Why do OBs differ so much in opinion?

I had an appointment today with my OB, but she was at the hospital so I saw someone else in the practice. He was way more sympathetic and understanding to my issues than my regular OB... While she will wait to the very end to deliver me, he read all my charts and actually said that he didn't see a reason to not schedule a C-section next week sometime (I'm 37 weeks on Tuesday) before, and I quote, "waiting for something to go wrong."

I'm hoping he might talk to my OB, but I don't think she'd care anyway -- she's pretty tough. But with my lower fluid levels this week on Baby A, and a size discrepancy (even though they are fraternal), I say it's time to get moving before there's a problem. I have an NST and another ultrasound tomorrow to check everything out and I'm hoping they also might say that things are fine to get moving on my C-section.

Does anyone else find that different doctors say different things? Does another OB mesh better with your philosophy than your own?

 

Does anyone else find that different doctors say different things? Does another OB mesh better with your philosophy than your own?
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Yes and yes. Regarding your first question, I've experienced this both personally when seeing my physicians and professionally (I work with physicians as a health care researcher). In regard to your second question, I switched OBs three times. Trust your instincts! Best of luck!

Oh, and I have heard that term for twins is 36-38 weeks and that outcomes can worsen post-38 weeks (although two of my friends delivered happy healthy twins at 39 weeks).

 

yup - different doctors have different opinions. my OB and i were on opposite ends of the birth philosophy spectrum and i was so relieved when i went into labour that she wasn't on shift. i lucked out & had a doctor that felt much more similar to me about birth.

basically, doctors take the information they learn in school plus new information that comes out as new studies are done plus their philosophy of medicine & extrapolate their practices/policies/routines from that information. it's no different than what any other working person does. it's good though because as PP mentioned, it means you can shop around.

 

Yup - I went through 3 OBs before finding my current OB who I absolutely LOVE and who has similar mindset to mine. I know I can trust her opinion 110% and don't second guess what she says. All dr.s are so different and it's important to find one that you feel comfortable with. And it's never too late - the last time I switched was the day before DS was born (I was very lucky that she agreed to take me on knowing that I was so close to delivery!) Good luck - and remember, you are your own advocate. Find someone you can rely on!

 

This is not completely true. Full term for twins is also 37 weeks, no matter how many you carrying. I carried for 38w2d. My doctor is one that beliefs that the risks after 38 weeks outweigh the benefits, but she will not schedule before 38 weeks (also my hospital wouldn't allow to be induced before 38 weeks without medical reasons). This research (and the table at the bottom) is quite interesting. http://www.ispub.com/journal/the_internet_journal_of_pediatrics_and_neonatology/volume_5_number_2_27/article_printable/what_is_the_optimal_gestational_age_for_twin_delivery.html. and it clearly shows the benefits in carrying 38-39 weeks if medically possible.

To OP: I agree you have to go with your instinct, especially size discrepancy (how much?) and lower fluid levels there could clearly be a medical reason, and I think 37 weeks is then a fair compromise ... I would ask you're other doctor what she thinks about today's doctor's opinion. Good luck!

 

Yeah, the OBs in the practice I used with the girls varied in opinions also. The dr I started off seeing, told me that a c-section was my best option when I was just 9 weeks along, she also scheduled my c-section in October for a January delivery. The dr that was scheduled to deliver the girls - my OB was to be on vacation that week - wanted me to try for a vaginal birth if baby A was head down and talked me into changing my plans to an induction instead of c-section if baby A was head down. She was not and we had to do the section BUT the dr that delivered also would not have scheduled a c-section for twins one day before 39 weeks and single baby 40.

 

Yes, I'm sorry that I didn't provide more context. I am actually a statistician in the health care industry, so I shouldn't be cavalier (it's just that sometimes I'm in a hurry when I post!). There *isn't* consensus on the optimal gestational age for multifetal pregnancies. However, a host of research studies suggest that the primary outcome, perinatal mortality, is lowest overall (i.e., not stratified by complicated v. not complicated pregnancies) for a twin pregnancy at 37 to 38 weeks of gestation. In complication-free pregnancies, when both babies are prospering, neonatal complications do appear to be reduced with delivery post-38 weeks. The original poster suggested some issues with fluids, etc., which is why I mentioned the earlier delivery period.

Click here for additional details.

 

TeamTurner, thanks for the link and the clarification! I've always felt that if all's well with babies and mother, going past 38 weeks could be beneficial. It was the choice I made with my twins, but I've only had one study that agreed. Now I have more science to go with my instinct.

:thanks:

 

I also just wanted to add that fluid levels can flucuate to a degree, and you can even control it to a point by increasing your own liquid intake. If you are even slightly dehydrated then babies get less fluid. Good Luck!!!

 

i'm an ob nurse, therefore i work with all kinds of different ob's that come to my hospital, and they are all as different as night and day. it's like someone's personality. some people are more cautious in life and it carries over to their practice, and some are more aggressive in life and work. it's difficult as a nurse since we're supposed to be able to remember all of their quirks by heart.

 

I always loved my OB, but once PG I had to see all the docs in the practice and she was always booked so I never saw her. I felt uncomfortable with this, especially because it seemed like no one ever read my chart. They'd ask why I was there, talk about my one baby (but I was PG with twins).

So I switched to a peri at 13 weeks and it was the BEST decision I ever made. The peri said they would not let me go past 38 weeks because the placenta starts breaking down after that with multiples.