually didn't get to hold them what was
one by one at first? They were in the nicku
in separate CODs at separate ends of the room because
that's all they had at the time. Yeah, it was
a little bit sad, but I mean, the facilities up
there are just so wonderful and the nurses are incredible.
So I didn't get to hold them until about twelve
(18:17):
hours after the birth, and that was separately, and it
was all about of a whirlwind. I think I was
a little bit drugged up still, to be honest, and
I just couldn't believe everything that happened.
Speaker 5 (18:26):
I was just I think I was just in shock.
Speaker 4 (18:29):
But I do remember the moment that I held them
both together, which was a couple of days later, and
that was just the best thing ever, Like they were
finally safe, they were finally together, they were finally with me,
And yeah, it was just a beautiful, beautiful moment just
holding them.
Speaker 1 (18:46):
Yeah. Well, you had, you know, months and months of
stress and anxiety and stressful birth. To have them safe
would have just been so special.
Speaker 5 (18:57):
Absolutely, Yeah, it was just wonderful. Yeah.
Speaker 3 (19:01):
And the question that I'm sure everybody asks a twin mom,
did you mix them up?
Speaker 5 (19:06):
No?
Speaker 4 (19:08):
So well, I guess from the beginning. So we actually
discovered that the reason that Billy caused the emergency c
section was because I got an infection after the waters broke.
So I ended up getting an ecoli infection on my
placenta which spread to Billy because only her amniotic sac broke.
(19:29):
So it was really easy to tell them apart because
she had a line with antibiotics. So I know that
sounds it's quite sad, but at the same time that
it was impossible to mix them up, so we definitely
knew who was who. But even after we got home,
I never mixed them up.
Speaker 5 (19:44):
I just knew who was who.
Speaker 4 (19:46):
And I think the way that I answer that because
everyone says, oh my god, they look exactly the same.
I just say, I'm their mum and I can tell.
So they're so different in personality, even their laughs, their voices,
They've got opposite sides, like hair worlds.
Speaker 5 (20:04):
Yeah, they're just so different to us.
Speaker 1 (20:06):
How old are they now?
Speaker 5 (20:08):
They're two years old. Yeah, they just turned too.
Speaker 1 (20:10):
Yeah, and how was your recovery?
Speaker 5 (20:13):
Yeah it was rocky.
Speaker 4 (20:15):
My pain was definitely not controlled in the first few days.
Speaker 5 (20:21):
Yeah, my pain level was just through the roof.
Speaker 4 (20:23):
And the way they explained that is sometimes because of
the extra stretching and things with twins, the pain level
can be higher, so it was really hard to get
that under control. So yeah, definitely for the first couple
of weeks, I actually had to go home with pain relief,
which is apparently not that common, so I need an
extra extra week with the painkillers. But after that it
(20:46):
was it was fairly okay, I think.
Speaker 1 (20:49):
Yeah, yeah, well you were sleep deprived and looking up
through newborns.
Speaker 5 (20:53):
Yeah, I barely remember that.
Speaker 4 (20:55):
So, yeah, pumping eight times a day and you know,
feeding eight times a day, and yeah, sterilizing and trying
to get maybe an hour and a half combined sleep was. Yeah,
it was definitely a whirlwind, and you kind of forget
your own needs when you're going through all that, and
certainly with twins in nick you and special care as well,
(21:15):
you're you know, coming back and forth for feeds and
doing as much as you can while they're in hospital.
Speaker 1 (21:21):
Yeah. Well, thank you Mony so much for sharing your story.
It's really remarkable and I'm really glad that the twins
and you are okay. And how are they today? Are
they wild?
Speaker 5 (21:33):
Yeah, they're amazing.
Speaker 4 (21:35):
So they've just been so determined since the beginning, and
it's really blown me away.
Speaker 5 (21:41):
How robust and strong they are.
Speaker 4 (21:45):
They're still a little short and little, i'd say for
two year olds, but they've been so active since the beginning.
They walked, you know, twelve months. They're talking a lot,
they love reading books, they're just they love climbing over things.
