“Comparing Our Twin and Singleton Pregnancies” – with Phuong and Khanh Nguyen

On this episode of High Risk Birth Stories, Phuong and Khanh Nguyen join Dr. Fox to talk about the birth of their twins. Phuong and Khanh are from Vietnam, and talk about navigating the US healthcare system as well as Phuong’s three-week stay in the hospital before delivering her twins.

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Dr. Fox: Welcome to “High Risk Birth Stories” brought to you by the creators of the “Healthful Woman Podcast.” I’m your host, Dr. Nathan Fox. “High Risk Birth Stories” is a podcast designed to give you, the listener, a window into the life changing experiences of pregnancy, fertility and childbirth. All right, welcome to Phuong and to Khanh Nguyen. Thank you so much for coming on the podcast for volunteering to tell your story. And for coming in to do it in person. How you guys doing?

Phuong: Hi, we are good. And it’s a pleasure to be here.

Khanh: And not having any pregnancy this time.

Dr. Fox: Yeah, that’s right, Silverstein thought you were pregnant again. So you reached out to me through the podcast email saying that you wanted to tell your story, which is amazing. And we’re gonna be talking about both of your births. First, from May of 2017, your twins.

Phuong: Yes.

Dr. Fox: Jennifer and Jonathan. So they just turned four, right?

Phuong: Yeah.

Dr. Fox: Excellent. How are they doing? Are they like wreaking havoc on the world? Are they tearing up the joint?

Phuong: Yeah. They destroy their bedroom every time you put them to nap.

Khanh: Now they’re fighting more.

Dr. Fox: Amazing. And then also your one and a half year old Jaden. Take our listeners back to before you got pregnant with the twins. Right? So I guess this must’ve been in 2016 or so. Where were you guys living? What were you guys doing sort of work-wise? And, you know, where were you? What was your situation at that time?

Phuong: In 2016, we were working in New York City, both in finance, and we were married for a year, busy young professionals.

Dr. Fox: How did you meet each other?

Phuong: We met in New York City actually through our mutual friends.

Dr. Fox: Okay.

Khanh: [crosstalk 00:01:44] Roosevelt Island.

Dr. Fox: Okay.

Phuong: We are both from Vietnam. Khanh came here earlier than me. He had been there for over 10 years at that time, and I, about five, six years. We just couldn’t wait to start a family. But before I came to the U.S., I knew that I had PCOS. But at the time, I didn’t really worry a lot because the doctors in Vietnam said that, you’re young and I had ultrasound of the uterus, of my ovaries, and everything looked great, good egg reserve, and I had a couple of friends who also had PCOS, and they got pregnant without any problem. So I didn’t worry, just the doctors told me to take birth controls to regulate my periods. And when I want to get pregnant, I can talk to the doctors again and they can help me if I have any difficulties. So I didn’t think too much about that. I came here, got busy with work and navigating the healthcare system here because it’s very different and overwhelming. At the beginning, I didn’t know which doctor to go to see, how to look for doctors and the insurance was confusing. So I didn’t really see any doctor for the first three, four years.

Dr. Fox: What’s it like in Vietnam? How’s it different?

Phuong: In Vietnam it is very easy. Most of the time, if you have something, you go to the hospital, and you do everything there, and go to a different room and they do all the tests for you. And you just describe, oh, I have this problem, and they will tell you to go see this doctor, that doctor.

Khanh: Each department, different…

Dr. Fox: So all of like the offices are in or attached to the hospital. And is everything socialized there? Meaning it’s part of like just being a citizen there or do you have to pay every time you go? How does it work?

Phuong: Over there we pay but it’s not very expensive. I think it’s really affordable.

Dr. Fox: Got it.

Phuong: It’s just in our mind, any problem, just go to the hospital.

Dr. Fox: Right. Okay.

Phuong: And when I came here, I asked my friend, “Oh, I want to check this. Maybe I should go to the hospital,” and my friend said no.

Dr. Fox: Do not go to the hospital.

Phuong: You only go there if you have any emergency or you’re gonna die.

Dr. Fox: True. All right. So you took a while to find your doctors.

Phuong: Yeah.

Dr. Fox: And okay.

Phuong: After I started working, and then people at work started explaining health care, and insurance for me, so I started looking, okay, what kind of doctor, different kind of doctors and how to look for them. But at the beginning, I just generally Googled and found in-network doctors.

Dr. Fox: Right.

Phuong: So I just picked an OB-GYN. And when I saw her, I told her my concern about PCOS, which they say, no problem. We have effective ways to help you when you want to try to get pregnant, but for now, you are young. Don’t worry.

Dr. Fox: Right?

Phuong: It’s New York City. Just enjoy.

Dr. Fox: Okay. And so ultimately, did you have to do any treatments to get pregnant?

Phuong: Yeah, so after we got married, at the time, we were not young, we were over 30. So we couldn’t wait to start a family. So we started trying right away, but I didn’t get pregnant after trying for a year. So at that point, we decided that we would go to seek reproductive assistance, infertility treatment, and we went to Columbia Infertility Center, and they did a lot of tests, the results came back, it was okay. They said the only thing that I had were irregular periods. So it would be difficult to time, to try to…like the best time to try for pregnancy. But my egg reserve was good, the ovaries, the uterus, look normal. So after consultations with the doctor, we decided that we would do IUI.

Dr. Fox: Okay.

Phuong: And then I would take the Clomid to help with my ovulations. So everything went smoothly, no problem. Oh, and the test results from Khanh was good, so like no…

Khanh: Yeah, everything seems to be okay.

Dr. Fox: It was just because of the PCOS, your periods were not so regular.

Phuong: Yeah.

Dr. Fox: When they were talking to you about Clomid, did you know at the time that there was a risk of having twins because of it?

