Problems with OB

After another frustrating doctor's appointment, I thought I would reach out to the twin moms and see if you had any guidance.

(Long backstory)

When we found out we were pregnant, I called my regular gynecologist, but she no longer delivered babies. Her office recommended a practice in their building, that delivers at the hospital near my home that I expect to go to for the births. I had heard great things about the midwives and was fine with this development.

At the first visit we found out we're having twins (yay!) and were then declared "high risk" because of the possible complications. At the long intake visit, no one mentioned the possibility of midwives until I went to make my next appointment and the scheduler asked if I wanted a doc or midwife. I went with doc since thats what it seemed like was the option. From then I have had four appointments, with three doctors, none of which were very warm or cuddly. The nurse will tell me one thing (you shouldn't be taking calcium, or "its too early for that test") and then the doc will have the opposite opinion (calcium will not hurt, it may help, and "its the right week to have that test."). Its frustrating and confusing.

We went to the hospital tour the other night, and halfway through I just lost it. It started in the birthing room (wont get to deliver in there) and then by the time we got to the post-partum area, the nurse mentioned something about moms who's babies are in the NICU get singles so they don't have to hear the other babies come in and out, I just started balling. The nurse had me stay late and talk, and was really good at calming me down. She suggested I see a midwife at our practice, as birth support instead of as a deliverer.

Then at this morning's appointment, my husband reminded me about asking about the midwife, and the doctor said that with twin pregnancies, midwives are not involved in patient care. He said since the deliveries are so different and that there is no "normal twin delivery" the midwives don't do it. I asked about having a midwife as labor support and he said "well, if you have a c-section there won't be any labor."

I am so confused. I don't understand this process at all. And really just want someone consistent to give me answers. Anyone go through this? Should I be switching OBs? I'm only 15 and a half weeks.

 

I'd call the orginal ob and ask for a new ref for a high risk ob. These docs don't seem to know how to treat a twin pregnancy

 

If you're not feeling comfortable with the doctor's office - I would switch. Midwives may not be involved -but you could look into a doula, someone other than family that could be your advocate.

My 2nd one got the diagnosis of T-18 at approximately 18 weeks and I switched to an new office and it was the best decision I ever made. They're now involved with me with this pregnancy.

 

I agree, sounds like it's time to switch practices. I'm noticing with my current perinatology practice (I only see one doc there, but have met with others on occassion due to complications), that peri's tend not to be quite as 'cuddly' as my reg OB was. However, I've had the benefit of being pregnant and delivering before. I think a doula souonds like a great ooption...even if you have a c-section, she can soothe your nerves ahead of time and help with personalized baby care after. I WISH I had had a doula for my first pregnancy. I did 24 hours of labor before my c-section, and the personal attnetion would've been great!

 

If you are not happy with the docs office you should change.

I will try to answer some of your concerns to the best of my knowledge and if I'm saying something incorrect I hope someone will chime in and correct me.

1. It sounds like you are worried about being high risk. Since your post doesn't indicate if you are experiencing any complications (if anything it sounds like you are having a very normal twin pregnancy) I will tell you that I was told at my docs office that they declare all twin pregnancies as high risk. They have a different protocol (cautionary) for high risk and want their twin pregnancies to follow that protocol. So even though you were told you are high risk that doesn't necessarily mean your pregnancy is any more risky than any other regular twin pregnancy. I'm considered high risk but I have had absolutely nothing happen during this pregnancy... aside from early Braxton Hicks that I also had with my two singleton girls.

2. I have also had each appointment with a different doctor. My office recommended that because the doc that will eventually deliver my babies will be the on one call and the more of them I see during the pregnancy the more likely it becomes that I have met the delivering doctor before. Warm and cuddly isn't a preference for me, I'd rather have competence, but of course everyone is different.

3. If the nurses are telling you different things from your docs (calcium, taking a test at some specific week) I would rather listen to the docs. They are the nurses overseers and give them instructions. They are also more highly educated in this particular field. If the nurses are telling you a different story from what the docs are recommending than tell them that and ask about it.

4. I'm not quite sure why you had such a difficult time at the hospital tour. Was it because of the NICU and being high risk as a twin mom to be? Sounds like you need a consult to help you deal with those fears but I cannot comment on them more specifically because you have not indicated if there is a specific risk involved in your pregnancy that causes your concern.

