As an emergency department nurse, Christina Nix regularly encounters complex medical challenges. But nothing prepared her for being the expectant mother of monochorionic diamniotic (Mo-Di) twins.
Mo-Di twins are genetically identical, originating from one egg that split into two embryos after fertilization. The babies share a placenta and blood supply, but each has their own amniotic sac, which surrounds the baby during pregnancy. Due to their shared blood supply, Mo-Di twins are at greater risk for certain complications and tend to be born prematurely.
Nix and her husband, Bryan, were thrilled to find out they would be having twins last year. When tests revealed the babies were Mo-Di twins, however, they began to worry.
“We went online and learned about all the bad things that can happen,” Nix said. “My obstetrics office couldn’t even handle this type of pregnancy because they didn’t have appropriate monitoring, so friends of mine recommended I go to Brigham and Women’s Hospital.”
Twelve weeks into the pregnancy, Christina had her first visit with Carolina Bibbo, MD, a maternal-fetal medicine specialist and director of the Brigham’s new Comprehensive Care Center for Multiples.
Launched in December, the Center for Multiples specializes in caring for pregnant women carrying two or more babies, including those that are at higher risk of complications, such as Mo-Di twin pregnancies. The clinic’s multidisciplinary team draws on their extensive experience in caring for multiples — providing expert medical care as well as compassionate psychosocial support and patient education to help families navigate the unique joys and challenges of welcoming twins, triplets or more.
The center is the only one of its kind in Massachusetts and one of just a few dedicated clinics in the country providing specialized care for mothers expecting multiples.
“Having multiples can be very exciting but overwhelming at the same time,” Bibbo said. “These pregnancies can be accompanied by higher risks of complications, but most moms and babies do extremely well. We’re really focused on making moms the centerpiece of care.”
Staff nurse Lucy Graves, MSN, RN, CBS, agreed the team is committed to making sure families feel supported.
“During a high-risk pregnancy, patients are often coming in every one to two weeks, so we really form a bond,” Graves said. “Because of our experience, and the fact that we care for twin and triplet pregnancies every day, I think we also bring a level of calm that reassures patients. You can’t guarantee everything will always go smoothly, but we can promise that we’ll be right there with them every step of the way.”
Providing a Range of Support
Over the ensuing months of Nix’s pregnancy, her care team kept a watchful eye on the babies’ growth while also offering the family reassurance. Early imaging had suggested one of the twins was smaller than expected and possibly missing out on nutrients due to the shared placenta.
At week 28, Nix was admitted to the Brigham for a projected 30 days of continuous monitoring. Four weeks later, new abnormalities were detected on her ultrasound. Nix was brought to Labor and Delivery, where her care team discovered she had developed preeclampsia, a condition characterized by high blood pressure that poses risks to both mothers and babies. Both babies were safely delivered via cesarean section, each weighing under 4 pounds, and transferred to the Neonatal Intensive Care Unit (NICU). Under the care of NICU staff, the twins got stronger, healthier and thrived — and headed home with their parents this January.
“Dr. Bibbo is like a saint,” Nix said. “From the first appointment there, she was very involved, talking with us every week and even taking time after hours to explain how we could move forward with things.”
Bibbo said she first became aware of the need for more personalized care for families with multiples when she was a clinical fellow in the Brigham’s former Twin Clinic, a predecessor to the Center for Multiples. Over time, she noticed patients continually express that they wished appointments covered more than just the mother’s and babies’ physical health.
“Mothers carrying multiple babies have many other psychosocial and emotional stressors that make their pregnancy experience completely different from those mothers carrying a singleton,” she said.
To address this, the center’s team includes a dedicated social worker, lactation specialist and childbirth educator. The team also collaborates with other providers in the Department of Maternal-Fetal Medicine to connect patients with nutritional support, genetic counseling, hematology services, research study opportunities and more.
In addition to hosting childbirth and breastfeeding classes specifically tailored for families of multiples, the team hosts a monthly Q&A session via Zoom with Bibbo and Graves for patients in their third trimester. The group sessions enable patients to talk to their care team — and each other — about what to expect during delivery and how to prepare their home for the babies’ arrival.
“Patients really enjoy having that safe space to talk and connect with one another,” Bibbo said. “We are blessed in Boston to have so many good hospitals with excellent specialists, but I think the need for psychosocial care, maternal needs and specialized education is often overlooked. They are all really important for helping these moms feel better prepared for the joy of the babies’ arrival and any challenges they might experience along the way.”