Phuong: Yes. They told me that but they say the statistic is very low.

Dr. Fox: Sure. How do you feel about that now?

Phuong: I mean, at the time, I didn’t really think. Oh okay, they say it is low, then I guess it’s not that easy to get twins. They have regulations when they do IUI, something that they will make sure not too many…

Dr. Fox: Do ultrasounds to make sure that you’re not going to have, you know, Octomom or something like that.

Phuong: Yeah.

Dr. Fox: Okay. Got it.

Phuong: But I really didn’t think…I just want something…oh, regulate my period, and then maybe that’s the solution. And then we did IUI, everything went smoothly. But after the waiting period, I take the test and nothing so a little disappointed.

Dr. Fox: Right.

Phuong: But that was fine. It was the first time you tried. We can do another time. Usually people don’t succeed right away.

Dr. Fox: Right.

Phuong: So we did another round of IUI but it also failed.

Khanh: I think it was the anxiety too.

Dr. Fox: Yeah.

Khanh: The anxiety and stress of timing. I mean, it was a factor.

Dr. Fox: Yeah. You tried for a year. And now you’re seeing a specialist. And they’re recommending, you know, treatments, and it’s still not working. When did it ultimately work? Clearly it did at some point.

Khanh: Yeah.

Phuong: Yes. So at that point, I was really disappointed and stressful because I was already…oh, I was 32. I was going to run out of eggs. I’m not young anymore. So we had another consultation with a doctor to see what was wrong. And they said, “Nothing seems wrong. But sometimes it just doesn’t work. We can try another time. But if after that it still fails, you should think about IVF because that’s the way to go.

Dr. Fox: Right?

Phuong: To me, it was a little terrifying, because I read about it. And I know that IVF is not easy. It’s very exhausting and it put a lot of tolls on mental health, on physical health.

Dr. Fox: Right.

Phuong: And also, it’s very expensive here. Yeah, the insurance doesn’t cover it. So we talked, Khanh and I talked, and we decided we would try another time. And if it doesn’t work, we will take a break. We will think about it after that.

Dr. Fox: Right.

Phuong: But this time, that time we decided we would not do the IUI, we will try naturally, just have the drugs to regulate my ovulation. Because Clomid didn’t seem to work, they switched to Letrozole.

Dr. Fox: Yeah, to Letrozole. Yeah.

Phuong: The thing they said it’s more effective, it stimulates more eggs, something like that.

Dr. Fox: For some people it’s more effective than using Clomid.

Phuong: And I had to take the shot in my belly at home.

Dr. Fox: Yeah, that was probably the HCG, I’m guessing, was it, that they give you?

Phuong: I don’t remember exactly.

Dr. Fox: It was just a one time shot?

Phuong: Yes.

Dr. Fox: At the time of ovulation?

Phuong: Yeah.

Dr. Fox: They call it the trigger shot, I think. Yeah. Which is a very strange name. But that’s to sort of make you ovulate. Okay.

Phuong: Yeah.

Dr. Fox: You found out you’re pregnant, obviously, I guess a couple weeks later, which must have been very exciting.

Phuong: I actually, I didn’t have much hope about that time when I tried. And then I didn’t even take the pregnancy test at the time. Maybe it fails again.

Khanh: We were kind of relaxed and we were just, like, yeah, it probably won’t happen.

Dr. Fox: Wow. So the time you think it’s not gonna happen, it did. And when did you…tell me about the day you found out it was twins.

Phuong: I suddenly got tired and sleepy, I said, “Can it be that I am pregnant?” And I took the test at that time, and it showed that I was pregnant. So I called them and they say, come in for the blood test so they can confirm and I came in and came back pregnant. So they told me to come in for the ultrasound. When they did the ultrasound to check my ovulation, they said, it showed two eggs ovulated. So I came in for the ultrasound, they said, “Oh, yeah, I hear the…I see they show me one little thing.” And then later on, “Oh, I see something else.”

Khanh: This was the end of October.

Dr. Fox: Okay.

Khanh: And we, I think before that we were planning to go to the Grand Canyon, Arizona.

Dr. Fox: Right.

Khanh: Never been there and I think we’re all ready to go.

Dr. Fox: Right.

Khanh: And that came and we decided that just probably postpone that.

Dr. Fox: Right. Obviously, you were a little surprised, twins.

Phuong: Yeah.

Dr. Fox: Not crazy surprised, if they saw two eggs coming out, but were you like surprised happy, like, “Oh my god, this is great. Now we’re gonna have two kids. Like we tried for all this time,” or was it surprised, like, scared, like, “Oh my god, this is not what I thought was gonna happen?”

Phuong: Actually, I…my mind was kind of blind when I heard twins, like twins. What does it mean?

Khanh: When we did the ultrasound at stage, you can’t always differentiate. Only the doctor can tell.

Dr. Fox: Got it.

Khanh: Oh, I was like, I don’t know. Just, yeah, the two spots that they pointed out, I just can’t make it out but…

Dr. Fox: Okay.

Phuong: But the interesting thing is, at the time, I was working in a hedge fund. And a lot of people in the firm had twins.

Dr. Fox: Okay.

Phuong: My direct boss had a girl and a boy twins who are actually delivered by Dr. Silverstein.

Dr. Fox: Is that how you found us?

Phuong: Yes, yeah, that’s how we found you, but it was also a story about how finally I got to…under your care. So she talked about twins occasionally. And I always, “Oh, nice, you have a girl and boy twins. I wish I would have twins.”

Dr. Fox: Right.

Phuong: So when the technician told me we have twins, it took me a few weeks for that to really sink in.

Dr. Fox: Right.

Phuong: To see what it really means. And I started doing research about raising twins and complications.

Khanh: And complications with twins.

