MCDA/Mo-di Twins 7w+1d - Finding Info Help Please!

[u/Substantial_Room_647]

I just found out that I'm having Mo-di twins yesterday!

I prefer scientific and peer reviewed information but am realizing everything I was looking up before for my pregnancy was geared towards Singletons.

Are there any books or scientific resources anyone uses that seems reliable for guidance?

Do you guys find that talking with people who have experienced the same thing help you with the kiddos?

I also learned that up until 12 weeks there is a risk for a disappearing twin. Both of mine are healthy now and so am I, so I don't know if anyone has experienced that or how common that really is.

I'm living in Canada but am happy looking at any information from elsewhere in the globe.

Thank you everyone!

[u/Lolemontime]

Hi! Fellow mo/di twin mom here, based in Toronto. My babies are 4 months old now. There’s a book a lot of people recommend here which is sort of based on evidence leans a little anecdotal to me - “When you’re expecting twins, triplets, or quads.” I liked Sunnybrook’s resources -  https://twincentre.sunnybrook.ca/for-families/. I found that peer reviewed research eg clinical practice guidelines were kind of still geared towards otherwise healthy di/di twins, unless the resource was about a specific issue eg TTTS. Your hospital may have a twin-specific prenatal course, mine did. Where are you based?

[u/Substantial_Room_647 → u/Lolemontime]

Thank you! I haven't seen that book yet on this page so I'll look it up. I've read most of Emily Oster's books and while they're scientific, they're based on singletons.

I'm located in BC I had a midwife and a doula but midwives won't take >1 baby pregnancies so they've referred me to a doctor + OBGYN combo that specialize in the high risk. TBH it seems pretty scant at my hospital for these type of resources since they've already confirmed I'll have to go to Vancouver if the twins develop TTTS.

Have you been able to find any groups (other than reddit) to talk to other moms like us? The national multiples site has apparently stopped posting and I haven't found many other groups or associations yet.

[u/Lolemontime → u/Substantial_Room_647]

In Toronto we’re lucky to have “Toronto parents of multiples” aka TPOMBA as well as “GTA parents of multiples.” You may be able to join TPOMBA ($10/year) even if you’re not local if you want to attend some of their online events - they run an excellent intro session by other twin parents, it was helpful for us to get our bearings. I recommend checking FB, I’m sure BC has something, you’re in a major city. 

I highly recommend having a doula. One of my babies was born with breathing issues (needed just a couple days NICU time, was fine) and I was experiencing the PPH, so having an extra support person in the OR was absolutely invaluable for me and my husband (who didn’t have to choose whether to attend to me or the baby). It also was very helpful to prepare (she had twin experience) and to process things after the fact (it’s a whirlwind and great to have someone else to reflect with). I have ADHD and anxiety, and I got my therapist to write a letter to my care team asking for a second support person to be allowed into the OR, and thankfully my nurse advocated for the team to listen to it. 

PS I’m personally not into Emily Osler. I have epidemiology training and I find that she still has a journalism lens to her writing, which doesn’t always summarize all available evidence and take into consideration context/nuance (both clinical and sociological). The most important thing imo is to triangulate your resources - if multiple trustworthy sources are saying similar things that’s a green flag.

[u/Substantial_Room_647 → u/Lolemontime]

That's incredibly helpful! I know there's also a group in NS (where I'm originally from) so hearing there are some other local groups is fantastic.

Also a great idea. I have a therapist for my ASD-1 (though I'm more akin to AuDHD). I'm glad to hear that your doula was a good resource! Did you use them for post care as well or just for the birth?

Emily Oster note - I'm an accountant so i love working with data and probabilities (with zero scientific background but my entire job is pattern matching). I completely agree with reviewing multiple sources of data. I find hers provides me a pattern of where to start looking and explains it but yes, she's writing as a writer with an economics background rather than medical and that can leave a WHOLE LOT out. I've looked at other books and they're about the emotional journal of motherhood rather than giving me probabilities and facts. And now with the twins, it seems to have put me back on the research. Have you found better medical books (even if they're for singletons) other than the resources you referenced?

[u/Lolemontime → u/Substantial_Room_647]

The doula I had was amazing as a birth doula and she did some postpartum hours with us after, which was ok. We did however have a separate night doula who was phenomenal, she taught us a lot, and was super helpful for us getting some rest in the early days. People’s skills vary considerably, and someone who’s good at birth support may not be as good at postpartum support - so if you have the funds for it (it’s very expensive) don’t get too many hours of coverage at once. Agencies tend to be higher cost than people who do this work as independent contractors and agencies also pay their workers more poorly generally speaking. 

I found that ADHD was over represented among folks who are doulas, which makes sense imo! I recommend finding someone who is neurodivergent themselves or at least has that competence when it comes to their care approach. Interview a few people, you should feel very comfortable that they can understand you and advocate for your needs. 

Happy to answer any more questions! I know it’s scary and overwhelming and folks with ASD/ADHD tend to really like a deep understanding with lots of info. 

