April 8, 2025 • 31 mins
One embryo. Two heartbeats. After years of fertility treatments, Laura Parr found herself staring at an ultrasound screen showing the impossible—her single frozen embryo had split into identical twins.
In today's episode, Laura shares her extraordinary journey from having her son Lucas through IVF, to the shock of discovering her second embryo—frozen for two years—had developed into identical twins - with no history of twins in the family. She takes us through the emotional rollercoaster of multiple ovarian induction cycles that finally yielded nine precious eggs and the complex reality of carrying monochorionic diamniotic twins who shared a single placenta but had separate amniotic sacs.
From severe morning sickness to a dramatic caesarean at 34 weeks, Laura's precious twins transformed their families life forever.
Diary Of A Birth features mums telling their miraculous stories of bringing life into the world. If you’d like to share your birth story, we’d love to hear from you at podcast@mamamia.com.au or send us 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 Amma Mia podcast. 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.
Speaker 2 (00:44):
Hi.
Speaker 1 (00:45):
I'm Cassania Lucid and this is Diary of a birth.
I'm fascinated by identical twins. One embryo splits to create
a perfect copy, two babies genetically the same, but with
their own identities and personalities. Occurring in roughly one in
two hundred and fifty berths in Australia. They're relatively rare,
(01:08):
but let's be real. Any parent of multiples will tell
you how challenging it is. The nappies, the feeding, and
let's not forget the actual pregnancy. After undergoing IVF with
their first baby, Today's mum was left with one viable embryo,
and when it came time to add to their family
(01:29):
two years later, she and her partner had one last shot.
Fortunately for them, the embryo took they weren't expecting was
a high risk pregnancy with identical twins so let's meet
today's mum.
Speaker 2 (01:43):
Hello, my name is Laura and this is the diary
of my birth with Alex and Riley.
Speaker 1 (01:53):
So, Laura, can you tell us a little bit about
your life before you fell pregnant with your twins?
Speaker 2 (01:59):
Life was pretty busy and I guess interesting. My husband
and I were both working, working full time. There was
lots of travel, lots of holidays, lots of fun times,
lots of going out and eating out. Yeah, we were
also renovating our house, planning and starting to renovate, meeting
with the architects, the builders, and yeah, life was busy,
(02:22):
just traveling. I work in Melbourne, but traveled to Sydney
quite a bit and we were able to get to
Greece of what where my husband's family is from. And yeah,
it was good. We had time. We had a lot
of time for four kids.
Speaker 1 (02:35):
You had a baby before you fell pregnant with the twins.
Now I know that you went through IVF with both
of your babies. Can you tell us a little bit
about that process of falling pregnant with your first.
Speaker 2 (02:48):
My husband and I I guess we decided, you know,
we wanted a family, we wanted kids. We tried for
a little bit, and I naturally didn't get anywhere. I
was son to get really impatient. I was still fairly
young at the time, but you know, I wanted things
done kind of now. We decided to embark on IVF. Actually,
before IVF, we did a few cycles of a varying induction,
(03:10):
which didn't work after two rounds, and went straight to IVF. So,
you know, did the hormones, did the injections, the egg collection,
which was a huge process. And this was in the
middle of COVID winter lockdowns, so not a fun time. Yeah,
it was really really tough. To be honest, The injections
not nice and I'm not very good at them. My
(03:31):
husband actually couldn't be in the same room when I
was doing them. Injection after injection after injection into a
collection of which I don't know if this is a
good number or bad number, but I was fortunately, I
guess to get nine eggs collected in the end, and.
Speaker 1 (03:45):
All those nine eggs you got how many embryos.
Speaker 2 (03:49):
Out of the nine every day kind of dropped off,
dropped off, dropped off down to two embrus that were
I guess day five blastsicists that were ready and appropriate
to be implanted.
Speaker 1 (04:01):
Yeah, and you got really fortunate with your first and
you feel pregnant with him straight away?
Speaker 2 (04:07):
Yes, yes, very fortunate the first round. What and we
got beautiful Lucas.
Speaker 1 (04:12):
So Lucas comes along and you know you're ready to
try again and you've got your one embryo left. So
what was going through your mind when you were ready
to implant that embryo?
Speaker 2 (04:25):
Gosh, it was full on. So look, yeah, as you say,
we had one embry left, it had been frozen for
two years. There was a lot of hope and a
lot kind of writing on that final one emberor I
really didn't want to go through IVF again, the whole
hormones and egg collection. I also got a very hyperstimulation
(04:46):
and ended up in the emergency warard for a night.
And yeah, it was one embror and one final one
and all our hopes and dreams we kind of resting
on this one embrew that had been frozen for two years,
and we're just hoping that one worked.
Speaker 1 (05:02):
You had your transfer, you went home. Now, for those
who haven't been through IVF, when you get an egg transfer,
you're not guaranteed to be pregnant. There's about a ten
day window that you have to wait, and then they
do a blood test and they can tell you if
you're pregnant or not, and it is the most excruciating. Wait, yeah,
how did you feel going into that blood test, because
(05:24):
I know that you waited, which a lot of women
don't wait.
Speaker 2 (05:27):
It's a waiting game, right, It's like at the end
of your pregnancy, when you're waiting for baby to come.
It's a waiting game. Between that implantation and the blood test,
it's a waiting game. And then from that blood test
to the phone call, it's it's huge. What probably helped
was I went on holidays, So after the implantation, I
(05:48):
went on holidays, just up to write for a few
days with my husband and son. I also got acupuncture,
which has shown to support and help that implantation. And
I just waited, and I tried to be really patient.
I got the blood test and then just waited from
the phone call from the fertility clinic.
Speaker 1 (06:08):
What was that phone call?
Speaker 2 (06:09):
Like tears of happiness and joy. I still remember it.
And I remember getting the phone call first with Lucas
exactly where we were, exactly the time, and exactly feeling
of just you know, hope and want and longing and
this real, like I don't know, it's somewhat desperate feeling
(06:29):
that you just so want this baby and so want
this child, and relief, complete relief just washed over me
because they call you and you know the call is coming,
and you know you know they're going to either tell
you the best news or the worst news. And both
times they were very quick and just said straight away, congratulations,
(06:50):
you're pregnant.
Speaker 1 (06:51):
Did you go for a dating scan?
Speaker 2 (06:52):
If you went through, We did go for a dating scan.
I think about week seven. I remember calling up my
obstetrician at the time and said, oh, look, I'm pregnant.
I'd love to come in and see my ob and
they're like, oh, no, no, you're earlier to ORR. You
know week seven, you know, come back in a few
more weeks, come back at week ten. And I said,
oh no, no, I really want to go, like I
(07:13):
just want to make sure that it's a viable pregnancy
and it's healthy and safe. And they're like, okay, sure,
never always come in. And so I in at that
week seven for that first dating scan.
Speaker 1 (07:24):
And your partner was with you, yes, Yehannie was with you. Yes,
So a spoiler alert, you have twins, so we know
that we had twins here, But what I really want
to stress is you have identical twins, right, yes, so
they only implanted one embryo, so this wasn't a case
of you know, IVF putting multiple embryos in and that's
why you have twins, like you had identical twins. So
(07:46):
at some point during your early weeks, this embryo split
into your identical twins. I want you to kind of
paint me a picture of being in that ultrasound room
with your husband to find out that you are actually
having twins.
