The 4th Trimester Bodies Project is a photographic documentary dedicated to “embracing the beauty inherent in the changes brought to our bodies by motherhood, childbirth and breastfeeding.” Created by photographer Ashlee Wells Jackson, the project very simply presents the bodies of mothers in stark black-and-white photographs. In many, the mothers wear only black underwear with and without bras; in most, their children appear with them.

Jackson, herself, is a mother of three: a 7-year-old son, Xavier, and twin daughters Nova, 10 months old, and Aurora, who died of complications that developed due to twin-to-twin transfusion syndrome. In part, it was this very painful experience that inspired Jackson's photography project.

What is Twin-to-Twin Transfusion Syndrome?

Twin-to-twin transfusion syndrome (TTTS) affects identical twin pregnancies (or higher multiple gestations), due to the two babies sharing a common placenta. TTTS occurs about 15 percent of the time among identical twins. Fraternal twins are not at risk for this syndrome because they each have their own placenta. Each placenta occupies its own separate space, like two trees growing beside each other, and there is no direct sharing of blood between twins.

When two fetuses share a placenta, they are usually separated by a thin membrane, though connections exist between the blood vessels that radiate from each cord insertion into the placenta. Because of these connected blood vessels, the twins exchange blood back and forth. In an uncomplicated twin pregnancy, an equal exchange of blood in both directions is maintained so that both twins receive a balanced sharing of nutrients and oxygen.

In a TTTS pregnancy, though, the blood vessels connecting the umbilical cords and circulations of the twins are abnormal, and this results in an imbalance of blood flow among the twins; in essence, one receives too much, the other too little. This abnormality affects each fetus in very different ways. The recipient twin — the fetus receiving too much blood — is at greater risk for cardiovascular volume overload. The donor twin — the fetus receiving too little blood — is at greater risk for cardiovascular collapse, malformations, and malnutrition.

A common therapeutic option is reduction amniocentesis, which involves draining the excess amniotic fluid by inserting a needle into the sac of the recipient. Another common therapy is amniotic septostomy, in which a hole is created in the membrane between the fetuses to allow some of the excess amniotic fluid in the recipient's sac to enter that of the donor who usually has no or very little amniotic fluid. Even in cases where corrective measures are taken, fatalities may still occur. Painfully, Jackson is one example of a mother who suffered because of TTTS. Her 4th Trimester Bodies Project is meant, in part, to address such issues.

Beauty In All

"After coming out the other side of a very traumatic pregnancy and birth experience myself and struggling with the strangeness of my new body, I felt like it was finally time to make this project a reality," Jackson told the Huffington Post.

Her ongoing series is scheduled to culminate in a community website, gallery show, and printed publication. Meanwhile, Jackson has scheduled tour stops in Portland, Los Angeles, and Kansas City for the end of this month and next, and she plans to travel to other cities after that.

“It doesn’t matter how you’ve come to motherhood or how old your children are,” the project website declares, as Jackson is attempting to appreciate the beauty underlying every mother's experience. "As much as I love capturing the stories that are triumphant because they’ve defied some odds or struggle, I also find such beauty in the women who have had normal, healthy, happy pregnancies and birth experiences," she told the Huffington Post.

Source: Ward MA. Elective laparoscopic fetal laser photocoagulation in twin-twin transfusion syndrome: a case report. AANA Journal. 2013.