Peri/OB questions - I'm new!

I've been lurking since I found out I was having twins - scared to death and excited.

What has been happening:
At 7 weeks I went to my OB for severe morning sickness and pain in my left ovary and lo and behold found out we were having twins. My OB was freaking out because they looked to be MOMO. So she set up a peri appt.

March 2nd - saw the peri - he did the NT scan and saw that they are MODI. I was so overwhelmed and didn't ask very many questions. He did say that if they are in the right position I could deliver vaginally. But said I was high risk for complications.

March 8th - saw OB - she seems very nonchalant now after seeing that they are in two amniotic sacks.

March 30th I have an appt with the peri and he said we should be able to find out the gender.

Anyway, my concerns are about delivery. Will my OB deliver or the peri? I'm scared about the hospital my OB delivers at. My BF had a c-sect there and got a staph infection. When I delivered my 2nd my OB didn't make it, the nurse barely got her gloves on to get my daughter. It has a NICU level II - what does this mean? I know there may be a risk of TTTS, from what I read it could happen during delivery.

I know this is long, but I guess I'm wondering what questions I should ask the peri next week. And do I go by what the peri says or my ob if they are different? And can I choose which one delivers?

 

Ok first you want to make sure it is clear how many placentas there are. If there is only one, but two amniotic sacs you will want to make sure that you are comfortable with how often they are seeing you. Most mono/di twins have u/s growth scans every 2-3 weeks to make sure there isn't a large size discordance. Usually your ob is the one who delivers the babies, so make sure he/she has experience with twins. The peri usually steps in if there are complications near the time of delivery. A level II NICU is a lower level NICU so find out how far the babies would need to go to get to a higher level NICU if there were complications. Get a clear answer on what to expect your ob to do and what your peri will do. Try not to worry about your delivery yet because it will probably come down to the wire depending on their positions closer to delivery, they can flip a lot at the end.I hope that answers some of your questions. Congrats and the ladies on this site are extremely helpful.

 

You sound like I did about a year ago First thing- take a deep breath, try to relax & enjoy your pregnancy (easier said than done- I know!!)

At my u/s at 10 weeks the dr thought they were mo/mo & we were sent to the peri. The level II u/s showed they were mono-di. My ob's office treats twin pregnancies the same as singletons in the beginning as long as everything is looking ok- they were pretty nonchalant at 1st too, but kept a closer eye on me at the end. I went to the peri each month for growth scans & to make sure my girls were doing fine. The further along I got the closer the peri & ob visits got. I think around 28 weeks I started every 2 weeks at the peri, then at the very end I was weekly.

The peri specializes in the health of the babies, so normally they don't deliver. There are more risks w/ a shared placenta, however most likely everything will be just fine. You may very well be able to deliver vaginally depending on your & your babies' health, as well as their positions- I actually delivered naturally. Did he say that you were high risk for complications just because the babies are mono-di- or is there something else? One of the ob's in my practice (who is very pro c-section for twins) told me that I was the perfect candidate for a vaginal twin delivery since I had a previous vaginal birth- since you have 2 other children I would say the same for you!

Is there another hospital near you? With twins I would want to try to deliver at a hospital that has a level III nicu if possible. Chances are you won't need it, but if you do, you don't want the babies moved to a different hospital than you. Hopefully your peri & ob will be on the same page for the babies' & your care- my peri would fax over his report (w/recommendations if necessary) after each visit. You may want to ask him when he likes to have you deliver by (mine said by 38 weeks), ask about extra protein, recommended weight gain. Try not to worry about problems unless they actually present themself. I worried so much for most of my pregnancy- I wish that I was able to enjoy it a little more than I did.

Good luck!

 

Congratulations on your twins!! And, yes...try to relax but become informed so you can make the right choices for you and your babies. Most peris also do deliveries, but ask him just so you know. We are in a situation where our local hospital has no NICU and is just not that great of a hospital overall. My peri has more experience than my OB in delivering monochorionic twins, and he delivers at a hosptial with a level 3 NICU, so that's where we want to deliver. Right before I hit 34 weeks we plan to go up there (2 hours away) to just stay until the babies are born.

If your OB and peri differ in their opinion on things (ours have) you just have to weigh everything out and make a decision yourself. How far away is the nearest hospital with a level 3 NICU? In my thinking, not only is that a good idea for the babies but generally they are better hospitals overall for the health of Mommies too. Ask your peri and OB how many monochorionic pregnancies they've delivered.

For a monochorionic twin pregnancy you should have ultrasounds at least every two weeks, starting at about 14 weeks. Push to make that happen! And try to gain a good amount of weight in the beginning, because it's harder at the end. 24 pounds by 24 weeks is a good goal to set (if you're average weight). Try to get lots of protein in your diet as well.

Hope everything goes well for you...glad you joined us!

 

Thank you so much or your replies!

Let's see...

They do share one placenta. Not sure if I'm "high risk" just because of them being MODI. I have minor MVP and low sugar. I have had 4 miscarriages, 3 before DD1 and one in between the two girls. I do know that the peri said he will start seeing me every two weeks after Mar 30th (I will be 17 wks then). As far as hospitals, ( I'll say the names to help with confusion)

Northeast (Level II) OB - very close to us

Kingwood (Level III) Neither - very close to us - hate hate hate this hospital very graphic reasons regarding miscarriage

Woman's Hospital (Level II & III) Peri - about 45 min to 1hr away which I drive to see the peri anyway.

I lost 6 lbs due to morning sickness, but the past two weeks I have gained 13 lbs from that loss - so 7 lbs from pre-preg weight. I'm a little girl, so was about 6-7 lbs under weight to begin with. I bought Dr. Luke's (?) book, and have been trying to drink 2-3 Ensures a day.

I will ask about delivery weeks,- before we knew they were MODI, my OB was saying bedrest at 27 weeks, delivery at 32-36 weeks.

I will probably have more questions, but thank you for the kind words thus far. Right now I'm counting down the days to see the babies again.

 

I think pp's covered your questions but I just wanted to say congrats! I'm having modi twins as well. Feel free to PM me with any questions. I see my peri every 2 weeks. He's watching for TTTS and monitoring my cervix length. Even though my Ob and Peri work closely together I know they have different opinions concerning things like cerclages and bedrest. I agree that you should find a hospital that you are comfortable with that has a level III NICU just in case you deliver before 34 weeks. Also your ob will likely deliver your babies so find out if she/he has experience with twin deliveries. Try not to worry too much, the risk of TTTS is only 25% and 50% of twins are born after 37 weeks.

 

Just wanted to say
Sounds like you are up in North Houston? My dd had mo/di twins about 4 months ago at Methodist in the Med Center. Her peri was at The Womens Hospital and ob at Methodist. I know many women in Houston have their twins at TWH and seem to like it. In dd's case the peri saw her every other week and the ob on the other weeks.
Good luck!
Lindy mom to Stephanie and Nana to
Cameron and Corey

 

I'd try to deliver out of a hospital with a level III NICU. I only saw a peri, not an OB and peri, so my peri group delivered. We delivered at U of M, a hospital with the highest level NICU.