Dr. Fox: Yeah.

Phuong: But really, I knew nothing about it until… And then at that time, Columbia told me that now we have to find an OB-GYN. We will not see you anymore. Our job is done.

Dr. Fox: Right.

Phuong: I went on Google and looked for doctors. I also didn’t know what doctors I should look for. I just looked for a general OB-GYN. And I found one at Weill Cornell, Lower East Side. He seems to get really good reviews. People thinks that he advocates for vaginal birth, natural birth, and he has midwives who support the pregnancies.

Dr. Fox: Right.

Phuong: I went to see him. He’s really nice. But the visit, he started laying out all the risk of then with twins pregnancy, you have to watch out for preterm labor, you can expect to have regular, normal pregnancy for the first 20 weeks, and after that I will watch you more carefully for any preterm labor, and you should be prepared for a C-section. So that kind of terrified me, because I know that he is…it’s factual. He just wanted me to be aware, but the way I heard it is like, okay, I’m gonna have a C-section. I don’t have my choice.

Dr. Fox: But you thought he was kind of pessimistic about it. It’s like, he wasn’t really…he was telling you, it’s not going to go the way you want it potentially.

Phuong: I did ask him, have you ever delivered twins vaginally? And he said, “Oh, we deliver a lot of people here. This is very general.”

Dr. Fox: Got it. I understand. Okay. And so you found us, and it was a little bit of a story to get in, right?

Phuong: Yes. So I went back, it was a pass, the first three months I remember. So I decided to tell my boss so he can be prepared that I’m pregnant with twins and he said, “Oh, great. And do you have a doctor?” Like, here I’m seeing this one, kind of okay. And then he said, “Oh, we see… I don’t know. But we saw the practice, this person, they’re really good.” And he starts to tell about his twins’ birth story, because it was a breech extraction of the second twin.

Dr. Fox: Oh, so your boss’s twins…

Phuong: Yeah.

Dr. Fox: Now it came to us, but we did a vaginal birth for them [inaudible 00:14:21] breech extraction and Silverstein did the delivery.

Phuong: Yes.

Dr. Fox: Okay.

Phuong: He was very impressed.

Khanh: She really wanted to have a natural birth.

Dr. Fox: Okay, got it.

Phuong: Because he’s from France. And in France, it seems like they do more natural birth but he’s still impressed.

Dr. Fox: Right.

Phuong: He said that Silverstein came in and pulled the second twins out while having the music on.

Dr. Fox: You know, in France, they do a lot of twin births, vaginally, and they publish on it. So like if you read, like in the medical studies on twin births, they have a lot of the biggest publications on it. It’s one of things they’re known for. If I’m right, I saw you guys for your first visit, is that right, in the practice, in the office at least? I think so.

Khanh: We just had so many visits. [crosstalk 00:15:09]

Dr. Fox: I think I saw you for the first visit. And what was it like, the pregnancy, in terms of maybe how you felt physically, like, how are you feeling? And also just sort of emotionally, was it scary? Or was it you felt confident that things were gonna go okay?

Phuong: The pregnancy actually was very smooth at the beginning. I didn’t have terrible morning sickness, almost nothing at all. And I was walking, walking after I was transferred to your practice. And everyone here said, “Oh, you don’t have to restrict anything. You can do light exercise.”

Dr. Fox: Right.

Phuong: We also started renovating our apartment at the time.

Khanh: We needed more room.

Phuong: So actually, we spent a lot of time going to Home Depot and tools and different designs, and I didn’t think much. I just went to all the regular visits and everything came back normal.

Dr. Fox: Until…

Phuong: Until, yeah, I think the 24th week.

Dr. Fox: Yeah, the third trimester got a little interesting for you.

Phuong: Yeah, the second, the 24 weeks, I came and the ultrasound showed that my cervix started to shorten. It was still closed but it was short.

Dr. Fox: Yeah. At the time, Dr. Rebarber, he… No, first, I was given the progesterone to insert at home.

Dr. Fox: Yeah.

Phuong: And was watched closely. And the next time, 26 weeks, I came back, and it was shorter, much shorter. It seems like the progesterone didn’t work that well, so Dr. Rebarber put the pessary disc to prevent it from opening.

Dr. Fox: Right.

Phuong: And then on 27 weeks, I came in, and it showed that I was 3 centimeters dilated, almost 3 centimeter.

Dr. Fox: Yeah.

Phuong: And I didn’t feel anything at all. And they say, “Oh, you have contraction, do you feel anything?” No, I didn’t feel anything. So they rushed me to the hospital.

Dr. Fox: Starting at 24 weeks… I mean, everything’s going great until 24 weeks. And we know that all twins are at risk for this but your cervix started getting short, which doesn’t necessarily mean anything bad, but it’s a risk and so we pay attention to it. And I’m pretty sure by then already, your daughter was already measuring a lot smaller than your son, that there was some concern.

Phuong: Yeah.

Dr. Fox: I mean, frequently twins are different weights. And you know, girls tend to be smaller than boys. But it was a little bit more than we were comfortable with. You’re on watch for two things.

Phuong: Yeah.

Dr. Fox: But that 27, 28 week visit, I mean, you’re open 3 centimeters. That’s a big deal at that point.

Phuong: Yeah.

Khanh: We were not prepared.

Dr. Fox: Yeah. So you got a nice hotel room on the Upper East Side at Mount Sinai Hospital. See, you got to go to the hospital. You were there for like three weeks, right?

Phuong: Yeah, quite some time.

Dr. Fox: Oh, my God.

Khanh: Almost a month.

Dr. Fox: Yeah.

Khanh: We could see the cherry blossom. I remember the moment that we got in it’s…the cherry blossom started outside.

Dr. Fox: Right. So yeah, you had a view of the park.

