Choosing a new OB practice

MrsP419

Hi everyone!  I wanted to ask some advice.  Prior to finding out I was having twins, I was (technically still am) at an all midwife practice where I had my son. I love them and trust them, but am starting to feel like it is not the place for me with a twin pregnancy/delivery.  First of all, the hospital they deliver at is quite far, and is not one of the high risk hospitals in the area (no level III Nicu).  Secondly, they do not have ultrasound as part of the practice; it has to be billed through a separate u/s provider.  With the ammt of ultrasounds twins normally have, I am foreseeing an insurance nightmare.  It would be so much nicer to be able to do any "routine" u/s just as part of the ob appointment.  They also do not have a perinatologist/maternal fetal specialist near their building; that would require extra travel as well.  

I have a few choices for switching.  I still need to check with my insurance to narrow them down, but I wanted to see what exactly is ideal.  There are two hospitals, and each one is highly rated and has a level III NICU.  However, I am noticing quite a difference in size in the OB practices.  My questions are:

-with a multiple pregnancy, does the size of the practice matter?  Did you go to a practice that had a lot of obs/midwives (like more than 8 or 10), or one that had 3 or 4 that you saw on rotation?  Do you think it makes a difference?

-How often are you routinely seen (some places want to see multiple mamas every 2-3 weeks from the get-go, and some are more spaced out).  

-How often do you have an ultrasound?  Is it done right at your appointment?  I was told by the tech I did see that ultrasound was really the only way to measure twin growth (as opposed to measuring the belly), and I would need "frequent" ultrasounds, but not sure HOW frequent.  So far I have had two, and one was the initial dating ultrasound where we discovered the twins.

-What (if anything) is important in a practice specifically for a multiple pregnancy as opposed to a singleton one?

For my singleton births, a low key, midwife-heavy, low intervention practice was what I wanted and what I had.  But obviously that "plan" changed a bit with a multiple pregnancy, so I feel like I am on square one!  Thanks for any help!  

Burberry0421

MrsP419 said:

-with a multiple pregnancy, does the size of the practice matter?  Did you go to a practice that had a lot of obs/midwives (like more than 8 or 10), or one that had 3 or 4 that you saw on rotation?  Do you think it makes a difference?

-How often are you routinely seen (some places want to see multiple mamas every 2-3 weeks from the get-go, and some are more spaced out).  

-How often do you have an ultrasound?  Is it done right at your appointment?  I was told by the tech I did see that ultrasound was really the only way to measure twin growth (as opposed to measuring the belly), and I would need "frequent" ultrasounds, but not sure HOW frequent.  So far I have had two, and one was the initial dating ultrasound where we discovered the twins.

-What (if anything) is important in a practice specifically for a multiple pregnancy as opposed to a singleton one?

Size of the practice shouldn't matter. Make sure you like who you are seeing. I like my dr fine, but my hubby hates him. So, that's fun. I see a regular OB & a high risk OB. We are doing every other visit with one then the other.

I had a couple of appts + u/s's in the beginning. I was seen at 12 weeks for my NT scan. Between 16 & 26 weeks, I am going in every 2 weeks for an u/s to check cervical length to check for signs of preterm labor. 

I have an u/s with every OB appt. They schedule the u/s for 30 mins, then the OB for 30 mins.

I didn't feel like I was being treated like a high risk OB patient (5 miscarriages) & secondary infertility for 2 years THEN Clomid NOW twins. That's pretty much high risk in my book. I went looking for more help from an MFM & found it. They are now working in conjunction with my regular OB (5 mins away) because they are an hour away. So, I'll see both offices for the remainder of my pregnancy. You need to make sure you feel taken care of. Talk to the dr about your fears & what you're looking for. Research what other mamas have gone through & what you think the best coverage is. If you can make it all work, great! If you have to give on some things, that's ok too. 

Good luck!

SWA80

Size of practice did matter to me. My OB's office had 8 and they made me rotate through them all. They had varying levels of experience with twins. I ended up switching to an MFM's office that delivers. I saw three doctors there (and one high risk nurse that was fantastic) which was much more manageable for me.

MrsP419

Thank you so much for the replies and the advice.  I have two consults scheduled- a small practice at a large hospital, and a larger practice at a smaller hospital.  Fingers crossed that it is really clear to me where I need to be.  If anyone can think of any essential questions I should ask in my OB interviews, please LMK!