Speaker 2 (08:01):
So we get in the room. It wasn't a long
wait and very quickly I was up on the table
and the obstetrician you know, put the gel on, put
that ultrasound one thing on, and very very quickly and
very clearly we can see what we can hear and
see your heartbeat, healthy, bible, normal pregnancy relief here tears,
(08:26):
a cry, tears of joy, happiness done, obviously positive pregnancy
and blood test. You know it's good and baby at
week seven, very strong heartbeat, wonderful and I was just
crying and crying and crying, but positive, good tears and
then the obstetrician at the time. I just remember this
so clearly. He got the sonography, I don't know the
(08:49):
wand the thing, and he very quickly moved it from
one side of my uterus to the other and up
popped another embryo on the screen, the black and white
sonography screen, very clearly another embryo moving, and automatically said
there's two. He didn't say anything, he was silent, he
(09:10):
was still. He is normally a very talkative ob and
he didn't say a word. At the same time, I've
got my husband in one corner of the room, engaged,
but probably like also not that engaged. I have a
student midwife in the other corner. Again, I don't think
she was paying much attention at the time. And then
all of a sudden, everyone was like watching and looking
(09:33):
at the screen and looking at me and looking at
my tummy, and my robe looked at me, looked at
my tummy, looked at the screen, looked at me, looked
and I just kept saying, there's two, there's two, like
I could read and interpret the ultrasound that, you know,
the black and white screen, and I knew what I
was seeing. And again he doesn't say anything for a
long time, and I was like, oh my god, just
(09:54):
talk to say something for such a normally talkative guy.
He looked at me, looked at the scan and said, congratulations,
you're having twins. And more cries, more shock, more tears,
more laughter. It just was a huge, huge, huge shock.
Any profanities, Yes, I'm sure, yes, I think so. I
think I swore yes, I remember the shock. I don't
(10:17):
remember what I said, but I remember the shock. And
then just like both like laughter but tears.
Speaker 1 (10:23):
So you and your husband get in the car. You've
just found out this very shocking news. What's that conversation sound?
Speaker 2 (10:29):
Like? God, that was really tough. I'll be honest with you,
Like this was just obviously not expected at all. Like,
we don't have twins in the family. It's not a
genetic link. They were completely random, identical twins. We get out,
I'm meant to get back to work, Jani's meant to
get back to his work, and we just like are
still processing the news and still processing the information. And
(10:53):
I must say it took weeks and months to process
it and come to terms with that. You know, just
a lot of questions I think, like are they healthy.
Is it going to be a viable pregnancy? Can I
carry twins? How are we going to feel? How will
I emotionally cope? How will I physically cope? You know?
Can I actually carry twins to term? Well? Will that look? Like?
What does this mean for my career? What does this
mean for Lucas our son? You know, we're giving him
(11:15):
two siblings. We're renovating our house. Does it fit another room?
Do we have to get a new car? You know?
Three car seats? What does this mean for our family?
And this wasn't on the cars, This wasn't planned. We
wanted like this normal kind of two parents, two kids,
and very quickly we're outnumbered three like that, And.
Speaker 1 (11:34):
To add complexity to this twin pregnancy, which is already
a challenge, you know, we know that sort of risks
increase with multiples. With a twin pregnancy. You actually had
a very rare type of twins and they're called MCDA twins.
Now I won't try and pronounce the actual name of it,
but basically you told me that that means that they
had a single placenter with two amniotic sacs, which means
(11:57):
that they were sharing nutrients from one placenter, correct, can
you tell us what the doctors told you about what
that actually means.
Speaker 2 (12:05):
So in that first stating scan, ob very clearly could
see the type of twins that they were and very
quickly said, look, this is a high risk twin pregnancy.
They're sharing a placenter. Drew diagrams and kind of drew
what it looked like. But effectively positive news is that
they're in two separate amniotic sacs and there was the
membrane between them. However, sharing a placenta, as you say, like,
(12:28):
they're sharing nutrients from that one plus center with two
umbilical cords, and so there's a potential risk. I mean
a lot of risks for twins, but one of the
most concerning ones they worry about is twin to twin
transfusion syndrome, which is where one twin gets more nutrients
than the other and it's really a problem for both twins.
Because of that, I had to be monitored and scanned
(12:50):
every fortnight from I think week fifteen, just to make
sure that the babies are growing kind of normally and
healthy and equally and they're kind of getting equal amount
of nutrients, of which they were very fortunate and I
never had They call it t TTS twin to twin
transfusion syndrome.
Speaker 1 (13:07):
Basically that could mean that one twin's growing much faster
the other ones not getting any nutrients, and you can
really risk the life of the baby yourself. It's pretty serious. Yes,
So obviously that's a big concern for you throughout pregnancy.
And I also understand that you were very unwell through
your pregnancy as well. So what was it like, sort
of juggling a toddler, a high demand position at work,
(13:32):
being pregnant with twins.
Speaker 2 (13:33):
It was rough. It was really rough, And I compare
in contrast, I think a lot to my first pregnancy
that I was told was very boring, a very normal pregnancy,
not many issues, and this song was just very, very challenging.
I was nauseous, severely nauseous for mass every day. I
was fortunate I didn't throw up at all. But it
(13:54):
was just like, think of the worst hangover you've ever had,
mixed with travel sickness and motion sickness. It was rubbish.
It was really rubbish. And looking after my toddler, who's
two at the time, and here, you know, Terrible twos
was challenging, and then work and then travel to Sydney,
and yeah, it was a lot.
Speaker 1 (14:15):
Did you have anything any particular foods or drinks that
really got you through when you were feeling nauseous?
Speaker 2 (14:20):
Yes, Oh my god, ginger and just ginger beer and
fresh ginger.
Speaker 1 (14:25):
Okay, so let's move along. You're feel naughtously, feeling horrible,
But family's obviously very excited.
Speaker 2 (14:30):
Yes, yes, And in fact it was interesting because no
one knew were pregnant. We hadn't told anyone until we know,
had that dating scan, and so it was like double
the news, like oh we're pregnant and we're having twins,
kind of two in one, yeah, I think. Yeah, both
sides of the family very very happy. A bit of
a shock obviously, because as I said, like, twins don't
(14:51):
run in the family either side, and again it's not
a genetic thing at all. Yeah, a lot of excitement
from the family.
Speaker 3 (14:58):
Yeah.
Speaker 2 (14:59):
I remember actually one early on in the pregnancy justice,
we found the news and as I told my sister,
as remember crying, crying with her, Yeah, because I was
still processing the news and still processing what it meant
and again it wasn't planned, and she just held me
and I just cried. It was a beautiful moment, but
(15:20):
it was still hard to kind of come to terms
with it. Yeah, yeah, it still is a little bit.
I know the voice that over a year, but it's
wild to think we've had.
Speaker 1 (15:31):
Twins coming up.
Speaker 2 (15:33):
I was already a few centimeters dilated and Raley's feet
were coming.
Speaker 1 (15:38):
Out well, I mean, one is still so little. Like
I feel like once you get through that first year
it is, that'll sort of start to get a little
bit easier. But true first birthdays should be the celebration
of mum and dad, particularly mum, but mum and dad.