Phuong: Yeah.

Dr. Fox: That’s lovely. All right.

Khanh: Then when we left, it’s all gone.

Dr. Fox: Yeah. In general, we try to keep people out of the hospital, but it’s very tough. You know, you’re 27, 28 weeks, you have twins, you’re 3 centimeters dilated. It’s not like keeping you in the hospital is going to keep you pregnant. Right? There’s nothing magical about the hospital bed or the hospital room, we’re giving you a ton of medications or anything like that. It’s just, if you go into labor and deliver, we don’t want you in your apartment that’s being renovated. We want you in a hospital near pediatricians, near NICU.

Phuong: Yeah.

Dr. Fox: What were those three weeks like? Were you able to work? At least do a work from…you know, remotely? Back then, that’s pre COVID so working remote wasn’t the same as it is now where everyone does it. But you were able to do it?

Phuong: Yes. I was able to work remotely before that. I think it started in mid March. That year, I was told that I shouldn’t come into the office. I think when my cervix started to shorten…

Dr. Fox: Yeah.

Phuong: …I was told not to come into the office and work from home if possible. So I started working from home. And when I stayed in the hospital I…so I was working that whole time and that was actually helpful because I had something to do, and honestly I enjoyed my hospital stay.

Dr. Fox: Everyone was nice to you. The food wasn’t too bad. And you by that time, did you already know you had gestational diabetes? Or was it you learned it while you’re in the hospital?

Phuong: I learned it right before…maybe a week before…

Dr. Fox: Right before.

Phuong: …I got to the hospital and I was supposed to get all the thing at home to check, but I didn’t get it and then I got into the hospital so it was good. The nurses did it for me and they had the diet for me. And I didn’t have to worry about what to eat and cook.

Dr. Fox: Right.

Khanh: Which is helpful. I didn’t get to work from home. In the hospital was actually helpful because I wouldn’t have to worry about food or her being at home.

Dr. Fox: Yeah, I was gonna ask you, what’s it like for you that, you know, your wife’s in the hospital? It’s like a high risk situation. And so she’s not at home with you and you’re at work. I was gonna ask if that made you more afraid or maybe more secure that at least she’s being watched very closely when you’re not with her.

Khanh: I think the only thing…I mean, it feels more secure. Yeah, you know, I always saw the care that she got at the hospital was very good.

Dr. Fox: Right.

Khanh: The nurses were really attentive and good care, and I did not have to worry about food and care for her.

Dr. Fox: Right.

Khanh: It’s just the only thing, I have to make the trips, either in the morning to see her, because I don’t work from home and they don’t let you stay…they let you in the hospital but I obviously have to go to work in the morning. Either that additional trip after work or before work.

Dr. Fox: Were you working downtown?

Khanh: Yes. Around 23rd Street.

Dr. Fox: Yeah. So yeah, I mean, that’s quite…it’s a commute.

Khanh: Yeah. We were in Queens at the time still.

Dr. Fox: Ah, okay. Got it.

Khanh: Different direction.

Dr. Fox: Queens, 23rd Street, 98th Street.

Khanh: Yeah.

Dr. Fox: All right. And then ultimately, you got out of the hospital, I guess you’re, what, 30, 32 weeks, somewhere in that point?

Phuong: Yes.

Dr. Fox: Thirty three weeks.

Khanh: Yeah.

Phuong: I think I came in a little before I turned 28. So I was given magnesium.

Dr. Fox: Yeah.

Phuong: It made me feel terrible but only for a few hours.

Dr. Fox: Yeah, magnesium is not pleasant.

Phuong: Yeah, I listened to your podcast, and long before…in 2000 or something, in the past, they used to give you for long…very long times.

Dr. Fox: Weeks at a time, crazy, these poor women. They were so miserable. But at the time, they thought it was keeping them pregnant. See, it’s really interesting, because you’re in the hospital for three, four weeks. And you know, you didn’t advance in labor, you did not deliver the babies. And we really weren’t giving you much in terms of medication. But, 20 years ago, it would have been the same story but you would have been on the magnesium for like, three, four weeks. They would have said, “Oh, it’s because of the magnesium.” And this time you got it for a few hours just for a different reason. It just shows that, you know, a lot of the things that we think work are not the things that work. And it’s humbling for sure. So you’re back from the hospital, you’re home, you’re 33, 34 weeks, which is sort of a more secure time. And I don’t remember if you remember all these discussions, because we sort of discussed them internally, you know, your hope for a vaginal birth, we were still on board with it. But since Baby A, your daughter, the first one, was much, much smaller than your son, the second one…

Phuong: Yeah.

Dr. Fox: …one of the nuances of a twin vaginal birth is we’re very comfortable doing a breech extraction of the second twin but there’s a couple exceptions to that. And one of the exceptions is if Twin B is much bigger than Twin A, it might be safe, but we’re not sure that it’s safe so we don’t really do it. So I know that we added this…we were discussing that we’re happy to do it, vaginally but Twin B really has to come head first.

Phuong: Yeah.

Dr. Fox: We can’t do the feet first.

Phuong: Yeah.

Dr. Fox: Do you remember those, all those details of this? I’m just curious.

Phuong: Yeah, I remember that because their weight was different. It was not that straightforward.

Dr. Fox: Yeah.

Phuong: Yeah. And then they both have to be head down, which was the case luckily. I was watched very closely to see, like, how they grow, to see if the differences got bigger, even though I didn’t show any sign of labor. That’s why I was induced at 37 weeks and a half, because I think the…where differences start to get bigger and I wanted to…

Dr. Fox: I have 36 and a half in my notes. Baby A really wasn’t growing well.

Phuong: Yeah.

