WHY did you decide to see a peri?

I know some women see a peri in addition to their OB, and some just see their OB. If you decided to see a peri too, what prompted you to make that decision? Did you have complications arise before you considered it? Did your OB immediately send you when you found out twins? Did you immediately decide when you found out twins?

I go in next week for my 12 week u/s. My BIG, BIG scare right now is VTS since one of the babies had a smaller sac. (I've posted about that before so I won't get into that here). But I'm also wondering if I should have gone to a peri immediately when I found out that I was pg with twins and one had less fluid. I also plan to discuss it with my OB next week but I would like to know what most women have done.

Do your peri and OB work together, in the same practice? Do they keep you on separate schedules and it is up to you to pass info back and forth? Did anyone drop their OB and only see a peri? For what reason?

Thanks ladies!!

ETA: Did you need a referral from your OB? Did anyone's OB disagree with them needing to see a peri?

 

I only saw a peri--As soon as I found out it was twins, I decided to do that. I did not need a referral, but they did ask me why I was high risk before they gave me the appointment. And it was the best decision I ever made because my DS developed IUGR and lowish fluid and I was hospitalized. It was 10,000 times easier for me to be hospitalized at my "home hospital" with docs I knew than for other women who were transported in from their local docs. And I'm not sure a regular OB would have recognized DS's problem as quickly and been so aggressive about ordering bedrest. DS is napping in his pack-n-play right now but the outcome could have been very different had I not been monitored so closely and under the care of docs experience with high risk pregnancies.

So, I would encourage everyone pregnant with twins to see a peri. Hopefully, you won't have any complications, but better to be safe than sorry.

 

My OB recommended I see a peri once we found out it was twins, that was the only reason. I was not high risk for any other reason other than having twins. One nice thing too is with the peri, my insurance covered an u/s at every visit. :good: They would only cover one with a regular OB.

 

I decided to see a peri as my primary doc even before I knew I was having twins b/c I had PTL with my ds. One of the most important things to me (as others mentioned) was delivering in a hospital with a high-level NICU so that I could be with my baby/babies if they were born too early. I miss my reg OB b/c he's a great doc...but I'm so happy I'm with a specialist, as my pregnancy has already been plagued with complications.

 

My OB seemed pretty lax about us only seeing her until she found out that they are sharing a placenta and then she got us set up right away. I have my first appointment with them next week!

 

Thanks for your answers ladies! They are very helpful. One more though, how long did it take to actually get in to see the Peri? Is this something that is scheduled a few weeks in advance? If at my appointment next week my OB wants me to see a peri, will I have to wait long until I can get in?

 

My first pregnancy was a singleton (originally a VTS - but not preventable), and I delivered at 35 weeks due to HELLP syndrome. When I became pregnant this time with twins, I saw my original OB, and that appointment just did not give me the feeling that I was going to get the attention I needed. I sought out the peri team that actually diagnosed my HELLP the first time, and they agreed to see me exclusively, so I don't see a normal OB at all - instead a team of three peri's. Hands down I am so happy I went that route. It cost me a tad more but so worth it. They have been extremely proactive about everything, and they know my medical history in and out.

As far as seeing a peri for VTS, I don't think that will change anything. VTS is extremely common and happens to most women before they even know they have twins. However, any pregnancy with multiples is a high risk one, and I believe warrants periodic reviews with a peri, even if it's in conjunction with your OB.

You may or may not find that your OB and peri don't always communicate or agree on everything. Or you could find they work wonderfully together. But my advice is be your own advocate. These are your babies, and your own personal health. Choose the option that is going to help you sleep at night, and feel like you're doing everything you can...

Good luck!

 

I just met my peri for the first time last week and asked her that I wanted to deliver at her hospital because of the NICU. I was only able to get into see my peri with the referral from my OB. He referred me and I will no longer see my OB due to my decision. There is no NICU at that hospital and he wasn't going to monitor me as closely as the peri will. It took me three weeks to get into my peri due to the high volume of patients the practice sees. If your appt. isn't until next week you could phone your OB's office and ask for them to refer you to a peri. Maybe that will jump start you getting into the peri instead of waiting til your next appt. That is what I decided to do b/c I really wanted to get into the peri ASAP. I have a history of PTL with my first two pregnancies and that keeps me quite anxious with this twin pregnancy. I feel so much better now that I solely see the peri and I will get more ultrasounds!!! Good luck on finding the right team for you!

 

My OB sent me to a peri because the OB's office didn't do u/s. But, I'm glad he did.

Chances are, I'm one of the crunchiest ladies here. I had my twins at home at 39 weeks. But one of the reasons I could feel confident to do so, was I saw my OBs and peri until 37 weeks. If you need a peri, you'll have one. If you don't, you'll have the confidence boost of knowing you don't. I believe that many, maybe most twin pregnancies are normal and healthy. But there are a lot of different scenarios which can arise, and it's worth getting the best care you can.