Speaker 2 (15:55):
Oh, I agree for sure.
Speaker 1 (15:57):
Obviously with twins again high rise pregnancy of twins often
gestation is often a little bit shorter. But your doctor
didn't want you to go past a certain time. Can
you talk to us about that.
Speaker 2 (16:09):
With the twins, kind of coming to term is around
thirty seven weeks. For the type of twins I had,
it was about thirty seven weeks, and we had a
planned cesarean. Well, no, we had planned for a vaginal delivery,
and my ov was very happy for that. Given the
kind of the first physiological vaginal delivery with my first son.
We're working towards that and aiming towards that. It was great,
(16:32):
all on board. However, at week thirty two, my first son, Riley,
twin one, he flipped, so from being head down he
was now fit down and breach. And as soon as
that happened, that through, you know, a vaginal birth plan
alt the window because there's not much you could do
with like I know, with one spinning babies and you
(16:52):
can kind of get them to try and flip again.
You can't do that with twins. And so every week
and every scan I was just hoping like Riley had
flipped again and flipped back to head down, but he hadn't,
and he didn't, So then we had to think about, okay, well,
plan B cesarian and we had booked a cesarian for
kind of mid March, so that was booked in and
(17:13):
all good and all fine. And from that moment I
did a lot of research. I spoke to a lot
of girlfriends, particularly friends with twins and who had gone
through a cesarean, spoke to a lot of friends with
both negative and positive experiences of air cesarean. I did
a lot of research, a lot of information. I spoke
to a lot of people to kind of really get
me ready and prepare me for that moment. But that
(17:35):
planned Cesarean date didn't happen because the boys came early.
The boys came at thirty four and four, because I
went into spontaneous labor. Well, as you'd jumped back a step, Riley,
we think it's Frailey, chicky bugger. He kicked and broke my.
Speaker 1 (17:51):
Waters lot a little so and sound a little chicky
monkey had day.
Speaker 2 (17:56):
No because he was fit down and he was breach.
Like my ob says to me, he probably kicked kick
too hard and broke your waters. And one afternoon, I
remember i'd you know, been that day like shopping and
washing and cooking and cleaning and all the things as
you do as a mum and managing a family. I
had like a five minute break, and I remember lying
(18:17):
on my bed with my husband and my son and
we put on like Bluey or something for my son
to watch it. Oh perfect, I can literally just lie down,
get off my feet and watched this with him for
like half an hour and lye in bed. Within literally
like two minutes of putting on that show, my water's
broke and water went everywhere all over the bed My
(18:40):
husband actually was talking to another friend who's a twin
dad at the time on the phone, and Yanni had
thought I had actually like wet my pants all like
worse because I was holding my bump like I was
holding my backside. I was on the bed and I
like literally said, oh, and how my backside. He's like,
oh my god, have you like wet yourself or what's happened?
(19:02):
He was on the phone and he's like, oh, mate,
I'm gonna have to like drop off because I think
Lauren's just her waters are broken. Got off the phone call.
I was lying bed still with my son. All of
a sudden, we were like up and off the bed,
but there was water everywhere and it kept gushing and
gushing and gushing. Went to the toilet, waters coming. I've
got a like a maternity pad, put that in my underwear,
(19:25):
and very quickly I just said, okay, it's on like
waters are broken. We need to get to hospital.
Speaker 1 (19:31):
And this is a Sunday too, Sunday afternoon. Yeah, so
you basically had to call the whole new team in Yes.
Speaker 2 (19:38):
Yes, so my obi wasn't on call that weekend, and
I got a whole new team because it ended up
becoming an emergency s asaian and a whole new team
greeted us in hospital and you pay all the penalty
rates because it's a Sunday afternoon. So that was fun,
all new people. But look, we knew the hospital, we
knew the plan. My Obi. I was very lucky because
(20:00):
I spoke to him on the phone actually in hospital
about what was about to happen, and the saesarean and
you know, as discussed, you know we're going to be
doing s Y and zaid, So did have continuity of
care from him, and I knew what I was going
into and it was still to plan. It was just
a little bit early.
Speaker 1 (20:18):
Yeah, you get in there, get spinal tap, you're in
the theater and they take out the first baby. Yes,
what was that experience like? Did they have to go
straight to special care?
Speaker 2 (20:30):
They did shock again, a lot of shock because it
happened I think so quickly from when my waters broke
to then going into labor to then arriving.
Speaker 1 (20:40):
How long was it between when your waters broken when
the babies came?
Speaker 2 (20:43):
About three hours?
Speaker 1 (20:45):
It's very quick.
Speaker 2 (20:45):
Yeah, it's pretty fast. We got off pretty quick. And
then what they were hoping to do, was hoping to
keep me in for another day or two, even though
my water said broke. They were hoping I wouldn't start
contracting and kind of go into labor. But I did,
and I went pretty quickly, and the contractions wrapped up
bloody fast and hard, and boy, I didn't have my
(21:09):
Tenis machine or pain relief or anything planned, and gosh,
it just brought me back very quickly to that first
labor of my son, very quickly, ye three hours. And unfortunately,
because I then contracted when to labor, there was no
choice but to get the babies out because basically their
hope would have been to put steroids in to help
(21:29):
with GN development, to try and grow the lungs a
little bit faster. So their hope was to try and
keep those babies in for maybe a day or so extra. Yeah,
but because you started contracting, you had to go straight
to theater. I had to go straight to theater.
Speaker 3 (21:42):
Yeah.
Speaker 2 (21:42):
They would have liked another day or two, which would
have been good because my ov would have been back,
but it didn't happen, and luckily I was in hospital,
and luckily we got there quickly because in theater, I
was already a few centimeters dilated and Raley's feet were
coming out.
Speaker 1 (21:59):
And can you imagine if you had tried to deliver
vaginally you would have that would have been really really dangerous.
Speaker 2 (22:04):
Yeah, there's a thing. It's called twin blocking centro and
it's a really really dangerous and risky procedure where they
try and deliver. Well, I don't think they do it
or even attempt it where twin one. So twin one
is the twin close to your cervix meant to come
out vaginally first. That's an issue that they can't feed
(22:26):
first breach because the head can get locked with the
other twins head anyway. So they don't even attempt that
at all, and that was never an option and hence
the cesarean Yeah, that wouldn't have been an option and
it's very dire outcomes.
Speaker 1 (22:40):
Yeah, okay, so the boys come out and they go
straight to special care. How big were they They were little?
Speaker 2 (22:47):
So thirty four and four premature. There are about two
kilos each.
Speaker 1 (22:51):
That's pretty good.
Speaker 2 (22:53):
Yeah, look for their gestation age, it's not bad. I
think one was just over two killers. One was just
under two killers, but like literally fifty grams apart, pretty
equal weight.
Speaker 1 (23:05):
No, that's not. I mean I've heard people with full
term babies were at two and a half killers, so
it's not that's not. I know, five hundred gram is
a lot in the space of a baby, but I
mean you did an amazing job to keep them in
that long, and you know they got a little bit
extra support their special care.
Speaker 2 (23:19):
Yeah, well you think about it, but it's like a
four kilo baby, yeah, exactly, and the placenta and.
