Friday, December 9, 2011

Tippy meets OB

I waked into my OB's office yesterday and one of the first few sentences out of my mouth was, "I've spent almost 5 years and 6 figures on getting to this point. These twins mean the world to me. Are you going to be able to handle me as a patient?"

Wait, did I just say that? MY OB??? OH MY GOSH!!!! I HAVE AN OB!!!

Ha! I wish I was even harsher. Like, "Listen hear buddy. I'm going to co-manage this pregnancy with you, so you'd better be ok with that, otherwise I'm heading somewhere else". But I'm bad at being stern.

Ok, back to the story...So I met with my OB for the first time yesterday and it went really well. I first saw his nurse, who used to work in an infertility clinic before this job, so she definitely has a sense for our background, which makes me very happy. She took a lot of my health history and then shared some materials with me.

Then I met with my OB. I of course was hoping for a scan, or a listen for the heartbeats, but I didn't get so lucky. Instead, we just went into his office, me toting my notepad with questions, and he with a comforting smile. After I shared with him my "opening speech" he just looked at me and said,"Go".  Meaning, ok, girl, it's your show, ask your questions away.

So here's what we discussed (Answers in italic)

  1. Do you deem me high risk just because this is a twin pregnancy? If so, should we be consulting with a Peri as well? No, I don't think that you are high risk, just because you are having twins. You will get more monitoring after 20 weeks to make sure the babies are growing well and around the same rate, but no, you don't start out high risk. If you want to see a peri, that's your choice, and you can certainly consult with her if you like, but I don't think it's necessary.
  2. Do we need to do preventative monitoring of my cervix? What are my chances of cervical failure? Do you do preventative cerclage? The data does not support preventative cerclage, without prior failure, nor does it show that measuring cervical length prevents cervical incompetence. This is something that I'm worried about because I've known 3 moms that lost twins in the 20 week mark due to cervical incompetence. He then said that he would be able to better predict anything going wrong just based on symptoms that I'm having. And he will take care of me. He promises.
  3. These are all of the meds that I am currently on: Estrogen, Progesterone, Baby Asprin, Metformin, Lovenox, Prednisone, Pre natal, Extra folic acid. I'm supposed to stop most of them today, but am a bit nervous about it. Do we need to do any other monitoring of blood levels of progesterone to make sure it stays high enough after I go off? No need to monitor any levels. Your progesterone should be high enough because the placenta has taken over the production of progesterone and estrogen at this point.  Clearly stay on the pre-natals and extra folic acid. (See below for Lovenox and Baby Aspirin)
  4. I was tested and found to be MTHFR hetero C, which can sometimes be linked to blood clotting disorders. Should I stay on the Lovenox thru the pregnancy? MTHFR alone is not an indication to stay on Lovenox. If your RE wants you to stay on it, I will support that, but I'd prefer you be off it. If you want to stay on the baby aspirin, that's fine with me. I was worried about being off them both, just in case. I'm glad I can stay on the baby aspirin.
  5. What extra vitamins and supplements should I be taking? I have not seen any research that indicates taking other supplements are beneficial. Take what you want to take, but don't get a stomach ache. lol! 
  6. What are my chances of having a vaginal birth? Of being put on bed rest? We'll talk about that in March. I will probably push you towards a C-section, but if everything is perfect... well, we'll talk. But let's not worry about that until March. As for bed rest, I don't like to put people on it unless absolutely necessary. I like to avoid it and am not a believer that it does much good. I havent' had any twin pregnancies go to bed rest since I've been practicing, and I've had a lot of twin pregnancies.
  7. What are your guidelines on weight gain? 35-45 pounds ish?You started on the thinner side, so you could gain a bit more. Listen to your body. Eat when you are hungry. Go get a burger when you are craving it, but don't get it for every meal.
  8. Are there any books you recommend following? No, I think they do more harm than good. Especially the twin and multiple pregnancy ones. I don't want you to freak yourself out. Come to me with all of your questions and I will get you through his. I want you to trust me and know that we will have 2 healthy babies in the end of this. 
  9. I'm still exercising: running, body pump, spinning, swimming, warm (not hot) yoga. Any recommendations? Your body will tell you when to stop certain things. Do what you want to do as long as you feel good doing it.
  10. Is there any other precautions that I should be aware of being 37 and never been pregnant before? No
  11. When is my due date? June 28th 2012, but you won't go past 38 weeks, so that puts you at June 14th, 2012.

