OB concern already? WWYD?

beachy6

At my u/s yesterday, my RE told me to go ahead and make my appointment with my OB for two weeks after my last appointment with him. Basically, that's four weeks from yesterday. Make sense? I'll be almost 13 weeks by then.

When I called to make the appointment, they were able to get me in, but my OB is on vacation so I am seeing the midwife in the practice. My OB does twin deliveries, but I'm not sure about this midwife thing. Makes me a little nervous. Also, when I asked her about scheduling our NT scan, she had no clue what I was talking about. She said, "Well, I've heard them mention it." Then she told me to just talk to the nurse about it when I come in next week for our OB registration. That was thing number two that make my feelers go up. Shouldn't an OB's office that claims they deliver twins (or any number of babies for that matter) know what an NT scan is?

Also, isn't this scan done around week 12? Will I miss the opportunity if I wait? I'm so confused and love my OB when he is my gyno. I don't want to judge him as an OB based on his flighty staff, but isn't that who I'll be dealing with more anyway!?

So, wwyd? Hunt around for another OB or just stick with this office and see if it gets better? I will be almost 17/18 weeks before I even see my actual OB at this point and I really don't like that. Can I ask for an MFM referral as another set of eyes or does the OB decide if this is necessary?

Rynleigh

Yes, all of that is a forest of red flags, to me. Do you have the option to find another practice with your insurance? I would seek out an MFM/Perinatologist and let them know that you want to get your NT scan set up and ready to go on time (yes, it should be done between week 11 and week 13, usually done in week 12). I would not wait around and hope that this other practice could squeeze you in last minute. Certified nurse midwives can be excellent - but good ones will *know* what an NT scan is and when it should happen.

absolutelymaybe

Personally, I would keep the OB appointment but hunt around for another practice in the meantime. I don't know who this midwife is, but the fact she doesn't even know what an NT scan is would make me want to keep her far away from my lady parts and not have anything to do with my twins. The OB may be great, but is there any assurance that you won't keep getting shuffled back to the midwife at other parts of your pregnancy? That would worry me.

As for the NT scan...I thought it could be done up to 14 weeks, but I am not 100% on that.

beachy6

It is possible that we would be shuffled between my OB and the midwife because my current gyno/ob is the only one in the practice. So, this could happen anytime he isn't available.

Also, I had a cone biopsy done a little over a year ago, so that makes me nervous and I really wanted to talk to the OB about it since he was my gyno when it was all done. I don't know how this impacts my cervix, but he would and I'd like his opinion before 18 weeks!

I think I'll find an MFM and schedule the appointment myself. I didn't know if I could just do that or if the OB had to refer me. Sounds like a good plan while I wait to see the ob.

2momsinCA

If you were speaking with the office staff and they didn't know what an NT scan was then that is not surprising but if that was the midwife, then you do have an issue. My OB is great and she has a lot of twin experience, but her office staff probably wouldn't know what an NT scan is because she doesn't do the NT scan herself- the MFM she refers out to does the NT and anatomy scans. Your OB may be fantastic and may have lots of twin experience, which is great, but you should also try to see an MFM definitely before week 14 of you want to get the NT scan done.

12bailey18

I'm pretty sure the OB has to refer you to an MFM for insurance purposes, at least that's how it works for me. For any "specialty" doctor I have to get a referral. It would bother me that if your OB isn't available that you would see the midwife. That would not be OK with me. I agree that I would keep the appointment but maybe start looking around at other options. Is there a way you can schedule an appointment for when your OB gets back just to go over your concerns? My OB office (we're military so I have pretty limited options) has been a little difficult to work with in some areas and I've just learned that if something isn't OK with me or doesn't feel right I need to assert myself. If there's something I need and/or want regarding this pregnancy I'm going to stand my ground to get it. Someone once told me that we are our only advocates for our twins so we need to speak up. I'm unable to change OB's so it's made me pretty assertive. Good luck!

24karat

beachy6 said:

At my u/s yesterday, my RE told me to go ahead and make my appointment with my OB for two weeks after my last appointment with him. Basically, that's four weeks from yesterday. Make sense? I'll be almost 13 weeks by then.

When I called to make the appointment, they were able to get me in, but my OB is on vacation so I am seeing the midwife in the practice. 1) My OB does twin deliveries, but I'm not sure about this midwife thing. Makes me a little nervous. Also, when I asked her about scheduling our NT scan, she had no clue what I was talking about. She said, "Well, I've heard them mention it." Then she told me to just talk to the nurse about it when I come in next week for our OB registration. That was thing number two that make my feelers go up. Shouldn't an OB's office that claims they deliver twins (or any number of babies for that matter) know what an NT scan is?

2) Also, isn't this scan done around week 12? Will I miss the opportunity if I wait? I'm so confused and love my OB when he is my gyno. I don't want to judge him as an OB based on his flighty staff, but isn't that who I'll be dealing with more anyway!?

So, wwyd? Hunt around for another OB or just stick with this office and see if it gets better?3)I will be almost 17/18 weeks before I even see my actual OB at this point and I really don't like that. 4)Can I ask for an MFM referral as another set of eyes or does the OB decide if this is necessary?

1. An appointment with a midwife should be fine if you are OK with it. Some midwives will also accept mo-di twins (mine did) and be fine, but it's a matter of your preference and their experience. I was able to stay with my midwife-care practice for my entire pregnancy even with mo-di twins. I knew ahead of time that they were experienced with twin deliveries and they were closely affiliated with my MFM as well. 
   