5. I don't know where you are but might the docs issue with the midwifes be regarding insurance? If you get a doc to deliver your insurance might not cover also a midwife for birth support. You might however want to look into hiring a doula (I think you'd have to pay out of pocket for that) because that sounds exactly what you need regarding birth support, emotional support, helping you deal with the stress your experiencing etc.

6. From what I gather giving birth to twins is usually not done merely by midwifes. For one, you could end up giving birth to one twin but having to have the other twin taken by c/s. You cannot know that in advance. Also, it's much too early to tell if you are likely to end up with a c/s delivery or vaginal delivery. It will have to do with a lot of factors, probably the biggest one being if they (or at least twin A) are heads down when you are close to delivery. This is the same for all of us. None of us is 100% sure we'll have a vaginal delivery with both twins. Midwifes have no hands on roles in c/s deliveries so the doc wasn't just feeding you a line there.

7. Regardless, it sounds like you need to talk to someone for emotional support and get better information from your docs to lessen the confusion. I suggest being very clear about that with your docs, or switching docs and again being very clear about that with your new docs.

I hope you feel better soon and find a doc you are happy with, either at the office where you are now or at a new place. :hug: :hug: :hug:

 

Oh momma! Sounds like you are definitely not in the right place. Either you are high risk and you need doctors that are more informed and direct with you about twin pregnancy and your situation specifically, or you're not (other than a normal twin pregnancy) and you should be with doctors that can re-assure you that everything is going smoothly.

You'll find a really wide range of experience (by that I mean competence) out there when it comes to twin pregnancy. I'd guess that the problem is that there are so few studies, and what studies there are may not apply to your situation -- what a study shows is a trend overall might not be the trend with twin pregnancies like yours (di-di v. mono-di, first time moms v. multiparas, any number of things could make a difference.) But whatever the reason, I'm SHOCKED by the mis-information that can come out of OB's mouths when it comes to twin pregnancies.

Definitely change doctors. Change hospitals if you'd feel more comfortable. Figure out what you need and what you want. Ask around for THE BEST you can find. Join your local twin club and ask moms there who was happy with their care and why. Don't know if you have kids already, but for me, learning to get my family what it needed was an early lesson in parenting!

FWIW - I found out about my twins at 19 weeks. Mine was an otherwise uncomplicated pregnancy, my first. By 29 weeks I had lost confidence in my doctors and the hospital (which had an 80% twin c/s rate. That number is not supported by the evidence as being necessary.) I choose a midwife and homebirth. Loved it, but if you go with midwives, skill is even more important.

Midwife care might be an option for you, and even if not, a doula could help. I don't know your situation, but I'm sure there's an OB near you who would offer you better care.

Find a practice that's right for you and your babies' needs.

Good luck!

 

Change your docs now! I am 33 weeks along right now & wish I would have switched a long time ago - actually I regret not changing doctors everytime i go which is now 2x a week. I also have different answers all the time every week from who ever I see. My first pregnancy was wonderful I went to see midwives but as soon as we found out it was twins they switched me to the doctors who labeled me high risk who sent me to a whole different practice. I miss my old practice dearly & I would suggest you find someone youre comfortable with & can really talk to & get real answers. Good luck!

 

Double post, sorry!

 

I agree - change drs! If you're not getting the support or answers you need, it's time to find an office that will give you those. I had a multi-dr office with our first and HATED it. I love our dr, but the other drs there just were awful. No bedside manner (one practically screamed at me for gaining too much weight and if he had looked at my chart for even a second he would have seen that it was the first month I had even gained weight - and was underweight to begin with) and I felt like they didn't care at all. I switched providers and love our new doctor. She's the only one in her office (although she does work very closely with a peri's office) so I knew who I was going to see every appt and knew she knew my backstory and would take care of us. Just remember, you are your own advocate. If you don't like what's going on or how you're being treated, it's your responsibility to find someone that will treat you better. :hug:

 

Thank you all! I knew Twinstuff would help.

I think I just wish someone would be upfront with me, answer my questions and act like they are interested. I still don't know if the twins are mono/di or di/di (I asked, they said they would check...) or how it works for who is on call or anything. I just feel like I am not getting information. I asked about seeing a nutritionist in the practice, they sent me over, and they only deal with bariatrics (morbidly obese). Things like this. Little bits of mistakes that add up. I don't feel confident in my care, I always leave with more questions than answers.

I'm starting the process of asking around to see who had better experiences.