Speaker 1 (23:25):
Yeah, so how long were the boys in special care?
Speaker 2 (23:28):
They were in for nineteen nights? Wow, so five nights
we were in there with them, and then we had
to go home, which look is hard obviously living your
babies at the hospital while you go home, but also
okay too, because it meant that I could recover and
I could actually, you know, recover and heal from emecessaria,
which was major surgery, and I could rest at home
(23:50):
and be in my own bed and see our son
and be home and really recover.
Speaker 1 (23:56):
It was your son, like, where are these babies, Mum,
what's going on?
Speaker 2 (24:00):
I don't think he could put two and two together
at the time. I think of all the positives, right,
and I think we came home without them we could
spend one or one time with him, and he got
a lot of attention and quality time with us. He
didn't know any different, and we got used to basically
caring for three kids, but with a lot of help
and support while they're in special care.
Speaker 1 (24:20):
And how is life now with your three babies? The
boys are now just over one?
Speaker 2 (24:25):
It is wild? Yeah, chaos and crazy. It is nuts.
I swear three kids, it's beautiful. You just leave them
and they play together. They hold each other's hands, they hug,
they cuddle. They also you know, rip the hair and
pull the shirt and whack each other and literally crawling
over one another for like a toy, and they take
(24:46):
in stell toys. Again, there's beauty and there's chaos. It
we get both worlds.
Speaker 1 (24:51):
Okay, I can't let you go before I ask you
the typical twin questions, which I know that I'm sure
you get asked all the time. Did you mix them
up by any point when you first brought them home?
Speaker 2 (25:01):
Oh? Constantly, constantly? Who's who? I still do it?
Speaker 1 (25:06):
You can obviously tell the difference now, I'm sure your
partner can. Is there anyone that is like still struggling
like you're in laws or your parents.
Speaker 2 (25:12):
Oh look, most people when they come over, they're just
still a bit of a check, like, oh, this month's Friday.
Speaker 3 (25:17):
Right.
Speaker 2 (25:18):
Half the time they're right, half the time they're wrong.
But look fifty so well that's it.
Speaker 1 (25:22):
That's your probability though, isn't it.
Speaker 2 (25:23):
Yeah, yeah, yeah. We do tend to dress like Alex
in a particular color, generally like blues, and Riley in
kind of greens or red orange.
Speaker 1 (25:32):
They've got a color Palada, which I love that they do.
Speaker 2 (25:35):
They do.
Speaker 1 (25:37):
Well, Laura, Thank you so much for sharing your story.
Fascinating to hear about this kind of twin.
Speaker 2 (25:43):
Thank you. Yes, it's a crazy ride and I think
it's nuts every day, and we are blessed every day. Really,
it is a gift to have twins, and they're beautiful
and healthy and well. And Lucas is very lucky boy.
He gets two brothers. Yeah, two for the price of one.
Speaker 1 (25:58):
Thank you so much for joining us today, Laura, thank
you so much for having me on the show. Now,
given today's birth was a very technical one, we wanted
to bring in our resident expert obstitution and gynecologist, doctor
Bromin Devine to give us some insights. So what can
(26:20):
doctor Devine tell us about MCDA twins?
Speaker 3 (26:24):
So MCDA twins are always identical twins. They are the
identical twins that occur when the split of an embryo
occurs relatively early in embryo development, so somewhere between about
day two and day six of post fertilization life, round
about day three to day five, the embryo starts to
(26:47):
form its placenter part and its baby part, which is
known as the inncel mass. And MCDA twins form when
the inncell mass splits into two, so that you end
up with two separate babies that are genetically identical, but
they share a placenta and they share a big membrane
called the choreon, So they're in one choreonic sack, but
(27:07):
they're in two separate amniotic sacs because there are two membranes,
the choreon and the amnion. The amnions the inner membrane,
and so these twins have two separate inner membranes. They're
in their own little inner membrane sack. They share a placenter,
and because they share a placenter, you can get connections
of blood vessels between the two and that's quite common,
(27:29):
but with a particular type of blood vessel connection, you
can get a situation where one twin gives all its
blood or a lot of its blood across to the
other twin. What that means is that one poor little
twin ends up giving all its blood and the other
twin receives all the blood. So the twin that's the
giver the donor can end up very small and skinny
(27:51):
with hardly any amniotic fluid around it, and the recipient twin,
which is often the sicker twin, ends up with way
too much blood, way too much amniotic fluid. Its poor
old kidneys get over profuse and it makes a lot
of urine, and its poor old heart gets really overloaded
with fluid and they can go into heart failure. So
(28:14):
twin twin transfusion occurs about a third of the time
in monochoreonic twin pregnancies, certainly twin pregnancies, and of those third,
about half of them are associated with really severe outcomes.
So it's one of the reasons why we need to
deliver MCDA twins earlier, but also twins can come earlier
(28:35):
as well, that people can go into labor earlier with twins,
they can up to their membranes early and things like that.
So twin twin transfusion can be quite mild and we
can just keep an eye on it, or it can
be very severe and there are things we can do
to help it. But when we see people come to
us with MCDA twins, we usually warn them quite early.
(28:57):
You'll be having a lot of ultrasounds every two weeks.
We're going to be keeping an eye on these bubs
and keeping an eye on the fluid difference between them.
And there are certain very subtile things that we can
see very early on that give us an indication that
twin twin transfusion might be developing.
Speaker 1 (29:12):
And is there something to identical twins being more common
in IVF.
Speaker 3 (29:16):
Interestingly, we have definitely moved away from putting back multiple embryo.
Sometimes people will come along and say, look, I just
want to get this all over and done with. Can
you just put two embryos back from the get go,
And we're really reluctant to do that because twin pregnancies
are definitely more complicated. Even if there's two separate sacks,
two separate percenters. So in general that means non identical twins.
(29:39):
But even in that situation, you're more likely to go
into labor prematurely. You're more likely to have one bubby
grow at a faster rate than the other one. Not
so the twins are always going to be more complicated.
Birth can be more complicated. You're more likely to have
an intervention like a caesar or an instrumental birth. So
we don't want to increase people's complications. So the movement
(30:02):
away from putting back two embryos is very well established
now in Australia, and we almost exclusively put back a
single embryo where we do IVF, but because we want
to know that the embryo we put back is a nice,
hearty embryo. We grow embryos on now till they're five
days old. Certain circumstances will put them back earlier, but
(30:23):
generally we'll put them back when the embryos five days
post fertilization, and embryos at that stage, as I mentioned earlier,
are starting to form. The percent of heart and the
inncel mass and the innercell mass in IVF is a
little bit more likely to split, and that might be
to do with the fact that we're culturing embryos on.
It might be to do with the culture media, it
(30:44):
might be to do with other things that happened. But
the chance of having monochoreonic twins is increased slightly with IVF,
So even if we put back a single embryo, there
is a slightly increased chance with IVF that you're going
to end up with a twin pregnancy if you did
have a single embryo put back and you didn't conceive
a spontaneous pregnancy at the same time, which can happen
(31:06):
as well. If you did put a single embryo back
and people come along with twins as long as they
didn't conceive a natural pregnancy at the same time, those
are going to be identical twins because a single embryo
is not going to make non identical Twinssolutely, IVF does
increase your risk of having monochoryonic twins.
