OB question/vent

Wishing35

I go to a regular OB office and initially I was very happy with them but I'm starting to feel nervous about the care getting. I'm 31 weeks and they have me coming in now every two weeks for the basic urine, weight and heartbeat check. The last time I had an US was at 29 weeks at the MFM office, I only went there for ultra sounds no consults or anything,they said since my cervix was great I could stop the bi weekly ultrasounds there.
I asked at my last appointment at the OB when I would have another ultrasound and it was like she hasn't even thought about it, when she went to check with the doppler I had to remind her that I'm having twins as well. There has been no mention of NST checks or more frequent appointments or growth checks either. They don't measure my fundal height, and I know it's not accurate but if they don't check that or give me more frequent ultrasounds then how do I know the babies are both gaining and doing well? I feel like everything I read other twin moms are more tested and seen more frequently, it's starting to worry me. Also the OB says I'm not considered high risk either, I thought all twin pregnancies where considered high risk because of the possibility of pre term labor?
I plan on seeing another dr at the practice next visit and asking about the NST's etc. but Im having a bad feeling about all this. Am I crazy and thinking too much into all this?

CNYBride05

That was a little hard to read with no paragraphs.

Your OB is right - not all twin pregnancies are high risk.  Many, in fact, are not.  

If everything looks good, there is no medical reason to do additional testing.  In healthy singleton pregnancies, some women have 1 or 0 u/s.  I was on hospital bed rest and have still never had an NST, if that makes you feel better.  Fundal height is a non-helpful measurement with twins for the most part.  It can be stressful to read/hear of others' high-risk pregnancies and wonder if you are getting adequate care and I suppose it's possible that you aren't, but I think, in general, OBs and MFMs have seen this stuff enough to know what to look for.

But if you are concerned, ask your OB about all of these things - you are paying for a service. 

SWA80

I would not like having to remind the doc that I was carrying twins, can't really speak to the rest since my twins need extra monitoring.

mamatotwins0812

I can say that I 100% understand your concern, bc I had the same ones. But what I can tell you is that I had the same situation, which makes me believe its normal. I was going to a high risk specialist (bc of issues with baby b) and the care and attention I got there was dramatically different from my ob's office.  In fact I think I only had 1 u/s at my ob office the whole time and that's bc I insisted. They were much more casual about everything. I do think that if they were concerned they would do the additional tests/scans etc but for your sanity I would just count on having the more detailed care done by the MFN and the more "routine" stuff for the ob. It took me a while to realize that the ob's job is to check you out and deliver the babies. The other more detailed stuff is done by the MFN, at least in my experience. Try not to worry too much although I know that's hard . 

Wishing35

mamatotwins0812:

I can say that I 100 understand your concern, bc I had the same ones. But what I can tell you is that I had the same situation, which makes me believe its normal. I was going to a high risk specialist bc of issues with baby b and the care and attention I got there was dramatically different from my ob's office. nbsp;In fact I think I only had 1 u/s at my ob office the whole time and that's bc I insisted. They were much more casual about everything. I do think that if they were concerned they would do the additional tests/scans etc but for your sanity I would just count on having the more detailed care done by the MFN and the more "routine" stuff for the ob. It took me a while to realize that the ob's job is to check you out and deliver the babies. The other more detailed stuff is done by the MFN, at least in my experience. Try not to worry too much although I know that's hard :.nbsp;

Thanks, I think I'm reading too much online and it's freaking me out a bit. My OB will not send me back to the MFM unless there is a problem.I'm thankful right now that things are going so well, I just wish I felt more like they knew me when I go there.I don't like having to remind them that it's twins ,it makes me feel like if they are not paying attention to this then what else are they forgetting? Next visit I'm going to make them take some time and explain to me how the rest of my pregnancy is going to be handled so I have a clearer picture.

BabyCarryingVessel

Your prenatal care sounds identical to mine. I also wondered why so many on this board were getting ultrasounds and weekly NSTs. When I asked the OB, she said "why would we do that?"

