Is my MD doing enough?

I just had my 3rd OB apt since pregnancy. It was very much like the ones I had with my singleton baby--pee in cup, vitals, weight ck and heart beats on the doppler--and off you go! It seems like many other mamas here are having their cervix length checked and the babies measurements checked routinely. My OB says he is handling my pregnancy like a "routine pregnancy" so I guess it is a good thing that I am so low risk, they are not concerned...but still I keep wanting more check-ins and assurances that things are going ok. I have a level II ultrasound in two weeks, so I guess I will get my next fix then, but I thought with twins I would be having u/s like every other week. Maybe it will pick up once I am beyond 24 weeks. Does this sound like normal to everyone? I guess there would be some variation with MD approaches--maybe mine is more on the minimal end.

Also, is a level II ultrasound much different than the normal ultrasounds that are conducted in the Dr. office with the portable machines?

 

My OB treated my twin pregnancy the same way she treated my previous pregnancies. I never saw a Peri and never had any sort of extra visits. The boys are mono/di and had a very thick membrane separating them. She measured my belly, listened to the heartbeats and checked the fluid levels at every other visit, but she did that with my other pregnancies too. The only time they took any sort of special precautions was when I went into the ER for dehydration due to a really bad bout of gastroenteritis. Other than that, it was all very routine.

My Level II ultrasounds were always done by Radiology in the hospital, instead of the office. They were more detailed and definitely more time consuming. If you're concerned or have questions, you could always ask why they've chosen to take this approach. Is it possible that your insurance may not cover certain visits or specialists?

 

I know every ob is different but I didn't start to have an increase in monitoring until I hit 18 weeks- then I had u/s every 2 weeks with the peri because my babies were mono/di. Once I hit 24 or 26 weeks, I started seeing my ob every 2 weeks and then when I hit 30 I saw her every week. My pregnancy was "routine" except that I was carrying twins who shared a placenta, which put me in a higher risk category, but just having twins, according to my ob, puts anyone in a higher category. That was her approach, anyway. Good luck and congratulations on your twins!!

 

The only reason I am having extra appointments with the peri is that my twins are IVF twins. I have to get my cervix checked every 2 weeks due to this. Although I love the baby fix, since I pay a $40 co-pay every time I walk into the office and am low risk in every other way, I wouldn't mind going to just the ob sometimes

Laura
21 wks.

 

I have the same as pp said. I have monitoring every 2 weeks because of IVF twins. but after 24 weeks they decided that every 3 weeks is fine now. so now on they are checking my cervix every 3weeks. and I think after 32 weeks it woudl be every 2 weeks again.

 

I think it depends on the type of twins you have.. mine are mono-di, so they check for TTTS starting around 22 weeks or so. Up until 18 weeks, I hardly ever saw the doctor and they were mostly just meet and greet visits. Now I am at either the peri or the OB every week, but I think that I am on the higher end of cautiousness here.

The full scan is a LOT more detailed than the ultrasound you'll get in the doctor's office. They go over every square inch of those babies and you'll know all you need to know about them!

 

Your OB's treatment seems pretty normal to me. I'm having di/di twins and am only considered high risk because of my age (35) and because they're twins. I've seen my OB every 3 weeks until now; I'll start seeing her every two weeks now that I've hit 28 weeks. I've had ultrasounds at every other appointment so far - so every 6 weeks. I think I'll start having them every 4 weeks now unless some complications arise that require closer monitoring. My OB has basically just done the normal OB things - measure the belly, weight check, blood pressure check, urine test at every visit. Plus I've had some additional bloodwork to monitor my slight anemia. The OB monitors my cervix length via ultrasound, and she's only recently (at my 27-week appointment) started doing pelvic exams to check my cervix for dilation. I've not seen a peri. When I start to dilate, I'll start seeing my OB every week.

 

I don't know yet what type they are--they are definitely in different sacs, but we cannot tell if the placenta is shared or separate. I guess I will find that out at the u/s? Otherwise, I don't mind the laize-fair approach on the whole, I guess it just seemed different from everyone else here, but now I see it depends on the situation and circumstances vary. Thanks for the feedback!!

 

I was seeing my ob every 4 weeks or so, but i have gotten an u/s every time, even if its just on the little portable one. Depending on how my appt goes next week, i'm probably being bumped up to every 2 weeks. My twins are di/di so i'm not as much of a risk in that category, but my dr likes to be very thorough with twins, which i like.

 

I think the only reasons I had extra appt's is because I wanted them, and my Dr was happy to calm my crazy nerves! :lol: My OB always told me that after 24 weeks I would have to be seen at a minimum of every other week to check things and make sure things were going well. I agree that every Dr is different though. If you are concerned about it, it might not hurt to mention it and get your Dr's perspective on it. Good Luck!! Glad to hear everything is going well!

 

QUOTE(laurab @ Apr 24 2009, 08:40 PM) [snapback]1287346[/snapback]
The only reason I am having extra appointments with the peri is that my twins are IVF twins. I have to get my cervix checked every 2 weeks due to this. Although I love the baby fix, since I pay a $40 co-pay every time I walk into the office and am low risk in every other way, I wouldn't mind going to just the ob sometimes

Laura
21 wks.


