How did you decide if your dr had enough twin experience?

So yesterday I had a consult with a prospective new OB, and DH and I are trying to decide by this afternoon if we want to switch to him or not. (If so, I need to cancel my Monday appt w/my current practice!)

I picked my current practice before starting to ttc, based on recommendations of a couple of friends. I was mostly happy with them until about halfway through pregnancy when I started asking more questions about L&D. They are good doctors, and it's a large practice at a large hospital with an MFM in the rotation and OBs who have been at it for a long time. They also include high-risk pregnancies and infertility Tx among their specialties, so I assume they get more multiples than the average OB.

BUT ... now that I've seen 5 of the 6 OBs there (including the MFM) and have talked more about their standard procedures for L&D, I'm less comfortable with them. I think that if serious complications arose, I would be in good hands, but otherwise, they are "more aggressive than many and less natural than most," as one of the OBs said, which is not what I'm looking for. They seem very quick to induce with twins (one of the OBs said he'd induce by 36-37 weeks), quick to go to a C-section, and they give the mom almost no options when it comes to labor and delivery. Most of them say they don't do breech extractions for a breech Baby B, even though the research indicates that's actually the best and safest option. They seem a bit too entrenched in the medical model and their "standard" ways of doing things.

The prospective OB that DH and I saw yesterday is quite different. He's at a smaller, but newer and very well-equipped hospital that's much closer to our house (15 mins away versus 30-40 in heavy downtown traffic). It's a smaller practice, and the hospital is very "natural-childbirth-friendly," which my current hospital is not. I went over my birth plan with him yesterday and he was OK with pretty much every part of it, whereas my current OBs would pretty much throw it out the window. He spent a good 45 minutes with us, answering all our questions, and was a lot more informative and open (and approachable) than the OBs at my current practice. He also does the ultrasounds himself, and offered to give me one yesterday. DH--who has gone to all of my OB appointments with me--was thoroughly impressed by him.

Overall I do really like this new OB. My question though (and congrats if you've made it this far through my looong post!) is how do you decide if an OB has enough twin experience for you to be comfortable with? At my current practice, I feel like it's a given (though I'm not always impressed by their knowledge of the twin-specific research). But since this OB is young-ish and at a smaller practice, smaller hospital, he doesn't deal with twin pregnancies and deliveries quite as often. [He is, btw, in rotation with the other 3 OBs at that hospital so if I go into labor on my own, I have an equal chance of having any of the four. I think he's the youngest of the four. Another mom on this forum was delivered by one of the older OBs of the four and was quite happy with him, but her doc doesn't take transfers this late which is how I ended up finding out about this guy. ] He has done breech extractions for Baby B before, which is more than I can say for several of the older, more experienced OBs at my practice (there it's a rotation of six so again I don't know which I'd end up with unless I schedule). Since my B is currently breech, that's a plus. Anyhow ... sorry this is so long, but I'd welcome any insights or advice.

DH says he feels a lot more comfortable with this OB than the others but he's not pushing me in either direction; and while he's a very smart guy, more knowledgeable about the medical field in general than I am, and has been to all the appt's with me, he also--unlike me--hasn't done much research on pregnancy and childbirth, spent any time on multiples boards (and heard all the stories of things that can go wrong), etc. (He did read the chapter on L&D in my Mothering Multiples book and I've shared stories and statistics with him along the way, though, fwiw. )

 

I met this OB when I was fighting infertility and his office (him) pointed me towards IVF. Really sweet man. I got a referral to an RE and did my IVF. My RE wanted to send me to a high risk doctor at a peranatal clinic UNTIL she found out who my OB was. They had worked together and apparently he has a lot of twin/multiple experience. He was a very laid back doctor and I had an excellent doctor.

 

Laid back AND excellent sounds like a great combination to me. I'm hoping that's what this new OB is ... just not sure how to assess excellence. (I asked my local MOMs group for OB recs and didn't get much ... especially since most of those who responded weren't necessarily interested in going the natural route.)

 

My OB gave me a high chance of delivering vaginally unless Twin A was brech. He was, but my ob did everything in his power to give me a chance at vaginal with subsequent deliveries by giving me a great c-section. He came in on his day off to do it for me since the clinic had double booked him for my planned section. Good luck!

 

Hi there,
I started with one OB that sounds the exact same as your current OB. They told me they would only do vaginal birth if BOTH babies were vertex. They also told me that even if both babies were vertex that I could choose to do a C-section as well. I saw a series of 6 doctors at this practice and I only really liked ONE. I felt really nervous about the whole practice...not because they weren't good doctors but because emotionally I was just not comfortable there. To make matters worse I really didn't like the hospital even though it's a top level hospital for NICU. I got a referral to a new OB when I was at 24 weeks. I first went to check out the hospital and fell in love with it. I met the nursing staff and felt really at ease with all their procedures...it is a smaller hospital like you described, but I felt like the care was actually so much better. It was much more 'homey'...even the baby nursery was better staffed and actually holding the babies! The next day I met the new OB. His office was MUCH better than the other OB. Doc was very down to earth and I immediately knew I was in better hands. I switched right then and there and have not regretted it even now that I am at 34 weeks. New doc is confident that since my baby B is breech and baby A is vertex that he can handle it vaginally...which I was happy about...I want to avoid a C-section if it is possible, thank you! I will say that if I wanted to he would let me go to 40 weeks if I felt I could handle it and as long as babies were doing well still. BUT, he said in his experience with twins right around 34 to 36 weeks women get so darn uncomfortable that it is best for mother to just induce...so he is open to inducing at 37 to 38 weeks. Sounds reasonable to me! My point is...it sounds like you like the new doc and new hospital better than your current and I say...go with your heart. Everything will be fine! In my opinion it is best to go where you are comfortable and where you feel you can communicate your wishes even when the doc thinks you're off your rocker! Those babies in your belly are still YOURS not a doctor's and you should be able to make choices that are important to you.
Linda

 

it seems like you're leaning towards switching and it seems like that is what I would do from what you described. If a vaginal birth is important to you, you should be with a practice that supports that. If you don't switch you are going to have added stress when you are in labor about whether or not your MD supports your wants...

