Would you fire this OB?

MissyMakes

My husband and I are pregnant with di/di twins after a successful round of IVF. I've been to visit my OB twice so far: once at 6w5d for the initial prenatal visit and ultrasound and once this morning at 12w0d for my NT scan and checkup. Already, they've said/done a few things that have struck me wrong and made me doubt their experience and knowledge when it comes to successfully carrying and delivering twins. Here are a few:

- I asked about the difference in caloric intake and weight gain goals for a twin pregnancy versus a singleton pregnancy. Their response: absolutely no difference.

- I asked about the delivery experience at the hospital (will I have to be in an OR, will i be required to have an epidural placed, etc.). They said not to worry about it too much because I'll almost certainly have a C-section anyway.

- After my NT scan this morning at 12 weeks, the next ultrasound they want me to do is the high-risk ultrasound (with a MFM) at 22 weeks. So they want me to go through most of my 2nd trimester without ever looking at the babies again. I will have a checkup at 16 weeks, but no ultrasound.

I guess I'm just looking for someone to either talk me down or confirm that I'm right to have doubts. Would these things be red flags for you? Do you think it's time for me to look for a new OB group or am I just being an overly-worried FTM? Thanks in advance for your input!

Pittpanther

The biggest red flag for me would be the fact that you wouldnt be getting your anatomy scan before 20 weeks.  I thought that was very common practice???

Also, if you want the option of a vaginal delivery and they don't seem onboard with this, then I would absolutely look elsewhere! 

If you arent comfortable with them, its going to be a long pregnancy!  I personally would research and try to find someone who fits better with your expectations.

MissyMakes

@Pittpanther: Thanks! I'm fine with the idea of a C-section when it's needed, but I'd really like to attempt a vaginal delivery if it looks like there's any chance it can be done safely. To me, any practice that seems to push twin moms toward opting for C-section regardless of the babies' health and position reeks of inexperience with vaginal twin delivery. But it's a really big, highly respected practice in my area and I guess I'm just a little in shock that I'm even hearing these things from these doctors.

PinkinProvence

It sounds like you are not comfortable so there is no harm in looking elsewhere.  I would suggest looking for a high risk practice or finding an MFM who delivers.

Specifically,

(1) There really is no caloric intake difference.  If down the line, the babies are not growing then they will let you know and you can increase protein.  The most important thing is tons and tons of water and extra calcium. 

(2) It just sounds that they are not experienced with twins.  First, do your obs deliver at a hospital with a high level NICU?  If not, I would find a doctor who does.  All twin deliveries (even vaginal) should take place in an OR in case of extenuating circumstances.  My MFM has a 50/50 rate of vaginal v. c-section delivery of twins based purely on positioning of babies at time of delivery.  It is not pre-determined.  Perhaps your current doctors are not experienced and therefore prefer c-section delivery of twins because they are not equipped to handle.

(3) You should be having an anatomy scan at 18-20 weeks. 22 weeks is too late.  Also, you should be having transvaginal ultrasounds to check your cervical length between now and 22 weeks.  I began having both ultrasounds every other week at around 16 weeks.

All in all, I would look elsewhere.  Perhaps you can call up the MFM you are working with and ask for a referral.  Or if the MFM delivers just transfer your care solely to them.

somewhereincali

MissyMakes said:

- I asked about the delivery experience at the hospital (will I have to be in an OR, will i be required to have an epidural placed, etc.). They said not to worry about it too much because I'll almost certainly have a C-section anyway.

Yes, I would for htis reason.  The latest reasearch shows its just as safe if not safer to deliver vaginally, I wouldnt want an OB who assumes I'm having a c-section

MissyMakes

PinkinProvence said:

It sounds like you are not comfortable so there is no harm in looking elsewhere.  I would suggest looking for a high risk practice or finding an MFM who delivers.

Specifically,

(1) There really is no caloric intake difference.  If down the line, the babies are not growing then they will let you know and you can increase protein.  The most important thing is tons and tons of water and extra calcium. 

(2) It just sounds that they are not experienced with twins.  First, do your obs deliver at a hospital with a high level NICU?  If not, I would find a doctor who does.  All twin deliveries (even vaginal) should take place in an OR in case of extenuating circumstances.  My MFM has a 50/50 rate of vaginal v. c-section delivery of twins based purely on positioning of babies at time of delivery.  It is not pre-determined.  Perhaps your current doctors are not experienced and therefore prefer c-section delivery of twins because they are not equipped to handle.