I am only "high risk" as deemed by a twin pregnancy. Since they added that term to my chart, I have gotten no extra info or "they are doing great!" or anything. Its just frustrating.

Thank you so much. Will let you know as things develop. I didn't realize doula's do emotional support, I thought only help keep the drugs out of your delivery.

 

:good: i agree. it sounds like you need to find a doc or practice that more similarly matches your personal birth philosophy. without a doubt, there are a lot of things in pregnancy, labour & delivery that are outside of our control (and it seems like those things triple when you're having twins), but it's also important to remember that many twin pregnancies & births progress without complication or need for excessive medical intervention. don't borrow trouble before it's here. when i was pregnant i assumed everything was going to be fine & we dealt with problems & complications as they came up. i know that's easier said then done, but it helped keep my stress level down.

i don't know if this is an option where you live but it might be worth looking into - until very recently, here in Alberta, when you were expecting twins you could opt into a shared care plan with the midwives. this meant that you saw the midwives AND an OB throughout your pregnancy, and you delivered at the hospital, but baring major complications during L&D, the midwives would be the ones to deliver your babies.

i also agree with everyone who suggested hiring a doula. this is what we did & it was a total sanity saver! even if it turns out that you need a c-section, as a PP mentioned, having the doula there pre & post op can be a hugely calming influence. if you would like more info about doulas check out DONA. feel free to ask me any questions about doulas as well - i'm in the process of getting my DONA birth doula certification.

if you're a reader, i would recommend reading "Birthing From Within" - i found it really helpful in preparing emotionally, mentally & spiritually for birth.

:hug: twin pregnancy can be a really overwhelming process & it doesn't help when you feel like the professionals aren't supporting you the way you need. take a deep breath. you've got lots of time to figure things out. :hug:

 

I agree with PP, it is a good idea for you to switch drs. I started with a new ob at the beginning of this pg because I didn't like how my last ob handled the delivery of my son. I loved her at first, but as time went on I would have the same problem as you - but with the same person! My ob would say one thing one week, then something completely different the next week. If we ask too many questions she seems to get irritated and sometimes right at the start of the appt says things like, I don't have time to answer a lot of questions. I decided to seek a 2nd opinion at a different hospital with a different MFM practice. I had the first part of this yesterday where they did a u/s and I had a brief meeting with one of the drs. Though the meeting was brief and I will have the full consult today, I already feel like these drs have a much better idea what they are talking about and actually have a plan, which I had to practically beg my ob for and didn't agree with anyway. I am already in week 22, so at 15 wks, you're not too late! Good luck!

 

I'll 4th, 5th, 6th the suggestion to switch providers. I switched w/ my sigle pregnancy at 24 weeks because I was getting the same kind of responses from the ob and the nurse. It was driving me batty. I now go to a midwife practice at my hospital and they absolutely handle twin births. I may or may not have to see their overseeing doctors during this process, will have to deliver in the OR, and will most likely have an OB present at delivery, but if I am able to push vaignally my midwife will do the catching. The bottom line is you NEED to feel 110% confident in your doctors and their abilities, and it sounds like you absolutely don't. You don't want to find out just how much you differ from them philosoply wise while you're in active labor!

 

Ditto A) switch OB's...tell him/her your experiences and what you want, and B) use a doula (a lot of times, someone with midwife certification can act as a doula but make sure she knows when to back down. Ideally, if you can find a family practice with both OB and midwives they'll be used to working together). And yes, sometimes you may have to pay out of pocket but consider it an investment in your sanity.

We're looking at a planned c-section this week (troublemaker baby is breech and I have some other risks so my OB has recommended we don't try a breech extraction) and my doula did a great prep session with me and DH and will be there when I come out of OR and help with breastfeeding.

 

Hello all! I wanted to give you an update! (posted in my appts for the week too, sorry!)

Well, the new doctor was pretty great. He was patient and kind and answered all of our questions. We found out the babies are di/di (we had asked the previous doctor but no one ever told us!), and growing great.

At one point when reviewing my records, he said that my AFP test came back really high, 1/110. I panicked, having been told yesterday by my old doc that it was negative. But they never thought to send it along to my new doctor! So we called and they finally got the recalibrated results over, and it was fine. But man!

He said he expects me to stop working at 28 weeks, which was kind of a shock. I knew bed rest was an option and a reality, but so soon?! He said if my job is a desk job and I dont stand much we can talk about it as we get closer.

