Anyone not see a peri?

I have seen my OB twice. My first appointment was at 11 weeks, then 2 weeks later to re-check. She didn't mention anything about me seeing a peri, nor am I going to have any extra appointments or procedures.
I'll have a level II ultrasound at 19 weeks, then my OB will do a final ultrasound near the end (around 36 weeks) to make sure everything is ok.
I'll see my OB once a month until 32 weeks, then every 2 weeks after that.
This is pretty much the exact same schedule as I was on when I was pg with my son.

I didn't think about it at the time, but the more I read, the more I'm thinking this is not the norm. Seems like everyone else is referred to a peri or at least getting checked out a little more closely with u/s and NST's. I likely won't have an NST at all. Is this odd? Or are they just more laid back at my office? Don't get me wrong, if my pregnancy goes well, I'm glad to have less interference, but how would they know??

She did say that if I went into labor before 35 weeks, I'd have to go to the hospital downtown instead of our regular hospital, since they don't have a nicu.

 

I didnt see a peri and my schedule was almost exactly the same as yours. I think the level of intervention partly depends on the type of twins. I am not carrying mono/di and I have been healthy all throughout so there was no need for extra intervention. But its completely up to you. I think you should go with the level of intervention that makes you feel comfortable and like you are getting the best care.

 

I did see a peri and my OB. My OB recommended it just because the peri has much more experience with multiple births and insurance (at least mine) covered all u/s that the peri did, but would only cover one from a reg. OB. :umm: Anyway, I only saw a peri due to having twins, I was not high risk for any other reason. I really liked seeing the peri and my OB. I got an u/s at every visit with the peri and it was nice. :good: It made me more comfortable knowing the peri was really keeping a closer eye on things than my OB would have been.

 

I don't have an actual peri, but all of my ultrasounds are done at a special center, and they are reviewed by a peri (who I've never met or spoken to). He then sends the results to my OB, who discusses them with me and decides what to do. I've actually been really happy with my OB. My OB's practice has a lot of experience with twins, so they are very cautious and keep a close eye on those patients. I've had a few episodes of PTL, and my OB has been on top of everything. I think it all depends on your level of comfort. I am really happy with the situation I have. As long as you feel you are getting the best care you can, I think that's all that matters.

 

I didn't see a peri, just my OB. Saw him every month until 28 weeks. Then went to every two weeks until about week 34. Then EVERY week until week 38 (which is when I was induced). I had ultrasounds like every other visit, but towards the end had them almost every week. I love my OB though and was very confident in his skills. I had an uncomplicated vaginal delivery, after being induced at 38 weeks and 2 days.
My twins were di/di, and I didn't have any pregnancy complications, so that may have been a determining factor as to why I didn't have to see a peri.

 

I saw a peri once, but only because my OB suspected monoamniotic twins around 18-20 weeks - that was ruled out by the peri and I have not been back.

I am now nearly 38 weeks and had one NST a couple of weeks ago - one of the babies measured enough smaller than the other to warrant it (5 lbs. 1 oz. vs. 5 lbs. 12 oz.) - it turned out that the smaller baby was sooooo low that they couldn't get a good head measurement. NST revealed no problems and subsequent ultrasounds have shown concordant growth.

I do have an ultrasound at every visit, but that is my OB's MO for all pregnancies - he did the same with my singleton as well.

 

Ahh, ok! Thanks for the replies ladies! I am pretty sure I'm having fraternal twins (2 very distinct sacs) and I have no other issues at this point. My pregnancy with my son (same OB) went off without a hitch, and I made it to my scheduled c/s at 39 weeks without a single contraction (thank goodness). The day of my c/s my OB said I was still locked up tight LOL! I'm also under 35 (will be 32 the month after the twins are due) so I'm still under the AMA range.
That makes sense now. And yes, I trust my OB (actually there are 5 in the practice) and I am comfortable with all of them.

I'll mention the peri at my next appt, but I won't worry about any of the other stuff at this point.

Thanks again!!