(3) You should be having an anatomy scan at 18-20 weeks. 22 weeks is too late.  Also, you should be having transvaginal ultrasounds to check your cervical length between now and 22 weeks.  I began having both ultrasounds every other week at around 16 weeks.

All in all, I would look elsewhere.  Perhaps you can call up the MFM you are working with and ask for a referral.  Or if the MFM delivers just transfer your care solely to them.

Thanks @PinkinProvence. A lot of this is ringing true to me. 

1) Yeah, I was basically just looking for a weight-gain target since it's so important for twin moms to gain the weight sooner (much more in the 2nd trimester than singleton moms). In the end, I'm just going to ignore their comment and go with the recommendations from my books written by specialists in multiples gestation. If they tell me I'm gaining too much too soon, I'll just ignore that, too. 

2) I was very surprised to see their slant toward C-section. It is a large and very reputable OB practice in my area with a Level II+ NICU, so I expected that they would have a decent amount of experience with twins. I've seen 2 doctors in the practice so far and, admittedly, most of the odd comments came from the first one. So maybe there's just a bad egg there. Still - I'd hate to have her be the one on duty come delivery day.

3) Yes, I was concerned about waiting so long for the anatomy scan (it'll get crowded in there fast!) and the lack of u/s checkups on things like cervical length and making sure the babies are growing at a similar pace, etc. I guess I could call back and see if they would be willing to do another ultrasound around 18-20 weeks.

I know we're all responsible for advocating for ourselves as patients, but I'd at least like to not have to feel like I'm questioning the doctors every step of the way.

pea-kay

I'd switch. My OB claimed to have plenty of experience with multiples, but when I was the one printing out medical studies to show him, I decided it was time to go. I switched at 22 weeks. Shoulda done it sooner.

MissyMakes

Thanks so much, ladies! I admit to being totally inexperienced with all of this as a FTM, so I appreciate the input from those who have been there. I think I'm going to call a few MFMs and other OB practices in my area to see if I can get a feel for an appropriate standard of care for twin pregnancies. If they all say the same types of things as my OB, then I'll stay where I am. If not, I'll make a switch. I can usually get a quick read on how I'll like a doctor and, though I love my practice for Gyne and BRCA-1 care, I have not felt very good about them from Day 1 when it comes to prenatal care.

JoDoc

I guess I'm lucky, my OB was in my exact shoes not that long ago.  She too went through IVF with the same doctor I did, and she too had twins.  She knows exactly what I'm going through and what to tell me to expect.  She knows that I'm fine doing either type of delivery, whichever is safest and best for the babies and I (in that order).  She is amazing, answering any and all questions, even recommending things I didn't even know to ask about.

 

Bottom line, if I were you, if you are at all uncomfortable with your OB doctor, or ANY doctor for that matter, you have every right to look elsewhere.  Never feel bad or guilty for finding a doctor you trust and can rely on to have your best interests in mind, and will listen to your concerns. 

pixiem38

If you are already questioning the competence of your ob, I'd say that is a red flag. My original ob answered my questions just like yours did (actually the exact same questions, plus a couple others) and I gave him the benefit of the doubt until my next appointment. Next appointment I had the exact same misgivings and decided to switch. Switching was horrendous (a whole lot of twin incompetence ) and in hindsight I wish I had gotten the month jump on switching...

SV917

If you are uncomfortable, then switch. The biggest concern to me would be the c-section comment.

I'm not sure what is wrong with a 22 week anatomy scan or why your OB would even have a say in that. I went from the NT scan at 12 weeks to the a/s at 21 weeks without any ultrasounds in between (except the elective one to learn their sexes). My OB gave me a referral to the MFM but they would not see me until after 20 weeks. My OB had no say in that.

The only time I talked weight gain with the practice was at a nurse consult at week 9. She had me gaining 6 extra pounds over a singleton pregnancy to account for that extra baby. I decided to try to gain more and the doctor has been fine with my weight. The nurse said 30 pounds, and I'm already there at 31 weeks. Most doctors don't know much about nutrition unfortunately.

ashleighlt

Fire her. Those are reasons enough for me to not go back!

PurrCrasher

Absolutely I would, in fact, I DID! I had a similar experience with my first OB. My situation is complicated (and rare!) but in my case switching doctors saved both my mine and my babies lives. If you feel like you want more monitoring and a doctor that will support your desire to attempt a vaginal delivery you deserve that and there is no reason you shouldn't be able to at least feel like those are options. The bottom line is that if you have any reason to doubt that this doctor may not be right for you and your babies then you should switch. There is no harm in expecting more and advocating for yourself and your babies. Yes, you might need a c-section and something may not go the way you want it to (and I sincerely hope everything is perfect) but you need to feel like you have a doctor that is on your side and seeing things from your point of view.

