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Multiples
OB answers that made me question...
I met my OB for the first time last Friday. She is super nice and comes highly on the recommendation of friends (we're all RNs so we see what the drs are really like in action). I asked her a million questions and a few of these made me think because her answers didn't correlate with things I had read. Have you heard these answers from your OB such as:
Do you think I'll go on bedrest at some point? No-the evidence shows that bedrest isn't proven to help with preeclampsia or preterm labor. In fact, there are more complications associated with it such as muscle wasting and DVTs. You can expect to work all the way up to 37 weeks.
Your RN told me I should gain no more than 35 pounds. I read in Dr. Luke's book that I should aim for around 50 to improve the chance of having babies with higher birth weights. What are your thoughts? I haven't heard of Dr Luke but this is not true. You should gain around 35 for twins. If you gain more than that, it's just fat and not the babies and it is much harder to lose the additional weight after you have the babies.
I tend to question doctors based on evidence I read which makes it hard to trust their opinions 
Have you heard similar answers from your OB? Thanks for the input!!
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Re: OB answers that made me question...
My OB had me "take it easy" but didn't put me on official bed rest (my complications were an SCH early, then an irritable uterus and growth discordance later). It seems like doctors are split on whether or not bed rest helps, but I would prefer to err on the side of caution, especially with multiples. To me, when she told me to take it easy, I pretty much stayed in bed/ the recliner except to shower/ get food/ do short errands. I wasn't working at the time, but I'm pretty sure she would have pulled me out of work (I'm a teacher).
She told me to gain around 35-40 while my MFM said 35-50, preferably more towards 50. I was only able to make it to 34 before my c/s. I would question 35 as a max.
Dx: MFI- 3% morph
IUIs: Gonal-F + Ovidrel + b2b IUI= BFNs
IVF with ICSI= BFP! EDD 11/25/11
3/18- Beta #1 452! 3/20- Beta #2 1,026!! 3/27- First u/s- TWINS!
Our twin boys arrived at 36w5d due to IUGR and a growth discordance
Be kinder than necessary, for everyone you meet is fighting some kind of battle.
there are some studies that show bedrest doesn't help. my ob mentioned it to me but he also feels that it can't hurt and God forbid something was going wrong and he didn't Rx bedrest - and then the babies didn't survive - he'd feel horrible... i was never on bedrest with the twins but i was for my singleton after PTL issues.
my OB agreed with all of Dr. Luke's suggestions - he had never read the book but i brought up all the main points in her book with him- and he agreed with it all.
many docs have different philosophies - you need to find a doc you feel meshes with what YOU believe the most.
i had a bad feeling after my first appt with my OB. i was not comfortable at all with her care plan for my twin pregnancy. very similar answers to the same questions you posed, except she also said she would let me go to 41 weeks if i didn't go into labor on my own! oh hell no!
i switched to an MFM exclusively (he also delivered me, which is uncommon for MFMs) and was so glad i did. i was closely monitored, had complications during my c/s and let's just say my MFM is my hero. my pregnancy was basically uncomplicated, but it made me feel so much better to be in his care.
FWIW - i was about 15 pounds overweight PP and he said i could gain a max of 60 pounds. i gained 64 and lost it all by 8 weeks PP, most of it by 6 weeks PP.
I don't think it hurts to shop around if you're not comfortable with her. Every doctor is going to have different opinions. My OB has different ideas than my perinatologist, and sometimes when I see a different perinatologist, I get differing opinions too. I have enjoyed seeing 3 different doctors during this pregnancy because of the variety of care opinions. (The 2nd peri I only saw 3 times and probably won't again, but still).
FWIW, my main peri told me to aim for 50 lbs, but I was kinda thin to start with. (5'9'', about 140). So far I've put on about 38. In the beginning, I put on hardly any, and my peri kept telling me to eat more ice cream, but that's the only comment I've gotten about my weight from any of them. Last week when I saw the substitute peri (who seems much more conservative than the other 2 docs) my cervix had started funneling. It's still 2.9 though, and she said I could keep working. (I teach 5 hours/ day). About 6 weeks before that, when it first dropped to 2.9, she started talking potential bedrest. She also mentioned that they're not sure how effective bedrest is, but at the same time, urged me to be laying down as much as possible when not at work because they don't have anything else that might work better. I don't think she's inconsistent or airheaded, I think she just weighs what's going on at the time, and bases her recommendation on that. Same with the other 2 docs I see. Like one PP said, it's good to have someone who doesn't have a "one size fits all" approach. Good luck!
