Twin Pregnancy Explained: Risks, Birth & The Mental Load with Sinead’s OB Dr Drew Moffrey

 Twin pregnancy is often labelled “high risk”… but what does that actually look like when you’re the one living it?

In this episode of All At Once, we’re joined by Dr Drew Moffrey — Sinead’s obstetrician — to have a real, honest conversation about pregnancy with twins.

We unpack the different types of twins,, why there are so many extra scans and appointments, and what doctors are actually looking for along the way.

We also talk through birth — the options, the unknowns, and the scenarios you don’t always expect — as well as what happens after, including NICU and how families are supported in those early days.

But more than anything, this episode dives into the emotional side of it all — the mental load, the overwhelm, and how to advocate for yourself without feeling like you’re “too much.”

If you’re pregnant with twins, in the thick of it, or just trying to understand the world of multiples — this one’s for you.

Follow along for the raw, unfiltered reality of raising multiples.

• Instagram: @allatonce_co
• TikTok: @allatonce__
• YouTube: @allatonce_co

Thanks for being here.

If this resonated, sharing, rating or leaving a comment helps more parents of multiples find us.

Transcript

Sinead Finn (00:04)
Welcome to All at Once, a podcast dedicated to raising multiples because life with multiples deserves its own space.

Gabi (00:10)
Whether you're expecting twins, already deep in the chaos, or simply curious about life with multiples, you're in the right place.

Sinead Finn (00:16)
We're Sinead and Gabby, two moms with five kids between us, including two sets of twins.

Gabi (00:21)
sharing honest, unfiltered stories about the highs, the lows, and everything in between.

Sinead Finn (00:25)
This is a safe space to laugh, cry and feel understood all at

Gabi (00:30)
Let's jump in.

Gabi (00:31)
Hello and welcome back to All at Once. Before we jump into today's episode, we just wanted to say a huge thank you for all the love and support since our launch last week. Seeing you guys listen and share and connect with these conversations has honestly meant everything to us and is the reason why we started in the first place. So thank you and please keep listening and sharing. Today's episode is a big one. In this app, we're chatting with Dr. Drew Moffrey, Sinead's obstetrician and someone who's been a massive part of her twin pregnancy and birth journey.

In this episode, we dive into twin pregnancy and what it actually looks like. We talk through the different types of twins, why twin pregnancies are considered high risk, and what that actually looks like when you're living it, all the extra scans and appointments and decision making along the way. We also get into birth, what your options can look like, how those decisions are made, and some of the more unexpected scenarios that can come with twins. And then we also get into after birth too, including NICU and special care and how families can be prepared for time in either.

But a big part of this conversation is also around the mental health side and what parents of multiples are carrying, how to better advocate for yourself in your appointments and just trying to find that balance without feeling completely overwhelmed. So we hope you enjoy and thank you so much for being here. Bye.

Gabi (01:44)
Hi Drew, thanks so much for joining us on All at Once. I'm super excited to have you on today as Sinead's obstetrician to talk all things multiple pregnancy. I guess to start, for anyone that doesn't know you, are you able to share a little bit about yourself?

Drew Moffrey (01:56)
Yeah, thank you very much for having me on. It's great to see Sinead again. I'm a private obstetrician at Pindara. I have been there for about 14 years. So my biggest claim to fame is I'm the first doctor that was born at Pindara that is back there practicing. So I'm a true Gold Coast local. I look after everything women's health-wise at Pindara Hospital. I'm 100 % private, so I look after women for their gynecological problems, but more importantly,

They're obstetric and that's where my passion lies. look after low risk and high risk pregnancies. I look after lots of twins ⁓ and thankfully was privileged enough to help Sinead with her journey as well. I just sort of, yeah, am very passionate about obstetrics. It's just the privilege of being part of a woman's journey is what really, really makes me ⁓ just glow. love it. It's just lucky to be a part of that person's journey.

Sinead Finn (02:48)
That's amazing what made you specialize in obstetrics.

Drew Moffrey (02:51)
It's a funny story. All the way through med school, the whole way through med school, I was going to be an orthopaedic surgeon. I had this philosophy that the whole body revolved around the knee and I was going to be a knee surgeon to the stars and I did all my electives in orthopaedics and yeah, I was very much a sportsman when I was younger as well, so that all fit. And then as an intern, I did a rotation in orthopaedics and absolutely hated it.

And then straight after that, I saw my first baby being born. I had kind of avoided obstetrics as a medical student and hadn't actually seen a baby be born and saw it as an intern. It was just the most magical experience I've ever seen. And I just was hooked. And I just thought, how can this not be the best thing in the world to do for the rest of my life? Just, yeah, helping women birth their babies. And so I was really lucky. I just absolutely fell into it and loved it. And then my boss at the time as an intern, he

Gabi (03:18)
Hahaha

Sinead Finn (03:31)
Wow.

Gabi (03:35)
No.

Drew Moffrey (03:47)
He said to me, listen, if you really want to do this, I've got a job for you next year. ⁓ You can have 12 months of doing O &G and if you like it, then we can go from there. And so I was really lucky. I was in the right place at the right time. ⁓ And yeah, the rest is history. I ⁓ just, yeah. Exactly. And it's funny, speaking to old med school colleagues, they still sit there and shake their head that I converted from an orthopedic surgeon to an obstetrician, because they are very different personality poles.

Gabi (04:00)
It's like it was meant to be.

Drew Moffrey (04:14)
I'm sure everyone would know the jokes about orthopaedic surgeons and they do say that now I would never have fitted that mould but yeah.

Gabi (04:22)
Quite a change, but I'm sure Sinead's grateful that you made the change.

Sinead Finn (04:25)
Absolutely.

Did you ever have an interest in high risk or twin pregnancies or did you just kind of fall into that path? Just comes with the nature of the job, I guess.

Drew Moffrey (04:32)
⁓ I did

a lot of my training at Logan Hospital and I can't speak highly enough of Logan Hospital but ⁓ the nature of the clientele at Logan is a lot of high risk obstetrics. So I did to a certain extent fall into it there and so was dealing with a lot of high risk obstetrics through my training. Then I went and did a year at the Mata Mothers as a tertiary and once again kind of just fell into the high risk clinic and the multiples and

And so it kind of gravitated to me because obviously a lot of obstetrics is low risk women doing normal healthy things, which is fantastic. But ⁓ I think I just kind of really enjoyed that area of the challenge of dealing with high risk women and also making sure that they had these amazing safe births rather than being over medicalised and being put in a box of you.

sort of you've got a medical condition. I sort of really was passionate about trying to make sure they still had the same experience as these low risk births.

Gabi (05:28)
Yeah, absolutely. What about your first twin birth? Do you remember that? Or multiple? Might have been more than two.

Drew Moffrey (05:34)
Nah, well, funnily enough, I've never actually delivered triplets. It's one of my regrets in my career. Well, that's true, but ⁓ unfortunately, obviously, triplets are very, very high risk. And I looked after a few when I was a junior doctor at the Marta, but was never there for the birth. privately, I've had two people come through with triplets, and both of them I ended up having to transfer to the Marta.

Gabi (05:40)
Yep. There's still time.

Drew Moffrey (06:00)
before they birthed, unfortunately. So ⁓ who knows? Maybe it's still time yet. ⁓ But yeah, my first ever twin pregnancy, well, I dare say I probably had one earlier this, but my first one that I can remember ⁓ was at Logan. And you've got to remember I'm very old, so medical sort of training was very different back then. As a junior doctor, you're kind of literally the only person in hospital. And ⁓ I can remember a woman came in and,

with twins, very unexpected, and she had a vaginal birth, and I just thought it was the best thing ever. In hindsight, I was very lucky, because both babies were cephalic presentation. It was kind of just a very, very easy birth. was, I think it was her third birth, if I remember, or third and fourth birth, if I remember. So she just did an amazing job, and it was just amazing sort of thing. I can remember that. That was the first one that I really recollected. Like I said, I was a first year reg, so I was only

Couple of years out of med school, only person, only medical officer in the hospital at the time. ⁓ yeah, it was pretty special.

Gabi (07:02)
Amazing. Were you nervous at all? Like being the only one?

Sinead Finn (07:02)
Kind of, yeah, that would be really special.

Drew Moffrey (07:03)
Yeah. ⁓ absolutely petrified.

So yeah, like as a junior doctor, you've got to have a really good poker face. You've got to be sitting there and making sure you reassure the woman. But underneath you are absolutely petrified as to how things go. I've got a funnier story I'll share with you as well from and this is once again from Logan. Unfortunately, Logan is a slightly different socioeconomic area. And I had a woman came in and she'd had no care throughout her whole pregnancy at all.

