Regular OB or High Risk with twins?

cbj

 

Now that I am out of my first trimester (I am 15 weeks) I have been doing more research on Pregnancy with Twins.  I was scared to before this.  I love my OB practice and they were great with my DD.  The hospital I delivered at is only a few minutes from my house and I love the staff there.  That being said, I am nervous because there is no NICU there.  It is the only hospital that my OB delivers at. 

In my research I have read from several sources that with multiples your OB should see you ever 2-3weeks instead of every 4 weeks like a singleton pregnancy.  This has not been the case at my OB thus far.  Also I have read that Ultrasounds should be done regularly.  I have only had one to confirm pregnancy at 7 weeks and then one at 8 weeks when I have some spotting.  The next ultra sound that they are planning to do is at 20weeks.  All of this is making me a little nervous.  I am 36 so labeled advanced maternal age and high risk because of that along with the twins and have a history of GD. 

 My gut is telling me I should find an OB that specializes in high risk and delivers at a hospital that has a NICU just incase.  It will not be as convenient for us as the closest hospital is 45min away but I think if for nothing other than my peace of mind that is what we should do.

Any thoughts?

Sorry for the novel and thank you if you have made it this far.

LadyNikon

I see my high risk doc about every 4 to 6 weeks.  I see an OB or NP every two weeks.  The smaller appts are checking the heart beats and my overall health. I don't see my high risk doc again until July 17th for the AS scan of the twins.  

chickaboo1974

I was labeled AMA too, and my boys were di di.  I saw my OB very frequently- like every 2 weeksstarting at 7 weeks- until 28 weeks when it was every week, and I saw a MFM every 2 weeks after my NT scan at 12 weeks (complete with ultrasounds and cervical length checks).  My OB and MFM co-managed my pregnancy- I did end up developing pre-e and delivered early- my OB delivered me. 

ColleenS629

My only high-risk factor was that I was having twins. I saw my OB every 4 weeks up until 22 weeks, then ever 2 weeks until 32 weeks, then twice a week (that's when my complications were discovered). I saw my MFM every 4 weeks from 12w-32w when I started going every 2 weeks because of my complications. Some people will tell you that an OB is all you need with di/di twins, but that's because their pregnancies went smoothly. My OB has delivered many twins, but she did an u/s and said they looked great just days before my MFM noticed that Baby A's growth had slowed significantly and their growth discordance had become significant. If I had not been seeing my MFM, this would have gone undiscovered. That said, many MoMs do see only an OB and are just fine, but there are also many MoMs that need to see an MFM. IMO, an MFM is necessary. Obviously, it's your decision, though.

emilyec1

I saw my OB every 4 weeks up until the 3rd trimester, but I saw MFM every 2 weeks as well for an u/s. Has your OB talked to you about seeing an MFM as well? I started seeing mine around 16 weeks or so.

cbj

Thank you for all the responses.  I am new to this so I am sure what di/di and mono/di stand for and couldn't find it in the bump glossary. 

I think that I am going to have a talk with my OB since I really like the practice and would like to go there for my annual check ups after my pregnancy. 

But going to an OBGYN the specializes in high risk and that delivers at a hospital that has a NICU will be best for our families peace of mind.  With all the stresses that come with pregnacy/parenthood anywhere I can find some peace of mind is good! 

nuttycoconut

I'd go for the high risk dr and the hospital with a NICU. You are right, peace of mind is priceless! My twins are di/di (separate placentas and sacs). It is the least risky for a twin pregnancy but I'm still considered high risk. 

Eriksgal

Have you asked your ob if they have privileges at any other hospital with a nicu?  I think at the beginning I saw my ob every two weeks I think twice after the pg was confirmed then I saw the ob and the MFM monthly until I got to 28 weeks or so then it was MFM one week and ob the next week.  It worked out well because I got lots of monitoring.

honeybee72

CBJ:

Thank you for all the responses.  I am new to this so I am sure what di/di and mono/di stand for and couldn't find it in the bump glossary. 

I had to look it up myself when I first started on the Multiples board. It refers to whether your twins share an amniotic sac and/or placenta. If your twins share a placenta, they are at a much higher risk for twin-to-twin-transfusion syndrome (TTTS) and for growth discordance. If they do not share a placenta, they do not risk TTTS, but there may still be growth discordance issues.

My OB/GYN has only very basic US capabilities, so (I believe) they even refer singletons out for anatomy scans. I will see them every 4 wks until ~26 wks, then every 2 wks. I see my MFM every 2 weeks for growth & cervical checks from 16 wks to 24 wks. Then they dial back to monthly until ~32 wks.

ShopperKristi

CBJ:

Thank you for all the responses.  I am new to this so I am sure what di/di and mono/di stand for and couldn't find it in the bump glossary.  

 This is not meant to come off as snarky at all but just the fact that your doc hasn't discussed di chorionic/di amniotic vs mono/mono etc with you is a red flag to me.  My doc explained all of this to us early on so I knew what that was right away.  I see an OB and will deliver at a hospital with no NICU (has a special care nursery) but my doc has delivered many sets of multiples.  I also had a u/s at every appointment but was going only every 4 weeks until recently and it was fine.  Go with your gut on this one.  If you would like a higher level of care I would switch without hesitation.

MelleTX

I am pregnant with twins and AMA but I am choosing not to see a MFM unless the need arises. 

I see my OB every 4 weeks until 24 weeks then it will be every two weeks. And I get a sonogram at every appointment.  My OB's practice has several OBs with tons of experience with high risk pregnancies and multiples. My OB is the mom of twins as well. 

She said they only require MFM referrals on IDs and trips or more. Fraternal twins are a case by case basis depending on the health and the amount of elective testing the mother chooses. I am doing no elective testing so unless I have a problem, I just see my OB.

I did however, also choose her because she is affiliated with the hospital with the best level IIIc NICU in the area.... just in case, I don't want to be separated from them. They also have a program where if the babies have to stay an extra week in the NICU, I can stay with them free of charge (excludes meals).

CER+MEL

When I was at your point and realizing that I might want to see an MFM, I called my OB's office to get a referral.  I saw one, he saw no need to see me again as things were going well, but I felt better hearing that from him.  Later in the pregnancy (don't remember when exactly--third tri, maybe?) my OB started sending me to the MFM's office for ultrasounds, which is the practice's policy for multiples. 

The hospital I delivered at was newly built, and the NICU wasn't equipped for babies born before 32 weeks (again, don't remember why--staffing, maybe?).  I did a hospital tour at another affiliated hospital that I would have gone to if, God forbid, I would have gone into PTL prior to that.  I even saved maps to both hospitals on my work computer in case I went into labor at work and someone had to drive me. 

I was glad I did my homework on all of that even though, thank goodness, it was all for nothing.

Mye

i went to the high risk and the reg OB once a month, until the last 2 month, then I went every two weeks to the reg OB