Meet The MoMo Moms – Charlotte Magazine

Dr. Michael Jones has treated a range of pregnancies, from textbook to high-risk, in his 37-year career in obstetrics and gynecology. But until 2022, he’d seen only one case of monoamniotic, or MoMo, twins. Then, within a span of three months at his Concord practice, he treated three.

MoMo twins occur when a single fertilized egg results in identical twins that share one placenta and amniotic sac. They account for just 1 in 8,000 twin pregnancies. One in 250 pregnancies will naturally result in twins, so the odds of having MoMo twins are 1 in more than 200,000—less than 0.1%.

“When the third one came, the ultrasound tech came back to my office and said, ‘You’re not gonna believe this, but here we go again,’” Jones says with a laugh. “It’s like a 1-in-2 million chance you’d have three at one time. This will never, ever happen again.”

All three mothers were patients at Atrium Health Women’s Care Copperfield OB/GYN. Throughout their pregnancies, Jones worked closely with neonatology specialist Dr. Kelecia Brown and a team of ancillary staff. Ada and Ivy were born in July 2022. Remi and Rayne came in August, followed by Raleigh and Sailor in September. All six girls are healthy, rambunctious toddlers. But what their mothers went through to bring them into the world isn’t just rare—it’s incredibly risky.

Sonographers can diagnose a twin pregnancy as early as eight weeks gestation. On the rare occasion an ultrasound identifies MoMo twins, a specialist like Brown is alerted so she can mobilize a care team of sonographers, nurses, neonatologists, and counselors to help manage the pregnancy.

“We get very excited as a unit,” she says. “These are very special pregnancies.” In her 20 years of practice, residency, and fellowship, she estimates she’s seen 100 cases of MoMo twins. “But three at the same time? That’s very unusual,” she says. “In medicine, you know, there’s a saying that things usually come in threes.”

MoMo pregnancies require near-constant monitoring, so mothers are admitted to the hospital between 24 and 26 weeks and remain there until they deliver. The most common complication is cord entanglement, which can happen as the twins move around in utero. If they twist their umbilical cords or wrap them around each other, it can cut off their oxygen supply. 

“Twin pregnancies in general have a higher risk of preeclampsia, or high blood pressure, and deep vein thrombosis,” Brown says. “(MoMo twins) have a much higher risk of birth defects, so we do a very detailed anatomy ultrasound and take a good look at their hearts because there’s a high risk for cardiac defects. These mothers will all deliver by cesarean section, so they all have to recover from that, and there’s always the risk of blood loss and infection.” 

For the babies, the biggest risk is prematurity. They’re all delivered six to eight weeks early because, as they begin to run out of space in the womb, the risk of their umbilical cords cutting off oxygen rises exponentially. The babies spend the first few weeks of their lives in the Neonatal Intensive Care Unit (NICU). To prepare, mothers get injections of antenatal betamethasone, a corticosteroid that helps speed up the babies’ lung development. They also require frequent ultrasounds and fetal heart rate (FHR) monitoring two or three times per day to note any decelerations. “If we see that too often, we wouldn’t wait until 32 weeks,” Brown says. “We’d plan the delivery sooner.”

The care team monitors the mothers’ emotional well-being, too. “To be plucked out of your daily routine and put in the hospital for weeks, and told you can’t work, you can’t see other children at home? That’s hard,” Brown says. “The biggest concern for mothers, especially, is being away from small children. Then there’s the unknown of having a preterm baby when you have no idea what that means or involves. It’s a lot to process.” 

Brown would know. She’s the mother of monochorionic diamniotic, or MoDi, twins, which share a placenta but have their own amniotic sacs. “I myself had a very difficult pregnancy,” she says. “I was hospitalized for 10 weeks. When I counsel these patients, I say, ‘This is tough, but you will get through this, and we’ll take great care of you.’ It’s a mental battle. I think I cried a million tears during my pregnancy. I always bring my personal story with me and share what a joy it is to be a twin mom. I can talk some ‘twin talk’ before I talk about medicine.” 

The toughest conversation, though, is when they discuss the 30% risk of stillbirth. “Hearing that is mentally very hard for couples to grasp,” she says. “But as days become weeks and they check off that time, they realize, OK, I’m doing this. Then they get to the hospital and those fears abate. We’re trying to mix the excitement with the scary.”  

Summer Morrison and her husband weren’t shocked to see two babies on her eight-week ultrasound—they had a funny feeling it would be twins—but they’d never heard the term “MoMo” before. “It’s so rare, even the providers didn’t really know much beyond the basics,” Morrison says. “They said I was high-risk and I’d deliver early, but no one really had a lot of information. They did their research and told us what they could. Then they told me to stay off Google.”

Morrison went home and started Googling. “The likelihood of making it to viability is only 50%,” she says. “But once you make it to 24 weeks, you have a 90% chance of having a successful delivery. So a lot of it was just holding our breath and taking it week by week.”

Summer, with big sister, Ella, and twins Ada and Ivy

At 26 weeks, she began her eight-week stay in the high-risk maternity unit at Atrium Health Cabarrus. Her husband stayed home to care for their toddler, Ella, and Morrison was able to continue her job as an operations associate for Atrium from her hospital bed. 

About four weeks after she checked in, she learned another MoMo mom had just been admitted. “I asked my nurse to give her a note,” she says. “I put my number in there for her to text me and gave her a few tidbits that helped my days go by a little faster.”