Gabi (07:17)
you

Drew Moffrey (07:31)
And she came in and actually presented to emergency because she had had abdominal pain, but she was actually in labor. And so they brought her down to us and ⁓ she, yes, she did, but she just didn't go see a doctor. So yeah, she did know she was pregnant, but just kind of it was in denial, I suppose is probably the better way to put it. so presented to emergency with abdominal pain. They realized she was pregnant, transferred her to us and we delivered this beautiful baby boy.

Sinead Finn (07:38)
And she had no idea. She had no idea she was pregnant.

Okay.

Drew Moffrey (07:59)
actually was a decent size. And there was myself as a first year reg, so was still quite junior. And thankfully there was this amazing experienced midwife with us, but then also a very junior midwife. And so we've had this birth and we've got this pretty healthy baby. It was about three kilos, because we had no idea how many weeks she was or anything. And she arrived so quickly, we didn't even have time to put an ultrasound on her or anything, sort of thing. She was literally having this baby as she walked in the door.

And the junior midwife went to stick her with the oxytocin, which is the needle that we use to help the placenta go. And this experienced midwife just said, stop. And I kind looked at her and said, well, what are you doing? Sort of thing. And she's like started like touching this woman's belly and goes, there's another one here. And I'm like, what? And ⁓ so I examined her and yeah, there was a foot sitting there. And so then we ended up doing a breach extraction of a second twin. And I'll just never, never forget like so many levels. One is

Gabi (08:43)
my God.

my god.

Drew Moffrey (08:52)
Thank

God this experienced midwife was there, because ⁓ if they had have given that hormone, that baby would have been in real, real trouble, the second baby. But also, like, yeah, this woman's gone from no babies or not even, like I said, in denial. I think she knew she was pregnant, but in denial of being pregnant to then having two babies all of a sudden. And yeah, that was one of the most wildest nights I ever had.

Gabi (08:57)
Mm.

Sinead Finn (09:05)
Yeah.

Gabi (09:12)
Wow.

Sinead Finn (09:14)
I can imagine that sounds pretty wild. I'm...oh my gosh.

Gabi (09:14)
Pet!

feel like

it's almost the best way to go through a multiple pregnancy though is just not knowing there's two of them. There's nothing to worry about.

Drew Moffrey (09:22)
Just in denial, yeah.

Sinead Finn (09:25)
Gosh. So you've supported thousands of parents through pregnancy. When you're caring for a twin pregnancy, what feels fundamentally different to say a singleton pregnancy?

Gabi (09:25)
You

Drew Moffrey (09:35)
⁓ I pride myself on being very personal and having really good relationships with all my patients. But a twin pregnancy is a little bit different because we see each other a lot more. ⁓ think you do get a better connection with a twin pregnancy mom because we're seeing each other so much more. Because they are naturally inherently high risk. And so ⁓ I'm trying to reassure them more and trying to make them feel ⁓

Sinead Finn (09:41)
Mm-hmm.

Drew Moffrey (10:03)
secure and positive about their pregnancy. So I think there is a lot better connection there between myself and twin mums. I think twin mums also are more open to wanting a better connection with me because of the fact that I think they really want that reassurance and support. Whereas some mums, like I've delivered three, four, five babies for some of my mums and they kind of see me just as a formality because they've had these births and they are all comfortable and they know me well enough to know, yeah, no, don't worry about it sort of thing. Whereas I think

mums really do want that reassurance that everything's going to be okay. ⁓

Sinead Finn (10:38)
Yeah, I can only speak

for myself, but like when I saw you, that was such a big thing for me to find and to OB I was very anxious and I really needed that reassurance. And that was something that I really think you were so great about. yeah, seeing you every week gave me so much relief in my journey. Yeah.

Drew Moffrey (10:54)
Yeah, and it's hard. It's really hard

to sort of be sitting here going, I've done every test and every test is normal, but are these two babies still okay? And it's hard just to say one baby's okay, but when you've got two, it's kind of twice as anxiety provoking, I suppose, if you want to put it that way. But yeah, I think a lot of moms also need reassurance, well, moms have multiples, that everything's going to be okay afterwards as well. Like the amount of moms that just sit there and go, how am I going to do two babies?

Sinead Finn (11:06)
Yeah.

Yeah.

Drew Moffrey (11:23)
And especially like yourself, first time mums, think really struggle with that. Like they have friends that struggle with one baby, how am going to struggle with two sort of things? So I think that that reassurance is really important in providing all the supports and making sure that they're confident enough in themselves that everything's going to be okay.

Sinead Finn (11:41)
1000 % yeah.

Gabi (11:42)
yeah, as Sinead touched on, she was quite anxious and I was also anxious too. And like you said, I think a lot of parents of multiples are, because they're a common theme of concerns that you're seeing parents of multiples come to you with.

Drew Moffrey (11:54)
⁓ I suppose one of the big things obviously is around breastfeeding. A lot of mums are worried about breastfeeding and how and why and stuff like that. And I suppose the other one is just, they gonna be okay and what happens if one's not? A lot of mums do, especially early on, ask me a lot of questions about what happens if one is not okay and if one has miscarriage or even if later if something happens to one of them. think, ⁓ like obviously, pregnancy loss at any stage is horrible.

Sinead Finn (11:59)
⁓

Drew Moffrey (12:22)
But I think a lot of mums worry what happens if I lose one or do I lose both and things like that. So I do have lot of conversations with my mums, especially early on around those sorts of things and about the reassurance. But then, yeah, the next thing after that would be breastfeeding. A lot of mums really sort of, ⁓ from very early on, are very concerned about how they're gonna feed their babies.

Sinead Finn (12:35)
Yeah.

And what's typically your answer when it comes to breastfeeding?


Drew Moffrey (12:47)
Look, I kind of say to them that it's really up to them. Thankfully in Australia, we're so blessed that there's great formula, but there's also so many other things that we can do. So I kind of just say to people, wait and see. I would say a fair majority of my mums are still breastfeeding at six weeks or expressing and giving breast milk to their twins. But I also kind of just reassure them that Fed is best and whatever works, because it's a...

Sinead Finn (13:11)
Yeah.

Drew Moffrey (13:12)
are significant sort of impact twins, whether, no matter how you do it, it's massive. And even if you've got to take the time to express and feed and trip, obviously most twins are a little bit smaller as well. So therefore sometimes they might need top-ups, even if you're breastfeeding really well, they might need extra top-ups because they have to, so it's just, the feeding, especially that first six weeks is a lot for multiple mums. And so I sort of just try and say this, there's so many supports here.

Sinead Finn (13:24)
You

Drew Moffrey (13:40)
and we can work out whatever you want to do. There's so many ways that we can try and navigate that as well.

Gabi (13:44)
I think that Fed is best message is so important, particularly around multiples, because I know sometimes that's not the message and you feel this extra pressure. And when you have multiples, like you said, it's actually, it's like a whole other job to like feed multiples and it does look like expressing or whatever. And I felt like I was like then having no time with these twins because I'm actually just, feeding them and then I'm pumping and so that reassurance I'm sure is incredible for.

the mums that say you because yeah, Fed is best

Drew Moffrey (14:10)
Yeah.

Exactly what you just said. I've had some multiple mums come to me at that six week appointment and say, I feel like I have not had one moment of enjoyable time with these twins or triplets but they feel that the dad has gets all the gravy because he gets the tummy time fun. And all I'm doing is feeding for the last six weeks. that's like around their mental health. We have, I have a lot of discussion with them at that six week market and

Sinead Finn (14:25)
Yeah.

Yes.

Drew Moffrey (14:35)
And yeah, so it's a common theme that all they've done is feed and nothing else for the last six weeks sort of thing.

Sinead Finn (14:42)
Absolutely. I think I did triple feeding up until four months. And I felt exactly the way as you described I had to start weaning them around four months purely because of mental health reasons, because it does take such a toll. And the amount of time that is spent around feeding was crazy.

As soon as I started moving on to formula, I just felt my mental health was so much better and I was able to spend so much more time with the twins.

Gabi (15:07)
And that's just as important, I think.

Drew Moffrey (15:07)
Yeah. Absolutely. And there's so much pressure on singleton mums to breastfeed 100%. But there's just as much pressure on multiple mums. And it's insane because like, yes, your body can do it, but you've also got to pay a price to be able to do that. so sometimes that price isn't worth it.