FWIW - here's my care - di-di twins discovered via routine u/s at 19 weeks. At that point I stayed on normal OB appointment schedule, but also saw my peri once every 4 weeks. The two offices communicated without my help.

Congrats and good luck!

 

My OB sent me to a peri for the 12w nuchal scan and the 20w ultrasound, but those were the only times I saw him. I felt better knowing that a peri had at least looked at me, and that I knew where I would go if any problems developed. But none ever did.

My OB was affiliated with a hospital that had a NICU for babies over 30 weeks (I forget what level that is). I know you can never really know if you will have PTL, but since I wasn't at any particular risk, we just made contingency plans in case I did go early, but planned for a fairly normal twin delivery at the OB's regular hospital.

My peri and OB sent my records back and forth to each other, but other than that I don't think they really communicated. There wasn't really any disagreement between them, except that my OB thought I was gaining a bit too much weight and my peri said not to worry about it. :good:

 

I am 14 weeks pregnant with twins and my OB said that I needed to see a peri for all my ultrasounds (which I have every four weeks right now). My OB referred me to a particular peri that their office works with and they correspond pretty well with eachother. I got right into the peri's office, I did not have to wait at all. I see my OB every 4 weeks and the peri every 4 weeks.

 

My OB specializes in high risk pregnancies, although he is not a peri. I had ultrasounds at every visit with my twins as well as with the singleton I delivered with him. I did, however, see a peri once with my twin pregnancy ... the ultrasound tech who did my anatomical scan at 20 weeks could not find a membrane separating the babies. My OB was very concerned, but felt it was okay to wait two weeks for another ultrasound in his office - and in hindsight, he was right, nothing could've been done that early anyway. But I read too much online and freaked out - not my normal M.O. - and requested a referral, which I got quickly. The peri found a membrane and that was the last time I saw him. I guess I wanted to know membrane vs. no so I could figure out what we'd do with my 4 and 1-year-olds should I go on hospital bedrest. Thank goodness I didn't have to go down that path!

I did have mono-di twins, which are higher risk, but as I said, my OB did ultrasounds at every appointment - and I never went more than three weeks between an ultrasound prior to 20 weeks, then two weeks from 20-30, then weekly from 30-38.5. My OB did the ultrasound himself 99% of the time and I was comfortable with that.

 

My twins are from IVF and my RE suggested I see a peri because we have 8+ years of infertility and I have cervical problems going into this. I haven't started seeing her yet, I have one more appointment with my RE first and will start with the peri after that (January sometime). My peri is a total care doctor so I won't see my regular ob/gyn at all, the peri will do all of my ob care and deliver the twins.

 

If you decided to see a peri too, what prompted you to make that decision? My OB recommended that I see a perinatalogist for the N/T scans at Week 11.5. I decided to see the peri for the structural ultrasounds at Week 20. I also decided to go back about every 4-6 weeks, simply because I like the peri.
Did you have complications arise before you considered it? No.
Did your OB immediately send you when you found out twins? No, but my OB is a multiples specialist whom I see biweekly. He does a transvaginal (to check the length and shape of the cervix) and an abdominal (to check the growth and concordance in size of the babies) ultrasound at each visit.
Did you immediately decide when you found out twins?No; I was actually not familiar with peris before my OB recommended one.
Do your peri and OB work together, in the same practice? Not in the same practice, but my OB referred me to the peri- with whom he works most and recommends.
Do they keep you on separate schedules and it is up to you to pass info back and forth? Separate but they coordinate with one another.
Did anyone drop their OB and only see a peri? No; I like both of my doctors.

 

Having twins does not make you high risk. Having twins that share ANYTHING does.

Had i been having di di twins, I would have just seen my OB. (Unless something happened, of course.)

But we discovered they were mono-di at 7 weeks and I never even saw my OB.

High risk needs to be seen by a Peri, not an OB.

Good luck!

 

My OB set the appointment up at 9 weeks. I had my first peri appointment at 10 weeks. My peri did not deliver any more so he monitored us very closely and I still saw the OB. which was good with me because I got to have an ultrasound at every visit, peri AND OB and I went every other week to one or the other until 28 weeks and then it was twice weekly until I delivered at 38. (my baby A had stopped growing and had low fluid at 28 weeks)


My OB considers all multiple pregnancies to be high risk. Which does not mean that there will be a problem, it just means that even a healthy multiple pregnancy needs to be monitored more closely than a healthy singleton pregnancy. My peri's office had a much better ultrasound machine than the OB did. My twins are frats, they shared nothing except my womb and we were considered high risk. If I were you, I would ask your OB what he/ she thinks about a peri referral. They may have the better machine and monitor multiples closely already? or they may have planned to send you once they know that VTS is not the case?