Speaker 1 (31:29):
Diary of a Birth was hosted by me Cassenia Lukitch
with expert input from Dr Bromwin Divine. If you have
a birth story, we'd love to hear from you. Details
are in the show notes. This episode was produced by
Tina Matalov and myself, Cassanie Lukitch with audio production by
Leoportos
You're listening to Amma Mia podcast. 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.
Speaker 2 (00:44):
Hi.
Speaker 1 (00:45):
I'm Cassania Lucid and this is Diary of a birth.
I'm fascinated by identical twins. One embryo splits to create
a perfect copy, two babies genetically the same, but with
their own identities and personalities. Occurring in roughly one in
two hundred and fifty berths in Australia. They're relatively rare,
(01:08):
but let's be real. Any parent of multiples will tell
you how challenging it is. The nappies, the feeding, and
let's not forget the actual pregnancy. After undergoing IVF with
their first baby, Today's mum was left with one viable embryo,
and when it came time to add to their family
(01:29):
two years later, she and her partner had one last shot.
Fortunately for them, the embryo took they weren't expecting was
a high risk pregnancy with identical twins so let's meet
today's mum.
Speaker 2 (01:43):
Hello, my name is Laura and this is the diary
of my birth with Alex and Riley.
Speaker 1 (01:53):
So, Laura, can you tell us a little bit about
your life before you fell pregnant with your twins?
Speaker 2 (01:59):
Life was pretty busy and I guess interesting. My husband
and I were both working, working full time. There was
lots of travel, lots of holidays, lots of fun times,
lots of going out and eating out. Yeah, we were
also renovating our house, planning and starting to renovate, meeting
with the architects, the builders, and yeah, life was busy,
(02:22):
just traveling. I work in Melbourne, but traveled to Sydney
quite a bit and we were able to get to
Greece of what where my husband's family is from. And yeah,
it was good. We had time. We had a lot
of time for four kids.
Speaker 1 (02:35):
You had a baby before you fell pregnant with the twins.
Now I know that you went through IVF with both
of your babies. Can you tell us a little bit
about that process of falling pregnant with your first.
Speaker 2 (02:48):
My husband and I I guess we decided, you know,
we wanted a family, we wanted kids. We tried for
a little bit, and I naturally didn't get anywhere. I
was son to get really impatient. I was still fairly
young at the time, but you know, I wanted things
done kind of now. We decided to embark on IVF. Actually,
before IVF, we did a few cycles of a varying induction,
(03:10):
which didn't work after two rounds, and went straight to IVF. So,
you know, did the hormones, did the injections, the egg collection,
which was a huge process. And this was in the
middle of COVID winter lockdowns, so not a fun time. Yeah,
it was really really tough. To be honest, The injections
not nice and I'm not very good at them. My
(03:31):
husband actually couldn't be in the same room when I
was doing them. Injection after injection after injection into a
collection of which I don't know if this is a
good number or bad number, but I was fortunately, I
guess to get nine eggs collected in the end, and.
Speaker 1 (03:45):
All those nine eggs you got how many embryos.
Speaker 2 (03:49):
Out of the nine every day kind of dropped off,
dropped off, dropped off down to two embrus that were
I guess day five blastsicists that were ready and appropriate
to be implanted.
Speaker 1 (04:01):
Yeah, and you got really fortunate with your first and
you feel pregnant with him straight away?
Speaker 2 (04:07):
Yes, yes, very fortunate the first round. What and we
got beautiful Lucas.
Speaker 1 (04:12):
So Lucas comes along and you know you're ready to
try again and you've got your one embryo left. So
what was going through your mind when you were ready
to implant that embryo?
Speaker 2 (04:25):
Gosh, it was full on. So look, yeah, as you say,
we had one embry left, it had been frozen for
two years. There was a lot of hope and a
lot kind of writing on that final one emberor I
really didn't want to go through IVF again, the whole
hormones and egg collection. I also got a very hyperstimulation
(04:46):
and ended up in the emergency warard for a night.
And yeah, it was one embror and one final one
and all our hopes and dreams we kind of resting
on this one embrew that had been frozen for two years,
and we're just hoping that one worked.
Speaker 1 (05:02):
You had your transfer, you went home. Now, for those
who haven't been through IVF, when you get an egg transfer,
you're not guaranteed to be pregnant. There's about a ten
day window that you have to wait, and then they
do a blood test and they can tell you if
you're pregnant or not, and it is the most excruciating. Wait, yeah,
how did you feel going into that blood test, because
(05:24):
I know that you waited, which a lot of women
don't wait.
Speaker 2 (05:27):
It's a waiting game, right, It's like at the end
of your pregnancy, when you're waiting for baby to come.
It's a waiting game. Between that implantation and the blood test,
it's a waiting game. And then from that blood test
to the phone call, it's it's huge. What probably helped
was I went on holidays, So after the implantation, I
(05:48):
went on holidays, just up to write for a few
days with my husband and son. I also got acupuncture,
which has shown to support and help that implantation. And
I just waited, and I tried to be really patient.
I got the blood test and then just waited from
the phone call from the fertility clinic.
Speaker 1 (06:08):
What was that phone call?
Speaker 2 (06:09):
Like tears of happiness and joy. I still remember it.
And I remember getting the phone call first with Lucas
exactly where we were, exactly the time, and exactly feeling
of just you know, hope and want and longing and
this real, like I don't know, it's somewhat desperate feeling
(06:29):
that you just so want this baby and so want
this child, and relief, complete relief just washed over me
because they call you and you know the call is coming,
and you know you know they're going to either tell
you the best news or the worst news. And both
times they were very quick and just said straight away, congratulations,
(06:50):
you're pregnant.
Speaker 1 (06:51):
Did you go for a dating scan?
Speaker 2 (06:52):
If you went through, We did go for a dating scan.
I think about week seven. I remember calling up my
obstetrician at the time and said, oh, look, I'm pregnant.
I'd love to come in and see my ob and
they're like, oh, no, no, you're earlier to ORR. You
know week seven, you know, come back in a few
more weeks, come back at week ten. And I said,
oh no, no, I really want to go, like I
(07:13):
just want to make sure that it's a viable pregnancy
and it's healthy and safe. And they're like, okay, sure,
never always come in. And so I in at that
week seven for that first dating scan.
Speaker 1 (07:24):
And your partner was with you, yes, Yehannie was with you. Yes,
So a spoiler alert, you have twins, so we know
that we had twins here, But what I really want
to stress is you have identical twins, right, yes, so
they only implanted one embryo, so this wasn't a case
of you know, IVF putting multiple embryos in and that's
why you have twins, like you had identical twins. So
(07:46):
at some point during your early weeks, this embryo split
into your identical twins. I want you to kind of
paint me a picture of being in that ultrasound room
with your husband to find out that you are actually
having twins.
