Hospital has no NICU...new OB seems clueless...so stressed.

breezyweezer · December 2014

Long story alert:

My first OB was horrible, I finally switched to a new one and my first appointment was today. I asked her if she would be monitoring me every two weeks beginning at 16 weeks (all the research I have read says that this is the best way to monitor for TTTS in a monochorionic pregnancy) and she said no because there is nothing they can do because they aren't viable until 20 weeks. That may be so, but there ARE things they can do. There is laser surgery for one thing. So it basically seems like if anything does go wrong they will not catch it and even if they did catch it wouldn't know what to do about it. I know I could be worrying for nothing but I am one of the types of people who likes to prepare for the worst case scenario. During the ultrasound I had to ask the tech to measure the babies to make sure they were the same size. All they were going to do was check the heartbeats. They didn't measure the fluid levels in each sac or anything.

I also asked her about the hospital she is affiliated with and wanted to know what level NICU they have, and they don't even have a NICU. I hate living in a small town. So there is only one more OB in town the I could even switch to, and he is affiliated with the SAME hospital. So this means I either A. Stay with this OB and just hope they don't come early and need NICU time, or B. Find a new Dr. which would mean driving God knows where..we can barely afford gas for my fiance to get to work as it is..

I'm probably overreacting, but it seems like with the great chance of twins coming early I at least need a hospital with a NICU.

kefttsc · December 2014

I'm sorry you're having troubles. I can only speak to the topic of fluid levels and my doctor didn't start measuring that until about 24-26 weeks.

carrotcake06 · December 2014

Couple of things as I was reading: viability is generally considered to be 24w, not 20w. Many OBs do HB checks w an ultrasound that don't include measuring the baby - that's called a growth scan. Most of the increased monitoring comes in the third tri; however, I do agree that there should be more frequent monitoring w a mono/di pg.

NICU: if you deliver before 32w or 34w, the babies will transported to a hospital w a high level NICU without you (most likely). If there is no special care nursery at all, that might be anytime before 37w. I'd want to understand that protocol.

breezyweezer · December 2014

Thank ya'll I need to educate myself a little better (apparently my OB does as well since she is the one who said they were viable at 20 weeks -_-)

Gonna just not stress. I trust that the MFM will know what they are doing and I see them in 3 weeks!

pillowass · December 2014

I was going to suggest at least a consult with a MFM but it looks like you have that covered. I would definitely talk to him/her about contingency planning. Good luck!

PinkinProvence · December 2014

You need to see an MFM. You also should really be planning to deliver at a hospital with a NICU even if it is further away from your home.

Good luck.

breezyweezer · December 2014

So then do I tell the MFM that I want them to deliver the babies? Because the closest hospital with a NICU is an hour and 15 minutes away. I have no problem driving, I'll drive across country if I have to. As I was calling around looking for a hospital with a NICU I got the lecture not to drop in on a hospital unexpected which isn't what I was planning on doing anyways..My question now is do I switch Dr.s to one affiliated with a hospital with a NICU or do I ask the MFM to do the delivery? Either way is going to mean driving over an hour and that is going to be rough with appointments every two weeks possibly and then eventually once a week more than likely. If I ask the MFM to do the delivery, what happens if they come early? Is it feasible to drive an hour and a half while you're in labor? Especially preterm labor? Can I stick with my regular OB for a while as long as everything is uncomplicated?

PinkinProvence · December 2014

You can call your MFM and see if it is a group that delivers. If they do, ask what hospital they have privileges and what level NICU is there. If the MFM does not deliver, I would ask for a recommendation for a ob who she works with frequently and who delivers in a hospital with a high level NICU.

The other alternative is just to go to the hospitals website, look up the MFM department and pick a doctor there. Then make your calls - not to the hospital but to the physician's office.

I only went to an MFM for my entire pregnancy. Never bothered with a regular OB. I traveled about 1 hour to my doctor even though there were closer hospitals (even ones with good NICUs) because this particular hospital had the best NICU.

When my water broke, we jumped in the car and left. I wish we would have waited, showered and gotten things together because we had plenty of time!

breezyweezer · December 2014

thank you @PinkinProvence that helps a lot

auntjessy · December 2014

You're not overreacting. I wouldn't go to an OB that didn't have delivery privileges at a hospital with a NICU. We live in a small town also, with no NICU and I spoke with a nurse at that nursery while I was choosing my OB. She said that if the babies came before 36 weeks, they'd be sent by ambulance to a hospital with a NICU (45 minutes away) and I'd have to remain there until I was discharged. No thank you. I went to a high-risk OB an hour away and I'm glad I did. My babies were born via emergency C-section at 34+1 - I was there for 5 days and my son was in the NICU for 6 more days. Totally worth the drive.

breezyweezer · December 2014

Thanks again.

I found a hospital that is a little over an hour away in Plano, TX. Now just to call and see if I can get in with any of the OB's affiliated with that hospital, and also make sure they take Oklahoma Medicaid.

Bigboneded · December 2014

I do live in a bigger city and my OB didn't really treat me as high risk, though I think I am.... but we are di/di. I will deliver at my DHs hospital, which is kind of a magnet for high risk. He actually goes to small towns to pick up moms that are HR and transport them to here for ongoing care ante partum. So that may be an option wherever you are if there are complications.
The 20 week rule, is kind of they will try to treat after 20 weeks, but not so much before that. The ER might call in an OB if you go see them at 20w 5 days, but not if you see them at 19w 5 days...
At 17 weeks I was seen by an ER doctor only who diagnosed "threatened abortion", sent me home, and told me to follow up with my OB. After 20 weeks, I might have been admitted for the same... that's the "we don't do anything before 20 weeks" deal. Not really viable, so much, but half baked and they will try to buy more time agter that. 24 weeks is "viable" maybe- about the earliest we've had success saving....
Good Luck, its pretty scary feeling like you don't have options.... I hope you are able to have a provider you are confident in! :-)

zazu13 · December 2014

breezyweezer said:

Long story alert:
it seems like with the great chance of twins coming early I at least need a hospital with a NICU.

Yes. You don't want to deliver (especially via C-sec) and then be separated from your babies because they need to be transferred and you aren't cleared for discharge. Even if you do your monitoring appointments locally, find a way to get set up to deliver at a hospital equipped for the potential arrival of preemies.

basil2 · December 2014

There's nothing wrong with delivering full term twins at a hospital without a NICU (Mine were born at 37.6 wks in a community hospital 10 minutes from home. I didn't miss the NICU experience and the location made it worlds easier for my husband to pick up our older child to visit.)
It sounds like a MFM consult is a good idea. I'd find out what the earliest point is for delivery at the local hospital (it was 35 weeks here) and know where to go prior to that (good questions for the MFM). But if you're otherwise comfortable with the local hospital, there's a lot to be said for keeping things less complicated and closer to home.

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Hospital has no NICU...new OB seems clueless...so stressed.

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