Dr. Fox: That’s what we call growth restricted. And so if it’s twins, that’s about right. But that’s great that you got to 36 plus weeks when you were 3 centimeters dilated and 10 weeks earlier.

Phuong: Yeah.

Dr. Fox: So the plan was to deliver them vaginally, we induce your labor. Melka was with you, right?

Phuong: Yes.

Dr. Fox: Okay, so she’s a resident expert at twin births. She did a podcast on it, on twin deliveries. So how did that go?

Phuong: The induction was smooth. I actually I slept during that time.

Dr. Fox: Right. For our listeners, epidural. That’s why she slept in labor. Okay, got it. All right.

Phuong: Yes. And then I woke up and a little while, Dr. Melka, “Come out now. Okay, you’re 10 centimeters. Open now and we can move you into the operating room.”

Dr. Fox: Yeah.

Khanh: So it’s a real operating room that was…I haven’t seen so many…the knives, operating knives, I’ve never seen so many…

Dr. Fox: Oh, because, yeah, there’s a table out for all the instruments we would need if you had a C-section. And at the time, you know, when doing a breech extraction of Twin B is not an option, then there’s really legitimately like a 5% to 10% chance that we would have to do a C-section for Twin B. Those are the numbers. If you look in like the U.S., for twins who deliver about 5% to 10%, the second is born by C-section, and that’s almost always because either it’s not an option to do Twin B as a breech or the doctor or midwife is uncomfortable with that. And so we knew that going in that since we were comfortable with it, it just wasn’t an option for you, that there was about a 5% to 10% chance you’d need a C-section, so they have to have everything ready. So you come in the operating room, they had the whole table out and you get to see all of our wonderful instruments we use to operate at people.

Khanh: The number of doctors and nurses and assistants.

Dr. Fox: Yes, it’s like 15 of us. Yes, it’s a whole team. We send in a basketball team to deliver the baby. So you pushed out your daughter.

Phuong: Yeah.

Dr. Fox: Baby A.

Phuong: Very fast, I think in 10 minutes she was out because she was small.

Dr. Fox: She was four and a half pounds, right? Little. All right.

Phuong: Little but she was healthy.

Dr. Fox: Good.

Phuong: And then after that, Dr. Melka tell me, “Okay, one more.”

Dr. Fox: Right. And ultimately she used forceps to deliver Twin B.

Khanh: Yes.

Dr. Fox: Yeah.

Phuong: Yes. I pushed for more than 30 minutes, he still didn’t come out.

Dr. Fox: Yeah.

Phuong: And I think I started tearing a lot and bleeding a lot, so Dr. Melka told me, “I’m gonna use a forcep if you’re okay with it, so we’ll pull him out because I don’t want you to lose more blood, you are tearing a lot.”

Khanh: And I still remember that 30 minutes, you know, the nurses counting for her to breathe in and push. You know, I was watching all these videos before birth. And they said the husband would try to help and so I was following that breathing and I felt really dizzy just following that.

Dr. Fox: You were probably hyperventilating or something. A breech extraction of Twin B is something you need skills to do but so is forceps of Twin B.

Phuong: Yeah.

Dr. Fox: And yeah, listen, you’re fortunate that Dr. Melka was there. She’s got all the skills. So, you had your vaginal birth. Did the twins go to the NICU at all?

Phuong: No, they were small but they were healthy. They didn’t have to stay in the NICU at all. And yeah, Dr. Melka really did a great job with the forceps. There’s no signs on my son.

Khanh: There are no marks.

Phuong: And in my building, there’s another family whose son was also delivered with forceps, they said, “Oh no, they had something on the head.”

Dr. Fox: So you all went home I guess two days later.

Phuong: Yes.

Dr. Fox: Wow.

Phuong: Even though I begged them, can I stay one more night?

Dr. Fox: Yeah. No, no, I’ve been here for a month before I have a room. We’ll go to our suite. So what’s it like when you took the twins home? So here you are finally, your home, your place is renovated. You’re done. And it’s the four of you. What was it like that first day when you got home?

Phuong: It was surreal. I mean, I think that we put all our energy into the pregnancy to make sure that it was good, they were delivered healthy. And we didn’t think much about after that.

Khanh: Yeah, we did not have time to prepare much.

Phuong: I joined a twins group and I attended some class on twins, taking care of twins and breastfeeding and everything but nothing really registered in my mind until after they went home. And my daughter was small and she had reflux.

Dr. Fox: Yeah.

Phuong: They were a little small. So yeah, at the beginning it was rough. My mom was there to help us. But still, it was not enough. And it was just the first few months was rough.

Khanh: Struggling with the breastfeeding.

Dr. Fox: Yeah, it’s hard. Was your mom living in Vietnam, and she flew over or was she living here?

Phuong: She flew over from Vietnam.

Dr. Fox: Got it, to be with you.

Phuong: Yeah.

Dr. Fox: Were these her first grandkids or no?

Phuong: Yes.

Dr. Fox: Wow. So that must have been… Yeah. How long did she stay with you?

Phuong: She stayed for three months. Because at first we thought, we just need grandma. That should be enough.

Dr. Fox: Yeah.

Phuong: And then. I didn’t even know. We need more. His parents came, both, yeah, both grandma and grandpa.

Khanh: Both my parents came here.

Dr. Fox: Yeah. Wow.

Khanh: Yeah. Because a couple of times I have to do… we learned feeding both at the same time in the car seats…

Dr. Fox: Yeah, you needed a whole team of people.

Khanh: That was survival skills with twins.

Dr. Fox: [crosstalk 00:28:54] Those little twins, it’s a lot of work.

Phuong: Yeah.

Dr. Fox: That’s amazing. And then you decided to do this again, to get pregnant another time? What was that like? How did you make that decision?