Speaker 2 (08:01):
So we get in the room. It wasn't a long
wait and very quickly I was up on the table
and the obstetrician you know, put the gel on, put
that ultrasound one thing on, and very very quickly and
very clearly we can see what we can hear and
see your heartbeat, healthy, bible, normal pregnancy relief here tears,
(08:26):
a cry, tears of joy, happiness done, obviously positive pregnancy
and blood test. You know it's good and baby at
week seven, very strong heartbeat, wonderful and I was just
crying and crying and crying, but positive, good tears and
then the obstetrician at the time. I just remember this
so clearly. He got the sonography, I don't know the
(08:49):
wand the thing, and he very quickly moved it from
one side of my uterus to the other and up
popped another embryo on the screen, the black and white
sonography screen, very clearly another embryo moving, and automatically said
there's two. He didn't say anything, he was silent, he
(09:10):
was still. He is normally a very talkative ob and
he didn't say a word. At the same time, I've
got my husband in one corner of the room, engaged,
but probably like also not that engaged. I have a
student midwife in the other corner. Again, I don't think
she was paying much attention at the time. And then
all of a sudden, everyone was like watching and looking
(09:33):
at the screen and looking at me and looking at
my tummy, and my robe looked at me, looked at
my tummy, looked at the screen, looked at me, looked
and I just kept saying, there's two, there's two, like
I could read and interpret the ultrasound that, you know,
the black and white screen, and I knew what I
was seeing. And again he doesn't say anything for a
long time, and I was like, oh my god, just
(09:54):
talk to say something for such a normally talkative guy.
He looked at me, looked at the scan and said, congratulations,
you're having twins. And more cries, more shock, more tears,
more laughter. It just was a huge, huge, huge shock.
Any profanities, Yes, I'm sure, yes, I think so. I
think I swore yes, I remember the shock. I don't
(10:17):
remember what I said, but I remember the shock. And
then just like both like laughter but tears.
Speaker 1 (10:23):
So you and your husband get in the car. You've
just found out this very shocking news. What's that conversation sound?
Speaker 2 (10:29):
Like? God, that was really tough. I'll be honest with you,
Like this was just obviously not expected at all. Like,
we don't have twins in the family. It's not a
genetic link. They were completely random, identical twins. We get out,
I'm meant to get back to work, Jani's meant to
get back to his work, and we just like are
still processing the news and still processing the information. And
(10:53):
I must say it took weeks and months to process
it and come to terms with that. You know, just
a lot of questions I think, like are they healthy.
Is it going to be a viable pregnancy? Can I
carry twins? How are we going to feel? How will
I emotionally cope? How will I physically cope? You know?
Can I actually carry twins to term? Well? Will that look? Like?
What does this mean for my career? What does this
mean for Lucas our son? You know, we're giving him
(11:15):
two siblings. We're renovating our house. Does it fit another room?
Do we have to get a new car? You know?
Three car seats? What does this mean for our family?
And this wasn't on the cars, This wasn't planned. We
wanted like this normal kind of two parents, two kids,
and very quickly we're outnumbered three like that, And.
Speaker 1 (11:34):
To add complexity to this twin pregnancy, which is already
a challenge, you know, we know that sort of risks
increase with multiples. With a twin pregnancy. You actually had
a very rare type of twins and they're called MCDA twins.
Now I won't try and pronounce the actual name of it,
but basically you told me that that means that they
had a single placenter with two amniotic sacs, which means
(11:57):
that they were sharing nutrients from one placenter, correct, can
you tell us what the doctors told you about what
that actually means.
Speaker 2 (12:05):
So in that first stating scan, ob very clearly could
see the type of twins that they were and very
quickly said, look, this is a high risk twin pregnancy.
They're sharing a placenter. Drew diagrams and kind of drew
what it looked like. But effectively positive news is that
they're in two separate amniotic sacs and there was the
membrane between them. However, sharing a placenta, as you say, like,
(12:28):
they're sharing nutrients from that one plus center with two
umbilical cords, and so there's a potential risk. I mean
a lot of risks for twins, but one of the
most concerning ones they worry about is twin to twin
transfusion syndrome, which is where one twin gets more nutrients
than the other and it's really a problem for both twins.
Because of that, I had to be monitored and scanned
(12:50):
every fortnight from I think week fifteen, just to make
sure that the babies are growing kind of normally and
healthy and equally and they're kind of getting equal amount
of nutrients, of which they were very fortunate and I
never had They call it t TTS twin to twin
transfusion syndrome.
Speaker 1 (13:07):
Basically that could mean that one twin's growing much faster
the other ones not getting any nutrients, and you can
really risk the life of the baby yourself. It's pretty serious. Yes,
So obviously that's a big concern for you throughout pregnancy.
And I also understand that you were very unwell through
your pregnancy as well. So what was it like, sort
of juggling a toddler, a high demand position at work,
(13:32):
being pregnant with twins.
Speaker 2 (13:33):
It was rough. It was really rough, And I compare
in contrast, I think a lot to my first pregnancy
that I was told was very boring, a very normal pregnancy,
not many issues, and this song was just very, very challenging.
I was nauseous, severely nauseous for mass every day. I
was fortunate I didn't throw up at all. But it
(13:54):
was just like, think of the worst hangover you've ever had,
mixed with travel sickness and motion sickness. It was rubbish.
It was really rubbish. And looking after my toddler, who's
two at the time, and here, you know, Terrible twos
was challenging, and then work and then travel to Sydney,
and yeah, it was a lot.
Speaker 1 (14:15):
Did you have anything any particular foods or drinks that
really got you through when you were feeling nauseous?
Speaker 2 (14:20):
Yes, Oh my god, ginger and just ginger beer and
fresh ginger.
Speaker 1 (14:25):
Okay, so let's move along. You're feel naughtously, feeling horrible,
But family's obviously very excited.
Speaker 2 (14:30):
Yes, yes, And in fact it was interesting because no
one knew were pregnant. We hadn't told anyone until we know,
had that dating scan, and so it was like double
the news, like oh we're pregnant and we're having twins,
kind of two in one, yeah, I think. Yeah, both
sides of the family very very happy. A bit of
a shock obviously, because as I said, like, twins don't
(14:51):
run in the family either side, and again it's not
a genetic thing at all. Yeah, a lot of excitement
from the family.
Speaker 3 (14:58):
Yeah.
Speaker 2 (14:59):
I remember actually one early on in the pregnancy justice,
we found the news and as I told my sister,
as remember crying, crying with her, Yeah, because I was
still processing the news and still processing what it meant
and again it wasn't planned, and she just held me
and I just cried. It was a beautiful moment, but
(15:20):
it was still hard to kind of come to terms
with it. Yeah, yeah, it still is a little bit.
I know the voice that over a year, but it's
wild to think we've had.
Speaker 1 (15:31):
Twins coming up.
Speaker 2 (15:33):
I was already a few centimeters dilated and Raley's feet
were coming.
Speaker 1 (15:38):
Out well, I mean, one is still so little. Like
I feel like once you get through that first year
it is, that'll sort of start to get a little
bit easier. But true first birthdays should be the celebration
of mum and dad, particularly mum, but mum and dad.
Speaker 2 (15:55):
Oh, I agree for sure.
Speaker 1 (15:57):
Obviously with twins again high rise pregnancy of twins often
gestation is often a little bit shorter. But your doctor
didn't want you to go past a certain time. Can
you talk to us about that.