 

I have to respectfully disagree, and so do most insurance companies and businesses in regards to FMLA. Having ANY multiples can be high risk. Each case is different. But this, coming from someone with di di twins, I am indeed high risk. I'm at an increased risk for many things that are typical of twins, including pre-term labor, pre-eclampsia, and more. They don't have to share anything to be high risk... I'm truly an advocate of my own health, and am quite glad I sought out the care of a peri team for this pregnancy before anything went wrong, because I've been proven several times, it was the wise choice.

 

This is really helpful information ladies. I was just going to ask my OB about seeing a peri, to see if he thinks it's necessary. But I may go ahead and push for a referral. If not a formal one than at least a suggestion for a name. The hospital with my OB has a level III NICU but no peri's. The peri's for the system are at another hospital in town. So right now I think I will keep both. My appointment is one week from today (finally!!!!) so I am really anxious to get in there and 1) see that the babies are okay and 2) ask the dr all my questions. In the meantime, I appreciate all your advice and sharing your stories!!

 

I did not see a peri at all. My OB has a lot of experience with twins, and the ability to do their own ultrasounds. Just do what makes you feel comfortable. Interestingly though, statistically peris have no better results with twins than do regular OBs. Ditto triplets. It's not until you get up to quads that the statistics bear out a need to see a peri. If you do see a peri, expect them to be much more proactive. The way I've heard it described is that your OB will treat you for anything that comes up. Your peri will assume you are going to have any complication you could have and act accordingly. Peris generally take patients off work earlier as a precaution even if there are no complications at all, for example. It's all just a matter of your comfort and your pregnancy. I saw my OB, worked until 35 weeks, and delivered at 37 1/2 weeks without a single complication.

 

Yeah that!

 

It really just depends on the peri's office. I had my first appt. with mine at 10w. And I called after my first OB appt at 6.

I respectfully disagree. Having twins does make you more of a high risk patient. Maybe it just depends on your insurance or OB. But I know many people who were considered "high risk" just because they were pregnant with multiples. The fact is having multiples you are at more of a high risk than someone who is just having a singleton. I have had both.

 

Having twins does not make you "high risk" here in MN at least that is what I was told. I would NOT have been referred to a Perinatologist if they were not sharing a placenta. That is what I mean. I guess I assumed it was the case everywhere and I was specificall told "Being pregnant with twins does not automatically make you "high risk." Guess maybe it does.. dunno.

 

I agree in that being pregnant with twins does not mean an automatic "high risk" pregnancy. However, many things with any multiple pregnancy can still go wrong - thus always a good idea to confer with a peri at some point. My OB would have had me see him the whole pregnancy and a peri a couple of times, had I not sought out a peri myself for exclusivity. But I did have to have a reason for insurance to cover it... in my case I had several factors, not everyone has. Hope that better explains what I mean (I'm pretty absent-minded these days!)

 

Well... they DO share a uterus

 

I think that all doctors (not by state, but by each individual doctor or practic) determine whether they see it as high risk or not. That would be my guess because I had no issues whatsoever and I was considered high risk.

:rofl: :rofl: Love it!!

 

I am 29 weeks 0 days today with twin girls. They share a placenta but have separate sacs. I have been seeing my OB since 9 weeks, and he did several of the basic ultrasounds in his office and set me up with a more formal (don't know the name of it) u/s at 20 weeks. I am scheduled to see my peri on Monday, and I am really looking forward to it. I just want to make sure that everything is going well. My peri works on the floor above my OB, and is only affiliated with the hospital that my OB is affiliated with (across the street from their building ). The peri works directly with my OB and will forward all info from my appts. to my OB. My OB had always said that he would send me to a peri since I was carrying twins, and I am feeling confident in his suggestion. The peri will then be the twins' dr. in the hospital (and nicu if needed). My hospital has a level 3 nicu, and I am very happy that I had chosen to go with this one. Now I just need to stay calm and patient til my peri appt. on Monday.

 

It has been my experience that High Risk patients need to be seen by Perinatologists. That's all I'm saying.

The whole point of my post was NOT to say anytihng about di di twins but to reaffirm the fact that:

anyone pregnant with mono di twins NEEDS TO BE seen by a high risk specialist and if you want to be seen by one for di di twins, then I'm sure that's fine too.

Hope that clears up any confusion.

 

My OB was very proactive and knew I had fertility issues (2 miscarriages) so he saw me every 2 weeks instead of once a month. I also had an ultrasound at 6 1/2 weeks, 8, and 10...I love my OB and everyone in his office - they always answered my questions, and I always felt totally confident with them. When I was 28 weeks, Baby A lost a ton of fluid - so he sent me to a Peri...which really didn't give us any more answers than my regular OB! They both told me the same thing - bedrest!

I think if you feel totally confident in your regular OB you should be fine - if not, go see a peri!
My OB has delivered lots of twins...and the hospital had a NICU, so I was not worried about that. After I was put on bedrest, I had Ultrasounds twice a week, so I felt that my OB was totally monitoring us appropriately. We got to know him so well - he came to the babies Baptism!

Hope things go well for you!