Phuong: We were happy with the twins. Luckily, I always feel incredibly lucky and grateful that I found your practice and under your good care, and they had a great outcome, and a boy and a girl twins, that’s like winning the lottery, and got the vaginal birth. And every time I tell anyone, oh, I delivered them vaginally, they couldn’t believe it. They just assume, “Oh twins, how was your C-section recovery?” I was not sure if I wanted one more. I kind of left it open and then we got busy with work, with the twins and didn’t think much about that. And then we got pregnant with the second spontaneously before…

Khanh: Especially with work for a while, it didn’t happen. And then actually we wanted again, I think it was around the time when we were both a little bit more relaxed.

Dr. Fox: Yeah. So interesting. So yeah, no treatments, no doctors, just, you know, the old fashioned way, you wake up and you’re pregnant. And that pregnancy, you’re a little bit older, and you’re deciding what to do with genetic testing. There was a lot of discussion about what to do. Ultimately you decided just to do the blood test, the ultrasound and not do an amniocentesis or CVS. Correct?

Phuong: Yes. So I was borderline 34, and by the time I’ll deliver him, I would be 35, so consider advanced age.

Dr. Fox: Right.

Phuong: So at the beginning, the first screening, I got more tests, and I got to know his gender very early on. And I was thinking if I should do amnio or CVS early to rule out any issues, but all the other screening tests, the genetic screening tests came back normal. And we also did our own genetic testing, screening, and we don’t carry any genes. So I decided not to do it I think in the first trimester.

Dr. Fox: Right. Yeah, around that time. And then I’m curious, what was it like the second pregnancy? Because the first one, you know, you’re being seen every week or two, you’re in the hospital for a month, you have the diabetes, you have the short cervix, you have the pessary. You have all this stuff going on talking about the birth and this and this. And the next time we’re basically probably like ignoring you the whole pregnancy because there’s nothing going on. Was it sort of a pleasure to have, like, such a straightforward pregnancy? Or did you kind of feel like you’re being, you know, like, what’s going on, no one’s paying attention to me?

Phuong: It was a pleasure that I, yeah, I thought, oh, finally, I can enjoy a normal pregnancy. But it was also different because we had the twins.

Dr. Fox: Right? You’re busier.

Phuong: Yeah, it was just taking care of them, we took all the time. I didn’t really think too much about my pregnancy. I didn’t even care much about what I ate or sleeping.

Dr. Fox: Right.

Khanh: Visually I didn’t realize how big the twin pregnancy was until the second pregnancy.

Dr. Fox: Right. You guys…you’re like half the size.

Khanh: Yeah, it’s so much smaller.

Dr. Fox: How much weight did you gain with the twins with the first pregnancy? Do you remember?

Phuong: I remember that I didn’t gain much in the hospital. They pushed me to eat more.

Dr. Fox: Okay.

Phuong: But I couldn’t.

Dr. Fox: Got it.

Phuong: I think I gained 10 pounds.

Dr. Fox: What about with the next pregnancy?

Phuong: I didn’t gain a lot, maybe 15 pounds.

Dr. Fox: Okay.

Phuong: I didn’t keep track actually.

Dr. Fox: For Jaden’s birth. It was very different from the twins, right? He ran out of there. Right?

Phuong: Yeah. But before that… So the first, the genetic testing for the first trimester was fine. But actually, I didn’t get to enjoy a normal pregnancy. I still have to see you guys a lot before, because he didn’t grow.

Dr. Fox: Right, at the end, he was…

Phuong: Yeah, the second trimester, he started to fall below the 10 percentile, 5 percentile was small. And they were concerned. They watched me closely for the fetal growth. I didn’t have gestational diabetes at that time, but they watched for the fetal growth. He just kept staying at 5 percentile. And they said maybe I should think about doing more genetic testing to see if there’s any potential reason that makes him small.

Dr. Fox: Right.

Phuong: So I met with the genetic counselor again. And I still remember it was very traumatic. I guess part of it because of the hormone, I was emotional and then I was late in the pregnancy.

Dr. Fox: Right.

Phuong: And she laid out different conditions, the different risks, that may happen. And really, the only way to know for sure is to do the amnio. But then I was at the end of the second trimester, and I thought, if there was something, what would I do?

Dr. Fox: Right.

Phuong: It would be too late to terminate it and then if we keep it and it ends up being a problem, we were not ready for a special needs child. It was really difficult. I just remember I couldn’t stop crying…

Dr. Fox: Oh, man, yes.

Phuong: …in that visit. But after that, I met with Dr. Stephanie Lam, and she kept reassuring me, “We don’t think that there’s any problem here,” because he was small.

Dr. Fox: Yeah.

Phuong: He’s considered constitutionally small. And even if he grows at that rate, by the time he was born in full term, he would be over 6 ounce, which is bigger than the twins.

Dr. Fox: Yeah, 6 pounds.

KhanhKhanh: Six pounds.

Phuong: Six pounds.

Dr. Fox: And listen, it’s very wise when we see a baby and it’s measuring small, yeah, the majority of them are just small. There’s nothing wrong with them. They’re just small, particularly, you know, if the parents aren’t as big. And you know, there’s a lot of things that go into that. And so we try not to, you know, scare the hell out of everybody if the baby’s measuring small. And so we wait and we see. And there are circumstances where it gets to be more concerning like if the percentile is dropping or other things are there. And we talk about possible genetic causes, but it’s still very unusual that that would be the cause, particularly if the baby looks normal. Right? You know, that sort of the anatomy looks normal, the face looks normal and all the screening tests are normal. And so we sort of talk about it as a possibility, but not not a likely possibility. And just, some people do an amnio for that reason specifically, most don’t. I guess it also depends when it’s even suspected. If it’s in the third trimester, most people don’t do an amnio. In the second trimester, a lot would. So it’s one of those things where it’s… And the messaging you get from different people, you know, some people say it in a way…even if everyone’s saying the same information, some people say it in a way that makes you think, oh, my god, there’s something horrible happening and you’re scared, and other people say it in a way that, oh everything seems to be okay. And a lot of that is just, you know, how people present information and, you know, how people hear information. It’s a balance, because you don’t want to blow it off and, like, not tell someone about it but you also don’t want to scare them every time you say something. So you know, that’s our job to try to be balanced with these things.