Speaker 5 (22:02):
Yeah, I guess they're just normal two year olds.
Speaker 4 (22:04):
And to be honest, we're quite scared of, you know,
what would happen with all the complications and how delayed
they might be, because that's a very real possibility with
twins with taps. And I think it's really like testament
to the treatment that we had and the treatment that
was available to us that it really helped them, especially
(22:26):
you know now with their development as well.
Speaker 5 (22:28):
So yeah, I'm just so thankful.
Speaker 4 (22:30):
To the doctors for getting us where we are today,
and they're just lovely little girls.
Speaker 3 (22:38):
Because TABS is such a rare condition, I wanted to
ask our resident ob and gynecologist, doctor Bromin Devine about
how likely it is to come across it.
Speaker 6 (22:47):
In Australia, we see monocoreonic twins in about one in
four hundred berths. It is more likely if you get
monocoreonic identical twins where the embryo splits, but they share
a placenter with IVF pregnancies, and that's probably because of
the way that we manipulate the embryos a little bit
in the lab or the media that we use. But
(23:09):
TABS or twin anemia polypcythemia sequence occurs in about three
to fifteen percent of monocoreonic twin pregnancies or MCDA twin
pregnancies that we see in Australia. Now, there's two reasons
that it can occur. Sometimes it's spontaneous and other times
it's because we do laser therapy. So when there's a
(23:30):
shared placenta, there are blood vessels that communicate between the
two twins because they've got one placenta between the two
of them. Sometimes, if there's a big blood vessel that's
connecting them, the twins can have major shifts in their
amniotic fluid and they can become very sick with the
condition that we've talked about before called twin twin transfusion.
One of the ways of treating twin twin transfusion is
(23:53):
to use laser therapy to disrupt that connecting blood vessel,
and one of the things that can happen as a
result of that is you can get little partial connections
or what we call partial anastemosis in the placenta, where
you get a little connection between an artery and a vein,
and that leads to one twin giving all their blood
cells to the other twin. So that twin that gives
(24:14):
the blood cells is called the donor, and it gets
a very low quantity of red blood cells and become anemic,
and the other twin, which is the recipient, gets a
much increased number of red blood cells, and that's a
condition called polycythemia, or that twin becomes polycythemic. Now it's
bad to be anemic and it's bad to be polycythemic.
(24:36):
So the poor little anemic twin doesn't grow, doesn't get
anywhere near as much oxygen or nutrients, and the other
twin can get really overloaded with a really sluggish blood
flow and get clots in blood vessels and things like that,
so it's dangerous for both twins. Interview. Turine transdusion is
one of the forms of treatment, or a partial exchange transdusion,
(24:57):
one of the forms of treatment that they do for
this condition. That's done by very specialist obstetricians known as
maternal fetal medicine specialists, and it's usually done at a
maternal feedal medicine clinic in one of the big tertiary hospitals.
They have specialist obstetricians who've done additional training in really
high risk pregnancies. And the other thing we do is
(25:17):
we monitor these twins very carefully by keeping a very
close eye on the blood flow in the brain because
we can see the sluggish blood flow to the polycythemic
twin and quite a rapid blood flow to the donor twin.
By checking on the blood flows using ultrasounds, so there's
a lot of intense monitoring that's done, and then sometimes
it's just a case of if it's getting out of
(25:38):
control or it's getting to a situation where it would
be better for the babies to be born, they will
actually make plans to deliver the babies earlier.
Speaker 3 (25:49):
Darry of a Birth was hosted by me Kasi Luk.
It's with expert input from doctor Broman Divine. If you
like our show, don't forget to subscribe and rate. It
goes a long way to allowing us to continue sharing
your stories. This episode was produced by Ella Maitland with
audio production by Tina Mattlov
You're listening to a Mama Mia podcast.
Speaker 2 (00:25):
Mamma Mia acknowledges the traditional owners of land and waters
that this podcast is recorded on. We pay our respects
to elders past, present and emerging, and feel privileged to
continue the sharing of birth stories and knowledge that has
been a fundamental part of Indigenous culture. Hi.