 

I never saw a peri and had an uneventful pregnancy and delivery. It is possible! I saw my OB once a month until I was 28 weeks and then it went to every 2 weeks, with an u/s at every appointment. I only had an "official" u/s at my 7 week first appointment, 20 weeks, and then starting at 28 weeks I had a growth u/s every 2 weeks.

I wound up having a quick u/s done by my OB at every appointment b/c they could never find both heartbeats with the Doppler.

Oh and just b/c they are in separate sacs and each have their own placenta does not necessarily mean they are fraternal! I have identical twins who were di/di.

After reading here on TS about how many women were seeing peri's I asked my OB if I should see one. She said that just b/c I was pregnant with twins did not automatically make me high risk and she considered herself and her staff experienced enough to deal with my pregnancy. She was right.

 

i saw a high risk ob but not a peri. he and the other docs in his office were awesome

 

I'm going to be the lone dissenter and say that you should probably see a perinatologist. Your visit schedule doesn't seem appropriate for twins. You should have growth ultrasounds more often than 19 weeks and 36 weeks, you should also have cervical checks every two weeks. You should also have at least one NST weekly starting at week 32-33. Just review the posts on this board, about half have a normal/uncomplicated pregnancy while half have trouble- and there is no telling who will have trouble. Just because your twins are di/di doesn't mean that you won't have preterm labor, high blood pressure or IUGR.

This is coming from someone who just had di/di twins at 37+1 with a fairly uncomplicated pregnancy, no PTL or bedrest, only a growth discordance at the end that resulted in a csection at 37 weeks (would probably have gone further). Not to scare you, but there are two other sets of twins here (being discharged today) and we are the only ones taking our twins home when we leave.

I initially saw my regular ob and a peri and ended up switching to a peri who also delivered at the hospital where I worked (for convenience). All of my providers were more cautious than yours. My current doctor was very non alarmist and I was probably his healthiest patient-- but he said that all twins should be considered high risk and have a higher level of care. While there are many uneventful twin pregnancies, there are also many that have problems.

 

I am not seeing a peri, but I have an ultrasound every month until week 32 then I have one every week. At week 32 I also have NSTs every week. My bi weekly appointments will start at 32 weeks as well.

 

I never saw a peri during my pregnancy. I just saw the OB monthly, had a U/S monthly. I started with the NST's probably around 32 weeks and then went to the OB weekly at 36 weeks.

 

Yeah I would ask about the NST's and more u/s to monitor growth. I have never seen a peri and my pregnancy was deemed low risk by my very hands-off and laid back OB. Then I went into PTL at 32 weeks requiring 4 days of hospitalization and subsequent bedrest. It was at 32 weeks they did the first internal check and found me dilated, I did not even feel the contractions I was having so imagine if they had not checked me then--it may have been too late! Throughout my pregnancy my main issue has been my MD treating me so 'low risk' when I really wanted more monitoring. Of course there is something to be said for some of our 'fear-based' medical practices, but when it is your babies on the line, it is hard to want to take those chances! If you want more monitoring I would ask for it. You may not need to see a peri per say, but at least have more check ins to know the babies are doing ok...

 

I never saw a Peri either. I saw my OB once a month from 12 weeks until around 20 weeks, then saw them every other week till 28 weeks and then saw them every week till I had the babies. I had ultrasounds at 12 weeks, 16 weeks, 20 weeks, 24 weeks and 28 weeks and then no more ultrasounds. I had NST's every 5-7 days from 32 weeks on. I had fraternal twins, with no complications. My OB did say that they are very cautious with all of their twin pregnancies.

 

In the early days I saw my OB and Peri once a month each. Now that I am at 34 weeks I see each one every other week. Its a lot of appointments but I feel better knowing they are being closely watched. I get an US at every appointment. That is the other reason I don't mind the appointments. I love getting so many pics of my babies. My Peri does a 3D at every check as long as they are in a good position.

 

The same thing here although we went to weekly OB appts at 32 weeks.

