Do you recommend an OB and a Perinatal Dr?

April+

I am pregnant with twins and although I have not had any sign of potential complications would you recommend that I stick with my OB but also see a Perinatal Dr? I see some people that are seeing both at the same time and would like to do what is best from the beginning. The hospital that my OB delivers at also does not have an NICU but it is the closest hospital to me. The Perinatal that I am thinking of seeing does work in a hospital that has an NICU. What would you do? I am new to pregnancy and multiples for that matter, so I want to make sure I do things right. 

Rynleigh

Since we're low-risk for our twins, our OB wants us to begin seeing our perinatologist soon after our A/S, around 20-24 weeks. If my cyst growth seems to continue, that might happen sooner. We'll see. I'll also start seeing a midwife around the same time, and my OB probably won't see me so much after week 24 until after birth & delivery for my postpartum visits. 

honeybee72

The answer to this can also depend on the amount of experience your regular OB has with multiples as well as the type of equipment they have. My regular OB group has a lot of twins (based on what the last doc I saw told me), but they also refer most of them out to the perinatologist group for regular monitoring. One of the reasons is that their ultrasound equipment is *very* basic and would not really be suitable for the detailed growth scans the perinatologist does.

Not all OB's believe twins are automatically a high risk, especially if they are di/di. Yes, there is still a higher risk of complications, but your OB may feel they can monitor for some of those issues and only refer as necessary. You should talk with your regular OB about how they manage the care in a multiple pregnancy.

Personally, of course I want the best care for myself and my babies, but I also don't believe in worrying where there isn't reason to.

jessican08

I would personally not be comfortable delivering at a hospital with no NICU. It would suck to deliver early and have your babies transported to a different hospital and not be able to see them while you were there.

Regarding the peri/MFM in addition to the OB - I would see one. As the saying goes, everything goes fine until it doesn't. An MFM just gives you that added level of expertise with a riskier PG.

GL!

April+

Thank you all for your input. I think I would feel more comfortable seeing both and since my insurance allows me to choose my own providers I will probably make an appointment to see an MFM in addition to my OB. Does anyone know if I would be able to transfer my care to another hospital if my twins were delivered early? I know they would have to be transfered to a hospital with an NICU but would I be able to transfer my care as well so that I could be with them?

Ourfamilyof5

I have di/di twins so I'm not considered to be quite as high risk as some of the other ladies on this board. I'm completely comfortable with the care my OB is giving me and she's extremely knowledgeable on pregnancy with multiples. That being said, she's had me seeing an MFM since 14 weeks (I've seen him twice now at 14 and 20 weeks and will see him again at 24 weeks and 28) due to a very big size discrepancy between my twins. My extremely small baby has caught up in size and is now on track, but that's the reason why I was initially sent to an MFM. I'm not sure if I would have been regardless, but my does OB seems to like working alongside the MFM for multiples...so maybe so.

I wouldn't personally be comfortable delivering my twins at a hospital with no NICU. I know a lot of twins don't get any NICU time at all, but I've seen and read that far too many DO get it, even if only for a few days. I just wouldn't want to take a chance on being in a different hospital and away from my babies if I had an option to choose another hospital!  

turtle_1278

I started seeing an MFM at 21 weeks after my a/s.  We moved and my new ob sent me straight there.  My first ob was not going to send me to one and I was uncomfortable with that.  I had no complications until I unexpectedly went into labor at 35 weeks.  And I had made sure when we moved I was going to deliver at a hospital with the highest level NICU in my area.  I'm glad I did since my girls were in the NICU for 18 and 20 days and my one little girl was level 3 for the first 4 days due to needing a little help breathing!  Hopefully you won't need any of that but I would cover all my bases just in case!

jessican08

April+:

Does anyone know if I would be able to transfer my care to another hospital if my twins were delivered early? I know they would have to be transfered to a hospital with an NICU but would I be able to transfer my care as well so that I could be with them?

Someone correct me if I'm wrong but I think most hospitals and insurance providers would not approve a transfer for you unless there was a medical necessity for it. You would need to wait until you're discharged from your hospital before you could visit the babies in the NICU at whichever hospital they were transferred to. 

Ruthie04

April+:

Does anyone know if I would be able to transfer my care to another hospital if my twins were delivered early? I know they would have to be transfered to a hospital with an NICU but would I be able to transfer my care as well so that I could be with them?

Previously, I worked in the case management department of a large hospital...meaning, we were often responsible for patient transports. In cases of hospitalizations during pregnancy, the patient was sometimes transferred to a hospital with a NICU that could accommodate the baby's gestational age/needs. In instances where the baby had already been born, the mother would remain at the delivering hospital, while the baby was transported by ambulance/helicopter to a hospital with a high level NICU. I once had to arrange a patient transport with a mother in pre-term labor and it was a total NIGHTMARE!! We were terrified she would deliver a pre-term infant in rush hour. I don't know if this is how it works everywhere, but that was my experience.

With that being said, I would do everything I could to get my care at a hospital with a NICU. On our way to the hospital, we pass two other hospitals, both with small NICUs. However, we opted to see the MFM and OB at the hospital with the high level NICU. I was not automatically referred to the MFM, but requested to have my ultrasounds at their practice. I just want to be at a facility that can handle any type of emergency. 

leapgirl8

The other option is to find an MFM who delivers, so you don't have to see both. We found out it was twins when we were still under an RE's care and transferred care to an MFM. Never had an OB.

bearfootz

My OB had plenty of experience with twins and did an u/s at each visit, but still had me see an MFM in addition to regular appointments with him.  The MFM's did not do deliveries though and were based out of another hosiptal with rotating office hours at my hospital. 

I would confirm with your hospital what their policy is.  I was fortunate to have a level III NICU at my hospital, but if they had needed care beyond what could be provided there they would have been transferred while I stayed there.  I am currently seeing a new ob that delivers out of a different hospital and she said if they anticipate an early delivery you are sent to another hospital w/ nicu for delivery to avoid being seperated. 

Good luck to you!

turtle_1278

jessican08:

April+:

Does anyone know if I would be able to transfer my care to another hospital if my twins were delivered early? I know they would have to be transfered to a hospital with an NICU but would I be able to transfer my care as well so that I could be with them?

Someone correct me if I'm wrong but I think most hospitals and insurance providers would not approve a transfer for you unless there was a medical necessity for it. You would need to wait until you're discharged from your hospital before you could visit the babies in the NICU at whichever hospital they were transferred to. 

 

^^This.  I met a mom who this happened to while our girls were in the level 3 NICU.  I felt awful for her because she had been separated from her baby until discharge.  With multiples you never know what might happen so it's best to be prepared just in case!

JenLC99

I saw an OB but had a peri doing my regular ultrasounds.  The peri did the ultrasounds at my OB's office so it was perfect for me; I didn't have to go anywhere extra for my ultrasounds and NSTs, and because a peri was reviewing my results he was familiar with multiple pregnancies and the warning signs of something going wrong.  In my case all was perfect and I was induced at 38 weeks (my request), no complications whatsoever.