2. Yes, the NT is usually done weeks 11-13. Was it the receptionist or midwife who didn't know what it was? If it was the midwife, switch practices. If the receptionist, then you might be able to overlook it. Usually the first prenatal appointment (a nurse intake exam) happens between 8-12 weeks and the NT appointment is scheduled either prior to or at that appointment. They may want to get your medical history first before scheduling, as insurance will often not cover it unless you have risk factors. If you do have risk factors, you may want to look into the Materni21 or other tests (blood vs u/s) as those will be more definitive. The NT will only give you odds, not a definitive yes or no.
3. You should definitely be seen by your OB prior to 18 weeks with twins. Di-di are the lowest risk, but they are still a high risk pregnancy and you should be seen well before the midway point. If you have additional high risk factors (incompetent cervix, losses, etc) there's no reason they should be pushing you that far out. Advocate for yourself and see if they can get you in sooner. If not, you have plenty of reason to find a new OB.
4. Yes. MFM appointments almost always require a referral, which usually requires having established care with an OB first. With di-di twins it's not quite as imperative to get in to an MFM office ASAP, but it definitely isn't a bad idea. Referrals can take time too (my first MFM appointment was a full month after my referral approval and request) so I'd try to work on that sooner rather than later. You may also see if you want to switch entirely to an MFM. Some have privileges for L&D, some do not. Mine was affiliated with a major hospital and L3 NICU 1.5hrs away so we only would have been under his care for L&D if I went into preterm labor.

DoublePortion

Since you like your OB, I'd suggest calling and asking for an earlier appt. You don't have to wait till the RE releases you.

CameraBug131

I have to say I LOVE my gyno, but was not impressed with his office as OBs. My sister works at a hospital and found me a fabulous MFM. I started going to her and never looked back. Pregnancies, and twins especially, are high-risk enough. You need to advocate for yourself and better safe than sorry. Def ask for an MFM recommendation. If they won't give it to you, find another doctor. 

TRS48

I was unsure about my OB since week 12. At 23 weeks I went to a perinatal at my own discretion and he was shocked at the lack of care I was receiving at the OB... And sent me straight to the hospital for a week with concerns of preterm labor. The minute we got to the hospital I knew I should've listened to my gut & switched OBs when I sensed something was off. Luckily a new practice took me at 25 weeks but I wish I would've done it sooner, if so perhaps I wouldn't be on bedrest since week 21 & have spent a week in the hospital high risk unit. Go with your gut.

adpilove

I could have written this whole thing. Infact, I wrote something very similar to this last week. I'm sorry but I find it very bizarre that working in an OB office, that anyone there wouldn't know what an NT scan is. I dealt with this last week and was so turned off. I'm sorry you're dealing with this.

Ylvelill

Just chiming in and agreeing with everyone else. Get a MFM, call yourself if you must, I would not risk things going badly.

zazu13

I bypassed the OB and had all my monitoring and delivery with the MFM. My RE wrote the referral and my first appointment was at 14w. They did offer genetic screenings (maybe NT included) but we decided to forgo it.

e74

My OB didn't do the NT scan.. Said they didn't have as high tech of equipment as MFM and referred me to one... They did all my ultrasounds... Yes, based on what you have described, I would be slightly concerned...

beachy6

Thanks for all the responses ladies. I haven't checked this for a bit. I did end up calling the office back the next day and was able to make an appointment with my actual OB for the day after my original appointment, even though I was originally told that he was out of town the entire week. WTH?

I've decided to just go to the nurse intake appointment (June 5th, so a couple of weeks before my OB appointment) and see what kind of feeling I get. I will have a list of questions to ask then and hopefully she can answer them. Basically, I want to know about an MFM, cervical checks due to a cervical surgery, etc. If I'm not feeling it then, I'll refer myself somewhere else. I'm like a pp that the closest MFM is an hour away. But, it will be worth it for better monitoring, I think. Hopefully, the nurse calms my nerves and I don't need to travel so far for appointments, but it's not worth risking this pregnancy having a good outcome just to stay close.

erinwithtwins

Trust your instincts. Find and OB you like and see a MFM for major scans.

I was told I should be seeing both. I see a MFM every four weeks for detailed scans. He said I don't need him for delivery but need him for everything else leading up to it. He was a referral from my RE but turns out he works with my OB all the time. I see my OB every week and a half - two weeks for "a quick look". They like to keep a really close look on twins with them possibly changing so quick and me being high risk.

Maybe you can see a MFM and ask what OB close to you they recommend.
Good luck!

beachy6

Thank you all so much for the advice. I am following it and trusting my instincts. I found a new OB today and feel so much better about the monitoring I'll be receiving.

I called my old gyno/ob and spoke to a nurse today. She confirmed that there is no u/s until 22 weeks and twin pregnancies aren't monitored any differently than singleton pregnancies.

 

When I called the new office I picked, it was completely different. It feels like a ton of bricks has been lifted from my shoulders!

Rachiemoo

Get an MFM.

24karat

beachy6 said:

Thank you all so much for the advice. I am following it and trusting my instincts. I found a new OB today and feel so much better about the monitoring I'll be receiving.

I called my old gyno/ob and spoke to a nurse today. She confirmed that there is no u/s until 22 weeks and twin pregnancies aren't monitored any differently than singleton pregnancies.

 

When I called the new office I picked, it was completely different. It feels like a ton of bricks has been lifted from my shoulders!

Yeah with that sort of monitoring policy, you made the right decision.