 

The way things are set up here if you are high risk or multiples you go to the Maternity clinic staffed with OB's, if you are non high risk you go to the clinic that is staffed by family docs. I am seeing an OB. My appointments were slow at first and the second u/s wasn't until 18 weeks but after that it has been monthly for those and OB appointments were monthly, then bi-weekly. Now I am pretty much going weekly with NST's weekly too.I like the extra monitoring because my last pg didn't get much so I feel better knowing there is more this time. NST's should start around 32 weeks and as for my u/s they are getting closer together the closer I get to delivery not stopping, that doesn't sound good to me.

Go with what you are comfortable with but I would personally want more frequent u/s and NST's towards the end. Good luck!!!

 

I never saw a peri, only my OB, and my twins even had growth issues. However, I went to the local hospital to have my u/s every two weeks once the growth issues started and a doctor was always there monitoring the u/s. I'm not sure if the doctor was a peri or not because he/she was never the same doctor when I went.

 

I am having a moment... What is a peri?
I get ultrasounds as often as I see my doctor. So until I hit 20 weeks once a month and now its every 2 - 3 weeks. My last ultrasound booked is October 15th and then he will decide from there when my induction date will be. I get the results of my ultrasounds from my OB every time. The only issue they ever found was PAC's with my Twin A and then at my last ultrasound there was no sign of it anymore. My OB told me my pregnancy is normal. My OB has lots of experience with multiple births and high risk pregnancy too so I am quite happy with the care I am given!
If you want more frequent u/s then I would talk to your OB at your next appointment.

 

I am not seeting a peri - around here you see an OB unless you have specific problems, then you get referred to the peri but still keep your OB.

I interviewed 3OB's and ended going with an OB who is the overseeing manager at the widwife practice associated with the local community hospital. (he had experience with twins and even delivered his own twins!) So far I have had monthly appointments and am just switching over to every 2 weeks (i'm 22 weeks) I generally see one of the nurse midwives (all have over 15 years experience) for the general appointment (urine sample, weighing, measuring fundal height, blood pressure, discussing any concerns, listening to heartbeat on doppler etc)
When I need an u/s I got to the hospital - since it's a community hospital they are not crazy busy and if its not an emergency you can get an appointment within a day or two if necessary.
The midwives all have a weekly meeting with the OB to discuss your file - if he has any concerns then he phones or call you in to discuss, and if I have any concerns then he calls back the same day generally.

When I had my level 2 u/s I went to the larger teaching hospital. after the tech had finished, she went & discussed the findings with a peri who then came in to talk to us.

I decided not to go with a large OB practice since you get to see all the OB's on rotation - even those with less experience, and I was petrified of turning up at l&d and finding the most junior OB.

When it gets nearer the time I will start seeing my OB at my appointments but since there haven't really been any concerns that the very experienced midwives can't handle, there hasn't been the need.

I feel that the most important thing is to have an OB or peri that listens to you and answers your concerns in a timely manner. don't forget that if you are not happy then you can look for another OB.
yes, there are lots of moms to be of twins who have specific problems and that really warrants a specialist. Your OB should have the professionalism to admit that a problem is beyond his experience and readily give you a referral to a peri.

I hope this helps, it is just my opinion, but I have had a lot of experience in my life with dealing with doctors in general and have learned the hard way that you are the one who is in control not the doctors and you have to take responsibility for finding the 'right' doctor and being on top of when you should have tests, getting results back, making sure you have copies of results etc. ie do not assume that the system is 100% efficient and you are your best advocate for getting things done.

 

For both of my twin pregnancies, I went to my regular OB. I saw them every 4 weeks until 28 weeks, when we switched to every 2 weeks. Then at 36 we switched to every week. I had all my u/s at the hospital instead of at my OBs office (where they had an u/s tech). So a peri looked at the results, but I never saw them specifically, and the results were sent to my OB.

As for u/s, I had my 20 week one, then went every 4 weeks for measurement u/s. Then for this last twin preg, we started with u/s every week at 36 weeks. My first pregnancy I gave birth at 36w3d, so I didn't get to that point.

This one I gave birth at 38w3d.

I never had a NST.

Talk to your doc about your concerns.

