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...