Phuong: And that’s what I feel really great about all the doctors here, even with the first pregnancy with the doctor at Weill Cornell’s, when he told me about all the risks, it’s all factual. I know they’re all true.

Dr. Fox: Right.

Phuong: He doesn’t mean anything. He just laid it out to me.

Khanh: Yeah, it’s the way we received the information, that it just…

Phuong: But I guess maybe the way, yeah, we received it, the way he laid it out, just made me feel scared, I just felt like, oh, I don’t have any other choice.

Dr. Fox: Right.

Phuong: I would just have to go with that. I don’t get to make a decision or try for something better outcome. And when I came here, it was very different. And the message was that, yes, everything is possible. We will watch you closely. And we will discuss as we go along. There’s a possibility you can try for vaginal birth. And then there’s a possibility for C-section. We have to see how it goes at the end. We cannot tell at the beginning. But the message is that you don’t have to worry, like we have the plan. We will watch you and try our best.

Dr. Fox: Yeah.

Phuong: And the same with the genetic, I think the genetic counselor, she also just wants me to be aware with all the risk, and the different options of the testing, but it wasn’t scary.

Dr. Fox: Yeah, some of it is just personality, right?

Phuong: Yeah.

Dr. Fox: Some people have the personality…and some of it is…or a lot of it, I think, is just experience, like if you take care of a lot of twins, you just sort of see how they usually play out. And you’re like, okay, like most of the time, everything’s fine. And so when you see someone’s twins, you’re not going to automatically jump to all the problems. You say, listen, most of the time, everything’s fine. We have to watch you for this and watch you for this. And here’s what we’re gonna do. And the messaging is generally very optimistic, because you have enough experience to back that up. Right? That you have reason to be optimistic. And another part of this is just a lot of people love listing all the bad things like, you know, you could have this, this, this, this and this.

Phuong: Yeah.

Dr. Fox: And it’s all true, but how often, right? You know, you could tell anyone who is pregnant say, “Well, yeah, you could bleed to death.” Like, oh my God, like that’s horrible. You know, what’s the chance that’s gonna happen? It’s, you know, like, 1 in 10,000, something like that. So, it’s just the list. You know, and that happens a lot when people use the Google, right? Because they’ll still find a condition, whatever it is, it could be pregnancy, which isn’t a condition, or let’s say they get diagnosed with some, you know, disease, some condition, then the list, here’s all the things that can happen to you. And you think that, you know, they’re all the same possibility, all the same chance. And it’s just not true. I mean, it’s like, you know, it’s like you’re doing any numbers in finance, what’s the likelihood, what’s the percent? And, it’s hard to do that. But it’s important because it puts it in context, and you know what to focus on and what not to focus on. And you really can do it in a way that’s less scary, I think.

Phuong: Yeah.

Dr. Fox: I want to hear about your experience for the next birth.

Phuong: Yes. So for this, Jaden was small. He was still five percentile. So at the beginning, I was allowed to be pregnant until 38 weeks.

Dr. Fox: We were gonna see you around 38 weeks. That was the plan.

Phuong: Yeah, that was the plan. But somehow, miraculously, at 37 weeks he grew past the 10 percentile.

Dr. Fox: Right. He picked up, the kid, he got the message.

Phuong: Yes. So I was allowed, now you can go into your 41 weeks, but probably I would deliver before that. So I just kept waiting and waiting, nothing happened.

Khanh: I asked to stay…to work from home at the time, because I was working in New Jersey.

Dr. Fox: Okay.

Khanh: And then so I asked my company, let me just stay at home waiting. So this time waiting at home.

Dr. Fox: And they did.

Khanh: Yeah.

Dr. Fox: It’s a good thing.

Khanh: Yeah.

Dr. Fox: Right.

Phuong: The waiting period. So I didn’t go into labor. I scheduled for C-section at 41 weeks.

Dr. Fox: And that’s an induction, not a C-section.

Phuong: Yeah, induction, one on one with…

Dr. Fox: Okay. For 41 weeks, you’re ready to be induced.

Phuong: Yes. And the night before the scheduled induction, in the middle of the night, I woke up, I felt something in the belly. I thought I needed to go to the bathroom because at that time, I still didn’t know what contraction feels like.

Dr. Fox: Right.

Phuong: I never felt it in the first pregnancy.

Dr. Fox: Right, because you had an epidural before your first contraction the last time.

Phuong: Yeah.

Dr. Fox: Okay.

Phuong: And then still came back. It didn’t go away. And it kept coming back and more and more often. And maybe I’m in labor.

Dr. Fox: Right.

Phuong: So I watched time a little bit. And then I told Khanh, we should call the doctor.

Khanh: We didn’t do that during the twins’ labor, the counting between the contractions.

Dr. Fox: Right, you didn’t have any of that. Okay.

Khanh: It was like, wow, this is very frequent. Is it right? We’ve never done it before.

Dr. Fox: Right.

Phuong: So we call in Dr. Melka, who also happened to be on call that night.

Dr. Fox: Your friend Dr. Melka, she’s back, ready for you? Okay.

Phuong: Yeah. And I was on the phone and because I guess I was in pain so she could tell that I was in active labor, and said come on in, come into the hospital. And we got an Uber to drive us. At first they refused to let me in because he thought that I was sick.

