TW: miscarriage, twin molar pregnancy, twin loss, cancer, chemotherapy, c-section, PPD. 

I’d love the opportunity to share my birth story as, unfortunately, I found it very difficult to find any support on molar pregnancies and twin pregnancy loss. After suffering missed miscarriages, I finally got the courage to try to conceive again. I naturally fell pregnant with fraternal (DCDA) twins. My husband and I were absolutely over the moon. From that moment, I suddenly felt a sense of relief that everything happens for a reason, and these twins were going to be perfect and healthy. I do remember thinking, “If I lose these twins, I don’t know how I’ll ever recover”. Everything looked perfectly normal and healthy. The twins were growing well, and I had typical nausea throughout the day but nothing alarming. 

I suddenly noticed some spotting one night, and my heart instantly sank. The fear of miscarrying again came rushing back. We went to our private obstetrician appointment at 10 weeks, where the twins looked absolutely perfect. Both had really strong heartbeats and were growing accordingly. A month later, our world came crashing down. I noticed that Twin B had some unusual patches on the placenta (I’m a sonographer). We were quickly sent to the maternal-fetal medicine unit for additional scans and amniocentesis. We were told that Twin B would likely die over the coming months due to a twin molar pregnancy, with uncertainty about Twin A's survival. They estimated a 50% survival rate for the healthy twin, with a 50% risk to my health, including preterm delivery, preeclampsia, postpartum haemorrhage, hysterectomy, metastatic cancer from the molar placenta and chemotherapy treatment. Unfortunately, there aren’t many documented cases in Australia, so the advice was really difficult to trust. We were also advised to consider selective termination of Twin B and, ultimately, the entire pregnancy. I found this time incredibly difficult to emotionally process. The only comfort I still held on to was the two little heartbeats that continued to grow. My private obstetrician steered me to be optimistic and continue with the pregnancy with a week by week approach. I was absolutely terrified. As a health care professional, I felt particularly scared as I didn’t feel I would fall on the better side of the statistics. For me, my biggest fears were preterm delivery and chemotherapy. I couldn’t live with myself if the surviving twin was born unwell as a micro prem due to a decision I had made. My biggest concern with chemotherapy was the effects that it would have on breastfeeding and, ultimately, my mental health during my postpartum year with my baby. As the pregnancy continued, I developed ovarian hyper-stimulation syndrome due to the elevated HCG from the molar placenta. The nausea and pain were incredibly consuming throughout the pregnancy, but one day I suddenly woke up with the sensation that my nausea had eased and the pain was not as intense. I knew then and there that our Twin B (Rosie) had died. I arranged for an ultrasound, and my heart was broken. It was incredibly difficult to balance the loss I so badly wanted to mourn and the guilt I felt knowing that my emotions would have an effect on the surviving twin.

As months passed and the pregnancy continued, our little Twin A continued to beat the odds. I developed cervical incompetence at around 25 weeks, where I was suddenly placed on bed rest. These were some of my darkest days. Until that point, I was busy at work, studying at university, and keeping myself as busy as I could. When I was forced to lay on the couch at home for weeks on end, I suddenly had to sit with the weight of everything that I’d been through and was yet to still overcome. Processing and circling the pain of the situation. Being pregnant with a healthy little baby whilst also carrying her lifeless twin sister, our daughter Rosie. I was arranged a C-section for 38 weeks as this was the safest way to remove the molar tissue from my uterus, in hopes of avoiding chemotherapy postpartum. On the 10th of January 22, I gave birth to our twin, a daughter, Sienna James. 8 pounds of healthy and perfect in every way. The day was incredibly hard but also so beautiful and perfect in the same breath. I was beyond terrified of the statistics I’d been given. I would have a bleed and lose the ability to have future siblings for her, or that I would not make it through the procedure. Thankfully it was an uncomplicated birth. The molar tissue was removed where the team felt that all margins of the tumour were. Our little Twin B - Rosie, was sent away for genetic testing. 

Having a birth where I said hello to our surviving daughter and goodbye all in the same moment was really hard. The guilt of taking the happiness of the day for our Sienna but then also not wanting to take a moment for Rosie was really confusing and hard to navigate. Sienna developed an ABO blood incompatibility within a few hours of birth and was quickly taken to the special care nursery for severe jaundice and anaemia. To have her taken away (for about 3 days) and advised she might need further special care and to prepare to go home without her, after the intensity and pain of the pregnancy was incredibly difficult to process. I just needed her in my arms, safe. We were so grateful to be sent home as a family of three and quickly settled into our newborn love bubble. I continue to have monitoring for cells, and chemotherapy treatment will be decided at the six-month postpartum mark, but my doctors feel optimistic. As the weeks have continued, I felt this intensity of overwhelming anxiety and fear that something might happen to Sienna get stronger, as if every day I have this trap door beneath me that I’m always terrified will suddenly open. Spending the entire 9 months in fear and constant anxiety that every appointment would bring heartbreaking news, has been very difficult to overcome postpartum. I feel robbed of the experience of a happy pregnancy, birth and even postpartum days. I hope to be able to find the brighter days where I feel safe and comforted by the fact that she is healthy. Until then, living with this anxiety and fear has become my new normal, which, with time and therapy, I hope to be able to overcome.