differences in prenatal care with twins

curlywhirly

I currently see a practice of midwives. We've only had one appointment with them since finding out about the twins, and it has definitely crossed my mind that they may not be the best practice to be with for multiples (but I had a fabulous experience with them during my first birth). I didn't get the feeling from the midwife that she'd had a lot of experience with twins, but that is a bit of an assumption on my part.

So during my next appointment I want to ask specifically how the plan of care will be different because I am having twins. They have already told me that I will have an ultrasound every month to monitor their growth. I've heard people here say that they see a MFM--was this recommended by your OB, or is this something you decided to do? When and/or how often do NSTs occur?

What are the other prenatal care tests or events would one expect to have during a twin pregnancy?

If you've carried a singleton and twins, how did you prenatal care differ between the pregnancies?

RunbabyRun

With my DD I saw my OB every 4 weeks and had only 3 ultrasounds. This time around I go every 2 weeks and have an ultrasound atleast once every 4 weeks (more like every 2 weeks with the way things are going).

My MFM did want me to have a NT scan due to having multiples but really that was the only thing that varied thus far between pregnancies.

 

 

tmbuchmann

My reponse may be long, so I'll try and keep it short:

I've heard people here say that they see a MFM--was this recommended by your OB, or is this something you decided to do? My doctor, told me that because I'm carrying twins, I'm automatically considered high risk, some doctors are different this is just what mine said. I saw a perinatoligist (sp?) When and/or how often do NSTs occur? I got mine 3x/week for the last 4 weeks and 1x/week for about 2 weeks before that. My NSTs were at my peri's office.

What are the other prenatal care tests or events would one expect to have during a twin pregnancy? I had an u/s at ever peri visit and OB visit. During the u/s they determine if there is a membrane between the babies, if they are sharing a placenta, and they monitor how much fluid is in there for the babies. They also measured my cervix for the 1 & 2nd trimesters.

If you've carried a singleton and twins, how did you prenatal care differ between the pregnancies? My first was much simplier, I didn't have near the doctor appts that I had with the twins, or the extra stress of everything that can go wrong. At 31 weeks we had a pre-term labor scare and I got the steriod shots. Other than the extra peri office stuff, my OB saw me more often as well. He did visits like this: 1st tri = 1 visit/month, 2nd tri = 2x/month, 3rd tri = every week.

Things like GD and pre-e can come on real fast so they kept a much closer eye on me. GL!

atc282

curlywhirly:

They have already told me that I will have an ultrasound every month to monitor their growth. I've heard people here say that they see a MFM--was this recommended by your OB, or is this something you decided to do? When and/or how often do NSTs occur?

We moved abroad right after finding out it was multiples. My dr. at the time strongly suggested seeking an MFM as the healthcare was much different there than here. I only say an MFM while in the UK but got a midwife for in between monthly visits. Once I returned to the US (about 23 weeks along), I only saw an MFM--mine happened to deliver multiples and was at the highest level NICU so I just saw him throughout the remainder of my pg. After 24 weeks, I saw my MFM every 2 weeks until I hit 32 weeks and then it became bi-weekly visits.

Didn't need a referral from my initial dr. for an MFM--just looked through my insurance co.

NSTs began for me around 31-32 weeks? Can;t remember. I think I only had one NST and the rest of my pg I had BPPs which were basically very detailed u/s that looked for specific measurements, etc. I had those 2 times a week from weeks 34-until delivery.

What are the other prenatal care tests or events would one expect to have during a twin pregnancy?

Urine samples each visit, weight and BP, FFN tests (because I had an infection twice during my pg they had me do these several times but I don't think all twin pg require them), cervical length checks (I started getting internals from high 20s and beyond), GD test, multiple ultrasounds, BioPhysical Profiles, NSTs...

If you've carried a singleton and twins, how did you prenatal care differ between the pregnancies?

For me, the care has been so different this time around (I'm having a singleton in a few weeks). I only saw my OB once a month up until 34 weeks. Then now I'm seeing her weekly. So far less dr. visits! And far less ultrasounds (I've only had 3 with her this pg and she normally only does 2).

HTH and GL

pea-kay

do you know if they're di/di or mo/di? i think that makes a difference in the kind of treatment you should be getting.

Mrs. Alice

I was first told that I would get an u/s every appointment.  My OB was new to me and I didn't know how much experience she had with high risk twin pregnancies either.  I also felt a little uncomfortable with just having her manage it and she was really vague as to when I would be seen by a MFM.  She told me after 20 weeks or if there is a problem.  Well from what I found out about mo/di twins is that they need to be monitored a lot more frequently starting after about 14-16 weeks.  So on my request I started seeing a MFM at 18 weeks.  Since my complications started at 22 weeks there was nothing normal about it after that. 