I was in a practice with several MFM's and several general ob's. some of then were comfortable with breech extractions of B and some were not. My MFM doctor said the best predictor of a healthy delivery is HOW COMFORTABLE THE DOCTOR IS WITH THE DELIVERY. so if the OB on call when you go into labor is comfortable delivering B breech, then go for it, BUT if the OB is not comfortable doing a breech delivery they it's safest for everyone to do the c-section.

I feel for your desire to have a natural birth, but unfortunately having the type of delivery you wanted is one of the first things that you might have to sacrific for your twins. what's most important in the end is two healthy babies, not how they were delivered.

good luck!

 

QUOTE(1stTimeMom26 @ Nov 20 2008, 01:21 PM) [snapback]1079191[/snapback]
I feel for your desire to have a natural birth, but unfortunately having the type of delivery you wanted is one of the first things that you might have to sacrifice for your twins. what's most important in the end is two healthy babies, not how they were delivered.


I agree with this statement SO much. I too had baby B breech and baby A head down from about 20 weeks on. I planned for a vaginal birth and was hoping to make it all the way. I went into labor on my own at 36 weeks 1 day. When I arrived at the hospital I was fortunate to have my own ob on call who I was very comfortable with. He knew of my desire for a vaginal birth and had been supportive of that choice all through my pregnancy. I had only been in L&D for about half an hour when they did an ultrasound to determine the babies positions to help plan for the birth. It was a good thing they did because at that point baby A had shifted from head first to shoulder first. At that point we had to make a quick decision on what to do because both babies were appearing to be in distress. At that point all of my hopes for a vaginal delivery went out the window and I was prepped for a c-section. I had a spinal and both babies were born within an hour of arriving at the hospital. As much as I had wanted a "normal" delivery, I don't regret how they were born and the section actually ended up being easier than I thought. I would switch to a doctor that seems more in tune to what you want, just be aware that things can change very quickly once you are actually in labor.

 

I would look at it in this simple way:

- if your boys possibly have one placenta, I would go with the high-risk OBs. I am all for natural birth and their interventionist philosophy would really bother me but one placenta is high risk and can cause problems.

- if your boys have two placentas, I would switch docs in a heartbeat.

 

They are di-di and each have their own placenta. (Though they've moved pretty close together; I dont' think they're fused though.) Would two fused placentas be dangerous like having one placenta?

 

Well my dr. has 2 yr old twins herself so that was pretty good experience I thought!

 

QUOTE(SC_Amy @ Nov 21 2008, 03:10 AM) [snapback]1080057[/snapback]
They are di-di and each have their own placenta. (Though they've moved pretty close together; I dont' think they're fused though.) Would two fused placentas be dangerous like having one placenta?


No, fused is fine. The danger with one placenta is that they can have interconnecting blood vessels and end up with TTTS up until the time of birth. Two placentas can't have interconnecting vessels so that's not a danger. There are some docs (including the head of the peris at the hospital where we delivered - Stanford) who don't consider two placenta twins very high risk at all. They basically just watch for maternal complications (growing two babies can be hard on the body) and make sure both twins are growing (just like they would do for one baby). Since your twins are di/di and you have found a doctor you love who doesn't look at your pregnancy as an illness to be healed then I would switch. Good luck!

 

QUOTE(Ali M @ Nov 20 2008, 11:05 PM) [snapback]1080165[/snapback]
There are some docs (including the head of the peris at the hospital where we delivered - Stanford) who don't consider two placenta twins very high risk at all. They basically just watch for maternal complications (growing two babies can be hard on the body) and make sure both twins are growing (just like they would do for one baby). Since your twins are di/di and you have found a doctor you love who doesn't look at your pregnancy as an illness to be healed then I would switch. Good luck!


That is very good to hear--especially coming from an experienced peri. I wasn't sure how likely it is that something could happen--either prenatally or during delivery--that someone who's less experienced w/twins might overlook or not know how to deal with.

(Question: All di-di twins each have their own placenta, right? That's what I'd thought but sometimes I get confused by these things. )

 

QUOTE(jordynsmama+2 @ Nov 20 2008, 10:34 PM) [snapback]1080120[/snapback]
Well my dr. has 2 yr old twins herself so that was pretty good experience I thought!


Nice! I have found a pediatrician who has twins herself (and also came highly recommended by my neighbor who went to her as a kid and is now taking her DD to her); I'm excited about that.

And this OB *is* a twin himself--ID--for what it's worth. So he at least has some kind of vested interest in twins, lol.

 

Do both hospitals have level III NICU's? If so, I'd go with the OB you like better. If only one has a level III NICU, I'd choose to deliver at that hospital.

 

The smaller hospital has a Level II NICU, but the prospective OB has privileges at both local hospitals with Level III NICUs. If I go into labor early (say, before 35-36 weeks) or there's any other indication that either baby might need Level III NICU care, he could do my delivery at the closest Level III NICU hospital (or if the babies seemed fine but then the need arose, the baby/ies in need would get transferred there after birth; it's about 10 mins from the smaller hospital).

Originally I was only considering the two hospitals with Level III NICUs but since I'm not comfortable with the doctors there and their approach, this seems like a reasonable compromise.