My twins are also IVF twins but I'm not getting much extra monitoring at this point. I'm under 35 and in good health and my doctor doesnt see any reason to treat this pregnancy like anything other than a normal twin pregnancy right now. On my first visit he did do an in office ultrasound on the little portable machine. My next visit was immediately following my nuchal scan. I will see him again 4 weeks after the nuchal scan appt and he will do routine stuff and probably the portable ultrasound. I will have my next level II scan at around 20 weeks and he says that I will have another of those later in the pregnancy which makes me feel pretty good. I agree with you though that the laissez faire approach is at times a bit frustrating, but I really trust my doc and I know that part of what he's doing is helping me keep my head on straight for the long haul and he doesnt want to medicalize this pregnancy more than necessary. But I also know that at the first sign of trouble, he will be all over it. He and I have been through alot together in the past year or so (early miscarriage followed by surgery to remove huge fibroids). Right now I could punch him in the nose though because he wont give me drugs for my nausea. He is adamant that I can have NO drugs unless I get too bad to function.

 

I was seeing the OB every four weeks until 24 weeks - then I went to every other week. Now at 28 weeks, I am seeing the OB every week. I go to a separate office in the hospital for u/s every four weeks from the beginning until I deliver. The OB also told me that I will be getting non stress tests two times a week until delivery starting at 32 weeks. The OB starting checking my cervix at that 24 week mark when I started seeing him every other week and of course they check it via ultrasound every time. My friend just had twins in December and her schedule was a little different - seems like she started the more frequent monitoring later - weekly appointments starting at 32 weeks.

I think like everyone else said - it really depends on your situation and your OB's common practice - every OB is different. Good luck with everything!!

Christina

 

I was seeing mine once a month, but also didn't find out about the twins until 19 weeks! After we found out there were two she's made it so I see the Peri once a month and her once a month so I'm seeing someone every 2 weeks. It sounds like at 28 weeks she'll start seeing me more often.

Yes, the Level II is a more indepth ultrasound.

 

Again, everyone has already commented.... but I think it depends on your situation. I am having Di/Di fraternals, boy and girl. So seperate everything. But, my appointments will be every two weeks after week 28, and I have had three ultrasounds, and have another scheduled at my 30 appt. just to check growth. I am 26 weeks along.

 

I have mono/di twins. We found out at 12 wks. From that point thru 28 wks, I went every 4 wks. My appt would include b/p and protein (pee-in-a-cup) checks, fundal height, a q&a session w/ doc, and an external ultrasound. In addition to the usual u/s stuff, the ultrasound checks the babies heart rates as well as my cervical measurements. At 28 wks I started going every other week. I didn't have an internal u/s to check my cervix until about 30-31wks. Now at 33 wks, I'll start going 2x/week. Once for an NST and once for an ultrasound, plus seeing my dr. at each visit. I had one visit w/ a peri at about 31 wks due to gestational diabetes. He did another anatomy scan on the babies and was pleased enough w/ their progress and my glucose levels that he said he doesn't need to see me again unless there is a new complication.

It seems like a lot of people get more "doctoring" than me, too, but my pregnancy has been pretty uneventful. Also, my Dr's fill in for the peri on some of the off shifts so I think they have a higher specialty level than some docs. They also have a pretty fab u/s machine in their office, so there is no need for me to go elsewhere for my u/s's. My Level II was done at my OB's office. So yes, I think a lot of the difference in frequencies depends on your individual pregnancy as well as the comfort level of your doctor with your case.

Eve

 

I felt the same way about my OB but then, now that I look back, it makes sense. I didn't have any complications with this pregnancy. I did however start seeing a perinatologist at 22 weeks so at that point I did start seeing either my OB or the peri every 2 weeks. At this point, I would take it as a blessing.

 

I think what you're describing sounds normal. My OB sees me 1x a month for vitals, heartbeat, growth scan, and fluid level checks. But in addition to that I have to go to her office on one other time per month just to have my cervical length checked. Its kind of annoying to go all the way there just for a quick vaginal u/s, so I usually whine until the u/s tech agrees to show me the babies Anyway, that amounts to check-ups of some sort every 2 weeks.

Oh - and we did our 20 week level II anatomy scan at the perinatology center at our hospital, but that was our choice. I have never been pregnant, but the quick check-ups I receive have often made me wonder if this is all there is to it...seems like so little to lead up to such a big event! But like PP, my twins are also IVF twins and I was used to going to the doctor every day and endless procedures in order to conceive - so I was shocked by how little I go now that I'm pregnant (though no one has ever mentioned this as a reason for the increased monitoring of my cervix, I can't see why it would make a difference)!

Anyway - My dad is an OB and I always tell him (leaving out the TMI details) what happened at the doctor and he's never thought that she was monitoring too little. As long as he's happy with the care I'm getting, I trust it. Good luck to you!