Drew Moffrey (15:26)
And look, like I said, we're so lucky here. We've got such great formula. If we lived in Africa, absolutely, you can't get fresh water, can't get formula, breastfeed 100%. But we're so lucky here. Like, ⁓ there's so much research around breastfeeding now saying all the benefits, but there's also so much significant benefit in that first six weeks of breastfeeding. But then if you transfer after that, all those, a lot of those benefits, especially gut, biome, health, and all that sort of stuff have been embedded in that first six weeks as well. And that goes whether you're

Sinead Finn (15:30)
Yeah.

Drew Moffrey (15:54)
topping up with formula, topping up with express milk. All those benefits are still there if you sort of breastfeed just for first six weeks.

Sinead Finn (16:00)
so many parents hear terms like identical, fraternal, modi, di-di. Can you explain the different types of twins and why it matters medically?

Drew Moffrey (16:11)
Yeah, I kind of say there's four types of twins. there's DCDA, which means two sacs two placentas, but there's two types of them. So the two types of DCDA twins are ones that have come from two eggs that have been fertilized. So essentially they're just two pregnancies sitting in the same room. There's the DCDA twins that are actually from the same egg though. So they're obviously, we know them as identical twins. Then the next level is what we call

Sinead Finn (16:15)
Mm-hmm.

Okay.

Mm-hmm.

Drew Moffrey (16:37)
MCDA, so one placenta, two sacs. And then the third, the fourth type I should say is MCMA. So one placenta and one sac. And so those, the DCDA, MCMA, MCDA ones that are identical, it depends on when the egg actually splits. And so there's a rough rule of four. If it splits in the first four days, they'll be DCDA. So two sacs and two placentas between days four and eight.

they're one placenta and two sacs, and then between eight and 12, one placenta, one sac. And then unfortunately, if the egg splits after 12, that's when we have conjoined twins. And so it's kind of, yeah, that rule of four is sort of gives us how we go. So the two placentas and two sacs, they're by far the safest, and thankfully they're also probably about 70 % of twins as well. So.

there's none of the big worries that we have in terms of the complications that twins can kind of get on top of each other. And so they're great. The next one, probably about 20 % is the MCDA, so one placenta, two sacs. That's where we start getting some complications where we can have, I'm sure people have heard of one twin stealing food off the other twin and there's a few other things like that. So it's called twin-twin transfusion syndrome. And then the third one,

Thankfully, it's quite rare, MCMA, where one's sac one placenta, ⁓ there can be a lot of issues with that, especially, I know it sounds funny, but just simply logistics of the twins getting tangled with each other. And so they are quite high risk. ⁓ And so those ones we delivered quite early.

Sinead Finn (18:10)
That's so interesting. I've never had it broken down like that before. Do you find that parents come in with, like when you tell them the type of twins they're having, do they come in with any misconceptions?

Drew Moffrey (18:20)
I always get asked about if they're identical or not. obviously we can tell if they're one placenta, but most of the time we can't tell until the birth. And I always joke, like I've actually even had mom say to me, I'm like, one's a boy, one's a girl. And then they've said, are they identical? I'm like, not quite how it works, but and I'm sure, yeah. Oh, exactly. It's yeah.

Sinead Finn (18:39)
Yeah!

Gabi (18:39)
It's a common question I'm still getting.

Sinead Finn (18:42)
Yes, I get it all the time still.

Drew Moffrey (18:46)
it's my favorite joke. just sort of go, just listen to what you've just asked. ⁓ yeah, so lot of, thankfully, like I said, the majority of mums are DCDA, which I sort of really reassure them that that's the safest type and it's the easiest for them. And essentially, yeah, we kind of can treat them like it's just two pregnancies traveling in the same uterus, thankfully.

Sinead Finn (18:51)
Yeah.

Gabi (19:07)
Obviously it depends on the type of twins, but any guess twin pregnancy is considered higher risk. In practice, what does that actually mean? Like what are the risks?

Drew Moffrey (19:15)
Yeah.

So yeah, it still definitely is high risk. And when we talk about the type, it just kind of means higher, higher risk, unfortunately. Having said that, some of my mums will go through their whole pregnancy absolutely breeze through it without any problems and have amazing safe pregnancies. we just need to keep a very close eye on them. So the two types of risk factors come into one is for mum and one is for the babies

We know twin mums are much more likely to have diabetes, we're much more likely to have ⁓ high blood pressure issues later in pregnancy. ⁓ Unfortunately, it's also more likely to have a miscarriage. Unfortunately, there's a thing called vanishing twins syndrome. I'm not sure if you've come across that. Unfortunately, if there's twins there early and then a miscarriage of one of the twins, ⁓ thankfully the second pregnancy can keep going, but that can happen sometimes. So there's those risks to mums.

⁓ And then there's the risks to the pregnancy. So preterm birth ⁓ is a big risk. that's, it's a difficult one because sometimes it's preterm birth because the mom goes into labor, but often it's preterm birth atrogenically because we're delivering them early because of risks. ⁓ And then the other big, really big risk with twins is just size. We know size of twins are always a little bit smaller. And then depending on the other factors of such as

the twin-twin transfusion syndrome we spoke about and a few other little things that can happen. That's where we can get into trouble from that point of view. ⁓ growth is probably the biggest thing ⁓ with regards to twins. And that's why we see each other so frequently is because we need to closely monitor the growth, but then also monitor blood pressure regularly and all those other things.

Gabi (20:56)
Can I ask, I had the two sacs two placentas, but then the risk was still there for one of my twins. was ⁓ smaller, but then her brother's obviously not eating the food. So why is that the, how does that happen? If that makes sense.

Drew Moffrey (21:12)
It's

literally just because obviously uterus is designed for one baby. And so it's just because of the fact that when two placentas have ⁓ embedded in the uterus, the development of your daughter's placenta wasn't as quite as good as the son's, unfortunately. And then the blood flow around the uterus and the blood flow to the baby, just depending on where those placentas are and how they've developed. That's why with DCDA twins, you can still have growth issues from that point of view.

The growth issues with the MCDA and MCMA twins are usually a bit more ⁓ pathology involved with, like you said, one twin stealing the food off the other and things like that. often with DCDA twins, it's just that the 1 % is just not working quite as well as it should just because, yeah, it just hasn't developed as well.

Gabi (21:59)
I was just going to ask like, there's those sort of risks and then is there, what are the rarer but more serious risks, I guess, that you might encounter and become higher risk?

Sinead Finn (21:58)
go Gabby, you go.

Drew Moffrey (22:10)
So twin-twin transfusion syndrome is really the big high risk thing with MCDA and MCMA twins. That happens in about 10 % of MCDA twins. So I'm getting my tongue twisted around that. that is where, as the placenta has developed, the blood vessels have essentially favored one of the twins over the other. And so

the blood flow from that placenta goes more to one. It can be fatal to both twins. It can be fatal to one. Ironically, when babies are born with severe twin-twins transfusion, it actually is the smaller baby that does better, Generally, the bigger baby is, yeah, there's a lot of issues with them being fluid overloaded and heart failure and things like that. So a lot of people naturally think the bigger baby is the better one, but it's generally the smaller baby that actually does better. Thankfully now, it's,

It's one of the most amazing things I've ever seen. I've never done one because of, you can imagine with what I'm about to explain, the technicality, but they can actually do ⁓ intrauterine laser of that placenta. So it's the most phenomenal procedure where they can go in and they laser blood vessels in the uterus. And so therefore they divert the blood and equal the blood flow up between the babies. And that's one of the reasons why with MCDA twins you'd be having scans at least every two weeks.

early on when you pick up one twin not having enough fluid around them and having an empty bladder and growth being off and the other twin would have lots of fluid and then the growth things happen and stuff like that. ⁓ there's also along with that ⁓ twin-twin transfusion syndrome, there's another thing that's similar to it where the bigger baby actually has really, really thick blood and the smaller baby has really, really thin blood. Essentially they become, they're stealing the red blood cells, not only just all the blood flow through the placenta, but then they actually

steal the red blood cells as well. And ⁓ that's obviously very significant as well. And that's once again, that's even rarer than twin-twin transfusion syndrome. those are the sort of the two really significant ones with MCMA cord entrapment is the one that we really worry about. And like I mentioned before, it's literally just the twins moving and rotating normally, but unfortunately, because they're in one sack that those cords can get entangled and unfortunately not.

true knots can form and the cord tightens and unfortunately, yeah, bad things happen after that. they're kind of the most significant risks, yeah, moving for those sorts of things.