Anyway, I think your care is fairly standard for an OB office. I understand your worry, but take it as a good sign! I started getting weekly appointments and nsts around 34 weeks. My bp starting elevating around 35 weeks and then I started going in twice weekly. They were excellent and gave me great care. Worry not, but always ask questions and express your concerns, especially if you feel something is off. GL!!

CNYBride05

MrsLee04:

All twin pgs are high risk. I repeat....ALL.

I disagree with this statement and have had multiple conversations with providers in a variety of arenas/disciplines (midwifery, MDs, NPs, etc).  I think it's important for all pregnancies to be as normalized as possible.  Multiples pregnancies are more likely to be or become high risk. But simply carrying more than 1 fetus is not innately high risk. 

ktjruss03

CNYBride05:

MrsLee04:

All twin pgs are high risk. I repeat....ALL.

I disagree with this statement and have had multiple conversations with providers in a variety of arenas/disciplines (midwifery, MDs, NPs, etc).  I think it's important for all pregnancies to be as normalized as possible.  Multiples pregnancies are more likely to be or become high risk. But simply carrying more than 1 fetus is not innately high risk. 

While I agree to some extent, if shouldn't be treated as just an average pregnancy either. It also depends what type if twins you are carrying. In general Di Di twins are lower risk and don't automatically need more monitoring. That being said you should still have at least a growth ultrasound every 4 weeks. My Ob office doesn't do NST unless there is a reason for it.

Wishing35

CNYBride05:

MrsLee04:

All twin pgs are high risk. I repeat....ALL.

I disagree with this statement and have had multiple conversations with providers in a variety of arenas/disciplines (midwifery, MDs, NPs, etc).  I think it's important for all pregnancies to be as normalized as possible.  Multiples pregnancies are more likely to be or become high risk. But simply carrying more than 1 fetus is not innately high risk. 

I always thought high risk meant something was more likely to go wrong, not necessarily that there were already complications. I guess it doesn't really matter so much being labeled that way ,as long as I'm being watched carefully and different than a singleton pregnancy.

.

Mrs.Guz

I'm pregnant with di/di twins and was automatically referred to an MFM who I see as frequently as the OB. My OB doesn't do anything different from a singleton pregnancy aside from checking for 2 heartbeats and she doesn't measure me. Otherwise I get the exact same treatment as I did with a singleton pregnancy.

I've had no issues, that would put in the "high risk" category, but having regular ultrasounds, we were able to catch that baby A isn't growing at the rate she should or has been so we have to monitor her extra closely.

I would talk to your OB about your concerns. You need to feel confident that you are getting adequate treatment.

pillowass

CNYBride05:

MrsLee04:

All twin pgs are high risk. I repeat....ALL.

I disagree with this statement and have had multiple conversations with providers in a variety of arenas/disciplines (midwifery, MDs, NPs, etc).  I think it's important for all pregnancies to be as normalized as possible.  Multiples pregnancies are more likely to be or become high risk. But simply carrying more than 1 fetus is not innately high risk. 

Actually, carrying more than 1 baby puts you at much higher risk for pretty much every complication and poor outcome imaginable. I would run from any provider who tried to "normalize" my twin pregnancy. Increased monitoring of twin pregnancies (which is what happens when you are classified as high risk) improves outcomes for moms and babies. True, most twins end up doing just fine, but we don't assess risk in retrospect.

OP, I would also be pretty freaked out if I had to remind my OB that I was having twins. I would see if you could circle back with your MFM just to make sure you are being properly monitored. FWIW, after 30 weeks, I was having ultrasounds every 2-3 weeks to monitor growth. I didn't have a NST until 36 weeks but my MFM would have ordered them if anything of concern came up on the ultrasound.

Mrs. Alice

MrsLee04:

All twin pgs are high risk. I repeat....ALL. If you look up the definition of high risk pg you will see that clearly, and every experienced MFM will tell you as such (you cannot rely on OBs for an accurate answer on this one). I agree you should be seen more often at this point, but fundal checks are worthless. I also didn't have NSTs. But I saw my OB and MFM frequently at that point and had scans done by both each time I went.