Speaker 3 (00:47):
I'm Cassanya Lukich and this is diary of a birth.
When Marnie Cochrane fell pregnant through IVF at forty two,
she thought the hardest part of her fertility journey was
behind her. But she was in for a big surprise.
Her single embryo transfer turned into identical twin girls. Then
(01:07):
a routine scan at twenty two weeks revealed a complication
that would change everything.
Speaker 4 (01:13):
Everything had been fine prior with the scans in between
thirteen and twenty two weeks. And when I walked in
that day to the hospital, you know that were scanning
me and everything seemed normal. At the end of the scan,
they said, oh, look, we're just going to bring in
a doctor, and you know, we waited for what seemed
like forever.
Speaker 3 (01:31):
In today's episode, Marnei shares her extraordinary story of navigating
one of the rarest twin complications taps, where one twin
becomes dangerously anemic while the other develops too many red
blood cells.
Speaker 1 (01:46):
So let's meet today's marm.
Speaker 4 (01:48):
My name's Many and this is the diary of my
birth with my twins, Billy and Poppy.
Speaker 3 (01:56):
You know, your journey to getting pregnant obviously took a
little bit of time. But what was your life like
before you fell pregnant with the twins.
Speaker 4 (02:06):
I have been with my husband for a really long time,
so we had been together, I think for about six
years before we settled on the Gold Coast and bought
our first townhouse together, and we had plan to get
pregnant pretty soon.
Speaker 5 (02:23):
And yeah, it.
Speaker 4 (02:25):
Took obviously many years, but in that time, I guess
we just spent a lot of time together.
Speaker 5 (02:31):
He's fantastic.
Speaker 4 (02:33):
We have adopted five birds, and we eventually upgraded to
a bigger house on the Gold Coast. We hoped for
a child and for the birds as well, so somewhere
a little bit bigger that would house the birds and
us and hopefully a child.
Speaker 1 (02:51):
Yeah, when you got pregnant, you went through IVF. They
just put one embryo in and lo and behold.
Speaker 4 (03:00):
Yes, Well we didn't actually find that out until about
thirteen weeks. So the IVF journey I was so nervous
about that. I really was quite reluctant to do it.
But we needed it obviously as I got older. But
we had a bit of a triple whammy. So my
age was against me. I had suspected endo and also
(03:23):
my husband has a male fertility issue as well.
Speaker 5 (03:27):
Like everything was against us.
Speaker 4 (03:29):
And yeah, so we found a newer specialist and it
went like a dream, like they got more eggs than
they thought they would get.
Speaker 5 (03:37):
They told me maybe three, like zero to three. We
got five.
Speaker 4 (03:41):
I think they expected maybe one to fertilize out of those,
and we got three embryos out of that, and then
they implanted one and at first we thought it was
just one child. So I'd had a couple of scans
at seven weeks and then at eleven weeks and the
child was developing quite nicely. But yeah, we found out
(04:04):
at thirteen weeks that that embryo had actually split and
we were pregnant with identical twins.
Speaker 1 (04:10):
Was it that the embryo split quite late in the process.
Is that why they wouldn't see it? Or was baby
be hiding.
Speaker 4 (04:18):
So the first couple of scans I had wasn't like
a professional ultrasound place. It was with my utility specialist,
which is what they usually do just in the early weeks,
just to make sure that there's a heartbeat and that
you know, you go along and you do your.
Speaker 5 (04:31):
Nipped test and stuff like that.
Speaker 4 (04:33):
So they were really quite quick, and I think she
was just looking for a baby and a heartbeat and
didn't go looking for that second because we had one
embryo implanted. I was forty two. It was amazing that
I got pregnant first round at my age with one embryo.
So yeah, I just don't think she went looking for it.
Speaker 1 (04:54):
So your partner, Lee and you, when you find out
you're having twins, what was your reaction?