With that, we talked a bit more about him being the right OB for me and he wanting me to feel comfortable with that, so call him any time, email him, whatever I need to make sure this is right, otherwise, I'm welcome to look for someone different who might approach this differently.

What do you guys think? I do feel comfortable with him, and I know he's got a lot of experience with twins, but I do know some of you twin moms out there would subscribe to a more monitored pregnancy and say I should definitely be seeing a peri, right? I'd be happy to hear all of your thoughts. 

One of my main concerns is that I don't want to go down too many worm holes of worry, so I feel like if I'm with this OB who is not going to be overly anxious about every little thing and just let me navigate this with how I am feeling in my body and mind, (which is the route I prefer in life...) well, then he just might be the best choice for me.

We do have a scan coming up with a Peri in a few weeks and I will definitely be asking her questions about the OB I've chosen and if she subscribes to his theories. 

On another note...I've seen some of you pregnant ladies out there on your blogs answer questions every week about cravings and weight gain and such... but I don't know if there is a standard list of things you document every week? If so, can you email me or in a comment below send me a list of those things you document? I want to start seeing how things change over the weeks and that seems like a great way to do it.

Ok, that's all for now. Heading to bed to dream of these babies...


michelle said...

I'm definitely a fan of having a peri as part of my team. The one I see is a rock star of sorts when it comes to twins. He always has better answers to my questions than my OB just because he sees way more twins and therefore way more complications than my OB. I love being able to get two opinions. I basically only see him for my growth scans but I get 30+ minutes to ask him all my questions and I have a lot. :)

Btw, my peri strongly recommends twin moms and ivfers stay on baby aspirin the whole pregnancy.

Ps. I'm 39 and otherwise not considered high risk simply due to having twins either.

sarah said...

I had a long and winding 5 year road with multiple ivf's that resulted in my twins (a little over a year old now). My OB was fantastic, and promoted tandem care with a peri. At 36, I was technically advanced maternal age (ha!) but that helped jump some insurance hurdles. Anyway. As much as I love my OB I would definitely say that my most intense, intelligent, and informative care came at the hand of the peri.
I had a moderately complicated pregnancy that I don't want to scare you with. I would definitely say that if you want to stick with just your OB that is great, but don't be shy about sharing symptoms, worries, or even freaky hunches with him. It sounds like he will take you seriously and that is great. (and if by some chance you live around the Seattle area I can hook you up with a great multiples group)

Bernadette & Duane said...

It's sounds like you've got a wonderful OB! I would go with your gut and if you are ok with just seeing him, then do it. I would imagine you can always consult a peri if any problems arise. My twin pregnancy is mainly monitored by my Indian IVF doctor. It's not the traditional western way but we love her and being in the reproductive field she sees more multiple pregnancies than singles! So, go with whatever makes YOU comfortable (oh and Tidy too!)

Heather said...

I was *that* patient too. My OB was fabulous. I love her. Yours sounds pretty good to me. You need someone that will be able to handle your worries and talk you off a ledge if necessary, not blow you off as *that* patient. He or she needs to be able to do what needs to be done to manage your stress, even if it means additional meds like baby aspirin or tests at times. My OB didn't do US's in her office though, so I got a Doppler, which was priceless to me.