 I agree.  It makes kind of makes me cringe when I hear the attitude that just an extra baby is no big deal or no higher risk.  I would personally feel very uncomfortable with an OB who followed this type of care.  While not every multiple pregnancy is complicated, everyone is high risk which simply means there is a higher likely hood of issues arising and should require some extra monitoring.  Average twin gestation and birth weight is 35 weeks and 5ish lbs, compare that with a singleton.  Obviously a big difference between the two.

CNYBride05

MrsLee04:

CNYBride05:

MrsLee04:

All twin pgs are high risk. I repeat....ALL.

I disagree with this statement and have had multiple conversations with providers in a variety of arenas/disciplines (midwifery, MDs, NPs, etc).  I think it's important for all pregnancies to be as normalized as possible.  Multiples pregnancies are more likely to be or become high risk. But simply carrying more than 1 fetus is not innately high risk. 

You can disagree all you want.  You're still wrong.

Really?!  Where did you get your medical degree?

People wear high risk like a badge of honor or something to be excited about.  

As I said before, "multiples pregnancies are more likely to be or become high risk. But simply carrying more than 1 fetus is not innately high risk."

kolabola29

In case this is helpful to you, my ob is very cautious and risk-averse, and I do not get NSTs (although I do get bi-weekly growth scans and have since 32 weeks).  At a recent appointment, we had a long conversation about NSTs, which he was not recommending for me, but he knows I'm a researcher, so he wanted to make clear why he wasn't recommending it. And he said he had once again reviewed ACOG's guidelines and recommendations and confirmed that they don't recommend them when they are not otherwise medically indicated. (They don't recommend NOT doing it or don't frown upon it I don't think, it's just not an affirmative recommendation.) Here's the info I could find: 

Indications for Antepartum Fetal Surveillance (which include NSTs)

The results of antepartum fetal surveillance have not definitively demonstrated improved perinatal outcome. Therefore, all indications for antepartum testing should be considered somewhat relative. Usually, antepartum fetal surveillance is used in pregnancies with a high risk of antepartum fetal death. Some of the conditions in which testing is appropriate include the following:

Maternal conditions: antiphospholipid syndrome, poorly controlled hyperthyroidism, hemoglobinopathies such as hemoglobin SS, SC or S-thalassemia, cyanotic heart disease, systemic lupus erythematosus, chronic renal disease, type 1 diabetes mellitus and hypertensive disorders.

Pregnancy-related conditions: pregnancy-induced hypertension, decreased fetal movement, oligohydramnios, polyhydramnios, intrauterine growth restriction, post-term pregnancy, moderate to severe isoimmunization, previous fetal demise (unexplained or recurrent risk) and multiple gestation with significant growth discrepancy.

https://www.aafp.org/afp/2000/0901/p1184.html 

katiebenes

Though twin pregnancies are "higher" risk they don't automatically go into the high risk category. (They just tend to require more monitoring which I guess technically can be seen as high risk)

I am not a high risk pregnancy. I am monitored more, but there isn't the full high risk for mine. 

 

The rest I'm not sure about. I am having weight, fundal height, blood pressure and heart rates every two weeks at this point, and currently I'm on monthly growth checks, they might switch me to every three weeks tomorrow at my appointment depending on my fundal height change.

Dragonfly1226

Here's the thing. Even if you are not high risk (we can leave that debate out of it) then it is still a part of your normal care to make sure that both babies are growing on track. The OB does this with a singleton pregnancy by measuring fundal height. However, this is an ineffective way of measuring growth for both babies in a twin pregnancy since one baby could be doing all the growing. When you measure fundal height you belly cannot distinguish the growth of each baby. For that reason, you should be having periodic growth scans. I had them every four weeks once I hit 24 weeks, every two weeks once I hit 30 weeks, and every week once I hit 34 weeks. With twins, once you reach the end there is a higher risk for one or both babies to go into distress so it is also reasonable to expect periodic BPPs or NSTs. I had BPPs done at the same time as the growth scans. This was all done by my OB as part of my basic care. I never saw a MFM since I was pregnant with di/di twins and no complications arose during any of these tests. I give a huge side eye to any doctor who is not planning to do more frequent u/s towards the end of a twin pregnancy. You are right to question the level of care you are receiving.