Khanh: He thought she was very ill. So the driver was like, “No, no, no, I’m not taking this person.”

Dr. Fox: Oh, the Uber wouldn’t let you ride.

Khanh: Yeah.

Dr. Fox: Oh, okay.

Khanh: And, they came and they wouldn’t let me take her into the car because I see…maybe it’s dark at 4:00 something, 3:30?

Phuong: 3:30, 3:00, yeah.

Khanh: So he did not see from afar but I had to explain that she’s in labor.

Dr. Fox: No, she’s not drunk. She’s not gonna throw up in your car. She’s just gonna deliver a baby in your car, much better. That’s not as messy.

Khanh: Yeah.

Phuong: So yeah, he let me in and drove me and I had to…really hard not push because I think he was very ready to go out. [inaudible 00:41:57] okay, I have to hold it until I get to the hospital. And we got to the hospital, they wheeled me into the room. It was not a normal delivery room. Maybe it was a waiting room.

Dr. Fox: I think it was like the triage room. Oh yeah, where they just…just to get checked to see if you’re in labor.

Phuong: Yeah, I was fully dilated. The nurses were doing…inputting my information into the system. And then I couldn’t wait and Dr. Melka said, “Okay, now you can push.” Just after two push he came out.

Dr. Fox: What time was he born?

Khanh: He was born 5:00…

Phuong: Ten to 5:00.

Khanh: Yeah, 5:00 in the morning.

Dr. Fox: What time did you get to the hospital? How many minutes before he was born?

Phuong: 4:45 we got to hospital.

Dr. Fox: Within 15 minutes of showing up.

Khanh: The nurses were connecting her to the monitor.

Dr. Fox: Yeah.

Khanh: And it didn’t even complete one cycle through the screen yet and it was done.

Dr. Fox: Right, because, yeah, that’s 20 minutes. Okay, so within there.

Khanh: I was still having the paperwork with me and I haven’t filled it yet.

Dr. Fox: Wow, amazing. So it’s the exact opposite. No epidural.

Phuong: No epidural.

Khanh: They were plugging in and they didn’t have time to even…to do that.

Dr. Fox: Amazing and he was healthy. Everything was fine. He came home with you again, I guess a day or two later, whatever it was.

Phuong: Yeah, he was healthy.

Khanh: Actually, that day we were left with him because the hospital was so busy. The nursery was full, so we were left with Jaden in the room with us.

Dr. Fox: Wow.

Khanh: So until like 1:00 from 5:00.

Dr. Fox: Wow. And this is all like right before COVID, right about a month before? It was on February, correct?

Phuong: Beginning of February, six weeks…

Khanh: It probably was around but we didn’t…wasn’t aware yet.

Dr. Fox: Got it. All right. And so it’s, you know, one and a half years since he’s born, it’s, you know, four plus years since your twins are born. You’re here, it’s 2021, you’ve got 3 kids at home. What did you learn from all your experiences from your birth stories?

Phuong: I think each one has its own difficulties, complications. And I am always grateful that I have found you guys, a great practice. I think that if I had gone to another doctor, probably I would have a different outcome.

Dr. Fox: So what would you guys say to a couple about to embark on their first pregnancy?

Phuong: Find the doctor that you feel comfortable with, that’s different. Do the research beforehand, find the practice that share the same value with you because that will help you along the way later on. And you can trust the doctors.

Khanh: I think it’s difficult for first time parents though still, first time, the anxiety with the first pregnancy.

Dr. Fox: Yeah.

Khanh: But just to learn about it, not over prepared…I think with too much information, you also get overwhelmed.

Dr. Fox: Do you think it would have been different for you if you had this podcast before you got pregnant, before you delivered?

Phuong: Yeah, I think if you had this podcast…because I do learn a lot listening to your podcast about different conditions, different things that other women go through with their pregnancy, with their birth stories. Some people go through very challenging situation and came out with great outcome or a lot of gratitude. That’s what I learned through our birth stories and pregnancy, that the gratitude, that there are doctors who really care about patients.

Dr. Fox: Phuong, Khanh, thank you so much for coming in. This is great. I love hearing your story. It’s so nice to see you guys. So different from the first time we met, you know, beginning of your first pregnancy and now here you are, you’re seasoned veterans at the pregnancy and parenting thing.

Phuong: Especially for us who came from another country, who came here and don’t really understand the system, then sometimes we have difficulty explaining what we are concerned about, or conditions, the possible conditions, so having the right doctors who watch out for possible situations and complications, really a big help.

Khanh: I think we are grateful for all the doctors here, Dr. Melka, especially of course.

Dr. Fox: Yeah.

Khanh: But, I mean, everyone here throughout the two pregnancies. Ultimately, I think, for all the parents or the first time parents, they just need to find some doctor that they click with. Just that you mentioned at the beginning, it’s the personality, too, that we…and you know, professionally, you know, of course, it’d good.

Dr. Fox: Right.

Khanh: But to find someone they feel comfortable working with, a click personally, that makes the whole process easier. And I think that’s what happened for us with your practice. I mean, others might find yours not suitable because of something else, but they can find some other doctor that they might click that is still good for them. Yeah.

Dr. Fox: I totally agree. Thank you for listening to “High Risk Birth Stories” brought to you by the creators of “The Healthful Woman” podcast. If you’re interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at hrbs@highriskbirthstories.com. If you like today’s podcast, please be sure to check out our helpful woman podcast as well, where I speak with leaders in the field to help you learn more about women’s health, pregnancy and wellness. Have a great day. The information discussed in “High Risk Birth Stories” is intended for information and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcasts are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on “High Risk Birth Stories” have given their permission for us to share their personal health information.