I saw a peri for screening and NT testing simply because of my age, but I guess you wouldn't necessarily be having those? Or maybe they automatically do those tests because you are having twins? I wasn't a huge fan of either peri I saw though, as they were much more doom and gloom in general which did nothing to quell my anxiety. Neither were the hand-holding type I was used to with my OB.

Best wishes! Sounds like you are off to a good start in the OB department!

Sybil said...

I am only seeing a peri (I just refer to him as a high risk ob). I am 32yrs old, IVF#2, FET#1, but I had a completely backwards uterus that had to be flipped in the OR, while I had a spinal. So I have already had a few complications. My husband is a neonatal dr and he says all twins should be followed by a peri - if only as a precaution. Thanks for posting all your questions & answers! It is nice to compare notes! As far as documenting progress, I just took bits that everyone else had done and customized it for me. I would say the top things you might want to keep up with are weight, cravings, emotions, symptoms and anything else that you want!

Roccie said...

What about fish oil supplements? :)

Holly Hansen said...

First of all, I love your writing style and your OB management style! Congratulations on your pregnancy. You must be so excited and nervous at the same time. I noticed that your doctor says you don't need special supplements. You might want to ask him about L-methylfolate. Women with the MTHFR polymorphism have a limited ability to break down synthetic folic acid to its active form, L-methylfolate. I work with NeevoDHA, a prenatal specifically indicated for women with MTHFR. It contains L-methylfolate as an alternative to synthetic folic acid. It is just something very simple and safe you can do to be certain MTHFR-related folate deficiency is not an issue during your pregnancy. Best of luck to you for a happy and healthy pregnancy!

Elle said...

You have moved onto an OB?! That is so awesome. I am so glad everything is going so well! I think about you often and send you happy vibes. I still chuckle about the midnight snacks in your early pregnancy post.

Keep it up girl! Keep those babies growing strong!

Amy Lagerquist said...

Hi there,

I just found your blog through a lurk on FC. I lost my twins - also conceived after many ART tries - in August during my second trimester. I'm currently TTC again, and multiples will again be a possibility.

When I see answers to twin mamas from their OBs that are akin to yours, I cringe. Keep in mind that despite what your OB told you, ART pregnancies - especially multiples - are higher risk. If you are able to press your OB to bring a peri into your care team, I highly recommend you do it.

My pregnancy was very complicated and turned into a disaster at 14w2d. My OB team didn't take me seriously, and while they couldn't have likely prevented what happened, they absolutely could have treated me with the care and concern I deserved as a high risk OB patient (who had already had a moderate placental abruption at 7w2d and had been bleeding the 7 weeks prior to coming under their care). As a result, my hubby and I have changed our insurance so that any future pregnancy will be solely managed by our RE, who is also a high risk OB. (We're undergoing treatments again to try and conceive #3.)

Oh, and I do second the recommendation for adding fish oil. My RE recommends it (and 100+ grams of protein per day) to strengthen the amniotic sac. SROM was part of my loss story, so you can bet I'll be hopping on the fish oil wagon myself once we're pregnant again.

Best to you...

Mangopuppy said...

I like your OB so far...but yeah, if you are having concerns, bring them up and don't let them just be dismissed.

When did you find out about the MTHFR? Is that the given reason for your infertility (I thought you were "unexplained"?).

If you want to do more reading, join the "Lovely Lovenox Ladies" on Babycenter -- lots of ladies with MTHFR and other blood issues (or none, but have to be on anticoags for one reason or another).

If I were you, I'd consult with hematology regarding whether to continue on BA or Lovenox or both. You are lucky that you know you have this issue going into it, so you can take precautions as needed.

Anonymous said...

I am so excited for you T!!! - ADH

Holly Hansen said...

Mangopuppy is right. Babycenter has a very large community of women with MTHFR who have been in your shoes. Lovely Lovenox Ladies is great. They are really educated about MTHFR and clotting disorders. Many of them know a lot more than their doctors about the condition.

Anonymous said...

