Twin heart beats bring hope
The birth of twins brings light after a long dark passage.
KASSON - Kjersten Hess went to her ultrasound appointment last April weighed down by feelings of loss and foreboding.
Only weeks before, Kjersten’s mom, Patrice Parsons, had died. And the sense of emptiness and pain from the loss remained fresh wounds for Kjersten.
To add to the incongruity, Kjersten’s ultrasound appointment, the first since finding out she was pregnant, was held on the same day of her mom's celebration of life ceremony. Kjersten had tried to reschedule the appointment, but the next available opening wasn’t until a month later. Kjersten didn’t want to wait that long.
Her mom’s death cast a pall over her pregnancy, and she ended up getting sick in the doctor’s office. Life felt unfair. If a beloved mother could die, so could an unborn child. Kjersten girded for bad news. In the back of her mind, she imagined being told by a doctor that there was no heartbeat.
Instead, there were two heartbeats.
Even before getting married, Kjersten, a pediatric nurse, had always seen herself as a mom and wife. That was a tribute to her mom, who had been such a superb role model as a mother.
In August 2019, her mom was diagnosed with amyotrophic lateral sclerosis, Lou Gehrig's disease.
When Kjersten and her husband, Jeriel, married in March 2018, they hadn’t been thinking of starting a family right away. But as her mom’s condition worsened, so did their urgency.
“I knew that even if I was pregnant, outside of a miracle, my mom would never meet my babies,” Hess said. “But I knew the next best thing was to share with her that I was pregnant.”
When Kjersten got pregnant, she and Jeriel shared the news right away.
As ALS was taking a larger and larger toll on her mom, Kjersten walked through the door of her mom’s Mankato home carrying a gift box containing a onesie with “Hello, Nana and Papa” stitched on it, as well as positive pregnancy tests, a pacifier and baby booties.
But from the moment Kjersten entered the house, Parsons was able to guess what the news was about.
“She was just filled with joy, happy tears and mourning tears,” Kjersten said. “She told me, ‘I know I will never meet your babies on this side of heaven.’”
Within days of breaking the news to her, Kjersten’s mom was in hospice. More than a week later, she died.
Babies at risk
Kjersten recalled how, on the day of the ultrasound appointment when her mood was so fearful and she was expecting such bad news, she learned that she was having twins.
As the doctor scanned her belly, Kjersten saw her husband’s eyes widen as he looked at the images on the screen.
The Mayo Clinic doctor performing the scanning went from one side of her belly to the other to confirm what they were seeing. Then she moved back to the center of her belly before saying matter-of-factly, ‘Oh, you guys are having twins.’”
But doctors began to see the potential for complications.
Doctors began to suspect Kjersten’s twins were mono-die twins. Short for monochorionic, diamniotic, it’s a condition where twins share a single placenta and blood supply but have separate amniotic sacs. The condition occurs at a rate of three to four in 1,000 births or about 4,500 cases a year.
In some mono-die cases, a rare, more serious complication can emerge called twin-to-twin transfusion syndrome (TTTS). A blood flow imbalance emerges in which one twin hogs the blood supply and nutrients to the other twin’s detriment.
One baby, in other words, becomes a donor twin, the other the recipient. Without intervention, the condition can be deadly to both babies.
As doctors monitored her condition, Kjersten’s pregnancy began to show clear symptoms of TTTS: One twin could be seen wallowing in an “Olympic-sized” amniotic sac, while the other was squished in a deflated balloon.
When Kjersten learned about her condition and the possible implications for her pregnancy, it terrified her.
An unequal tug of war
Most twin pregnancies develop from two fertilized eggs with each having its own placenta and amniotic sac.
But in the cases where they share the same placenta, “they have communications between their two umbilical cords,” said Dr. Mauro Schenone, a maternal-fetal medicine specialist at Mayo Clinic. “And in most cases, they are balanced.”
But when TTTS occurs, in which one baby is monopolizing the blood and the other is always donating it, the imbalance can be fatal.
“Before we had an ultrasound and before we had an intervention, fewer than 10 percent of these pregnancies survived,” Schenone said.
In Kjersten’s case, her care team recommended a surgical procedure called fetoscopic laser ablation. The surgery involves using a laser to cut the blood vessels down the middle of the placenta. The result, if successful, is that each fetus ends up with its own placenta, ending the unequal tug-of-war between them.
First pioneered in the late 1980s, the surgery is performed in only about 20 to 40 fetal centers in the U.S., Schenone said. Mayo’s fetal center, as a result, draws patients across the Midwest and the U.S. and as far away as Chile.
The procedure is not without risks. The invasive surgery can cause the mother to go into labor. Kjersten was only 19 weeks into her pregnancy, so preterm labor would have been fatal to her boys.
Kjersten said her case was complicated by the position of her placenta, creating a narrow window for Schenone to enter with a fetal scope. Other than some meds to calm her, Kjersten was awake during the surgery in case she had to reposition her body.
The first 24 hours after surgery are considered critical. During a post-surgical ultrasound, Kjersten could see from the screen that her boys had strong heartbeats. What’s more, the doctor could see that the fluids between them were beginning to equalize.
“Everything looks good,” Kjersten recalled Dr. Schenone saying to her.
Twin lights of hope, joy
Today, the three-month-old babies express the kind of complementary personalities that began taking shape in their mother’s womb.
Emmett, the recipient baby, is a bit more feisty than his twin. Kjersten calls him the “spicy baby.” Vinny, the donor baby, displays all the characteristics of a chill, content baby.
They enjoy each other’s presence.
“They’ll be fussing. And then, if you lay one next to the other, they seem to stop,” Kjersten said. “They like to be next to each other.”
Kjersten said the last year - a compressed period of darkness and light, fear and joy, heartache and birth — brought about a shift in perspective. She feels a keen sense of thankfulness for her faith and family, for the medical team that shepherded her through such a difficult time, and for her husband.
“I was so scared. Fear just flooded my life. And I hated that it did. But it was just the reality that I was living in,” Kjersten said. “And I was kind of living off of everybody’s faith.”
“We’ve seen a lot of dark days. We’ve experienced a lot of pain: Watching my mom deteriorate and losing her to ALS,” she said. “The boys have been our light, our beacon of hope. Even in the darkest of days, there’s always hoping for tomorrow. And that’s exactly what these boys have done.”