Brittany and Zach Woodbury were done having kids after the birth of their son, Sylas. But when the toddler started asking when he would have a brother to play with, the couple had a change of heart. Brittany became pregnant again, and at a 7-week ultrasound she learned that Sylas would be getting two siblings—twins—instead of one. This was the first of the pregnancy’s many surprises.
A few weeks later, a follow-up appointment showed that the babies shared a placenta and an amniotic sac, an anomaly that occurs in just one percent of twin pregnancies. Monoamniotic and monochorionic twins, or mono mono twins, have a survival rate of 50 percent in early pregnancy, and there are many potential complications. Brittany would need to be closely monitored and started going to weekly appointments by Joseph Landwehr, MD, maternal and fetal medicine at IU Health Ball.
“At one of my first appointments, we talked through risks and what to expect,” said Brittany. “Cord compression and entanglement is the main reason why mono mono twins don’t survive. Any kind of knot can restrict blood flow and oxygen to both babies. It was a day-to-day type of thing for us. One day everything could be fine, and hours later they could be gone, and there was nothing we could do to prevent it or help the situation.After the first appointment with Dr. Landwehr, my husband said, ‘Even if we lose them, they will know they are loved until the very end.’ We had to trust that something higher was taking over and helping everything go the way it was supposed to.”
The pregnancy was progressing normally until 20 weeks. Brittany started bleeding and rushed to the emergency room. The ultrasound showed that the twins seemed to be fine, and Brittany’s bleeding was caused by placenta previa, a condition in which the placenta completely or partially covers the opening of the uterus (cervix), caused the bleeding. She was kept on bedrest until she could see Dr. Landwehr, who discovered that the babies were showing a significant difference in vitals and heart rates. The discordance warranted an echocardiogram and a more in-depth ultrasound, so the Woodburys were sent to Cincinnati Children’s Hospital for further testing. Providers confirmed that one twin was starting to take over nutrients for the other. Fortunately, the discordance wasn’t high enough for surgical intervention, and over the course of a few anxiety-inducing weeks, the problem began to resolve itself.
The Woodburys were discharged after selecting IU Health Ball, a Level III Obstetrics Unit and Neonatal Intensive Care Unit certified by the state of Indiana, for delivery. A Level III designation brings 24 hour a day, in-house obstetricians and neonatal providers to support prenatal and delivery service needs.Brittany moved into her third trimester confident in her delivery plan and hoping she’d experienced the worst of the pregnancy’s complications.
“Toward the end of the pregnancy, mono mono mothers often have to receive inpatient care to keep a close eye on the growing babies,” she said. “I had a four-year-old at home, though, and a husband with a demanding work schedule, so we instead decided on routine monitoring, three times a week.”
After weeks of monitoring, Brittany finally made it to 32 weeks, which was the earliest the care team felt comfortable delivering the twins. The babies were born via c-section on July 14, 2021. The girls were small, but perfectly healthy. Baby A was named Tess; Baby B, Blair.
With the high-risk pregnancy finally behind them, the Woodburys were ready to conquer their next challenge: the NICU stay. “A few hours after they were born, I was able to go up and see them,” Brittany said. “They waited to let my husband hold them until I could get up there which was so nice. I held Tess first and Zach held Blair. Once your baby settles into you, everything just kind of disappears. It was a blur at first, but they gave us our space which we were appreciative of. Seeing them with tubes and wires and everything is hard but wouldn’t have wanted to have them anywhere else. When I left, I knew they’d be so well taken care of at Ball.”
After working on weight gain, feedings, regulating body temperatures and more, Tess and Blair were able to come home after a 39-day NICU stay. The homecoming meant they were finally able to meet big brother, Sylas, as visitor restrictions were in place when they were born.
“Sylas was so excited to meet them,” Brittany said. “The way that those girls look at him makes everything worth it.”
Although the twins shared virtually everything in the womb, they couldn’t be more different earthside. Tess is described as loud, outgoing, and constantly moving. Blair is the more quiet, reserved, and chill type. Despite the challenges they faced in the past, both girls are healthy, happy and meeting milestones. The latest? Walking!
Brittany advises parents with babies in the NICU—rare twins or otherwise—to have patience. “There is light at the end of the tunnel,” she says. “It’s so hard to see your baby in this situation, but you must trust the process and remember that this is temporary. You will get to bring [your baby] home.”