With Support From Mount Sinai West and Maternal Fetal Medicine Associates, a Complicated Twin Pregnancy Leads to a Successful Birth

Lauren Burstein, a married English teacher at a Jewish High School in New Jersey, found out her twin pregnancy was complicated by a condition called twin-to-twin transfusion syndrome, and would need specialist treatment and close supervision.

In July 2023, Lauren Burstein was told by her local doctor that she was expecting identical twins. Since carrying twins carries a higher risk for pregnancy-related complications, Lauren sought out the expert care of Nathan Fox, MD, Clinical Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, to oversee her pregnancy.

“Dr. Fox is phenomenal. He is extremely thorough, bright, and kind,” Lauren says. “It's very clear to me that he cares about his patients tremendously. He was available to speak to me when I needed to speak to him, and he really explained everything in depth and was able to provide this holistic picture of what was happening.”

With the type of identical twins Lauren was carrying (monochorionic diamniotic twins), each baby is in their own amniotic sac, but they share one placenta. In 15 to 20 percent of cases, this can lead to a potentially dangerous condition called twin-to-twin transfusion syndrome (TTTS). With this condition, blood flows unequally between the twins in their shared placenta. It carries a high risk for preterm labor and potential malnourishment, organ failure, neurologic or cardiac complications for the twins, and even death of one or both twins.

Signs of Complications

Unfortunately, in October 2023, at 18 weeks, Lauren began to show signs of developing TTTS. She was referred to a specialist hospital for further testing and observation. At 20 weeks, the diagnosis was confirmed, and she was admitted for treatment with laser ablation surgery the next day. This is a minimally invasive procedure that seals off shared blood vessels in the placenta with the use of a laser. The procedure was a success, but there were initially some cardiac issues affecting one of the twins that took another month to resolve. By 24 weeks, scans showed both of her babies to be healthy.

“It took about 24 to 25 weeks to feel a little more comfortable with everything, partly because of the cardiac issues,” Lauren says. “By then, I could start thinking I could potentially have a normal outcome. I was told the cervix looked good, the fluid was good, their heartbeats looked good.”

However, it was crucial for her to have access to a comprehensive team of experts to monitor her for the rest of her pregnancy. From 23 weeks, this high level of care was provided by Dr. Fox and a team from Maternal Fetal Medicine Associates, which partners with Mount Sinai West in providing care to high-risk obstetrics patients.

“All the doctors there that saw me during various monitoring appointments—there were extensive sonograms of both fetuses—they were all wonderful,” Lauren says. “They were all very knowledgeable and very thorough. Sometimes they would come in during a sonogram just because they wanted to see for themselves the images that they were processing in real time. They clearly care very much about their patients, and they have a lot of expertise. So I felt like I was in great hands.”

“When you're having complicated twin pregnancies, you really want to deliver at a center that has a lot of experience taking care of these types of pregnancies,” Dr. Fox says. “There's a whole host of reasons. Number one: the prenatal care with all the ultrasounds, testing, and examinations needed. Number two: the delivery itself requires a lot of coordination, and doctors who have the right experience. And number three: the neonatal care for the newborns needs to be excellent. As a higher care center, Mount Sinai provides all of this.”

A Choice to Make in Delivery

By 28 weeks, Lauren transitioned from two weekly appointments to one visit every other week—a sign of how well her babies were doing. At 32 weeks, she had an appointment with Jessica Spiegelman, MD, Assistant Clinical Professor, Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, who discussed with Lauren the options for delivery of the twins. Baby B was breech, not in the optimal head-first position—something that is common with twins. So Lauren and the team had to decide whether to try for a vaginal delivery or opt for a Cesarean. Due to the complicated nature of the pregnancy, Lauren’s delivery was going to be scheduled at Mount Sinai West at 36 weeks.

Lauren’s preference was to have a vaginal delivery, and the Maternal Fetal Medicine Associates and Mount Sinai team has more than 20 years of research and extensive clinical experience in performing breech deliveries with twins. As the first baby was head down, there was a strong possibility that they would be able to carry out a vaginal delivery for the first child, and then perform a breech extraction for the second child. However, there was still some level of risk associated with the delivery, which agreeing to a C-birth would mitigate. Lauren discussed the options with her husband, Avi, that night.

However, a decision would need to be reached a little sooner than expected—she went into labor the next morning, on January 10.

“Dr. Spiegelman was there from the beginning when I arrived at the hospital, and she was extremely comforting.” Lauren says. “I had to make a decision very quickly about whether I was going to go for a C-section or try for a vaginal delivery, and I felt like I really trusted her to be able to deliver vaginally. Obviously, she had the expertise, but it was also because of her kindness and the care she showed to me.”

Dr. Spiegelman and Dr. Fox were both part of the delivery team. Lauren’s first baby, Ethan, was delivered within forty minutes of her arrival at Mount Sinai West, quickly followed a minute later by his brother, Jonah, who was extracted breech and without any complications.

“Growing and Thriving”

“There were essentially zero complications with the delivery,” Lauren says. “And that was just magical to me. It was really incredible. And then the pediatric teams were great. They worked on the babies right away, and had a whole team for each baby—they were wonderful. After I delivered, I was brought into the recovery room, and the nurses there were really attentive and wanted to make sure I felt very much cared for. It made a huge difference for me and on the delivery, and it made a really big impact on me as a person.”

Since the babies were premature, they were immediately transferred to the Neonatal Intensive Care unit (NICU) at Mount Sinai West. Jonah stayed in the unit for 25 days, and Ethan for 27 days.

“The NICU experience is not easy,” Lauren says. “It's a very strange sensation to have children that are not at home with you. I remember every day leaving them and being with my daughter at home, and knowing I have these two other children, but I'm not with them all the time. But at the same time I was filled with this gratitude that they were okay, and that everything worked out.”

Lauren recalls that the NICU team went the extra mile to help support her. “We really love the Mount Sinai West, NICU. The nurses there and the physicians, they're all tremendous in their care,” Lauren says. “There were certain days I wouldn't get there till later in the day, and if I didn't get to speak to the doctor in person, I would always get a phone call with an update. And that's a lot, because it was hard not having them home. Having that communication is so important.”

The twins turned one year old on January 10, 2025, and are both thriving.

“They’re doing really, really nicely,” Lauren says. “They just keep growing and thriving, they're doing amazing. They're crawling and they're climbing on everything. They are so happy—they are just the sweetest, happiest kids.”