Speaker 4 (05:00):
Well, if I'm going to be really honest, the first
reaction was an internal screaming no. I guess A few
thoughts run through my mind. One was, oh my god,
how am I going to cope with twins? My finances
went through my head. Complications because I knew, like, we
did everything that they told us to do during the round,
so I knew that were identical twins, and so I
(05:23):
was scared for the risks, you know, to me to
the babies.
Speaker 5 (05:27):
So yeah, I was immediately.
Speaker 4 (05:29):
Fearful, but it's interesting what you do in that moment,
like lower scanning the one. All I wanted to find
out was if the other one was healthy. So I
just had that instinct to protect them and that they
were my babies, like immediately, even though I was like,
oh crap, what am I going to do? So but
(05:50):
once we started telling family members and workmates, you know,
that fear turned into excitement and we were just like,
oh my god, they're going to have a best friend
for life.
Speaker 1 (06:00):
How cool is that? And a connection for life?
Speaker 4 (06:03):
Absolutely yeah, And we'll never understand this. We'll never understand
this bond, but they will have it, and it was
just incredible.
Speaker 1 (06:11):
Unfortunately, at twenty two weeks you did find out that
there was a complication. Will you run us through that?
Speaker 6 (06:20):
Sure?
Speaker 4 (06:21):
So, because we found out quite late in the piece
that I was having twins and that they were identical
and that they shared a placenta, my referral to the
hospital was, I guess a.
Speaker 5 (06:31):
Little bit later than normal.
Speaker 4 (06:32):
So at twenty two weeks I walked into my maternal
fetal medicine scan. Everything had been fine prior with the
scans in between thirteen and twenty two weeks. And when
I walked in that day to the hospital, you know,
they were scanning me and everything seemed normal. And then
at the end of the scan, they said, oh, look,
we're just going to bring in the doctor. And you know,
(06:53):
we waited for what seemed like forever, and I've just
had no thought in my mind that anything was wrong,
even though I'd read the paperwork and the recommendations and
things like that. And yeah, they told us that they
suspected that the girls had twin anemia polypcythemia sequence or TAPS.
Speaker 1 (07:13):
So basically, one baby was anemic and one baby had
too much by.
Speaker 5 (07:18):
Red blood cells.
Speaker 4 (07:19):
Yeah, exactly, Yeah, Yeah, so yeah, bloodtoothin, blood tooth thick
they say, like lemonade and tomato sauce.
Speaker 5 (07:25):
That's the kind of consistency of the blood.
Speaker 1 (07:28):
Yeah, And what's the treatment for that? How do they
help you get to term?
Speaker 4 (07:33):
Yeah, it's a really difficult thing because one TAPS is
really quite newly discovered, like only in the last eighteen
years or so, so the best treatment still hasn't been
found out. So what they do is really individual to
each person. In our case, there were options that were
available to me and options that weren't. So in some cases,
(07:53):
they can do laser surgery to laser the tiny connections
in the BLAS center, doing in uterotransfusion, they can birth
the babies early, or they can just wait and see,
depending on that. So I had a bit of a combination.
They wanted to wait and see how the girls went
because in some cases they can adapt to their new
I guess environment in the womb. But it did progress
(08:18):
and did get worse, and that's where we had to
look to treatment.
Speaker 3 (08:22):
Yeah, so, as I understand it, you had a blood transfusion.
Speaker 1 (08:27):
Yes, how does that work in utero? Yeah?
Speaker 4 (08:30):
Sure, So this is very interesting, especially when it comes
to twins. So an in uterotransfusion for a normal anemic
singleton baby is quite common, but in twins it's really uncommon.
So what they actually had to do was transfuse adult
donor blood to my anemic baby and take out small
(08:54):
amounts of blood out of the polycyphemic baby and replace
that with warm saline. So it was a very scary
procedure and the way they do it. So I had
an anterior placenta. It was right in front, so easy
access to the placenta and umbilical cords. And they go
in with a big needle, one by one and they
(09:16):
go into the placenta and then the umbilical cord and
they that's when they transfuse the blood. And then obviously
they go into the next baby, big needle through the
plazender and the umbilical cord and take out small amounts
of blood and replace that with warm, salty water.