I ask about bedrest at almost every appointment just to make sure that I'm not doing something I shouldn't and their answer is the same every time: no bedrest (unless your cervix is thinning). Being pregnant we're at higher risks for blood clots, and being on unnecessary bed rest further increases those chances. While I don't know about working all the way up until 37 weeks, I'm assuming she's assuming the pregnancy is completely complication free.
The doctor also told me to gain between 15-25 pounds (I was overweight to begin with) and to try and make sure that my diet stayed healthy so that the weight I was gaining was the babies themselves, and not fat (from an unhealthy diet). Despite the fact that so many moms rave about Dr.Lukes book, I've heard a lot of OBs that don't necessarily agree with everything she says. FWIW I was also told if I gain more, then I gain more and we'll deal with it as it comes, but you don't want to gain too much because it's either fat or water retention, and then it's unhealthy for you and the babies.
I saw two OB's and a MFM. One of the OB's was just like this and as far as she was concerned bedrest was not required the other OB implored me at 25W and then flat out insisted at 27W. The MFM never advised bedrest.
In my situation I didn't really "listen" to the one who said to go on rest. I assumed that because the other said I was fine and the MFM didn't disagree that I could continue my version of light duty at work.
Ultimately, I was induced at 37w and once I delivered we discovered one of my daughters was IUGR and this was entirely missed by all three doctors.
If I had it to do all over again I would have sided with a more cautious doctor.
my MFM said 35-40 pounds. my OB never really addressed the weight thing. if i only end up gaining 30 or so, my MFM will be fine with that too. you dont necessarily need to gain 50 pounds. Dr. Lukes is not a physician. and many MFMs do not agree with her. but, some do. you should only gain that much weight unless specifically instructed to by your doctor (preferrably an MFM) with reasons to back it up. some people need the extra weight. some people dont. there is no right answer to the weight thing.
in terms of bedrest...my OB and MFM mentioned that it's always a possibility if i show minor signs of PTL issues. i guess i would say they disagree with your doctor on that one. my MFM said that he struggles with certain OBs that think they should treat twin pregnancies like singleton pregnancies. he said they insist on it, and that he gets frustrated with them....
I was told early on that some women go on bedrest, some don't. I didn't really question anything. Then at 23 weeks I was put on bedrest. So obviously my OB believes in it. But I remember reading online somewhere that there are conflicting opinions of whether or not bedrest works.
Re: gaining weight. My OB said to gain 40...then he looked at me and said, "Actually, gain more.". I tried to gain 20 by 20 as per Dr. Luke and was successful. I actually gained 35 by the time I delivered at 25 weeks. My OB was never concerned that it was too much.
The blanket answers would concern me more than anything.
My MFM didn't have a blanket bedrest policy one way or the other but she was pleased that I cut back my work hours at 20 weeks and was done working by 31 weeks. Sure there are women that work all the way up until delivery but it's not the norm and not a reasonable expectation. Even if you have no complications, just sitting up to sit at a desk is going to be rather uncomfortable/difficult at 37w PG with twins.
My MFM also never told me how much weight to gain. She was familiar with Dr.Luke but didn't take it as gospel. When I expressed concern over how much I'd gained she said "well it's twins - you can't expect to only gain 30 lbs!" I read Dr. Luke's book and tried to eat really high protein, nutrient-dense foods, but didn't try to put on a certain amount of weight. I ended up gaining between 50 and 60 lbs, went full term, and all but 8 lbs was gone by 6w PP (and I didn't nurse them, either).
Will you be seeing a specialist at all? I'm wary of regular OBs who claim to be able to handle twins. I've known too many people have an OB treat them as just a regular pregnancy and end up with complications. My MFM group was so on top of things and closely monitored all of its multiples patients, and delivered as well. I'm sure there are OBs that do twins and do them well but I didn't know of any.
Agree with PP that both bedrest and weight gain are individual. Depending on how active your job is as an RN (ICU nurse vs. med surg vs. school nurse), you may have to bow out of work long before bedrest ensues. I have a very active job in medicine and was working 80 hour weeks on my feet when pregnant. We hoped for the best.
At 23 weeks my contractions started and my cervix thinned. As a pro-active measure, I was pulled from work for modified bedrest at home. A lot of ob/gyns would have been reactive and made me work longer. My MFMs and I agreed that being pro-active at that point was safer. I lost 1 cm of my cervix in one week. We weren't playing around. Bedrest absolutely worked for me because of the strain of my job; there is no way I could made it otherwise. I made it to 36 weeks and delivered from high BP.