Sinead Finn (24:31)
That's so scary.

So you've kind of touched on this, but why do twin pregnancies have so many scans and appointments? What are you typically looking for each time a twin mother visits you?

Drew Moffrey (24:47)
Yeah. So DCDA twins should be having scans every four weeks from definitely from 20 weeks, but usually from 16 weeks. And the main thing for that is just purely the growth factor. we look at growth, but we also look at, like I mentioned, we look at the other things, the blood flow through the placenta to make sure that's going okay. And there's different stages of things we can look for that blood flow. So looking through the placenta is the first one. Then we look at the blood flow through their brain being the second one. And then I know it sounds funny, but then the blood flow through the liver is even more important. That's the third stage.

And so we look at those three things. We also look at the fluid round baby, ⁓ make sure there's fluid in their bladder, and then just their general growth as well. And we actually compare the two, because comparing the two, shouldn't have a discordant growth of more than about 15%. So if they're both small, then that's fine. If they're both big, that's fine. But if there's actually one growing significantly different to the other, that's where we'd be much more worried about how things going.

Growth velocity is something we really want to know as well. So if we had babies and they're on the fifth percentile, the next time we scan them, fifth percentile, next time we scan them, fifth percentile, even though they're really small babies, they're growing to their potential and they're growing okay. Whereas if we had a baby where it was 80th percentile and the 60th percentile and the 40th percentile, even though that baby's much bigger than the other one, I'm much more worried about that because they're dropping off. So that growth velocity is something that's really important. We want to see babies kind of chugging along that same percentile as what they should be.

Then obviously blood pressure is a really big thing. So we really want to be make sure that people aren't developing preeclampsia So that's one of the other reasons why we're seeing people just checking their blood pressure And then also just monitoring others ⁓

Sinead Finn (26:15)
Yeah.

Sorry, Drew can I just jump in with preeclampsia? Is the risk a

lot higher for a twin pregnancy versus singleton pregnancy? And why, why is that?

Drew Moffrey (26:27)
Absolutely, yeah, it is a lot higher. ⁓

Pre-eclampsia has all got to do with the placental uterine interface. And so obviously, ⁓ you've got such a significant difference in that placental uterine interface. ⁓ And so that's why it's so much more higher from a single to a twin. It's still definitely not guaranteed, but it is definitely higher.

Sinead Finn (26:39)
Okay.

Drew Moffrey (26:47)
It's just one of those things with preeclampsia as well. Unfortunately, there's no set condition. we kind of, there's certain conditions in obstetrics where I can say, this is what's going to happen around this stage. This is what's going to happen with preeclampsia can develop at any stage. It can be really mild and sort of rumble along for weeks. It can be really severe and 24 hours later, we have to deliver you. Everyone's really different. And that's the problem as well with preeclampsia. I've seen women in my room before in the morning and they've got normal blood pressure. Everything's great. And they ring me at six o'clock that afternoon and

they're in ICU by 10 o'clock that night. Like it's just, it can come on in the blink of an eye or it can be really mild and rumble along for weeks. It's one of those really tricky things that it's so very, very unpredictable pre-eclampsia.

Sinead Finn (27:26)
What are the typical signs?

Drew Moffrey (27:28)
So there's three big symptoms of preeclampsia. It's a frontal headache, so it's always right behind your eyes. So headache on the side, headache on the back, that's not gonna be worried. This one's like a nail going between your eyes. And the other one's seeing spots and stars. Like a lot of women who are multiple mums will be iron deficient because babies are taking everything, so they might stand up quickly and see spots and stars for five or 10 seconds. Super normal. This will be like 15, 20 minutes. It won't matter whether they're sitting, standing, laying down, even they'll still see a sparkle of spots and stars around the outside of their vision.

Sinead Finn (27:38)
rights.

Drew Moffrey (27:55)
And then the last one is a really severe pain underneath your right breast. Feels like something's about to pop out the side of your chest, like it's a balloon being blown up. Once again, like 15, 20 minutes severe pain, because it's high blood pressure going through your liver, swelling your liver. Liver capsular pain is horribly painful. So they're pretty much the three big symptoms of preeclampsia. A lot of people will say swelling, but I'm sure if you probably remember, like pretty much every twin mum will get swollen feet. I'm sure every one of your listeners knows that exactly.

Sinead Finn (28:17)
Yeah

the Kencos were real.

Drew Moffrey (28:24)
And so swelling used to be a thing we'd look for for preeclampsia back in the day, but it's not really a thing we worry about at all anymore. There's not really many other things, but those three sort of are really specific to preeclampsia. So we always sort of drill them into our patients. These three things call me straight away. Yeah.

we would have gone through all this.

Sinead Finn (28:42)
I know when you were talking about pre-clamps here it all came back like the stars and everything like that.

Gabi (28:47)
I remember

now thinking that I had like swollen ankles and I was freaking out and I was like I've forgotten that completely but you

Sinead Finn (28:51)
Yeah. my god.

I freaked out so hard when I saw my ankles the first time.

Drew Moffrey (28:56)
One of the phenomena, I don't know whether you've had any friends, but there's a true phenomena about your feet size increasing when you're pregnant. Like a lot of women will have a half a size bigger after they've finished their pregnancy, the poor things, they, all new shoes.

Gabi (29:07)
I know because I bought shoes

during pregnancy and now...

Sinead Finn (29:10)
went from a size eight to a size 10 in pregnancy. And now I've gone, I buy, don't know what shoe size I am. I haven't like gone and got checked since, but like there's been a couple of times I've bought a size eight and I'm like, girl, that's not working. Like I feel like, I think I've definitely gone up one shoe size. Bless.

Drew Moffrey (29:27)
Yeah, it's I've had women in tears because they have a whole shoe collection has had to be thrown out.

Gabi (29:34)
So obviously there's a lot of, you know, myths around when twins will come, but is there an average gestation as to when you expect twins to come?

Drew Moffrey (29:41)
Yes and no, it depends on ⁓ what happens with the pregnancy because there's definitely strong guidelines as to when we should deliver twins and there's been lots of research into the timing of twin births and things like that. So and it depends a lot on what type of twins they are. Obviously, there is definitely situations where we're delivering babies early. And like I mentioned before, preterm birth is a big issue. And some of that is from our creation and some of it is from women going into labor naturally. So

In terms of is there an average when women go into labor naturally, unfortunately no. That can happen at any stage and it's just one of those things we just have to deal with. But in terms of the guidelines, let's talk best case scenario, everything's been sort of perfect throughout their pregnancy. With DCDA twins, they should be delivered between sort of 37 and 38 weeks, so they should not go into their 38th week. And then with MCDA, so if they...

have gone, they should not enter their 37th week, so they should be born some stage in that 36th week. And then with MCMA, it's a little bit trickier, again, like I said, we really worry about that court entrapment, unfortunately. So generally, most of them will be born between sort of 32, 33 weeks. If everything's going amazingly well, you could maybe stretch it to closer to 34, but generally, they'll all be delivered by 34 weeks, that MCMA. So in terms of preterm,

It's obviously with the DCDA twins going a little bit further. The other thing as well is just simply the size of the twins and the size of the amount of fluid. the uterus, it is an amazing organ. It's the most phenomenal organ in anyone's body. And so it does stretch and stretch and stretch, but eventually it can get to the stage where it can't stretch anymore. So you either break your orders or you go into labor and things like that. And so that's kind of one of those things of when it happens, we deal with it. There's not really a...typical, most people still go into labour at this stage sort of thing.

Gabi (31:30)
Mm.

What are those fears, like you're saying you might not go past 34, you go past 38 for certain types? Like what are the fears if you go past, as per the guidelines, if you're going past that 38 week mark

Drew Moffrey (31:46)
Yeah, well, it's more so, unfortunately, the placentas can stop working. so we know that, like, it's not so much if you went into labour, then so be it. But it's, unfortunately, we know the placentas just aren't adequately sort of able to feed baby that well into your 38th or 39th week sort of thing. So we do know the risk of stillbirth goes up significantly after that.

Sinead Finn (31:53)
That's scary.

Gabi (32:09)
Yeah, I think I mentioned previously with Sinead that I had a lot of anxiety the further on I went in my pregnancy that, you know, around that risk that something is going to happen. yeah, so scary.

Drew Moffrey (32:16)
I can imagine.

Yeah, and also it's quite

tricky. Like with singleton moms, we sit there and we hammer into them about movement, movement, movement. And it's a lot more difficult with twin moms because it's like which twin's moving. And some moms will, twin moms will be like, I know exactly which one's doing what, but others are like, it is just one constant party in my stomach and I can't really differentiate who's who. And for them, it's a lot of anxiety going, is my first baby moving or is it my second baby moving? And so obviously we can't.