Speaker 2 (16:09):
With the twins, kind of coming to term is around
thirty seven weeks. For the type of twins I had,
it was about thirty seven weeks, and we had a
planned cesarean. Well, no, we had planned for a vaginal delivery,
and my ov was very happy for that. Given the
kind of the first physiological vaginal delivery with my first son.
We're working towards that and aiming towards that. It was great,
(16:32):
all on board. However, at week thirty two, my first son, Riley,
twin one, he flipped, so from being head down he
was now fit down and breach. And as soon as
that happened, that through, you know, a vaginal birth plan
alt the window because there's not much you could do
with like I know, with one spinning babies and you
(16:52):
can kind of get them to try and flip again.
You can't do that with twins. And so every week
and every scan I was just hoping like Riley had
flipped again and flipped back to head down, but he hadn't,
and he didn't, So then we had to think about, okay, well,
plan B cesarian and we had booked a cesarian for
kind of mid March, so that was booked in and
(17:13):
all good and all fine. And from that moment I
did a lot of research. I spoke to a lot
of girlfriends, particularly friends with twins and who had gone
through a cesarean, spoke to a lot of friends with
both negative and positive experiences of air cesarean. I did
a lot of research, a lot of information. I spoke
to a lot of people to kind of really get
me ready and prepare me for that moment. But that
(17:35):
planned Cesarean date didn't happen because the boys came early.
The boys came at thirty four and four, because I
went into spontaneous labor. Well, as you'd jumped back a step, Riley,
we think it's Frailey, chicky bugger. He kicked and broke my.
Speaker 1 (17:51):
Waters lot a little so and sound a little chicky
monkey had day.
Speaker 2 (17:56):
No because he was fit down and he was breach.
Like my ob says to me, he probably kicked kick
too hard and broke your waters. And one afternoon, I
remember i'd you know, been that day like shopping and
washing and cooking and cleaning and all the things as
you do as a mum and managing a family. I
had like a five minute break, and I remember lying
(18:17):
on my bed with my husband and my son and
we put on like Bluey or something for my son
to watch it. Oh perfect, I can literally just lie down,
get off my feet and watched this with him for
like half an hour and lye in bed. Within literally
like two minutes of putting on that show, my water's
broke and water went everywhere all over the bed My
(18:40):
husband actually was talking to another friend who's a twin
dad at the time on the phone, and Yanni had
thought I had actually like wet my pants all like
worse because I was holding my bump like I was
holding my backside. I was on the bed and I
like literally said, oh, and how my backside. He's like,
oh my god, have you like wet yourself or what's happened?
(19:02):
He was on the phone and he's like, oh, mate,
I'm gonna have to like drop off because I think
Lauren's just her waters are broken. Got off the phone call.
I was lying bed still with my son. All of
a sudden, we were like up and off the bed,
but there was water everywhere and it kept gushing and
gushing and gushing. Went to the toilet, waters coming. I've
got a like a maternity pad, put that in my underwear,
(19:25):
and very quickly I just said, okay, it's on like
waters are broken. We need to get to hospital.
Speaker 1 (19:31):
And this is a Sunday too, Sunday afternoon. Yeah, so
you basically had to call the whole new team in Yes.
Speaker 2 (19:38):
Yes, so my obi wasn't on call that weekend, and
I got a whole new team because it ended up
becoming an emergency s asaian and a whole new team
greeted us in hospital and you pay all the penalty
rates because it's a Sunday afternoon. So that was fun,
all new people. But look, we knew the hospital, we
knew the plan. My Obi. I was very lucky because
(20:00):
I spoke to him on the phone actually in hospital
about what was about to happen, and the saesarean and
you know, as discussed, you know we're going to be
doing s Y and zaid, So did have continuity of
care from him, and I knew what I was going
into and it was still to plan. It was just
a little bit early.
Speaker 1 (20:18):
Yeah, you get in there, get spinal tap, you're in
the theater and they take out the first baby. Yes,
what was that experience like? Did they have to go
straight to special care?
Speaker 2 (20:30):
They did shock again, a lot of shock because it
happened I think so quickly from when my waters broke
to then going into labor to then arriving.
Speaker 1 (20:40):
How long was it between when your waters broken when
the babies came?
Speaker 2 (20:43):
About three hours?
Speaker 1 (20:45):
It's very quick.
Speaker 2 (20:45):
Yeah, it's pretty fast. We got off pretty quick. And
then what they were hoping to do, was hoping to
keep me in for another day or two, even though
my water said broke. They were hoping I wouldn't start
contracting and kind of go into labor. But I did,
and I went pretty quickly, and the contractions wrapped up
bloody fast and hard, and boy, I didn't have my
(21:09):
Tenis machine or pain relief or anything planned, and gosh,
it just brought me back very quickly to that first
labor of my son, very quickly, ye three hours. And unfortunately,
because I then contracted when to labor, there was no
choice but to get the babies out because basically their
hope would have been to put steroids in to help
(21:29):
with GN development, to try and grow the lungs a
little bit faster. So their hope was to try and
keep those babies in for maybe a day or so extra. Yeah,
but because you started contracting, you had to go straight
to theater. I had to go straight to theater.
Speaker 3 (21:42):
Yeah.
Speaker 2 (21:42):
They would have liked another day or two, which would
have been good because my ov would have been back,
but it didn't happen, and luckily I was in hospital,
and luckily we got there quickly because in theater, I
was already a few centimeters dilated and Raley's feet were
coming out.
Speaker 1 (21:59):
And can you imagine if you had tried to deliver
vaginally you would have that would have been really really dangerous.
Speaker 2 (22:04):
Yeah, there's a thing. It's called twin blocking centro and
it's a really really dangerous and risky procedure where they
try and deliver. Well, I don't think they do it
or even attempt it where twin one. So twin one
is the twin close to your cervix meant to come
out vaginally first. That's an issue that they can't feed
(22:26):
first breach because the head can get locked with the
other twins head anyway. So they don't even attempt that
at all, and that was never an option and hence
the cesarean Yeah, that wouldn't have been an option and
it's very dire outcomes.
Speaker 1 (22:40):
Yeah, okay, so the boys come out and they go
straight to special care. How big were they They were little?
Speaker 2 (22:47):
So thirty four and four premature. There are about two
kilos each.
Speaker 1 (22:51):
That's pretty good.
Speaker 2 (22:53):
Yeah, look for their gestation age, it's not bad. I
think one was just over two killers. One was just
under two killers, but like literally fifty grams apart, pretty
equal weight.
Speaker 1 (23:05):
No, that's not. I mean I've heard people with full
term babies were at two and a half killers, so
it's not that's not. I know, five hundred gram is
a lot in the space of a baby, but I
mean you did an amazing job to keep them in
that long, and you know they got a little bit
extra support their special care.
Speaker 2 (23:19):
Yeah, well you think about it, but it's like a
four kilo baby, yeah, exactly, and the placenta and.
Speaker 1 (23:25):
Yeah, so how long were the boys in special care?
Speaker 2 (23:28):
They were in for nineteen nights? Wow, so five nights
we were in there with them, and then we had
to go home, which look is hard obviously living your
babies at the hospital while you go home, but also
okay too, because it meant that I could recover and
I could actually, you know, recover and heal from emecessaria,
which was major surgery, and I could rest at home
(23:50):
and be in my own bed and see our son
and be home and really recover.