Speaker 1 (09:33):
And were you awake for this procedure?
Speaker 5 (09:36):
Yeah, so the first.
Speaker 4 (09:37):
One at twenty eight weeks, that one was actually just
done in an ultrasound room. They set up a sterile
environment and they actually have blood testing on site, so
there's a formula attached to it as well. They find
out how much blood they need and the doctors calculate
all that. But yeah, I was awake, felt everything. There's
only a local anesthetic on your belly, yep, just to
(10:01):
numb where the injection site or the needles go in.
And I had like a little bit of medication to
I guess keep me calm, and medications to stop the
uterus contracting and things like that.
Speaker 5 (10:13):
But I could see and feel everything.
Speaker 4 (10:15):
So they had the ultrasound screen up so I could see,
you know, I just wanted to check that the baby
girls were still moving and hearts were still beating and
things like that.
Speaker 5 (10:24):
And Lee happened to be there with me during that one.
Speaker 4 (10:28):
I mean, it was very scary and surreal just to
think about it, Like when I think about myself in
that ultrasound chair looking at the screen. Yeah, it's just
it's amazing what they can do. A bit at the
same time, you're thinking, oh my god, is this my life?
Speaker 1 (10:42):
So yeah, I mean it's one thing to be pregnant
after you know, years of infertility. It's enough to be
pregnant with twins, and it's another thing on top of
that when there's complications. Definitely, So in terms.
Speaker 3 (10:57):
Of like your mental health and how you were coping.
Speaker 1 (11:01):
Yeah, how was that time for you?
Speaker 5 (11:04):
Yeah? It was very hard.
Speaker 4 (11:06):
I mean, the thought of having something wrong with your
babies in utero. Like I think the first thing I
went to was, you know, what did I do? You know, like,
this must be my fault. It must be something I ate,
something I did in my you know, like pre pregnant life.
You know, you think of all the things things and
mum guilt sets in really quickly, But really I just
(11:30):
had to turn to the focus of putting my trust
in the doctors. We have such an incredible medical system,
especially in Queensland, and access to the brilliant doctors at
Martyr Hospital in Brisbane. It's incredible, Like the doctors up
there are just world class and what they do is
just unbelievable. So I did really feel like I was
(11:50):
in good hands. I just had to trust that, yeah,
that we would be okay. It was definitely hard. There
were a lot of tears and I just had to
lean on my supports.
Speaker 5 (12:01):
Like I had to.
Speaker 4 (12:02):
Like, there weren't many people going through what I was
going through.
Speaker 5 (12:05):
It's so rare.
Speaker 4 (12:06):
It only happens in like three to five percent of
identical twin pregnancies, so yeah, it's it's extremely rare. There's
not a lot of people you can reach out to.
But like I had my family and then I also
had a tach support for them who were just wonderful.
So yeah, sought some help online as well. You know
what questions to ask and you know what's it like
(12:27):
and can anyone tell me if they've had any UTEROI
transfusion before, so really just reaching out to all the
resources I could to help get me by.
Speaker 5 (12:35):
It was just really like survival mode, to be honest.
Speaker 3 (12:38):
I imagine that there was a discussion of how far
into the pregnancy they would like you to get, and
I imagine that they were suggesting.
Speaker 1 (12:50):
A c section because you were higher risk.
Speaker 3 (12:53):
Did they have a goal for you and can you
tell us a little bit about going into labor?
Speaker 1 (12:59):
Sure?
Speaker 4 (13:00):
So, yes, the goal, and in most cases with taps
is thirty two weeks. Getting to thirty two weeks usually
the placenta is not happy by the end of thirty
two weeks and it's a good idea to birth them
because it gets riskier. There's no more treatment that can
be done at that stage. So the aim for me
was to get to thirty two weeks. Unfortunately, at thirty
(13:21):
two weeks I went to my local hospital. They didn't
have any nick Cure special care beds available for the girls,
so they turned me back around, referred me back to
the martyr and said, let's see what they think they
should do with you, and they suggested another transfusion, which
we did at thirty two weeks.