I took baby aspirin until the end of my pregnancy (about 2 wks before delivery). What I really liked about my peri was that he was very well-versed in research, could tell me the pros and cons of any ideas I had about my care, was NOT gloom and doom, and I had u/s at EVERY appointment. That really helped keep my anxiety at bay. You do what feels best to you. My peri and your OB sound similar in the more relaxed attitude about eating, gaining weight, etc. I did not end up with any major issues, but I was so glad to be followed by someone who I knew could handle anything throughout the pregnancy. I did not want to have to switch doctors. With my insurance, simply having a twin pregnancy qualified as high-risk, so I was able to see a peri from start to finish. Like I said, you do what feels best to you. -Bebehope

Lindsey said...

I like your OB's answers but I agree with people above that sometimes we have to pay more attention and ask the pushy questions.

Regarding MTHFR.... I had a horrible experience between my RE, OB and Peri trying to decide whether to take the lovenox or not. I have homozygous MTHFR (the worst kind) but I have normal homocystine levels. The RE said take it and don't listen to them, everyone else screamed NO! Eventually I decided to take it because it had few side effects but stopped when dx with complete placenta previa. All the research says that treating MTHFR with Lovenox is not necessary, its an over cautious "old" way of treating a way over diagnosed condition, but it was still REALLY hard for me to put down the needles! I do take a perscription B vitamin though, I think its the one that Holly mentioned.

LisaB said...

Wow, so interesting and informative. I cannnot imagine all the questions when/if I get pregnant. YOU HAVE AN OB! OOOEMMMGEE!! That is freakin fabulous :-) Good luck!

Anonymous said...

Lisa here: I'm going to chime in with the "add a peri to the team" people.

That said, here are some very specific supplements/twin adjustments to talk about with either your OB or your Peri, whichever you choose:

Omega's/fish oil, magnesium, zinc P 17 shots and Vitamin D (20,000 iui): all of these help your uterus remain calm, since irritable uterus is much more common with twin pregnancies and can lead to PROM

More protein, more water, more rest (1 hour a day in the middle of the day every day off your feet), heart rate not above 140, avoid warm/hot yoga (switch to pre-natal)

24 lbs by 24 weeks: it gets really hard to eat as the pregnancy progresses so get that nutrition and weight to them early.

I think you are doing great, and I think your getting some great feedback here from some great twin mama's out there.

I know it feels like if you have someone thinking about all the things that can go wrong that you will follow them down the rabbit hole, but I think the point is to have a dr who does think about all those things, and addresses them with specific instructions and counseling to you so you don't have to think of them, but can just swallow your omega pill, cuddle up on the bed with your giant glass of water and your midday nap and dream of nurseries and baby names. Two of them!

Serenity said...

Holy shit how did I miss that you were PREGNANT? WITH TWINS???


Okay, so I'm going with the "do what you need to in order to feel comfortable" camp. Plenty of people have delivered twins without a peri on your team. However, you're not just anyone. So if adding a peri to the team makes you feel better? do it.

Your OB sounds great, though; like he'll really listen to you and be thoughtful when it comes to answering your questions. I like that.

Congrats, hon.


Anonymous said...

I just have to say that I am a loss mother and lost my twins at 21 weeks. One day I went in for ultrasound and all was well. ALL was WELL! The VERY next day, I was contracting and by the time we went to the hospital it was too late. From 1st contraction to the time we arrived at hospital was 35 minutes. So your dr saying he will watch the signs and symptoms, It shakes my soul. I just dont like that. Please know that incompetent cervix is silent, so his approach in the watch category scares the bejeezus out of me. And the previous poster is correct, ART twins and pregnancies are higher risk in and of themselves.

That said you're doing great and don't panic or anything, just know that things aren't always as relaxed as this OB makes it seem. And yes I too had a OB who swore I didn't need to add anyone else to my team. To this day I kick myself. It's been 5 years and I have had another baby, but it doesn't get easier with the "I should haves" I was so worried about insurance, but looking back I would give anything...