Speaker 1 (23:56):
It was your son, like, where are these babies, Mum,
what's going on?
Speaker 2 (24:00):
I don't think he could put two and two together
at the time. I think of all the positives, right,
and I think we came home without them we could
spend one or one time with him, and he got
a lot of attention and quality time with us. He
didn't know any different, and we got used to basically
caring for three kids, but with a lot of help
and support while they're in special care.
Speaker 1 (24:20):
And how is life now with your three babies? The
boys are now just over one?
Speaker 2 (24:25):
It is wild? Yeah, chaos and crazy. It is nuts.
I swear three kids, it's beautiful. You just leave them
and they play together. They hold each other's hands, they hug,
they cuddle. They also you know, rip the hair and
pull the shirt and whack each other and literally crawling
over one another for like a toy, and they take
(24:46):
in stell toys. Again, there's beauty and there's chaos. It
we get both worlds.
Speaker 1 (24:51):
Okay, I can't let you go before I ask you
the typical twin questions, which I know that I'm sure
you get asked all the time. Did you mix them
up by any point when you first brought them home?
Speaker 2 (25:01):
Oh? Constantly, constantly? Who's who? I still do it?
Speaker 1 (25:06):
You can obviously tell the difference now, I'm sure your
partner can. Is there anyone that is like still struggling
like you're in laws or your parents.
Speaker 2 (25:12):
Oh look, most people when they come over, they're just
still a bit of a check, like, oh, this month's Friday.
Speaker 3 (25:17):
Right.
Speaker 2 (25:18):
Half the time they're right, half the time they're wrong.
But look fifty so well that's it.
Speaker 1 (25:22):
That's your probability though, isn't it.
Speaker 2 (25:23):
Yeah, yeah, yeah. We do tend to dress like Alex
in a particular color, generally like blues, and Riley in
kind of greens or red orange.
Speaker 1 (25:32):
They've got a color Palada, which I love that they do.
Speaker 2 (25:35):
They do.
Speaker 1 (25:37):
Well, Laura, Thank you so much for sharing your story.
Fascinating to hear about this kind of twin.
Speaker 2 (25:43):
Thank you. Yes, it's a crazy ride and I think
it's nuts every day, and we are blessed every day. Really,
it is a gift to have twins, and they're beautiful
and healthy and well. And Lucas is very lucky boy.
He gets two brothers. Yeah, two for the price of one.
Speaker 1 (25:58):
Thank you so much for joining us today, Laura, thank
you so much for having me on the show. Now,
given today's birth was a very technical one, we wanted
to bring in our resident expert obstitution and gynecologist, doctor
Bromin Devine to give us some insights. So what can
(26:20):
doctor Devine tell us about MCDA twins?
Speaker 3 (26:24):
So MCDA twins are always identical twins. They are the
identical twins that occur when the split of an embryo
occurs relatively early in embryo development, so somewhere between about
day two and day six of post fertilization life, round
about day three to day five, the embryo starts to
(26:47):
form its placenter part and its baby part, which is
known as the inncel mass. And MCDA twins form when
the inncell mass splits into two, so that you end
up with two separate babies that are genetically identical, but
they share a placenta and they share a big membrane
called the choreon, So they're in one choreonic sack, but
(27:07):
they're in two separate amniotic sacs because there are two membranes,
the choreon and the amnion. The amnions the inner membrane,
and so these twins have two separate inner membranes. They're
in their own little inner membrane sack. They share a placenter,
and because they share a placenter, you can get connections
of blood vessels between the two and that's quite common,
(27:29):
but with a particular type of blood vessel connection, you
can get a situation where one twin gives all its
blood or a lot of its blood across to the
other twin. What that means is that one poor little
twin ends up giving all its blood and the other
twin receives all the blood. So the twin that's the
giver the donor can end up very small and skinny
(27:51):
with hardly any amniotic fluid around it, and the recipient twin,
which is often the sicker twin, ends up with way
too much blood, way too much amniotic fluid. Its poor
old kidneys get over profuse and it makes a lot
of urine, and its poor old heart gets really overloaded
with fluid and they can go into heart failure. So
(28:14):
twin twin transfusion occurs about a third of the time
in monochoreonic twin pregnancies, certainly twin pregnancies, and of those third,
about half of them are associated with really severe outcomes.
So it's one of the reasons why we need to
deliver MCDA twins earlier, but also twins can come earlier
(28:35):
as well, that people can go into labor earlier with twins,
they can up to their membranes early and things like that.
So twin twin transfusion can be quite mild and we
can just keep an eye on it, or it can
be very severe and there are things we can do
to help it. But when we see people come to
us with MCDA twins, we usually warn them quite early.
(28:57):
You'll be having a lot of ultrasounds every two weeks.
We're going to be keeping an eye on these bubs
and keeping an eye on the fluid difference between them.
And there are certain very subtile things that we can
see very early on that give us an indication that
twin twin transfusion might be developing.
Speaker 1 (29:12):
And is there something to identical twins being more common
in IVF.
Speaker 3 (29:16):
Interestingly, we have definitely moved away from putting back multiple embryo.
Sometimes people will come along and say, look, I just
want to get this all over and done with. Can
you just put two embryos back from the get go,
And we're really reluctant to do that because twin pregnancies
are definitely more complicated. Even if there's two separate sacks,
two separate percenters. So in general that means non identical twins.
(29:39):
But even in that situation, you're more likely to go
into labor prematurely. You're more likely to have one bubby
grow at a faster rate than the other one. Not
so the twins are always going to be more complicated.
Birth can be more complicated. You're more likely to have
an intervention like a caesar or an instrumental birth. So
we don't want to increase people's complications. So the movement
(30:02):
away from putting back two embryos is very well established
now in Australia, and we almost exclusively put back a
single embryo where we do IVF, but because we want
to know that the embryo we put back is a nice,
hearty embryo. We grow embryos on now till they're five
days old. Certain circumstances will put them back earlier, but
(30:23):
generally we'll put them back when the embryos five days
post fertilization, and embryos at that stage, as I mentioned earlier,
are starting to form. The percent of heart and the
inncel mass and the innercell mass in IVF is a
little bit more likely to split, and that might be
to do with the fact that we're culturing embryos on.
It might be to do with the culture media, it
(30:44):
might be to do with other things that happened. But
the chance of having monochoreonic twins is increased slightly with IVF,
So even if we put back a single embryo, there
is a slightly increased chance with IVF that you're going
to end up with a twin pregnancy if you did
have a single embryo put back and you didn't conceive
a spontaneous pregnancy at the same time, which can happen
(31:06):
as well. If you did put a single embryo back
and people come along with twins as long as they
didn't conceive a natural pregnancy at the same time, those
are going to be identical twins because a single embryo
is not going to make non identical Twinssolutely, IVF does
increase your risk of having monochoryonic twins.
Speaker 1 (31:29):
Diary of a Birth was hosted by me Cassenia Lukitch
with expert input from Dr Bromwin Divine. If you have
a birth story, we'd love to hear from you. Details
are in the show notes. This episode was produced by
Tina Matalov and myself, Cassanie Lukitch with audio production by
Leoportos
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