Gabi (32:31)
Mm-hmm.

Drew Moffrey (32:49)
We definitely still encourage people to monitor their movements, but we can't rely on it as much as a singleton.

Gabi (32:55)
Yeah, absolutely. I struggled a lot with that. ⁓

Sinead Finn (32:57)
I remember calling Drew like once or twice and coming in for a scan because I couldn't decipher which one was which. And then I think every time I thought I'd like see Drew each week and every time I thought I knew who was kicking, he'd be like, it's actually this twin. And I'm like, I have no idea. But it does come with a lot of fear because...

Drew Moffrey (33:14)
Yeah.

Sinead Finn (33:17)
you don't know who's kicking sometimes and you're like, I felt so much movement up the top, but I haven't felt any movement down the bottom. And then you start spiraling or like, know, sometimes the scan is the only way to relieve that anxiety.

Drew Moffrey (33:30)
Yeah, absolutely. And it's important to, like the formal scans that you go and have is really good. One of the benefits of ⁓ private obstetric care is you get a scan every week. Obviously it's a less formal scan, but it's still a good scan to check the fluid, check the ⁓ Doppler, the blood flow through the cord, make sure bubs heart rate are moving. And also it's just really reassuring for mums to be able to see their babies on the screen every single week.

Sinead Finn (33:40)
Yeah. yeah, that was a big thing for me. I don't know if I had gone through the public system, how bad my anxiety might've been if I had to wait.

Gabi (34:03)
Well, I did and it was bad. Yeah,

Drew Moffrey (34:06)
Yeah.

Gabi (34:08)
those scans, I would have loved to scan every week.

Sinead Finn (34:11)
Yeah, I'm grateful. I'm so grateful because I would leave that scan and like I knew the next couple of days my mental health would be in a good place and then it would slowly creep towards the next scan and I would feel that relief again once I had the scan. But hey, people used to do the whole pregnancy without a scan back in the day.

Drew Moffrey (34:25)
Well, look, yeah, this is the thing. And look, there's so much research that say ultrasounds are 100 % safe. So my argument is there's no dramas, there's no risks to them at all. Like there's been that much research into them. ⁓ Why not? Just to make you ⁓ in a better headspace.

Sinead Finn (34:45)
Yep, absolutely. So I'd love to talk about birth and birthing options for twin moms. When it comes to giving birth to twins, what are the typical options available to twin moms?

Gabi (34:46)
Absolutely.

Drew Moffrey (34:58)
⁓ It's been something that's fluxed a lot over the years. it really, to a certain extent, it also depends on patients because it would depend on what their history is and where they're coming from and things like that. So it is, there's not really any really good guidelines to say this is the best thing for everyone. There was a really big study that looked at twin, it called the twin birth study, that looked at the best way to deliver twins. And ⁓ it did come out saying, Caesar's the best way, but.

Sinead Finn (35:18)
Okay.

Drew Moffrey (35:24)
As with some of these really big studies, international studies that we do, over the years we've kind of looked at it and looked at it and gone, well actually it probably wasn't the greatest study and the results that have come out of it probably wasn't as robust as they should be. ⁓ It's one of those tricky things as well, like a first time mum versus someone who's had three vaginal births before, ⁓ it's probably different advice that we're giving those to people as well because of the...

Sinead Finn (35:34)
Right.

Sure.

Drew Moffrey (35:53)
the risks and the difficulties involved as well. So it is really individualised care. I'll be brutally honest, I will say the majority of my mums that are in my care do have a CESAR and I would recommend that because ⁓ there's still really good evidence that says an elective CESAR for twins decreases the risks to babies significantly. And we also know, especially for first time mums, there is a significant percentage of those that will need a caesarean section at some stage through the birth, whether it be before the first or even before the second.

yeah, there's also like, there's, would say though, there's a bit of a movement sort of pushing back to try and do more vaginal births. and I think if the woman's counseled well, I think it works well, but I think they also have to have significant sort of ⁓ counseling around what the risks are, but also what the implications are down the track as well. And that probably goes with every single patient, but especially with multiples as well.

Gabi (36:53)
Yeah, because my goal was to have a vaginal birth because I had with Billy my first. And then, that was one of the things that my obstetrician spoke me through the chance of, you know, delivering the first naturally and then going into an emergency seizure, like you just touched on. Is that is that quite common? Like, have you experienced that?

Drew Moffrey (36:56)
Yeah. Absolutely. Absolutely have experienced it. Yeah. And it's, it's always a worry like no matter what hospital you're at, there's always ⁓ a delay in getting someone to theater and getting them having a seizure. So it's always a worry from that point of view. Different people, like different stats get thrown around by different people in terms of how common that is. So I'm not going to try and pretend I'm smart and know this off the top of my head. I did look at it before.

Gabi (37:13)
Yeah, okay, yeah.

Drew Moffrey (37:38)
before this, so the sort of the stats that they're quoting anywhere from 5 % up to 20%. So it's a pretty big range. Like personally, I would have said that it probably was close to that 20 % mark. In terms of someone like yourself who's had a previous vaginal birth, then that's fine. For first time moms, you've also got to add on top of that though, there's a significant percentage of them will have a seizure before the first baby as well. the stats for a first time mom trying for a vaginal birth is actually closer to about 50 % needing a seizure.

Gabi (37:44)
Mm.

Wow.

Drew Moffrey (38:06)
about 30 % of them will have it before the first baby and about 20 % them will have it before the second baby sort of thing. So it's actually pretty high from that point of view. But yeah, in terms of the big thing as well is the position of the babies and how they're positioned. The first baby is really important, obviously really has to be head down. The second baby doesn't matter as much. What we generally would say is if it was head down, fantastic, but if it's not, it's still not a concern.

we would really encourage mums for a vagina birth to have an epidural because unfortunately, I know that I'm sorry to horrify your listeners, but what generally has to happen is after that first bubs come out, the obstetrician or the midwife, but generally the obstetrician will put their hand up through the cervix and grab the baby and pull the baby down. So as you can imagine, if you didn't have any pain relief on board, that's pretty horrific. And so it's called a...

Sinead Finn (38:54)
I'm glad you shared that because

I had no idea about that. So I feel like that pace. ⁓ maybe because I didn't explore.

Gabi (38:56)
I did get that warning when I was...

Drew Moffrey (38:59)
Yeah, and it's pretty, and so

sometimes you can stay, if they're both head down, once the first baby's delivered, sometimes you can stabilize them externally, but it's pretty rare. But most of the time you've got to put your hand up there to grab some part of the baby to bring the baby down and to make sure that they're presenting properly. And then from that point of view, roll on from there. And breech births, unfortunately, breech births have gone away in Australia, but my last two breech births were both second twins.

A breech birth for a second twin is actually pretty easy. Obviously they've had one baby there, so the cervix is really nice and dilated, everything's great from that point of view. so, ⁓ so yeah, it's one of those things. It is a really lovely experience, but once again, it's just lots of important counseling around the increased risks that are involved in it.

Sinead Finn (39:48)
So when you tell a first time twin mom or first time mother that there is a risk that they might end up having a vaginal ance section, you tend to find that people then lean into having a cesarean or they're still willing to roll the dice?

Drew Moffrey (40:04)
Yep.

Like the majority of my mums, when you tell them those risks, they're like, well, I don't want to go through that trauma of being rushed off for a second Caesar and also then being taken away from their first baby as well. Because obviously within an elective Caesar, they've got both babies there. Yeah. And so if you have to rush them off for a second Caesar, then they're separated from their first baby, which is, that's a pretty significant sort of thing as well from them.

Sinead Finn (40:17)
Yeah, of course. I didn't think about that.

Drew Moffrey (40:29)
And even if we can do a spinal with that second baby, which most of the time we can't, because if it is a real emergency, we drift mum off to sleep, ⁓ it still means that they're kind of missing some of that. So a lot of mums will just say, listen, yeah, happy just to go ahead and have an elective seizure.

Sinead Finn (40:44)
That's quite traumatic. Yeah, I can't even imagine going through both. And then the recovery as well, when you're trying to care for two babies.

Drew Moffrey (40:51)
Yeah, like it's not an easy recovery as you know, but if you've labored, it's, kind of say you've run a marathon, then you've had a Caesar when you've done both. So the recovery is a lot.