PumpkinAndThePeanut

My twins were di di. I had many of the same concerns as I entered my third trimester. My OB never forgot I was carrying twins, but her office did originally schedule my appointments as if I was having a singleton and when I mentioned to her that I found it odd I wasn't starting weekly appointments until 36 weeks, she said I should actually start that at 34 weeks and had me schedule an additional appointment.

I asked her about NSTs and BPPs because it seemed from this board and the books I had read that these were the norm. She said we would only do those if a reason for them came up, ie., if a complication arose, and one never did.

As for ultrasounds, my OB never actually ordered one, besides my AS. I had several early ones done by my RE before I was released to the OB, and I also participated in a twin fetal growth study where I had monthly 3D ultrasounds done and the reports were sent over to my OB so she could review them. I'm not sure how many we would have done had I not been getting them through the study, but I know she wouldn't have had them done monthly. I would think you should get at least one growth scan around 34 or 36 weeks though, assuming your twins are di di and your pregnancy remains complication free.

I guess my situation is a bit unique with the growth study scans I got, but if your twins are di di and you have no complications, I see no reason for you to see an MFM or have NSTs or BPPs.

Wishing35

Dragonfly1226:

Here's the thing. Even if you are not high risk we can leave that debate out of it then it is still a part of your normal care to make sure that both babies are growing on track. The OB does this with a singleton pregnancy by measuring fundal height. However, this is an ineffective way of measuring growth for both babies in a twin pregnancy since one baby could be doing all the growing. When you measure fundal height you belly cannot distinguish the growth of each baby. For that reason, you should be having periodic growth scans. I had them every four weeks once I hit 24 weeks, every two weeks once I hit 30 weeks, and every week once I hit 34 weeks. With twins, once you reach the end there is a higher risk for one or both babies to go into distress so it is also reasonable to expect periodic BPPs or NSTs. I had BPPs done at the same time as the growth scans. This was all done by my OB as part of my basic care. I never saw a MFM since I was pregnant with di/di twins and no complications arose during any of these tests. I give a huge side eye to any doctor who is not planning to do more frequent u/s towards the end of a twin pregnancy. You are right to question the level of care you are receiving.

Thanks, this sums up all my concerns. Im going to call today and switch my appointment to a different doctor in the
practice and discuss everything.

Jen0204

MrsLee04:

The same place you did.

I wasn't excited about being high risk.  It's just a classification of a pg.  It meant "extra care necessary."  Who argues with extra care?  

You don't "become high risk."  You might develop complications, but there is a difference between having complications and being high risk.  High risk is just risk (one might develop complications).  Having complications means you have them.  High risk means you're at risk to develop them, but not necessarily.  As with all twin pgs, I was high risk, yet made it to delivery without complications. 

I think you have a real issue understanding the definition of high risk, and also take some odd offense to it.  It's not.a.big.deal.

I agree with this.  As much as I would have loved to have a "normal" pregnancy that just wasn't in the cards for me since I had two babies in there, which is inherently not normal.  Being high risk doesn't mean that there's anything wrong or that you have complications, it's just a designation that means you need to have a really close eye kept on you.  There are just certain things that automatically place you in that category - if you're over a certain age, have certain medical conditions, are pregnant with multiples.  How doctors choose to handle you being high risk is open for debate - some doctors even go so far as requiring bed rest at a certain point in the pregnancy regardless of if there are issues, other doctors don't do extra u/s or any NSTs unless a problem presents itself and treat it like they would any other pregnancy - but whether or not you're high risk really isn't.  

I, for one, am thrilled that I had tons of extra u/s and monitoring.  I developed really high BP around 32 weeks and my OB said that I would be delivering soon.  She actually wanted me to deliver then but my MFM said no way because I had no protein in my urine collection.  Every week they would argue about delivering me, with my bed rest getting stricter and stricter (my BP would only stay at an acceptable level if I laid down on my left side).  I delivered at 36 weeks.  My babies were kept in for an extra FOUR weeks and only had a 9 day NICU stay because my MFM fought to keep them in longer.  If my OB was my only doctor I would have delivered at 32 weeks and they would have had a much longer NICU stay.  And if she was the only one that I was seeing I wouldn't have thought twice about it and would have assumed that delivering them was necessary. 