 

If your twins are sharing a placenta you DO need to see a specialist. It's just too risky to see a regular OB. They are NOT trained in TTTS and all of the things that need to be watched in mono di pregnancies (or momo FOR SURE).

You are immediately 'high risk' when twins share AnYTHING and you need to be treated as such. You need high monitoring and anything less than that, is just not right.

If you are carrying di di twins, it's treated as a normal pregnancy and is not high risk (just due to them being twins, I mean.) Unless there is something else wrong.

Good luck and if they're di di (OP) you're good!

 

I forgot to add about ultrasounds. I had high level ultrasounds with the MFM specialists at 14 weeks (nuchal scan) 20 weeks (anomaly scan), 28 weeks (growth) and my next growth scan is scheduled for 32 weeks. At each of my monthly appointments, my OB always took a quick look with the portable machine in his office just to check the heartbeats and that they were happy to be there. I have had 2 cervical checks along with the ultrasounds at 20 and 28 weeks. The frequency of my appts will increase at 32 weeks. As I said, I was very comfortable with my level of care, but I know that some people require more so it all depends on what you need as a patient.

Good luck Mama with whatever you decide!

 

Since my level II U/S is on Sept 17th (about 3 weeks from now) I'm wondering if maybe my OB is waiting to hear what they say. I don't remember 100% of what my OB told me at my first appt since we were still in shock from seeing double! Plus I need to re-check with our (horrible) insurance and see what may or may not be covered. My husband said that could be playing a factor as well.

I do have a regular OB appt on Sept 3rd, so I will make a list of questions/concerns and make sure to go over it then.

Thanks again for all the replies, I'll update after the appt!!

 

I didn't see a regular peri, but my doctor saw me many more times than what you are describing. I went once a month until 20 weeks then I went twice a month. At 28 weeks I had a PTL scare so he started seeing me once a week. At 33 weeks he saw me twice a week. I had an ultrasound at every appointment to check heartbeats. They were measured (I think that is level two) at 15 weeks for the first time and then once a month after that. I only saw a peri at the hospital when I had the PTL scare, but I you might get another doctor that will at least do more checks than the normal pregnancy.

 

I see a high risk OB. My reg. OB never delivered twins and was not willing to take the risk. The high risk OB's office sends all u/s and reports to a peri. but I don't see one unless there is an issue. My appts were monthly until 20 weeks and now bi-weekly. They will be weekly starting at 30 weeks with NST's. I get a monthly u/s and weight check. Our twins are di/di and so far we haven't had any problems but as some people have said that can change in the blink of an eye. Even if you don't see a peri you really should be seen more often earlier with twins. My high risk OB is very easy going but she takes special care of a twin pregnancy b/c things can change so fast. I think that if you feel you are not being seen enough then you need to ask for more appts. I also have to agree with the PP who said 2 u/s is not enough.

 

I really struggled with this decision too, and I decided to stick with my regular OB and not see a peri (unless something comes up that warrants it). I have been going to my dr for years and I really like and trust him. I agree with all pp that it really is a personal level of comfort thing. I will say, though, that my appt schedule has been more in line with some other people's rather than what they're proposing for you. I've had at least a growth u/s at every appt since 17 weeks and my twins are di/di. I switched to every other week appts at 24 weeks and will be going weekly after my next visit at 33 weeks. Not sure if he'll start me on NST's then or not, haven't asked. Also he hasn't started checking my cervix yet as I've (KNOCK ON WOOD!!) had no signs of ptl so far, but he'll start regardless at 34 weeks. I've felt really well taken care of throughout.

 

I have just seen my regular OB. The dr office I go to has about 10 doctors total and they all are suppose to be really good with any high risk and multiples. I had my first confirming u/s at around 10 weeks then every 4 weeks we had a growth check via u/s. After week 26 I went in 3 weeks, then 2 weeks and right now I am on a 2 week schedule with every other visit getting a u/s. I think after my appointment today, we move up to twice a week for the remaineder of the time. He checks every visit with a mobile u/s but its not as detailed as the real u/s area. I am not feeling bad about not seeing a peri, I was feeling the same thinking wow it seems everyone sees one but me but its not the case. Good luck!