I have decided to step outside of my normal blogging trend today to post this “guideline” of questions to ask for those of you who are fairly new to your pregnancy with multiples. I did not ask many of these questions myself simply because I did not know. I have compiled this list after two years of reading message boards and hearing other MoM’s stories. Of course, I will need to throw in my own experience (or lack of) as well.
Can I stay with my OB or do I need to see a Peri/MFM?
Many women want to know if they can stay with their OB or if they need to see a Peri or a MFM simply because they are pregnant with multiples. This could be argued either way until the cows come home. There are many women who have stayed with their “regular OB” and delivered their twins or triplets without issue.
I called my doctor a “high risk” doctor. That is what everyone at the hospital referred to him as. No one ever said, “He’s a MFM and this is different from an OB because…” I was seeing him before it was discovered that I was pregnant with triplets because of the stillbirth of my first baby. I didn’t even know what a MFM was until AFTER my girls were born and I joined the wonderful world of message boards.
A MFM is a Maternal-Fetal Medicine specialist. An OB who practices maternal-fetal medicine is called a Perinatologist. So in basic terms, a MFM and a Peri are essentially the same. These specialists have training in high risk pregnancies and have been credited by many women for discovering problems and saving the lives of their babies. The best advice I can give is to ask questions. How many patients has this doctor seen who have had pregnancies similar to yours? If you are pregnant with one or more babies sharing a placenta or amniotic sac, you will want a doctor who has had much experience with complications related to such.
Those pregnant with identicals will want to discuss twin-to-twin transfusion. How will the babies be monitored? If your babies do start to show signs of twin-to-twin transfusion, what will be done? Do they have contacts with specialists in this area? Across the country?
How often will I have appointments, ultrasounds & non-stress tests?
You should be able to map out your appointments with your doctor. How often will you be seen? How often will ultrasounds be performed?
Near the end of my pregnancy, I scheduled to go three weeks between ultrasounds. At that point, my girls had never shown any signs of twin-to-twin transfusion and they were developing on schedule. I felt very uneasy about waiting three weeks for another ultrasound, especially considering my previous loss and the fact that the excess fluid in Baby B’s brain was being monitored. I expressed my concerns to my doctor and without issue, he scheduled me for an ultrasound.
What should I do if there is an emergency or concern?
Who should you call in case of emergency or if you have questions? Do you want to go to the local ER or would you rather be seen at the Labor & Delivery unit of the hospital where you will delivering?
Most women that I know see a doctor with a practice that uses a hospital for deliveries. My situation was a bit different in that the hospital I was deliver at had it’s own team of doctors. If I had a question or concern, there was a number I could call 24 hours a day and I always received a prompt response. I made two trips to L&D due to dehydration and the staff did a thorough job of checking the babies, my contractions, etc.
Will I have to go on bedrest?
This is the million dollar question. When I had that first conversation with my doctor after my triplets were discovered, I remember asking when I would be placed on bedrest. The misconception amongst those inexperienced with multiples (like I was) is that you will HAVE to go on bedrest. This is not always the case.
There are different variations of bedrest – from full out, in the hospital bedrest to modified bedrest. My doctor did not believe in bedrest unless there was a medical reason for it. Being pregnant with triplets was not a medical reason. I eventually ended up just staying off of my feet. My doctor knew that I was doing so and reminded me of it. I listened to my body and knew my limits.
I should note that I have heard of doctors that will place their patients on bedrest at a certain point in the pregnancy simply because those patients are pregnant with multiples.
Will I need a cerclage?
A cerclage is when stitches are placed in the cervix to keep it from opening. With many pregnancies, cervical issues arise suddenly and emergency cerclages are needed and are sometimes not effective because the cervix has already been compromised. You should discuss with your doctor their procedures for monitoring your cervix and what will be done if any issues arise.
If you are considering a cerclage, you should also discuss and research the risks and benefits to this type of procedure. Although not seen very often, there are doctors who will want to perform this procedure on all of their triplet patients “just in case.”
Will the hospital be able to care for my babies if they are premature?
Ask many questions as to the NICU and other nursery services at the hospital where you will deliver. You cannot assume that you will make it to the point of having take home babies and I’m sure the last place you will want to be is a hospital different from that of your babies.
In addition, there are hospitals that do not offer an “overnight” nursery. This means that, assuming no NICU, your babies will be rooming with you the entire time. Not that this is bad but you may want to be prepared and expect to ask for and/or need help.
What will happen if I go into pre-term labor?
We all know that there are drugs out there that can stop/slow down pre-term labor contractions. The question you should be asking is what is your doctor’s position and what actions will be taken? Again, the risks versus the benefits need to be weighed. Since delivering my girls I have read several articles where my doctor opposes the position taken by another “famous” doctor of mulitple pregnancies in Arizona in the usage of tocolytics.
How early is too early?
This is something that no one wants to think about (and I don’t even like to write it) but you need to know at what gestational age the hospital will try to save your babies if they are born too early. Most hospitals are at 24 weeks.
How long can I carry these babies? When will delivery be scheduled?
For a “standard” triplet pregnancy, you are looking at 36 weeks, give or take a few days. You may want to discuss this with your doctor. Don’t assume that what you read on the internet will apply to your situation and/or doctor’s position.
There are some doctors that may schedule your delivery weeks in advance to hold the date. My doctor would not schedule anything until I reached 34 weeks. Even then, the delivery date of 36 weeks and 4 days was moved up by 5 days (at the very last minute) due to scheduling issues.
Will I have to have an amnio before delivery?
This may sound far-fetched but there are some hospitals (probably only a handful) that require an amnio be performed to check the lung development of the babies before a c-section will be performed if that c-section is to occur early. What is early? Usually before 37/38 weeks. I agree that this is somewhat odd in that a women is not going to carry triplets to 38 weeks and will have to deliver regardless of lung development but for some hospitals, this is a standard procedure and those triplet moms have had to have an amnio.
Although highly unlikely, I mention it here because over the past two years I have heard of a handful of women who were quite surprised to learn of this late in their pregnancies.
Will I have my own hospital room? What accommodations will be made for my spouse/partner?
Although not as important, this may be something you will want to know. I knew about the possibility of room sharing but it did not sway me from changing hospitals. I have to tell you though that sharing a room that first night after my c-section was absolute torture.
I am sure I have missed some items. Does anyone want to add any or tell of their experience? What do you wish you had or had not known??