Speaker 5 (13:41):
Very very risky, but this time.
Speaker 4 (13:43):
It was in theater with an epidural, so I felt
a lot safer if something went wrong, they could just
birth the girls. Thankfully, it was very successful and they
sent me home the next morning and just said it
could be any time. If we get a couple of
days out of this, it'll be great, And I was like,
oh wow, Like reality just really set in. Then I
(14:04):
got to thirty three plus two and my waters broke.
So sitting on the couch on a Saturday night and
my waters broke and I went to hospital.
Speaker 5 (14:17):
Now, my local hospital still.
Speaker 4 (14:18):
Didn't have nick cure or special care beds, so I
stayed a couple of days there with antibiotics and there
was no labor progressing aside from the water's breaking.
Speaker 5 (14:27):
So they sent me up to Marta and.
Speaker 4 (14:30):
When I got there, we made it through one night.
The aim was to get me to thirty four weeks,
so that was the plan. I was like, we had
it in our minds Oka thirty four weeks, I was
thirty three plus six and I went for a well
being scan and everything seemed fine. That was at four
o'clock in the afternoon. At ten pm during a routine CTG,
(14:56):
my baby be had a very high heart rate.
Speaker 5 (15:00):
So they were like all of.
Speaker 4 (15:01):
A sudden, doctors and nurses swarming around me and said
it's time to get the girls out. So my husband
was still at home an hour away and didn't quite
make the birth.
Speaker 5 (15:13):
Oh no, yeah.
Speaker 4 (15:15):
I asked them to hold on, like cut, you just
hold on an hour until he gets here, but expecting
to birth the next day. He rushed up the motorway
but still didn't quite make it. But I found out
later that it was probably like a category one sea section.
They were like, these babies have to come now. It's
really bad, but I didn't realize like they made me
(15:36):
feel like, yes, it's an emergency, but everything's going to
be okay.
Speaker 1 (15:43):
Coming up.
Speaker 4 (15:44):
My husband arrived just as Poppy had been born, so
Billy was born first and she was the one whose
heart rate had caused the emergency sea section.
Speaker 1 (15:59):
So by yourself, were you scared?
Speaker 5 (16:02):
Absolutely?
Speaker 4 (16:03):
I burst into tears a minute that they told me
that the babies had to come right that minute. I
was frantic, like calling my husband. I just I couldn't breathe.
It was really awful. At one point when we got
when I got to theater and I had everyone around me,
and they asked you all the questions, what are we
doing today having a C section? I started to calm
(16:26):
down once I saw my medical team and I asked, someone,
can you put on my playlist? Because I had organized
a playlist and it was all my favorite songs. Forty
five minutes of my favorite songs. They said, yep, we
can absolutely do that. I was like, oh my god,
thank you so much, started crying again, and then one
of them put their hand on my shoulder and went, okay,
let's have a birthday party. And that's where I was like, Okay,
(16:49):
I feel well looked after now. So even though I
didn't have my husband, I had my music, I had
an incredible medical team, and I just really had to
be grateful for what I.
Speaker 5 (16:59):
Did have, not what I didn't have.
Speaker 4 (17:01):
So yeah, yeah, and I knew that the babies were
going to be safe as well.
Speaker 1 (17:06):
So the babies come out, did they go straight to
the niku?
Speaker 5 (17:09):
Yeah, So they showed the girls to me.
Speaker 4 (17:11):
Their cards had to be cut straight away and they
were whisked away. My husband arrived just as Poppy had
been born, So Billy was born first, and she was
the one whose heart rate had caused the emergency C section,
so she was born first, and then Poppy was born
and Lee just arrived, so he was able to follow
(17:32):
them up, which was amazing.
Speaker 1 (17:34):
Yeah that's good. That would have made you feel a
little bit calmer.
Speaker 5 (17:38):
Yeah. Yeah.