Sinead Finn (41:04)
Gosh, can't, yeah, I can't begin to imagine. So, you know, with twins, a lot of the time after birth, they've got to go to nursery or NICU. How do you determine, like, and how do you prepare a mother to let them know that there's a likelihood that they'll, their baby will either be going to nursery or NICU after they're born?

Drew Moffrey (41:22)
Yep. So there's, there is some really good guidelines. And so some really kind of basic ones is ⁓ under 36 weeks generally always go to the special care nursery. ⁓ So in terms of just to let your listeners know, so everyone sort of NICU and special care nursery, they get used interchangeably, but they are actually really, different than the neonatal intensive care, the NICU. Generally their baby's under 32 weeks. ⁓ And then the special care nursery is kind of

32 weeks and above. And so if you're under 36 weeks, generally you would definitely go to the special care nursery. the baby's suck reflex comes around 36 weeks, and that development and size are independent of each other. So really big babies, really small babies, they kind of, whatever weeks they are is what those development milestones will come at. So the suck reflex comes around 36 weeks. So...

We kind of give babies a benefit of the doubt after 36 weeks and let them stay with their parents and hopefully they have a really good suck reflex straight away. If they don't, maybe after 12 hours, if we know that they're not sucking, then they might have to go to the nursery, but generally that 36 week mark. But the other one is the weight as well. So two and a half kilos is a really firm cutoff. ⁓ If babies are above two and a half kilos and they get to go with mom and dad, if they're not, then they definitely need to go to the nursery. At Pindara, we have a really good system where babies are technically admitted to the nursery.

But after 24 hours, if they're feeding well, then they'll go with their parents during the day and then they come back to the nursery every feed. So that way we can still make sure they're feeding well. And so they kind of bounce in and out from that point of view to make sure that everything's fine moving forward. yeah, obviously all the other normal things definitely occur as well as to how, whether or not they need to go to the nursery. But those are the two big ones with twins in terms of.

gestational age and weight are probably the two biggest reasons that go to the nursery.

Sinead Finn (43:10)
And how do you go about preparing a family? Like how do you have that conversation with the parents?

Drew Moffrey (43:16)
I generally will warn everyone that there's a good chance I go to the nursery. And I kind of generally set that as my default, to be honest with you. And then once we're over 37 weeks, and if everything's gone perfectly with DCDA twins and they've got the elective in a couple of days, that's kind when I finally go, oh, actually, maybe babies will stay with you. I've experienced that that's probably a better way to set the expectations rather than saying, oh, no, the bub will be with you and then turn around and backtrack from that.

Sinead Finn (43:25)
Yeah.

Drew Moffrey (43:43)
I generally say to all my twin moms that they'll probably end up in the nursery and hopefully only for a day or two. And then we sort of, everything on top of that is great. So it's probably better to set that expectation. I don't routinely offer consults with the pediatricians or anything like that unless there was something significant with the twins. If there was a congenital abnormality or the babies were really small or something like that. Generally you don't have appointments with the pediatricians prior, but

Sinead Finn (43:43)
Yeah, agreed.

Drew Moffrey (44:12)
We do try and get our twin mums to go through the nursery prior just so they kind of know what it looks like and what it seems and so it's just not a big shock when they first walk in. And if the babies go to the nursery we have a spot for the bed. So if they've gone to the nursery straight from a theatre, from a Caesar, then there's a spot for mum's bed as soon as she leaves recovery. She gets wheeled straight into the nursery as well so she sits there and she can be with them as much as she can.

Sinead Finn (44:35)
I remember you preparing me that there was a chance that they would go to nursery, but we were pleasantly surprised in theater to learn that they were all good. And we were able to be one of the families that were able to go straight to the room with our twins, which was amazing. Cause like, I think it is better to prepare for the worst because I can imagine in most cases, you know, the twins do end up in nursery

Drew Moffrey (44:58)
I couldn't tell you the stats, but I would say that if you're before 37 weeks gestation, there's probably a decent chance they'll spend at least one or two nights, especially with twins. Because generally before 37 weeks, twins are usually going to be under that weight as well.

Sinead Finn (45:00)
Yeah.

Gabi (45:12)
know that we've touched a lot on, guess, the mental health of mom during pregnancy, as well as after, but I guess, is there anything that parents can do to advocate for themselves in those appointments with their obstetrician?

Drew Moffrey (45:23)
⁓ absolutely. My biggest thing with all my patients is just ask questions, ask questions, ask questions. I have a policy. ask people at least three times in every single appointment, do you have any other questions? Because there's some research that say people won't feel comfortable enough to ask questions until the third time. And they don't want to bother you. And they know you're busy and all those sorts of things. So I ask every single patient at least three times, do you have any other questions?

Sinead Finn (45:44)
you

Drew Moffrey (45:51)
And my advice is just ask as well. If you've got a doctor who gets cranky at you asking questions, then you probably need to find a new doctor because like there's so much that you need to know. And so my biggest thing is in terms of advocating for yourself, write a big list, get your list out ⁓ and go from there. Like don't ever be worried about asking questions. And I often say to people as well, if you ask me a question I haven't heard before, I'll get really excited because I've probably heard everything. ⁓ so, yeah, so it's... ⁓

Sinead Finn (46:16)
Yeah

Gabi (46:20)
Is there any questions that you wish people ask more? 

Drew Moffrey (46:20)

Wow, that's a good question.

Probably not, no. I think from my point of view is though, I just, I wish people were, how do I phrase this? I wish people were more open to ask questions. I really, I hate people feeling that they are a burden or a bother or they're wasting time and stuff like that. Like probably 50 % of them are like, I'm sorry for wasting your time, but, and then they'll ask the question.

My most important patient to me is the person sitting in front of me right then. And I never want anyone to feel that they're being rushed or anything like that. That's one of my philosophies with care. yeah, like I say to people all the time, write down questions and also ask questions when you think of it as well. Don't sit there and go, I'm only 15 weeks. I shouldn't ask anything about the birth because one, you might've forgotten it when we get to the discussion about birth, but also that's gonna sit there and eat in your.

back your brain for the next sort of 10 weeks until we get to that discussion as well. So just ask questions anytime. There's no wrong time to ask questions. So in terms of advocating for yourself as well, a birth partner is really, really important. like getting them to come along as much as they can to appointments is really good as well. Like obviously it's unfortunately not everyone can get the time off work. I totally understand that. And we often like FaceTime dads as well if they can't make it and things like that.

⁓ Sinead, were probably one of our better, the two of you guys I think came to every single appointment, but.

Sinead Finn (47:56)
⁓ I know,

I made Andy come to every single one. I think there might have been one, one maybe he missed at the end, towards the end.

Drew Moffrey (48:00)
it was and that was awesome. Like, yeah, and I think that's really important. think having a really good and look, having a really good supportive partner is really important. So that's one thing I'd sort of strongly recommend as well bring them to every appointment because you're going home and saying this is what happened today is still not the same and you're not they're not getting as educated as you are. ⁓ And so it's that's the other thing I'd say in terms of advocating for yourself, have someone else that can advocate for you as well and have bring them along to everything that they can.

Gabi (48:29)
I couldn't agree more because I struggled with that because we had an older child. so, you know, dad was looking after that child. And, know, there was one appointment where I, I heard like that Darcy wasn't growing. And I was like that, like tore me up because it was just me. had like, can't even take in the information at that point. So I walked out probably hearing not actually what happened, but you know, and not taking it all in. So it's definitely important to have a partner there.

Sinead Finn (48:29)
Absolutely.

Drew Moffrey (48:34)
Yeah. Yeah, absolutely. And look, like you said, in those sort of situations, I tell everyone, bring your bring your other kids like I've got a big box of books there and things like that for other kids, does not bother me at all from that point of view, like there's been appointments that we've had where I've had a screaming three year old that's just screamed for 30 minutes straight. And look, it's still it's still better than ⁓ than than you being there by yourself, I think.

Sinead Finn (49:20)
Absolutely. So if somebody was going to come to see you as a patient, twin mum, how often do they attend your appointments? So I know from memory, like the first trimester looked a little bit different to the second trimester. What would it look like with you?

Drew Moffrey (49:34)
So it depends a little bit on how, what type of twins obviously, but we'll just sort of go DCDA twins. ⁓ It's every two weeks through to that 14 week mark. And that 14 week mark is once you've had your NIPT test and your, the Nucle scan, the early anatomy scan, then you're in the clear risk of miscarriage and all that sort of stuff, even with twins is significantly reduced after that 14 week scan. And then you're in the good.