JuliaAndPete

Oh man this post is making me want to switch too. I'm also doubting my OB. Ugh.

Cleo421

I vote fire.

hnharden

If you are uncomfortable, I'd switch, better to do so sooner than later. With that said though, all offices and their procedures are different.I'm currently 25w with didi twins.I was not going to be referred to the MFM until later in the pregnancy ( it's been a pretty smooth ride so far, so hopefully that will continue). I did end up getting referred sooner due to the ob's office having trouble referring me to an endocrinologist, so they thought the MFM may be a bit more helpful in that area, which they were. So I had one untlrasound before my anatomy scan,at 21w, which I originally wouldn't of had. My MFM has released me back to my obs office to do monthly growth scans here on out unless something occurs. If you stay at your current office and their procedures aren't what you want/expect and you request more monitoring you might end up having to pay out of pocket.

Like I said, all offices are different, my MFM said with twin pregnancies she likes to see 26lbs gained by the 26th week. I looked at her like she was crazy. Then my ob told me not to worry about the number, that most of the time the babies will take what they need as long as you are eating a healthy balanced diet(like you should be pregnant or not), she did say that if I began to be worried about it to try including more protein. 

10-4LilBuddy

I would probably find another doctor. When I started, I actually found the best NICU in my town and then selected drs who had delivery privileges there. I interviewed a couple and went with someone who was able to be honest about risk but not too harsh. I also knew I wanted a MFM due to IVF, age, thyroid, and a previous LEEP. I wanted an OB who worked as a team with the MFM group. I am so pleased with my providers. They are conservative but not overly so and communicate very well.

CNYBride05

If you aren't comfortable, let them know. Nothing really screams "run away" to me. Di-di twins carry less risk than mono-di or mono-mono and in many ways are like a singleton pregnancy. The only thing I'd balk at would be the assumed c/s. it's not uncommon to go from NT to A/S with no u/s in between.

SwetaV

If you're not comfortable with their responses (I wouldn't be, especially because of the cs comment) then go with your gut and switch. If you don't you'll continue to have doubts throughout, which will make your pregnancy very stressful and you absolutely do not need that.

TobieRose

I got my first u/s at 14 weeks and didn't get another until the a/s at 21 or 22 weeks. (It was supposed to be earlier but they didn't have enough time available for twins until then.) So I don't think the u/s is a big deal, as long as they're checking on the babies via doppler etc. 

The other two things would bother me, though. 

macchiatto

I would switch! I ended up switching at 31w (actually started looking at 16w but it took a while to find someone good) and wish I had switched sooner. I agree it sounds like they're not experienced with multiples. And if you'd rather avoid an unnecessary C-section and want someone who's up on the research on nutrition guidelines for a multiple pregnancy ... I would look elsewhere!

macchiatto

And a dr who checks on multiples with a doppler rather than u/s I wouldn't trust either!

AmyJoy728

My OB said c/s at the beginning and then around 32 weeks she started talking about vaginal when A was down. I wanted a c/s from the beginning so I was kinda scared about the vaginal talk, and it kept up until I elected a c/s after not progressing past 6cm after laboring and being on pitocin for a day.

Not any one of them would cause me to switch, but all together might make me nervous. I also believe the anatomy scan is supposed to be between 18-20 weeks or else the tests that they do (which aren't accurate for twins anyways) may not be done..

lwatkins12

I'd go with your gut instinct and switch. I had my first ultrasound at 6 wks when they discovered the twins. I've had an US at every single appointment since (every 4 wks until 28wks). I was automatically referred to MFM because of twins and also my age. They did the a/s at the 16wk visit which was also the first visit. Mine are spontaneous di/di. If you're already having doubts than change before you're much further along.

KDR1979

The "almost certainly" will have a C-section would definitely make me look elsewhere. I never saw a MFM b/c my OB group is wonderful, has a low c/s rate for the city and is very experienced with high risk and twin pregnancies. I was the 3rd vaginal twin delivery in a week for them.

I also requested cervical length ultrasounds at 16, 20 and 24 wks b/c I was petrified of pre term delivery after 5 IVF's and 2 miscarriages. I don't even know how many ultrasounds I had.... a LOT!

I would look around!

katiebenes

I would leave. my Main problem is the c section part.