'My very own little and large babies'

By Jane Elliott
BBC News, health reporter

Jake was nearly four times the weight of Tom

A UK couple who had their own "little and large" twins contacted the BBC News website after hearing about a similar case in Australia. Here is their story.

As Georgie Armstrong cradles her identical twins she knows she is a very lucky woman.

From week 19 of her pregnancy, the smallest twin Tom looked unlikely to survive, and at week 20 she was advised to consider a selective termination because the outlook was so very poor for him.

But at 33 weeks, both the twins were born safely - although Jake's weight was nearly four times that of his brother born a minute later - 5lbs 2oz (2.32kg) to 1lb 6oz (0.62kg).

Unlike the Sydney 'little and large twins', who were recently in the news, the Armstrong boys did not have twin-to-twin transfusion, when the blood flows from one baby to the other.

Worry

Instead the boys, although identical, had a placenta each. This is the case for just 30% of identical twins.

Tom's placenta was insufficient for his needs and slowly starving him.

Jake and Tom are now five months and weigh a healthy 11lbs 15 oz (5.41kg) and 8lbs (3.63kg), but seeing the Sydney twins brought it all back for Georgie and husband Grant.

One was only a third the size of his brother. Lincoln Ryman weighed just 1lb 2oz (0.51kg) when he was born 11 weeks early along with his big brother, Byron, who weighed 3lb 6oz (1.53kg).

We really can't believe how amazingly well everything has turned out after the horrendous months of my pregnancy last year Georgie Armstrong In Pictures: Little and large twins The Sydney Twins

"It took me right back to the first few days after the birth of Jake and Tom," said Georgie.

"It made me feel extremely proud of my boys and how far we've come.

"It seems like such a long time ago now but five months is really not so long.

"We really can't believe how amazingly well everything has turned out after the horrendous months of my pregnancy last year.

"I feel so very proud of my boys."

Jake needed to spend nearly four weeks in the special care baby unit and his brother three months.

Thriving

Both are now thriving, and doctors are confident the babies have suffered no side affects.

"Although five months old, they are now doing all the things three month olds should be doing - that's their corrected age as they were almost two months early.

"One of the concerns with Tom was that his brain will have been affected by lack of oxygen in the womb, so his consultant is now on the lookout for any signs of this.

"But he is so far doing exactly as he should be, cooing and smiling and now trying to shove anything in his mouth, so things are looking positive on all fronts. "

Katrina Erskine, an obstetrician and gynaecologist at the Homerton Hospital, London, explained that twin pregnancies like Georgie's had increased complications.

"Most of the complications of pregnancy are increased in multiple pregnancy. In particular, there is a significant increased risk of pre-term delivery.

"There is also an increased risk of one or both of the twins not growing well, we therefore recommend growth scans every four weeks from approximately 26 weeks.

"Mothers are also more likely to have symptoms when carrying twins such as heartburn, swollen feet and ankles, anaemia and sickness.

"Identical twins have a possible added complication of one of the babies taking more from the placenta than the second, we therefore scan identical twins more regularly to check for early signs of this.

"Delivering twins can also be more complicated as they may lie in an unusual way - Caesarean delivery is therefore quite common with twins."

Diary

The Armstrongs, who live in Winchester, Hampshire, say they would not have managed to cope as well as they did with the traumatic pregnancy without the support of other mums Georgie contacted on the TAMBA (Twins and Multiple Birth Association) website.

Here Georgie, 35, who also has a two-year-old daughter Daisy, was able to share her struggle with others, making a unique record of the traumatic pregnancy.

At just 20 weeks Georgie started her online diary, telling readers that she desperately needs to hear similar stories, both happy and sad, to help them face the difficult decisions they may have to face about Tom's future.

Here are some of the entries she made:

21 weeks pregnant

"I've been doing lots of reading on the internet and yesterday came across something which seemed to describe exactly what is happening with twin two.

"It's simply what is called a starving foetus - all down to placental insufficiency.

"It's been happening from so early on, that from what I can gather there is no hope at all, and as we were warned by the hospital a couple of weeks, back, poor little Tom won't make it too much further.

"We have two weeks to decide whether to have a selective termination or just leave nature to take its course.

"If we don't want to go down the termination route they reckon that the risk to Jake if Tom dies is small even if they are sharing a placenta because Tom is so little and his share of the placenta is obviously so small so any changes in blood circulation will be minimal."

"I think we're both leaning towards just letting nature take its course.

"We have to do what's best for Jake now, but its difficult to know what that might be, and no one can give us any real idea.

"I'm also a little bit terrified of having a baby who survives birth and then lives with a debilitating condition because its so underdeveloped. And maybe watching a tiny baby die after birth - how stressful would that be.

"I just can't get my head around what's best for anyone anymore!! "I guess my 'ideal' would be to let nature take its course and for Tom to slip away in the next few weeks."

25 weeks pregnant

"I've got another scan in two weeks and then its decision time as he'll be almost a viable weight if he keeps growing at the same rate. If he does keep up this growth then we'll just let things be.

"In fact I think we'll just let things be anyway as I can't see myself actually being able to go through with a selective termination.

"Not sure which option would make me more of a coward... letting him be put him through the trauma of delivery and having God knows how many tubes stuck in him just to have him die hours or days later, or letting him go to sleep now without going through all of that, but never knowing if he might have made it or not.

"The second option also 'appeals' because I'm still terrified of coping with a child with severe special needs."

29 weeks pregnant

"We're meeting with the neonatal team at our next appointment in 10 days so we can talk about what sort of treatment we want for Tom.

"We've already decided that we don't want to try and keep him going at all costs and if he's not in a good way when he's born we'd much rather let him go there and then. On the other hand, if he comes out kicking and screaming we'll do what we can for him.

"They also encouraged us to think about we'd like to do with him if/when he dies. Its all rather surreal. "

Boys 15 days old

"Anyway.... the boys arrived safely by emergency Caesarean section at 33 weeks exactly, on the 7th December and all is going amazingly well at the moment.

"I started thinking this afternoon about how differently things could have turned out if we'd made different choices.

"Can't really explain how it makes me feel.

"We had such a wonderful evening at the hospital today. Mum and their sister Daisy came too, and mum had her first proper cuddle with both boys.

"When we got home I realised I actually feel happy.

"I really can't remember the last time I felt this way. Must be way more than a year ago (my dad died on 23 December last year).

"At the same time though I'm terrified the bubble is going to burst and we'll wake up to bad news from the hospital one day soon.

"Just have to keep taking one day at a time!"