A High-Risk Pregnancy with a Joyful Outcome: Twins!
Couple’s dream of a family comes true with help from Scripps
Couple’s dream of a family comes true with help from Scripps
Caitlin Welsh and her husband, Kevin, both dreamed of starting a family. For years, the couple tried, and while Caitlin did not have trouble conceiving, she was unable to carry a baby to term. Time after time, she miscarried, and each time was just as disappointing as the first.
“It was devastating,” Caitlin says. After yet another pregnancy loss, Caitlin had the good fortune to meet Rebeca Sandoval, MD, an OB-GYN at Scripps Clinic Hillcrest. In one of Caitlin’s most difficult moments, the two made a connection that changed the course of Caitlin’s pregnancy journey.
“I’ve never been close with many of my doctors, but when Dr. Sandoval met with me, there was an instant connection. She was so sweet, she gave me all the facts about what was going to happen during my procedure, and she made me feel safe and secure during that horrible moment,” Caitlin recalls.
Building trust with personalized care
Building trust with personalized care
Caitlin quickly got pregnant again but suffered yet another miscarriage. At 36, she would already be designated as having a high-risk pregnancy.
“It was the one thing we wanted most, and it just wasn’t happening. Dr. Sandoval advised me to keep working on getting my body healthy enough to sustain a pregnancy,” she says.
“When someone has two consecutive miscarriages or more than three interrupted pregnancies in total, we consider them high risk,” Dr. Sandoval explains.
“Caitlin fell into this category, so we dug into her history a bit more to see if we could find an underlying condition to explain why this kept happening to her. We did a workup on her and her husband — chromosome testing and tests to see if there was an immune reaction in her body that mistakenly saw a pregnancy as a threat — but nothing gave us any indication what was wrong,” she continues. “So, we talked about managing her care a little differently in the hope that a pregnancy would hold.”
A surprising early ultrasound
A surprising early ultrasound
“I’ve never been close with many of my doctors, but when Dr. Sandoval met with me, there was an instant connection. She was so sweet, she gave me all the facts about what was going to happen during my procedure, and she made me feel safe and secure during that horrible moment,” Caitlin recalls.
Caitlin WelshBy the end of 2023, Caitlin was pregnant again. This time, she and Dr. Sandoval addressed concerns with her pregnancy very early on — within the first four weeks. “We usually don’t bring someone in for an ultrasound until after the 8-week mark, but because of Caitlin’s history, we scheduled hers early,” Dr. Sandoval adds.
Going into her early tests in December 2023, Caitlin was understandably nervous, despite having the utmost confidence in Dr. Sandoval.
“Every time I went there, I was riddled with anxiety and prepping for bad news,” she recalls. “The ultrasound tech was so sweet and kind, reassuring me that I had a great team behind me and that everything was going to be OK. At that appointment, they ended up seeing a heartbeat, which was amazing!”
Caitlin and Kevin celebrated the Christmas holiday season with hope and excitement about the potential for a healthy pregnancy. Then, the familiar happened — Caitlin started to bleed.
“We were so upset, but we knew there was nothing we could do to help the pregnancy that early on,” she says. “We were prepared for the worst.”
On January 2, Caitlin went to see Dr. Sandoval expecting to hear that she’d lost another baby. What she got was the shock of her life.
“We went in expecting the worst news. Instead, the ultrasound tech said, ‘I don’t know how we didn’t see this before. There are two of them!’” she says. “I thought for sure it was someone else’s ultrasound — I didn’t expect that at all. Never in my mind did I think I’d ever have one baby, let alone two. It was a surreal moment — a real miracle.”
Dr. Sandoval was equally surprised. “We jokingly said she got a New Year’s gift,” she says.
At only five weeks along, now the hard work had really begun to keep Caitlin’s babies healthy and for her pregnancy to continue for as close to nine months as possible.
A few weeks later, Dr. Sandoval referred Caitlin to Scripps’ perinatology department, which specializes in caring for women with high-risk pregnancies. Caitlin had the trifecta of risks: age, a history of miscarriages and multiples, reason alone to see a specialist.
“Usually when we have a mother with twins, we send them to perinatology because there are some types of risks that are higher in multiple pregnancies,” Dr. Sandoval explains.
Specialized high-risk pregnancy care
Caitlin was referred to Brad Dolinsky, MD, a perinatologist at Scripps Clinic, who worked closely with Dr. Sandoval to manage her care.