Sinead Finn (49:44)
Mm-hmm.

Drew Moffrey (49:58)
We sort of see each other three weeks around, so around usually around 17 weeks and then three weeks again around 20 weeks. And then it goes fortnightly through to 28 weeks and then weekly from 28 weeks. So it is very intense. There's a lot of visits. So like a singleton pregnancy, it's probably twice as many visits as a singleton pregnancy.

Sinead Finn (50:18)
Yeah, so it's important that you like your OB. Yes, it would add up quickly, wouldn't it?

Drew Moffrey (50:21)
Absolutely, absolutely. And free parking, that's the other important thing. Gold Coast University Hospital, parking kills you.

Gabi (50:30)
was just going to ask, guess,one more thing about like support post the birth. Like, is there any support you'd recommend for parents of multiples following birth, you know, particularly in that six week period, but, you know, ongoing? Yes.

Sinead Finn (50:42)
the fourth trimester.

Drew Moffrey (50:43)
Yeah, the fourth trimester is massive. And look, I think it's really, really important to have a good team around you. Like it's so important to have a team and whether that's family, friends or professionals, it's different people, different things and also different cultures. Like I love the Chinese culture of they essentially the mum sits there and does nothing for six weeks and the family comes and lives with them. And it is just the most amazing thing ever. ⁓ And there's actually

Sinead Finn (51:04)
Yes.

Gabi (51:06)
Ugh.

Sinead Finn (51:10)
I read about this recently.

Drew Moffrey (51:12)
Yeah, there's actually a couple of cultures that do that, but specifically the Chinese culture is very, very, very, very good at it. But ⁓ I suppose my biggest thing is though, ⁓ pick your person for advice. That's probably one thing I'd say, because you are going to get advice from a million different people. And it is just insane at how contradictory you can be. And it can be really ⁓ disheartening when you get told something, and for the next week, you're doing this and thinking you're absolutely nailing it. And then someone comes along and says, what are you doing? It's the worst thing in the world.


Drew Moffrey (51:42)
And then you're like, who do I believe? And have I done the wrong thing for my kids for the last week? And so pick your person and stick with that person. So someone you trust. ⁓ I work really closely with a me boy I've called Michelle Jackson. Parents to be is, ⁓ she's amazing. ⁓ And so I pay, yeah, I pay for her to come out to all my patients and have her home visit. But then she also does a package where she'll come out to your house every week for six weeks. I don't, whether you did that Trinate or not, I can't remember. But yeah.

Sinead Finn (51:59)
So amazing.

I did the pre-nataland post-natal. I highly, I highly would recommend.

Drew Moffrey (52:14)
Yeah.

Yeah. And so her coming to your house, so you don't have to pack up the twins and get them in the car and get them to Pindara on an amazing clinic as well, where you see a midwife weekly for six weeks. ⁓ But it's just a little bit more difficult to get them in the car and get them to Pindara. ⁓ So Michelle runs a really great program, but it's and it's that one voice that she can give you and one bit of advice. And she also she's very similar to me and how passionate she is. That's why we work so well together.

⁓ She will answer text messages and phone calls at all sorts of time in the day and night as well. ⁓ And so from that point of view, I think it's also then educating your support network in terms, and you also being confident enough to say when someone goes, do you need anything? just unfortunately with Instagram and all this sort of stuff, you're going, no, everything's great. You're going, actually, I would love a dinner. Or can you come and do my washing and things like that. And knowing that when people come and.

Sinead Finn (53:08)
Yeah.

Drew Moffrey (53:11)
to your house, it doesn't have to be spotless. It can be messy. And if someone comes in and judges you, then they shouldn't be in your house and looking at helping you with your twins, like kick them out and go from there. So I would sort of really suggest, I think the old saying, it takes a village, unfortunately has kind of dissipated a little bit over the last sort of 10, 15 years. And I think it's now, especially social media, like everyone has these ridiculous expectations to be ridiculously fit and healthy in your bikini at six weeks and have the spotless house.

Sinead Finn (53:39)
Yeah.

Drew Moffrey (53:41)
have, be back at work and all this rubbish. ⁓ I think it's really important just to acknowledge that you are running around after these two little humans and that it's really, really normal to need help. shouldn't have to do it all by yourself. No matter how amazing your partner is, the two of you still can't do it all by yourself. You should have help from family and friends and just pick, and as long as they're really good people that are gonna be there helping you, then yeah, absolutely worthwhile. Tell them to cook you dinner and come and do your washing.

Sinead Finn (54:10)
That's great advice.

Gabi (54:10)
Fantastic advice, yeah, I love that. ⁓

Drew Moffrey (54:13)
One of my mums told me about her baby shower and it was the best idea. She got her favourite cookbook and ripped out a page, all the pages of her favourite recipes from her favourite cookbook and she gave it to every person at the baby shower and they then froze it and delivered it her at different stages throughout the first six weeks. It was the best idea and I think everyone should do that at a baby shower.

All At Once (54:23)
How good?

Sinead Finn (54:26)
I love that.

All At Once (54:28)
I love that because then you're also eating what you want to eat so it's worked out perfectly!

Drew Moffrey (54:38)
Exactly. Yeah, so no one's not. Yeah, absolutely. Exactly. It worked out perfectly. And she just said she said it was the best thing ever for her for six weeks. She said all her friends came and delivered her these amazing meals that she chose. And yeah, and it was also great because the friends were feeling involved. And they were really part of that community. That's the sort of thing that I think we're missing a little bit now that sort of stuff, unfortunately.

Sinead Finn (54:59)
I've been seeing a little bit of a trend online. They're having, people are giving up baby showers and having like, I think they're called nesting parties. So sort of what you said, Drew, where people like they're getting all their family and friends over and they're basically cooking up all these frozen meals. And then they're also helping with the nesting. So they're cleaning the entire house. They're setting up the nursery. And I'm like, that is such a, such a great idea.

Gabi (54:59)
Because sometimes...

Drew Moffrey (55:07)
Okay.

Gabi (55:22)
Sometimes I think people don't know how to help.

Drew Moffrey (55:22)
Yeah, that is good.

Sinead Finn (55:24)
Yes.

Drew Moffrey (55:25)
yeah, and I agree with that. And that's why I say, don't be shy in saying, bring me dinner. Because most of your friends would, but they just don't know that that's what you need. And unfortunately, like I was saying, like I am really big on this horrendous implication of social media and what the expectations are on mummies. And so they've probably seen that you're like, you're doing great. So they probably don't think you need anything other than a cup of coffee with that bring around to sit there and have a chat with you. And most of your friends, if you say I need help,

Sinead Finn (55:29)
Yeah.

Drew Moffrey (55:52)
do this for me, they'd absolutely jump at the chance of doing it, but most of just don't know that that's what you need.

Sinead Finn (55:57)
That's right. Especially your friends that haven't had kids before as well. Like I was clueless and I look back and I might kick myself. I should have done so much more, but you just don't know until you live it. Yeah.

Gabi (55:57)
Yes, for sure.

Drew Moffrey (56:00)
⁓ absolutely. Yeah.

Yeah. Yeah. yeah, absolutely. I feel really sorry for the first mom in a friend group. She's always the experiment. So that first mom in a big friend group, they're the ones that they're riding solo by themselves. And by the last mom, they get spoiled because everyone else looks after them. So

Gabi (56:14)
Ha

Sinead Finn (56:16)
Cheers. ⁓

Sinead Finn (56:23)
I was the last mum of my friend group but I was also the first to have twins so it was a little... say so. It was, it was. They were great.

Drew Moffrey (56:28)
⁓ same sign, yeah. A little bit of both, ⁓

Gabi (56:34)
We've just got some some rapid fire questions. All right. What is the one most common myth about twin pregnancies?

Drew Moffrey (56:42)
⁓ most common myth. would say it's around that identical thing. Like, yeah, I would say around, like a lot of people want to talk around the identical thing and, the arguments to and from. And look, the majority of, of identical twins are not decent. Most of majority of DCDA are not identical twins. Actually. And can I answer a second part of that? The next one is the, the family history of twins. That's probably the other really big thing. ⁓ so.

Sinead Finn (56:46)
Is that something you hear?

Gabi (56:48)
Yes.

Yeah.

Sinead Finn (57:10)
Yes, please talk to that.

Gabi (57:12)
So is that... yeah, because yeah.