On the receiving end was Keaira Davis, who was 24 weeks pregnant. “That was really helpful, because, finally, somebody was going through the same thing I’m going through,” Davis says. “I texted her with so many questions.”

Keira with Rayne and Remi

Davis had to leave her 7-year-old daughter in her mother’s care and a full-time job managing freight and transportation to begin her nine-week stay. Her boyfriend, who worked nights, visited when he could. She spent most of her time attached to the fetal heart monitor because Twin A was so difficult to register. “She stayed in the corner of my belly the whole pregnancy,” Davis says. “She wouldn’t move, so it was always hard to find her heart rate. If I had to use the restroom, I had to call the nurses to come take all the stuff off. There were wires everywhere.” 

Morrison’s girls, Ada and Ivy, were safely delivered on July 20, 2022. “When you take them out and see what the cords look like, you’re amazed that they actually survived,” Jones says. “It looks like a hair braid with 20 or 30 twists.” They spent 16 days in the NICU, learning to breathe on their own and regulate their body temperatures, but they were otherwise healthy. 

A few days after their arrival, Davis had a knock on her door. Vakoya Miller had just been admitted and wanted to introduce herself. “When Vakoya came, Summer had just had her girls, so I was Vakoya’s go-to,” Davis says. “She’d come to my room, and we’d talk. I gave her all the answers I could.”

Miller was a flight attendant for United Airlines and worked until she was 20 weeks pregnant before going on medical leave. She and her boyfriend had planned to move to Chicago until they learned how high-risk her pregnancy was. Like each of these families, they feared the cost of an extended hospital stay, but complicated pregnancies like these are medically indicated, and insurance companies must cover them. Miller was admitted to the high-risk maternity unit at 25 weeks.

Vakoya with Saylor and Raleigh

By that point, Morrison was home with her girls, but she and Miller had already connected through a support group for MoMo moms on Facebook. “Summer left an activity bucket for us,” Miller says. “There were puzzles, coloring books, and crochet. You watch a lot of TV and read a lot of books. You FaceTime a lot of family. But those days get loooooong.”

They had nonstress tests (NSTs) three times a day, at 6 a.m., 2 p.m., and 10 p.m. “Sometimes it took 30 minutes, sometimes four hours,” Miller says. “The longer ones were pretty brutal. You’re lying in weird positions, just trying to get what they need. I just had to tell myself to believe in your body and trust in the process.”

Davis had the same conversation with herself every time they had trouble finding her baby’s heartbeat. Then, a few days before her scheduled C-section at 32 weeks, Twin A’s heart rate dropped, and doctors feared she’d stopped breathing. Davis had an emergency C-section and delivered her girls in the early morning hours of August 19. Two NICU teams, one for each baby, were on hand.

Remi came first, weighing 3 pounds, 1 ounce. “She didn’t cry for a long time,” Davis says. “They put oxygen on her and raced her to the NICU.” Rayne came next, at 3 pounds, 2 ounces—but to Davis’ relief, she was crying. Both girls spent the next six weeks in the NICU “feeding and growing.” 

On Sept. 28, at just over 32 weeks, Miller delivered Raleigh and Saylor. They, too, spent 29 days in the NICU learning to breathe, eat, and grow. Morrison visited Miller there, in the same place she’d sat with her own babies weeks earlier. “Since I was like the pioneer, it was nice to be able to pass along some knowledge and encouragement,” Morrison says. “Each of us having gone through the same thing, we have this little community. All three of us still message back and forth on Facebook with pictures of the girls or something that reminds us of that time together.”

Today, all six girls are walking, babbling, and using their mothers as human jungle gyms. Davis says Remi is showing some speech delays, and they recently met with a neurologist who believes oxygen deprivation may be the culprit. But otherwise, all six girls are developing fine. As they approach their second birthdays, it’s hard to believe they had such ominous starts in life. 

Morrison continues to work for Atrium, and Miller recently returned to her job as a flight attendant. Davis started a new job at an assisted living center. The three families plan to get together each summer and take a group picture of the girls every year until they graduate high school. 

Their lives are messy and chaotic, but they remain grateful to Jones, Brown, and the team of medical professionals who got them here. 

“They were great patients, and great moms before the babies were ever born,” Jones says. “It’s a much harder job for them than it is for us. Luckily, we ended up with six very healthy little girls.” 

What Are the Odds? 

Most of us are aware of two types of twins: identical and fraternal. But within the identical group, which accounts for about 1 in 3 sets of twins, there are actually four subsections of twins. 

Twins from left: DiDi, MoDi, MoMo, Conjoined

Dichorionic-diamniotic, or DiDi, twins: Dichorionic-diamniotic, or DiDi, twins are the most common, with two placentas and two amniotic sacs. This is the optimal twin pregnancy because the babies don’t compete for nutrition
or blood supply. 

Monochorionic-diamniotic, or MoDi, twins: Monochorionic-diamniotic, or MoDi, twins account for about 1 in 5 identical-twin pregnancies. The babies share the same placenta but grow in separate amniotic sacs. 

Monochorionic, or MoMo, twins: Monoamniotic, or MoMo, twins share one placenta and amniotic sac. They account for 1 in 8,000 identical-twin pregnancies.

Conjoined twins: Conjoined twins, who share a sac and placenta, are also connected to each other at some point on their bodies. These occur once in every 50,000 to 60,000 births. Approximately 70% of conjoined twins are female, and most are stillborn.