Speaker 4 (17:39):
All I could like at that point was about the babies,
and so he was like, do you mind if I
go up and I was like, yes, please go, yeah, go,
and he named them up there and everything.
Speaker 1 (17:50):
So, yeah, tell me about your first time holding them. Yeah.
Speaker 4 (17:55):
So I actually didn't get to hold them what was
one by one at first? They were in the nicku
in separate CODs at separate ends of the room because
that's all they had at the time. Yeah, it was
a little bit sad, but I mean, the facilities up
there are just so wonderful and the nurses are incredible.
So I didn't get to hold them until about twelve
(18:17):
hours after the birth, and that was separately, and it
was all about of a whirlwind. I think I was
a little bit drugged up still, to be honest, and
I just couldn't believe everything that happened.
Speaker 5 (18:26):
I was just I think I was just in shock.
Speaker 4 (18:29):
But I do remember the moment that I held them
both together, which was a couple of days later, and
that was just the best thing ever, Like they were
finally safe, they were finally together, they were finally with me,
And yeah, it was just a beautiful, beautiful moment just
holding them.
Speaker 1 (18:46):
Yeah. Well, you had, you know, months and months of
stress and anxiety and stressful birth. To have them safe
would have just been so special.
Speaker 5 (18:57):
Absolutely, Yeah, it was just wonderful. Yeah.
Speaker 3 (19:01):
And the question that I'm sure everybody asks a twin mom,
did you mix them up?
Speaker 5 (19:06):
No?
Speaker 4 (19:08):
So well, I guess from the beginning. So we actually
discovered that the reason that Billy caused the emergency c
section was because I got an infection after the waters broke.
So I ended up getting an ecoli infection on my
placenta which spread to Billy because only her amniotic sac broke.
(19:29):
So it was really easy to tell them apart because
she had a line with antibiotics. So I know that
sounds it's quite sad, but at the same time that
it was impossible to mix them up, so we definitely
knew who was who. But even after we got home,
I never mixed them up.
Speaker 5 (19:44):
I just knew who was who.
Speaker 4 (19:46):
And I think the way that I answer that because
everyone says, oh my god, they look exactly the same.
I just say, I'm their mum and I can tell.
So they're so different in personality, even their laughs, their voices,
They've got opposite sides, like hair worlds.
Speaker 5 (20:04):
Yeah, they're just so different to us.
Speaker 1 (20:06):
How old are they now?
Speaker 5 (20:08):
They're two years old. Yeah, they just turned too.
Speaker 1 (20:10):
Yeah, and how was your recovery?
Speaker 5 (20:13):
Yeah it was rocky.
Speaker 4 (20:15):
My pain was definitely not controlled in the first few days.
Speaker 5 (20:21):
Yeah, my pain level was just through the roof.
Speaker 4 (20:23):
And the way they explained that is sometimes because of
the extra stretching and things with twins, the pain level
can be higher, so it was really hard to get
that under control. So yeah, definitely for the first couple
of weeks, I actually had to go home with pain relief,
which is apparently not that common, so I need an
extra extra week with the painkillers. But after that it
(20:46):
was it was fairly okay, I think.
Speaker 1 (20:49):
Yeah, yeah, well you were sleep deprived and looking up
through newborns.
Speaker 5 (20:53):
Yeah, I barely remember that.
Speaker 4 (20:55):
So, yeah, pumping eight times a day and you know,
feeding eight times a day, and yeah, sterilizing and trying
to get maybe an hour and a half combined sleep was. Yeah,
it was definitely a whirlwind, and you kind of forget
your own needs when you're going through all that, and
certainly with twins in nick you and special care as well,
(21:15):
you're you know, coming back and forth for feeds and
doing as much as you can while they're in hospital.
Speaker 1 (21:21):
Yeah. Well, thank you Mony so much for sharing your story.
It's really remarkable and I'm really glad that the twins
and you are okay. And how are they today? Are
they wild?
Speaker 5 (21:33):
Yeah, they're amazing.
Speaker 4 (21:35):
So they've just been so determined since the beginning, and
it's really blown me away.