Drew Moffrey (57:13)
Yeah, so you're actually more likely to have twins if they're non-identical. So if your mom had non-identical twins, then you're more likely to have twins, but if you have had identical twins, then it's less likely to be a family trait. So identical twins are more likely just a one-off, random, lucky split, and so that's not gonna carry down through the generations, whereas ⁓ if your family has lots of non-identical twins, then that's more likely because it means that you're

Sinead Finn (57:20)
Yes.

All At Once (57:28)
Yes.

Drew Moffrey (57:42)
your, the ladies lines are sort of those super ovulators that are throwing off two eggs every now and then.

Gabi (57:47)
Can I ask on this? Cause my dad's a twin. And then what I've heard is the skipping of a generation. So does this mean my daughters will not, they might, like not have twins?

Sinead Finn (57:47)
And can, yeah, go for it.

Yes.

Drew Moffrey (57:57)
No.

Well, no, because generally it's also like because your dad being a twin has got nothing to do with it because your ⁓ your mom is the one that sort of gives you those. So yeah. So sorry. It's your dad being it's. Sorry, I've just chatted your family. It's more so down the woman path because obviously it's yeah, your dad being a twin doesn't really impact on you. ⁓ It's more so your mom line. Yeah. Yeah.

Gabi (58:07)
⁓ What?

That's mind-blowing information.


Gabi (58:18)
Yeah!

Wow. Mic drop.

Sinead Finn (58:27)
Wow. So adding another layer to that question, I think there's a misconception around fertility, right? If you had IVF or IUI and you had twins, I imagine that you go back into the normal pool as everyone else. Like the chances is just the same, right? Like it's no, does. So because I got pregnant via IUI, does that mean that my daughter's chances are the same as everyone else's to have twins? ⁓

Drew Moffrey (58:40)
But I'm sorry. Yeah. Yeah.

Exactly, obviously we're doing hormones and all those sorts of things. Well, depends a little bit, hang on. With IUI, some people just do a natural cycle with IUI, some people do an artificial cycle. if you've got given hormones to do your IUI, then yes, the twins will be the same as everyone else down the track.

Sinead Finn (58:57)
Yeah. I did.

And same, same for me, if we tried again, the likelihood of having twins would be back to normal. Yeah. Where, where Gabby's had fraternal twins that, like, sorry, she didn't go through fertility treatment. So is her chances is one in 12 or something like that to have fraternal twins again? that how you don't? It's no. Yeah.

Drew Moffrey (59:13)
Yep, would be same as everyone else. Yep.

Yep. Yep.

I couldn't tell you the exact start, but I know it's significantly raised, then yeah, but your daughters have got a higher chance

Gabi (59:35)
Oh, my husband's never gonna give me another baby now. Cut that out.


Sinead Finn (59:38)
Sorry to burst your bubble there.

Gabi (59:44)
⁓ One more question, a rapid fire question. What is one thing twin parents Google way too much?

Drew Moffrey (59:50)
One thing Google, everything now to be honest with you. Yeah, yeah, yeah. One thing that I get asked all the time, to be a little bit controversial, be honest with you, the worst thing out of everyone now is the vaccination problem. that, like I have...

Sinead Finn (59:55)
Fair.

Gabi (59:56)
Or chat.

Sinead Finn (1:00:01)
Yeah.

Drew Moffrey (1:00:15)
I would say a dozen discussions around vaccinations every week now, where prior to 2020, I would have one a month. So that's and a lot of people are Googling, a lot of people are getting really bad information from social media. And that's probably my biggest bane, to be honest with you, is the misinformation out there about vaccines and vaccinations. Yep.

Sinead Finn (1:00:37)
Are we talking about, sorry to interrupt, are we talking about the whooping cough or are we talking about COVID vaccinations?

Drew Moffrey (1:00:43)
Everything. Whooping cough,

Sinead Finn (1:00:43)
Well, everything.

Drew Moffrey (1:00:46)
yeah, RSV vaccine that's now been introduced. COVID vaccine. Thankfully now I don't really talk people about COVID vaccine much, the main thing is the whooping cough, but even just the standard vaccines like MMR, boosters and all those sorts of things, they have been around for generations and generations. They are 100 % safe. There is that much evidence out there to say that. But even some people now are saying they don't want vitamin K anymore and

Sinead Finn (1:00:48)
Yes.

Drew Moffrey (1:01:10)
Vitamin K, it's a vitamin, it's not a vaccine, it's just a vitamin. And I sit there and say, well, why don't you want it? And they go, oh, it's artificial. I'm like, well, do you know what it does? And they like, no. And I'm like, my issue is when people, if they come and they're educated themselves and they've done some reading and we can discuss it, then that's great. But people just say no off the bat because they think it's something bad because they saw it on TikTok. That's kind of probably my biggest frustration with people Googling everything.

And also not realizing the significant, significant risks that are associated with it because we're being blessed in Australia. Our medical system has been so good over the last 20, 30 years. People don't realize that measles kills people and whooping cough kills people. And because our vaccinations have been so good, people don't realize that. And unfortunately it's coming back and people are starting to learn. that's really unfortunate. There's been more and more cases of whooping cough killing babies, but there's also, was a case a couple of weeks ago about of babies dying of measles.

Sinead Finn (1:02:07)
Yeah, it's like why I take the added risk.

Drew Moffrey (1:02:09)
Yeah. So, yeah, sorry. Sorry to get a bit controversial, but that's probably my biggest thing with nums and Googling.

Sinead Finn (1:02:11)
Yeah.

No!


Sinead Finn (1:02:17)
I think it's great for our listeners to hear, especially if they're expecting. When you think about twin families you supported over the years, what do you hope they walk away remembering about their experience?

Drew Moffrey (1:02:29)
I would hope that they have I would hope that they'd have a really connected experience and think that they weren't overly medicalised is probably the best way that I'd like to think of it. I'd love to people to say that they felt really well supported and they weren't overly stressed and they weren't put into this box of you're really high risk and we're gonna scare you with telling you every single bad thing that's gonna happen to you. ⁓

Sinead Finn (1:02:40)
I love that.

Drew Moffrey (1:02:54)
but at the same time really well informed and felt confident of what was happening, if that makes sense. I think it's really important for people to be well informed, but at the same time, I don't want them to be so scared of everything to do that they don't leave the house and they wrap themselves up ⁓ in a cotton wool.

Sinead Finn (1:03:14)
Yeah. Yes, absolutely.

Drew Moffrey (1:03:15)
Does that make sense? Yeah, I just want them

to feel like they've had a really good experience throughout their journey that didn't feel like they were stressed the whole time because they had a twin pregnancy.

Sinead Finn (1:03:26)
No, you did a great job in my experience. I can speak highly enough about you.

Drew Moffrey (1:03:29)
Thank you.

Thank you.

Gabi (1:03:31)

I feel you've given our listeners a lot of reassurance, but if someone listening is currently pregnant with twins, is there, and feeling overwhelmed, what reassurance would you give them?

Drew Moffrey (1:03:40)
My variations would be just find your care provider that you trust and that you feel comfortable with and that is have a good relationship with your care provider. And whether that's being, there are some midwives that will be high risk midwives and whether that be your GP doing shared care with a public hospital, with an obstetrician. I'm not saying that every twin mum has to have a private obstetrician by any means, but find your care provider.

and make sure that you have a good relationship with them and that you trust them and work with them closely. That would be my biggest thing because without that, then you're going to have a really long nine months, ⁓ maybe shorter depending on what type of twins you have, but you're gonna have a really stressful time that you're not going to enjoy your pregnancy journey and you should have someone that is there to have you back and be able to

work with you to what you want is probably the best thing.

Sinead Finn (1:04:38)
Thank you so much, Drew, for joining all at once. It's been an honor. We've learned so much. think our listeners are going to find this invaluable.

Drew Moffrey (1:04:40)
My pleasure.

Gabi (1:04:46)
So invaluable, thank you.

Drew Moffrey (1:04:46)
No worries, my pleasure. Thank you for having us on guys. yeah, no worries.

Sinead Finn (1:04:48)
Thank you so much.

Gabi (1:04:49)
Thank you.

Gabi (1:04:51)
That's a wrap for today on All at Once.

Sinead Finn (1:04:52)
We hope you laughed, maybe cried a little, and most importantly, felt seen while navigating the chaos of raising multiples.

Gabi (1:04:59)
We release new episodes every week. Subscribe to keep them coming.

Sinead Finn (1:05:02)
And if you want more in between, you can find us on TikTok and Instagram, sharing behind the scenes moments, practical tips, and exclusive guest insights, or watch the full episode on YouTube.

Gabi (1:05:12)
It's messy, loud and beautiful. Life with multiples all at once.