What Should You know?

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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??

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9 thoughts on “What Should You know?”

  1. Some really helpful points here. While carrying triplets is a totally different experience from carrying one, I am often SO grateful that my multiple pregnancy was not my first pregnancy!

    I have to say though, b/c of the pressure there is to ‘hold onto’ a multiple pregnancy for as long as possible, I have never heard of 36 weeks as the ‘standard’ for triplets. The average (as far as I’ve ever read or heard from a medical professional) is 32 weeks for triplets & 35 for twins. I delivered our triplets at 33 wks/6 days.

    Some people become overwhelmed with an abundance of information, but for me, knowledge is power & when I was pregnant, I felt better gathering up all the details I could. I read & read…and asked tons of questions.

    I’d also recommend joining a ‘twins/triplets club’ asap – often these women are great resources for sharing with you their stories, experiences and sometimes even recommend hospitals/mfm professionals.

  2. I wish I’d known that after a C section it is completely normal to shiver uncontrollably the first week of recovery. And that no matter how painful and difficult it is to walk, eventually you will be able to walk to the bathroom by yourself. :)

  3. Great post! All very important things to ask. The only thing I would add is along the lines of what Janna mentioned- it’s good to know exactly what you’re getting into when it comes to recovering from a C-section. I pushed myself too hard too soon after the surgery- lesson learned.

    Oh, we should also all remember the line said over and over in books about being pregnant with multiples, “Expect the unexpected!” To that I would add to that- roll with the punches. Its great to learn as much as you can, set yourself up with a birth plan, hospital, etc that you are happy with, but also be prepared to chuck all that out the window if needs be. I was all set up with an OB I loved and a birth plan in place when all hell broke loose and I had to be medevaced off my island to another island with a better hospital and more specialists. And stay there for about 5wks before the birth and 2wks after. Definitely not something I had planned for, but it all worked out beautifully in the end.
    .-= Jungletwins´s last blog ..A Heartfelt Thanks to That Crazy Old Hag =-.

  4. I second the expect the unexpected comment above!

    I expected bedrest and was up and running after my two year old (in heels no less) until the day I delivered. I expected to deliver early and had to be induced at 40 weeks. I expected a c-section and had a very easy vaginal delivery as a result of both babies turning head down and staying that way from about 32 weeks on. The list goes on and on…

    When I was pregnant with my boys I read all the books I could get my hands on, visited all the twin blogs and message boards I could find and joined a moms of multiples group so I could prepare myself. As a result I was on constant alert waiting for the “twin pregnancy” shoe to drop.. and it never did.

    I’m probably in the minority but my twin pregnancy and delivery were so easy that it made my singleton pregnancy and delivery seem hard by comparison. And that’s something I truly never expected to happen!

  5. I delivered my twins via c-section at 37 weeks, 1 day, and they did an amnio prior to delivery. I did not expect that, and it wasn’t a big deal, but for what it’s worth…

  6. I also would like to say “expect the unexpected”.

    I think the best advise I got from my Peri dr was to NOT have a birth plan … just be aware of what decisions you may be asked to make during the delivery.

    Pick a good Dr and a good hospital and trust the professionals to guide you in your decision making.

    Lastly, I had a c-section with my singleton and with my twins … I didn’t find it to be a big deal or painful … so please don’t let others scare you about this procedure. Your doctor can easily manage any pain with meds that have been proven safe (over years of use) for the babies.

    Your pregnancy and the birth of your children are important … enjoy the moment … but in the whole scheme of life they are but a blip on the radar of an entire life of experiences.

  7. I would be sure to ask your doctor’s philosophy on vaginal vs. c-section birth. For me, it was very important to have every opportunity possible to deliver my twins naturally. I know some doctor’s prefer c-sections for multiples and that is not a discussion you want to be surprised in your last trimester.

    One thing that I also learned along the way is that most hospital’s require multiples to be delivered in ORs for insurance purposes, so while you labor in an L&D room they move you to an OR for the delivery. I don’t remember reading about that hardly anywhere and we worked it out, so I was able to stay in a normal L&D bed instead of having to also move to a much more narrow, less comfortable OR table. It wasn’t a big deal, but I did have to ask.

    Also, I couldn’t disagree more about the comment on not having a birth plan. In spite of all of my planning, I ended up delivering in a different city/different hospital after we’d evacuated for a hurricane and I got food poisoning. We were stressed and out of our element, but my husband was able to hand my birth plan to the nurse and they followed as best they could. Also, I had a much, much more detailed version for my husband, doula and parents with contingencies included – what if I had a C-section, babies carted to the NICU, babies carted to different NICU levels, still borns – we tried to comprehend everything and everyone knew their jobs. It helped me to mentally prepare to do the plan and I think it helped all of us keep our heads when we ended up in a completely different delivery scenario than we ever expected.
    .-= Lisa´s last blog .. =-.

  8. There is some very good stuff in this post. From my perspective it feels a little intervention-focused (maybe because triplet pregnancies tend to need more intervention than twin ones?). My experience with very healthy twin pregnancy was not so much intervention but certainly lots of need for questions getting answered by my doc and others.

    The main thing I’d suggest is – do not hesitate to ask lot of questions and push your providers to explain things. It can mean the difference between getting what you want and not. For me, a vaginal birth vs a cesarean.
    .-= nonlineargirl´s last blog ..A Brief Interruption =-.

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