Speaker 5 (21:41):
How robust and strong they are.
Speaker 4 (21:45):
They're still a little short and little, i'd say for
two year olds, but they've been so active since the beginning.
They walked, you know, twelve months. They're talking a lot,
they love reading books, they're just they love climbing over things.
Speaker 5 (22:02):
Yeah, I guess they're just normal two year olds.
Speaker 4 (22:04):
And to be honest, we're quite scared of, you know,
what would happen with all the complications and how delayed
they might be, because that's a very real possibility with
twins with taps. And I think it's really like testament
to the treatment that we had and the treatment that
was available to us that it really helped them, especially
(22:26):
you know now with their development as well.
Speaker 5 (22:28):
So yeah, I'm just so thankful.
Speaker 4 (22:30):
To the doctors for getting us where we are today,
and they're just lovely little girls.
Speaker 3 (22:38):
Because TABS is such a rare condition, I wanted to
ask our resident ob and gynecologist, doctor Bromin Devine about
how likely it is to come across it.
Speaker 6 (22:47):
In Australia, we see monocoreonic twins in about one in
four hundred berths. It is more likely if you get
monocoreonic identical twins where the embryo splits, but they share
a placenter with IVF pregnancies, and that's probably because of
the way that we manipulate the embryos a little bit
in the lab or the media that we use. But
(23:09):
TABS or twin anemia polypcythemia sequence occurs in about three
to fifteen percent of monocoreonic twin pregnancies or MCDA twin
pregnancies that we see in Australia. Now, there's two reasons
that it can occur. Sometimes it's spontaneous and other times
it's because we do laser therapy. So when there's a
(23:30):
shared placenta, there are blood vessels that communicate between the
two twins because they've got one placenta between the two
of them. Sometimes, if there's a big blood vessel that's
connecting them, the twins can have major shifts in their
amniotic fluid and they can become very sick with the
condition that we've talked about before called twin twin transfusion.
One of the ways of treating twin twin transfusion is
(23:53):
to use laser therapy to disrupt that connecting blood vessel,
and one of the things that can happen as a
result of that is you can get little partial connections
or what we call partial anastemosis in the placenta, where
you get a little connection between an artery and a vein,
and that leads to one twin giving all their blood
cells to the other twin. So that twin that gives
(24:14):
the blood cells is called the donor, and it gets
a very low quantity of red blood cells and become anemic,
and the other twin, which is the recipient, gets a
much increased number of red blood cells, and that's a
condition called polycythemia, or that twin becomes polycythemic. Now it's
bad to be anemic and it's bad to be polycythemic.
(24:36):
So the poor little anemic twin doesn't grow, doesn't get
anywhere near as much oxygen or nutrients, and the other
twin can get really overloaded with a really sluggish blood
flow and get clots in blood vessels and things like that,
so it's dangerous for both twins. Interview. Turine transdusion is
one of the forms of treatment, or a partial exchange transdusion,
(24:57):
one of the forms of treatment that they do for
this condition. That's done by very specialist obstetricians known as
maternal fetal medicine specialists, and it's usually done at a
maternal feedal medicine clinic in one of the big tertiary hospitals.
They have specialist obstetricians who've done additional training in really
high risk pregnancies. And the other thing we do is
(25:17):
we monitor these twins very carefully by keeping a very
close eye on the blood flow in the brain because
we can see the sluggish blood flow to the polycythemic
twin and quite a rapid blood flow to the donor twin.
By checking on the blood flows using ultrasounds, so there's
a lot of intense monitoring that's done, and then sometimes
it's just a case of if it's getting out of
(25:38):
control or it's getting to a situation where it would
be better for the babies to be born, they will
actually make plans to deliver the babies earlier.
Speaker 3 (25:49):
Darry of a Birth was hosted by me Kasi Luk.
It's with expert input from doctor Broman Divine. If you
like our show, don't forget to subscribe and rate. It
goes a long way to allowing us to continue sharing
your stories. This episode was produced by Ella Maitland with
audio production by Tina Mattlov
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