Unfortunatelty nurses, physicians, scrub techs etc just have very active jobs that may or may not affect your ability to keep working at the same pace. The day my cervix thinned I did 2 hysterectomies then rounded then was attempting a bedside biopsy. I could feel my contractions strengthening and went straight to my MFM. I knew deep down that was it for work. Being out for 13 weeks pre babies and 7 weeks post baby was just a blip on the radar.
Weight gain is another area. I gained 50 lbs and lost it all by 6 weeks PP. Much of it was fluid at the end from pre-e. I never ate crazy; the weight just came.
I know that my MFMs handled my pregnancy very differently than most lay ob/gyns, and I can say that confidently because of my job.
There is a reason MFMs exist. Multi-fetal gestations can be uncomplicated, but MFMs are there for the ones that do have issues.
I'm not too bothered by her answers either. I never went on bed rest and carried nearly to term 36+w. That being said, I was on self-inflicted bed rest...I was so big and uncomfortable that I didn't do much except for lay on the couch and eat. The only reason I delivered early was because I complained of decreased fetal movement. I was feeling them less because quarters were so cramped. I was also just ready to be done.
Weight gain- I went overboard with gaining weight, like 70lbs. She's right, I can't take off the weight, I'm about 40lbs over my starting weight, and I was just too sleep=deprived to have a workout regimen. That being said, my babies were quite large for their gestational age. Most babies around 36 w have been a little under 6lbs, and mine were about 6.8 each. So did my extra calorie intake help with them to be high-weight babies, maybe? or maybe I'm just genetically inclined to make larger babies. Theoretically, if they had been in there another 4 weeks, they could have each 8-9lbs each.
My OB told me more than once that bedrest wasn't proven to help anything, but she told me to take it easy when needed.
and, I've been vocal on here that i think Dr Lukes weight guidelines are nuts
I agree with all of this. My OBs all said basically the same thing about bed rest.
Dr. Luke's guidelines are backed up with research for the most part--more so than other guidelines I've found for multiple pregnancies (at least as of the time I was pregnant, which was 3+ years ago now) so I felt comfortable following hers. If the dr has other research that points to gaining more than 35 lbs causing problems I'd be interested to see it, but Dr. Luke's latest research was 37-54 lbs for twins if you start out pregnancy normal weight and that weight gain is associated with good outcomes. And logically, it doesn't make sense that you'd need 25-35 lbs for a singleton and only 35 for twins considering the weight of the second baby, second amniotic sac and fluid, second placenta, etc.
robinsokj, do you have reliable research/links to back up your belief that Dr. Luke's weight gain guidelines are "nuts"? If so, I'd be interested in seeing them.
Also, OP, I think "expecting" to work till 37w in a twin pregnancy is nuts. There are some MoMs who do it with no problems but I was incredibly uncomfortable by that point. I would have had a difficult time working full-time even by 30w. I agree that those things are really determined on a case by case basis and depend on the type of work you do as well as your health, how the pregnancy is going, any complications, etc.
Both of those issues are very individual issues. For example, I was overweight to begin with, so there was no need for me to gain 50 pounds. Someone who is average weight/underweight would need to put on more then me. Up until a month ago my girls always measured right around the 50th percentile even though up until that point I had gained 15 pounds. Now they're in a lower percentile, but I've put on over a pound a week since then - they're just bigger and have less room to grow and I was told that it's not unusual for twins to gain less at the end then singletons. At my 34 week u/s they were 4lbs 13oz and 4lbs 14oz, so even though I'm only up 20 pounds they've grown well.
As far as bed rest, my OB told me that it's not their policy to put women pregnant with multiples on bed rest no matter what at a certain point. I had read on here that some doctors told people that they'll be out by 24 weeks, so I wondered if she would do the same. Of course at 26 weeks my cervix shortened, so I was pulled out anyway. In the past two weeks I've developed blood pressure issues and there's a concern of Pre-e. A big issue is the position of my babies - when I lay on my back or sit or stand the way that makes them positioned compresses my blood vessels and makes my BP shoot up. As soon as I lay on my side it goes down. Obviously that means I couldn't work.
Personally I wouldn't be concerned with the answers, although it would be better if they said "we'll see how things progress with your pregnancy". With your weight, if they measure on track and you don't gain a lot, great! If they measure small, then try to increase your weight gain. With bed rest, I'd be happy that your OB takes the approach of not assuming you'll go on bed rest. If you have specific issues that arise and you're concerned about her approach, then go from there, but I think it's good to hope for the best.