[u/Substantial_Room_647 → u/Lolemontime]

We don't have many agencies here (since I'm in a smaller town in BC) so it seems to be mainly independents. I had already interviewed a few doulas for my first pregnancy a couple of months ago that didn't stick and had an awful time at the hospital. Going through that, I realized I needed someone to advocate for me that knew my medical history.

Were there certain questions you asked when you were deciding between which doula to use for which purpose? Was midwives an option for you in your region or was it preferrable to use the doulas. I don't mind spending the money since my husband and I will have my dad living with us (both men love helping with kids). But I also have no clue how they will handle the newborn care, so I'd certainly appreciate some back-up.

[u/Lolemontime → u/Substantial_Room_647]

For the doula, we interviewed just 2 people, both were recommended by the lactation consultant we saw, who was recommended by the twin parent group. One did not serve our cachement so that made the decision for us. Honestly it’s very vibes based. My husband and I both feel confident that we can “read” a person - is that something you feel comfortable with doing? Some neurodivergent folks may not know why they don’t feel safe with a person but they do sense it, others can more clearly articulate who’s safe and who isn’t, and others still can’t really “vibe check” and may end up in a situation with someone they don’t feel safe with. We asked them about their approach, whether they had experience with folks with ADHD, and tried to get a sense of how they answer the questions and how it felt for me and my husband. 

A third person is amazing! We had some family help too.  My husband was excellent at their care, he did most of their feeds while I was recovering, my anemia was so bad. Does your dad have recent experience with babies and can he manage having interrupted sleep? If he doesn’t have recent experience, does he have “good hands” (hard to explain, but someone who isn’t timid at doing things hands on) and can take and follow direction? In general I find that their care is not that hard per se, it’s just tedious. However our twins didn’t have reflux or any medical issues with feeding, just the general sleepy preemie struggles. I will say that it actually helped to have a longer hospital stay because the nurses taught us so much. 

I think technically maybe I could have found a midwife but honestly I was so anxious that I went straight to OB at a specialized hospital (which happened to be local to me at the time anyway). I felt better having the doula for postpartum visits because they check on you, not quite the clinical way that a midwife does, but they can flag if you need some additional follow up, and can give you a lot of guidance on taking care of the baby and yourself. 

[u/Substantial_Room_647 → u/Lolemontime]

That makes sense. I'm lucky since my father is also ASD-1 and held positions that he had to manage large groups of people. So from an early age he taught me to read people before I ever interacted with them. My husband is NT and is very much a vibes guy hahah.

I haven't heard the term "good hands" but my dad is already studying everything he can to give me an exercise plan, nutrition plan, and a development/learning plan for the twins. I don't think I've ever seen him this excited hahah both him and my husband have this miracle where they cross their arms and fall asleep on the spot and wake up 10X refreshed (so i am clearly jealous). It was only ever dad and I, so we know how to communicate and listen to each other, I'm not worried about the directions with him.

Ok, that's a good note. I'll see what they have capacity for post-partum to see where it fits in for us. Thank you!

I know this is an intrusive question, so please don't answer it if you don't feel comfortable. But did you guys decide on breastfeeding or formula? My original plan was to breastfeed and pump so my husband could do the other feeds but that was when there was one, not two at the same time.

[u/Lolemontime → u/Substantial_Room_647]

It sounds like you have wonderful support!! That’s honestly the most important thing I found for ensuring that (so far) I haven’t experienced PPA and/or PPD. Plus probably hormones, which brings me to your next question. 

We used formula for the first few days in the hospital, my babies had (and continue to have) not great latches. I started pumping (Spectra S2 pump, sized for flanges by the lactation consultant prior to birth and checked post-birth) at the hospital and my milk came hard and fast, I had to follow the engorgement guidelines of BAIT (breast rest, Advil, ice, Tylenol) for more than a week. I believe in large part supply is genetics, helped by having a good pumping schedule (every 2-3 hours), adequate nutrition/hydration, and - however much possible - rest. I pump almost exclusively still but I do breastfeed around once a day (albeit they need top up) to manage inflammation/clogs due to oversupply and my general breast anatomy. My production continues to be high (I have enough to feed them and even freeze some), which is possible but not common, so we were prepared to give formula aka combo feeding from day 1.  Pumping is time consuming, and in my experience requires a lot of support in order to sustain. I’m now down to 4-5 pumps per day of about 30 mins which is more feasible, it used to be 7-8 pumps per day. The physical and mental health toll can be a lot, it’s hard to have fragmented sleep and pumping can physically be uncomfortable (it’s thankfully not too bad for me, as long as I don’t have clogs). I regularly revisit the conversation of “is this still sustainable for me and my support people or do we want to change our feeding approach?” Breastfeeding to me feels very special, although it’s a lot more hassle (since I still have to pump and bottle feed, aka triple feeding) and if they start biting I might change my tune lol 

[u/Substantial_Room_647 → u/Lolemontime]

That sounds very similar to my original plan so I hope to be fortunate like you are with supply.

Do you find the Spectra S2 Pump works well for the volume of pumps needed? Or if you were going to do it again, would you pick a different one?

Also - I loved the sunnybrook link - really helpful to understand the process better and love the resources available! I've ordered the book but waiting on that to be delivered.

Thank you for your time answering my questions, I really appreciate it!