During my exam he said I had a very narrow birth canal and that the angles of my pelvis made him thing I will likely have a c-section... never heard of this one before! But there are three docs there, one of whom has twins, so I feel like that will also be discussed in the future.

They were shocked we hadn't seen the babies since 12 weeks! (Me too!)

And the ultrasound tech was 90percent sure baby a is a boy. Couldn't tell with Baby b, it was playing with its umbilical cord too much.

So, all in all, I am pleased. We have an appointment with another on Monday, but I think I will cancel that. I am really comfortable with this group. They were all so friendly. The nurses all talked to the patients like they knew them, because they probably did. It wasn't cold or sterile. It was more caring.

Thanks for giving me the push to find someone else!!!

 

I am so glad you found a doctor/practice you feel comfortable at!
AND congrats on your 90% sure of a boy!!! that's great! Take care!

 

Fantastic news! Being comfortable with your practice is so important. Yes, you can discuss a lot, but at a certain level you need to trust that you and your OBs are on the same page.

Your old practice didn't tell you your twins were di-di? Wow. You'd think that would be the second thing they tell you, after "there's two in there!"

But one comment of warning - it sounds like this new practice is very conservative. Bed rest across the board at 28 weeks? That's very conservative, not backed by research and not necessarily right for all women. It could be a blessing if you have short term disability and it works for your needs and wants. But it's not usually an across the board thing. And the talk of a narrow pelvis requiring a c/s? True cases of CPD, babies not fitting through a mom's pelvis, are very, very rare. Especially for twins who tend to be smaller than singletons. It sounds like that doc at least is laying the ground for a c/s without a real reason. Which, if it's in line with your desires, is fine. But something to think about.

If vaginal delivery is something you're interested in, ask around for this practice's rates of twin vaginal delivery. Don't just take your doc's word for it. I'm surprised by how rare twin vaginal delivery is becoming, especially with first time, full term moms. Fewer docs are willing to do it.

Hope you you like the other two doctors as much. Another twin mom, very cool!

 

I'm glad you like your new OB...but this would set off alarm bells for me. This is total baloney. It is extremely difficult if not impossible to judge whether a woman can give birth based on any proportions of her pelvis. Your pelvis will stretch when you are closer to the end, and during labor itself...in fact many women feel a lot of hip pain because things get really loose. The only studies I have ever read in which doctors have scientifically tried to link hip dimensions to odds of successful vaginal delivery involve serious x-rays of the pelvis (obviously not during pregnancy!), and the correlations have been weak at best. This is a total snow job by your doctor, and probably because he either doesn't like to deal with twin vaginal delivery or because of his own biases. Lots of docs come up with their own anectdotal 'evidence' without ever considering that your situation is unique to anyone else's. They come up with what they feel comfortable with and go with that... a bit like old wives' tales, but they snow themselves into thinking it's scientific without looking at the studies that have actually been done on the subject.

Anyway, this may be neither here nor there since your twins might wind up being breech or transverse and vaginal delivery might not be an option anyway. But if he tries to talk you into a c/s due to your pelvis you need to realize he's full of it. The only pelvis related issues would be if you had a prior surgery on your pelvis, like having broken hips, or a deformity of the pelivs. If you are healthy in that area with no prior issues related to your pelvis then he has absolutely nothing to back up his claim. And he's full of hot air and scare tactics.

But don't be in fear... it's still possible to like a doctor and disagree with them on a topic. It might wind up being a mute point if your babies aren't positioned right, but even if they are positioned right you can insist that you want a trial of labor no matter what he says about your pelvis!

 

P.S. I totally agree with the other poster about bed rest as well. That is really bizarre for the doctor to bring up at this point. There is no good reason for bedrest unless you are experiencing complications. And this is really premature to bring up if you are fine right now. If your job has you standing a lot then I could see them wanting you to cut back hours or not work after a certain point, but otherwise there really isn't a reason if you and your cervix are doing fine!!

 

I'm so glad you are pleased with this new dr. :Clap: That will make things a lot easier on you. And :Clap: for being 90% sure one is a boy!!

 

Thank you all for more wisdom! I go back in 2 weeks for the 20 week scan, and will be meeting with another partner in the practice, who herself has twins. So I will ask her about the leaving work at 28 weeks and the narrow birth canal. Part of me thinks he was just trying to prepare us for possible eventualities, instead of us being surprised. But if I dont have complications, I'd rather keep working so I don't start eating into my maternity leave. And if both babies are down, I want to try to deliver vaginally.