Ourfamilyof5

OP - I did not have weekly NSTs, but did have weekly BPPs starting at 35 weeks. At 36 weeks it was determined (through an u/s) that my baby B's fluid had dropped to less than half of her brother's and I was sent to L&D right away to get labor going. I delivered them a few hours later. We wouldn't have known that her fluid level was low without my weekly u/s so I recommend requesting at least one more. 

 Aside from that, I felt fine, was measuring on fine and had no other complications.

 GL! 

starrkitten89

Jen0204:

MrsLee04:

The same place you did.

I wasn't excited about being high risk.  It's just a classification of a pg.  It meant "extra care necessary."  Who argues with extra care?  

You don't "become high risk."  You might develop complications, but there is a difference between having complications and being high risk.  High risk is just risk (one might develop complications).  Having complications means you have them.  High risk means you're at risk to develop them, but not necessarily.  As with all twin pgs, I was high risk, yet made it to delivery without complications. 

I think you have a real issue understanding the definition of high risk, and also take some odd offense to it.  It's not.a.big.deal.

I agree with this.  As much as I would have loved to have a "normal" pregnancy that just wasn't in the cards for me since I had two babies in there, which is inherently not normal.  Being high risk doesn't mean that there's anything wrong or that you have complications, it's just a designation that means you need to have a really close eye kept on you.  There are just certain things that automatically place you in that category - if you're over a certain age, have certain medical conditions, are pregnant with multiples.  How doctors choose to handle you being high risk is open for debate - some doctors even go so far as requiring bed rest at a certain point in the pregnancy regardless of if there are issues, other doctors don't do extra u/s or any NSTs unless a problem presents itself and treat it like they would any other pregnancy - but whether or not you're high risk really isn't.  

I, for one, am thrilled that I had tons of extra u/s and monitoring.  I developed really high BP around 32 weeks and my OB said that I would be delivering soon.  She actually wanted me to deliver then but my MFM said no way because I had no protein in my urine collection.  Every week they would argue about delivering me, with my bed rest getting stricter and stricter (my BP would only stay at an acceptable level if I laid down on my left side).  I delivered at 36 weeks.  My babies were kept in for an extra FOUR weeks and only had a 9 day NICU stay because my MFM fought to keep them in longer.  If my OB was my only doctor I would have delivered at 32 weeks and they would have had a much longer NICU stay.  And if she was the only one that I was seeing I wouldn't have thought twice about it and would have assumed that delivering them was necessary. 

I agree with both, and this experience was very similar to mine, except we were lucky to not have a NICU stay. I would be really concerned if I had to remind my doctor I was carrying multiples. there is nothing wrong with extra monitoring.

Cleo421

yes, carrying more than one fetus does make you inherently high risk. Again, the word risk means just that; that you are more likely to develop complications. Pp's notion that you only become high risk after developing complications is incorrect.

Think of it in actuarial sciences terms. Teenagers have higher premiums for auto insurance just because they are an inherently high risk group. And while most teens will not get into a car wreck, their chances of doing so are much higher than those of the general population and thus they're labelled high risk.

Analogies aside, I can't speak to the quote many conversations a pp has had with multiple providers from various disciplines, but any authority on multiple gestations will tell you they're considered high risk. Please don't conflate high RISK for complications with high complications. Tons of multiple gestation pregnancies occur without incident.

hnharden

I believe that since you have had to remind your OB that you were carrying twins that you have absolutely every right to be concerned. I would be fuming!  

On the whole 'high risk 'issue. I'm 16w with twins and  my midwife and other staff have told me that having twins I am at a higher risk for every complication except going over-due. Not that it doesn't happen, it's just not the 'norm' in twin pregnancies. I go to the high risk specialist next Thursday for my inital appt.