“There can be a lot of reasons someone is referred to perinatology — usually either a concern with the baby or a maternal medical issue the OB-GYN wants us to manage,” Dr. Dolinsky explains. “Typically, when there are multiples, the OB wants us to get involved right away to talk about potential complications and come up with a plan. Caitlin was referred to me primarily because of the twins, especially since they were monochorionic (identical).”
The plan for Caitlin involved twice-monthly ultrasounds and evaluation for twin-to-twin transfusion syndrome, a rare condition that occurs when identical twins, who share a placenta, do not share nutrients equally.
Because of her history, Caitlin was especially anxious throughout the pregnancy, and each of her many ultrasound appointments brought on the stress of receiving bad news. But Dr. Sandoval assured her there would be no disconnect between her and Dr. Dolinsky, and she would have the integrated Scripps team by her side every step of the way.
“From then on, I felt like we were at doctor appointments all the time,” Caitlin recalls. “I was nervous because I had lost so many pregnancies, but Dr. Dolinsky was very thorough and made sure I was really informed. All the ultrasound techs were amazing and calm — every time I went in, they would find the heartbeats right away to ease my mind. They were always in touch with Dr. Sandoval, and she would call regularly.”
Emergency delivery
Even with all the monitoring, Caitlin’s pregnancy was not without challenges. She developed gestational diabetes, which Dr. Dolinsky says can be common with multiple births, and she had to meet with nutritionists to devise a healthy eating plan.
Then, at 33 weeks, she started feeling unwell and headed straight to Scripps Mercy Hospital San Diego. Caitlin had developed preeclampsia, a serious condition that causes high blood pressure and swelling, and she needed to deliver as soon as possible.
“I couldn’t believe this was happening,” says Caitlin. “My baby shower was planned for the next weekend, and I had a C-section scheduled for 36 weeks.” Dr. Sandoval happened to be in the hospital that day. She had other scheduled surgeries to perform but made it a point to see Caitlin and reassure her.
“The moment I saw her, I broke down,” Caitlin said. “She was there for me, and I really appreciated her reassurance.”
Dr. Sandoval adds: “It was a really sweet moment to see both her and her husband finally ready to deliver after all they went through. It was both their hearts’ desire to get pregnant, and they’d been struggling for so long. She was in great hands, and she did really well.”
Welcome Charlie and Vivi
The Welsh twins, Charlotte (Charlie) and Vivienne (Vivi), entered the world at 8:45 and 8:46 a.m. on June 18, 2024. At 4 lbs. 6 oz. and 3 lbs. 7 oz., respectively, and seven weeks early, the girls were whisked across the hall to the neonatal intensive care unit (NICU). The NICU, operated by Rady Children’s Health, provides specialized care for the most vulnerable newborns in a place where they’re still close to their mom.
“Critically ill and premature infants are admitted to the Rady Children’s NICU. We strive to keep infants at their birth hospital so they can be closer to their mothers during recovery. It improves maternal-infant bonding, and is often easier for the entire family,” explains Stephannie Voller, MD, a neonatologist with Rady Children’s.
“Charlie and Vivi were born early and needed some initial respiratory and feeding support. Overall, they did really well and only stayed in the NICU for two weeks.”
A joyful homecoming
After two weeks, Caitlin and Kevin brought their two healthy bundles of joy home. Caitlin maintained regular visits early on with Dr. Sandoval and her care team as she adjusted to motherhood, and now more than eight months later, Charlie and Vivi are thriving, and Caitlin and Kevin could not be happier.
“It’s been amazing to see them grow and develop their own personalities,” Caitlin says. “Every day, I’m exhausted, but I also feel so much stronger as an individual. We had so many struggles, but we finally made it on the other side. This is all we wanted.”
While Caitlin calls her husband Kevin her “rock,” and has been blown away by the support of her family and friends throughout her pregnancy journey, she is eternally grateful for Dr. Sandoval and the team at both Scripps and Rady Children’s for keeping her and her babies healthy all along the way.
“Dr. Sandoval showed up for me 1,000%,” she says. “I am so grateful, and I give her so much thanks and praise. And I am so grateful to all the nurses in the NICU, their compassion and caring were things we never knew we’d need. They all are truly superheroes.”
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.