Besides the extra ultrasounds, there was nothing much different as far as testing in the beginning.  You should expect a lot more appointments and NSTs in the 3rd trimester. We opted to not do the quad screen and were not even offered NT scan.

lrrb

With the twins I've been going every 2 weeks from pretty much day one.  I also have an ultrasound at least once a month, sometimes two if I was worried about something going on.  I'm not going to see an MFM b/c I have zero issues going on, I'm sure if something presents itself later in the pregnancy (I'm 26 weeks) then I would be sent to one but no need as of now....my OB has done PLENTY of twins.  I'm not sure when Ill start going once a week but I assume it will be around 30 weeks.  I'm not sure how I would feel at a midwife group unless they have done a lot of twins and have access to an ultrasound machine in their office or VERY close where you could get in that day if you had an issue.  GL to you!

jxd215

curlywhirly:

I've heard people here say that they see a MFM--was this recommended by your OB, or is this something you decided to do? I was referred to a perinatologist by my OB for my 12 wk NT scan. She did my 20 wk anatomy scan as well, and an u/s every 4 weeks after that.

When and/or how often do NSTs occur? I had weekly NSTs and u/s to check fluid levels starting at 33 wks.

What are the other prenatal care tests or events would one expect to have during a twin pregnancy? I started biweekly OB appts at 28 weeks and weekly appts at 32 weeks. With my sister's singleton pregnancies this happened at 32 and 36 weeks, respectively.

I had all the usual screenings, with the caveat that the results might not be as easily interpretable because of the twins. Luckily we never had any issues with potential false positives, but we knew it was a possibility. I was also lucky in that I had no complications with my pregnancy at all. My OB practice was very experienced with twins, so I appreciated that while they were vigilant they didn't make me overly worried about things that weren't happening to me.

violaplayer

I would definitely find out for sure if they are di/di or mo/di. That makes a huge difference in care and potential complications. And find a practitioner, of whatever description, that has plenty of experience with twins. My OB had worked with several sets and his practice had a high risk committee that also monitored my care.

If you have mo/di - there are additional potential issues and an OB and MFM/Peri should really be involved in your care. 

MrsClark8109

My OB referred me to MFM due to IF issues and a history of anorexia she was concerned about weight gain. She said in most circumstances shes comfortable handling a twin pregnancy on her own but she'd prefer I see both her and MFM.

However, MFM thinks I'm unusually boring for a patient-- he refers to me as his "least exciting patient"---uh thanks I think doc!

I think the main difference (although I've only had a twin pregnancy but comparing to a friend with a singleton) is that I get ALOT of ultrasounds where as she has very few. They also monitored me alot closer for PTL.

schoolsoutbride

I saw midwives with my 1st DS and with the twins. I saw a MFM in addition to the midwives with the twins.

Had I been able to deliver vaginally (breech baby A), the midwives would have delivered baby a and the OB they work with would have delivered the trickier B baby.

I thought of the midwives as my caretaker and the MFM as theirs.

emma12210

My advice is, if you want to switch, do it early! I just switched OB's at 19 weeks, and ended up owing a lot of money (I'm due in Jan so I shouldn't have paid anything toward my deductible this year b/c they bill after delivery... since I switched, the OB had to go ahead and bill me now, so I'm having to pay $800 this year that otherwise would have gone toward next yr's deductible).

The reason I switched was so that I could deliver at a hospital with a NICU and where a MFM group has privileges... the other hospital had no NICU and no MFM, so myself or my babies would have been shipped out to another hospital if we had complications.

Anyway, I think the others gave good advice, so it's up to you... GL!

curlywhirly

pea-kay:

do you know if they're di/di or mo/di? i think that makes a difference in the kind of treatment you should be getting.

They are di/di, which the doctor reviewing the ultrasound was happy about.

KellyD01

I saw a midwife group with my twins because I loved them so much with my single! and I still love them. I actually think I got better care than most of my friends w/ their OB's. My midwife practice may be a little different than yours though, it's really something you need to decide for yourself.

I'll tell you about my experience so it may bring up some questions for your midwives. My practice is located in one of the best hospitals in our area. They are overseen by a group of 3 MFM's that combined have over 100 years of experience and are pretty awesome docs. They have a meeting w/ the midwives weekly to review cases and any concerns would be brought up to the docs at that point. The MFM's in our case actually share exam space with the midwives so if there's a problem a midwife can go and grab a doc. W/ a multiple pregnancy the midwife refered me to the MFM around 28 weeks for an appt. As long as things are good I wouldn't see them again until delivery. All multiples are delivered in an OR no matter what. (MFM delivers at least 1 of the babies depending on position) In my case I had a breech A so had a c-section. BUT my midwives were with me through the surgery letting me know what was going on. I met with the doc at 28 weeks and then becasue A was still breech we met again around 36 weeks. I went for monthly growth u/s and they actually had an older u/s machine in theiroffices that they used in between if they couldn't differentiate heartbeats just to be sure. (The girls were laying right next to each other and we had one anterior placenta and one posterior so there were times they weren't quite sure.) We had no NST's or biophysical profiles, but that was the decision of the MFM. It's just not policy with them or the hospital unless there is something to indicate it's necessity. All in all, if I ever went nuts and decided to have another baby I'd use them again w/o hesitation.