Monochorionic Twins and Reproductive Rights

In a society where the rights of the unborn are a hot topic, and often vehemently protected, we have to ask ourselves a question –

Why do some unborn babies have more of a right to survival than others?

This piece doesn’t intend to go into the right to choose, or abortion in general.  The point we’re trying to make is this:

Why are we failing monochorionic twins? And it seems, wilfully so?

From monochorionic diagnosis through delivery, this type of twin pregnancy is filled with acknowledged, well-documented risks.  The shared placenta alone is enough to classify the pregnancy as high-risk, and the list of possible complications that accompany the shared placenta only increase this risk. The most common threats to monochorionic twins – TTTS, TAPS, and IUGR – have been understood for years to require very specific screening so that these pregnancies have the best possible outcomes.

But health care providers still routinely deny patients access to specialized care, and in some cases treatment for the many complications that arise.  There also exists a percentage of women who are told that the type of twins they are carrying can’t be determined until after birth, resulting in being treated incorrectly, and an incompetent care plan.

This culture of denialism and ignorance when it comes to the complications associated with monochorionic twins, and the screening measures required to check for these complications, isn’t getting better; it’s growing.  Many providers exploit the excuse of a “lack of research,” or “unknown treatments and outcomes” for specific diagnoses –when it is simply untrue.

Research regarding monochorionic twin complications has evolved incredibly quickly over the past 25 years.  From the first TTTS laser surgery to the discovery and naming of TAPS, to the increased research and study into sIUGR – we understand better than ever how to diagnose and treat these diseases with high success rates.

So, why are doctors still failing monochorionic twins?

Why are obstetricians attempting to manage monochorionic pregnancies solo, without engaging the expertise of maternal-fetal medicine (MFM) specialists?

Why are MFM specialists refusing to routinely screen women for TAPS, which occurs spontaneously in 1 in 20 monochorionic pregnancies and can result in permanent injury and death?

Why do so many MFM specialists fail to obtain umbilical artery Doppler readings?

Why do MFM specialists tell women who make it to 24 weeks that TTTS is no longer a threat and they can discontinue bi-weekly ultrasounds?

Why are eligible women diagnosed with TAPS not being referred to tertiary centers for laser therapy, the only known causal treatment for TAPS?

Why do some of the world’s leading laser therapy surgeons refuse to screen for and treat TAPS? #TAPSisReal

Why are women pregnant with monochorionic twins told only that they’re “candidates for vaginal birth” with zero discussion of the unique risks vaginal birth poses to monochorionic twins?

Why are women considering vaginal birth of monochorionic twins not informed of their babies’ cord insertions and placental placement?

Why aren’t the risks of breech extraction – to mother and baby – discussed with women?

Our list goes on but the conclusions are here:

  • There is a lack of respect for monochorionic risks
  • There is an unwillingness to become aware of, and adopt updated research.
  • There is a lack of informed consent, trending towards misogyny provided to the women carrying these high-risk gestations

This all leads to a high incidence of injury and death to monochorionic twins.

It has been suggested that outdated clinical guidelines play a huge factor. Some say it is a God complex amongst providers.  Others rant against the patronizing patriarchy. 

The issue at hand is simple though. Whatever the reason, it needs to stop now. 

We can save babies. 

It’s as simple as updating clinical guidelines, educating providers, and holding them accountable when they fail to provide basic care. 

It’s about giving patients ALL of the information that is critical to their pregnancies and decision-making processes.  It’s about giving patients a correct and timely diagnosis, combined with information about all treatment options.

Implementing these basic changes can drastically lower monochorionic morbidity and mortality rates, while promoting fetal, reproductive and women’s rights.

And from our perspective – it’s about leading the change. 

Our goal is to educate everyone about the risks they face, the treatment they deserve, and the options available if things go wrong. 

This change starts with education on both sides.  If you are a parent in need advocacy for your monochorionic twins, or if you’re a professional who wants to find out how you can help your patients, get in touch.