New, with questions!
Hello, joining the group! I'm 9w pregnant with twins (thanks to Clomid). I've gotten over my initial shock and now I'm really excited. My sister (who is a med student) recommended me read the book When You're Expecting Twins, Triplets, or Quads by Dr. Luke and over all it is a great guide. My mom gave me some other books, so far I've read Twins 101, and she also gave me Twinspiration.
So my first question is, both When You're Expecting... and Twins 101 strongly urge choosing a hospital with a level 3 NICU. My local hospital has a level 2 NICU. According to their website, they can handle most situations, but for babies born before 30 weeks, they stabilize them first then send them to the level 3 NICU at Stanford, which is just across a bridge from here. That *seems* alright to me. It's early enough that I should be able to transfer to a doctor who delivers at Stanford, but on the other hand, it will be inconvenient to travel across a bridge for every appointment. I'd also be concerned about getting there while in labor, when in traffic it can take 45+ minutes. I would definitely transfer doctors if I had higher order multiples, but with fraternal twins I think we will be ok. What do you think?
Also, by my appointment next Monday, I need to make a decision about prenatal testing. At the group pre-natal class last week, I asked if the quad screen is still as accurate for twins, and they said that except for one of the tests, it is. But now one of my books says that the quad screen is difficult to interpret for twins, which I tend to believe, since if one twin has a higher level of some marker and the other twin has a lower level, it could cancel out. Thoughts?
Oops, I thought I responded and I guess it didn't go through. I had a similar situation in that I was pretty near a more "regular" hospital and one with a crazy good NICU. It's true that twins are more likely than singletons to need to go to the NICU, but mostly a "regular" NICU will do for the typical stuff and since you're in the Bay and not THAT far from Stanford, an unlikely transfer wouldn't be the end of the world but also you could just head to Stanford if there are problems or signs of labor really early. I gave birth (at 37+6, no NICU time, they came home with me 48 hours later) at a not-crazy-high-level NICU hospital but talked to my OB ahead of time about at what point in my pregnancy I should go to the other hospital. For me, they said prior to I think it was 26 weeks, if I went into labor to head to the other hospital. I did go there once for an emergency (that was totally fine in the end) at 20 weeks.
I did the blood test before we found out it was twins. They said my numbers were great for my age (I was 30! Sheesh) and then were all, "Oh yeah, twins, pretty much this doesn't mean anything." And then I never really thought about it again. I guess there isn't really anything you can do about it but you'll have loads of ultrasounds so they might spot problems then.
I totally didn't answer your questions before, did I?
I think the Dr Luke book is a great guide but it also seems to be a little extra cautious and nutty. The high-level NICU suggestion and unreasonable early weight-gain guide were sort of scary to me. Anyway, I don't think you want to go to Stanford regularly because the long drive gets really hard when you have to go to the OB several times per week at the very end for NSTs and you can't drive yourself so someone else has to take off of work to help you. And if you do go into labor that early and want to get to Stanford, you'll have time to do that. It's unlikely, of course that you'll go into labor that early! But when my water broke, I took a shower, waited 30 minutes, then got my boyfriend up to drive to the hospital. It was the middle of the night so it only took us 30 minutes to get there but it could've been 90 minutes in traffic. Anyway, complications can come up and if things are looking scary later on in the pregnancy, you could switch, but it seems like adding a lot of extra driving and stress in finding people to get you across the Bay for the billions of appointments later on.
Originally Posted by sempervirens
I was thinking about this after I responded to you earlier and you're asking if you should do it, right? Well, my thoughts are, why not? But also why? I mean, if you're doing it because you'd want to terminate or reduce, the results might not be accurate with twins so you probably wouldn't get much information to help you decide. If you're doing it because you'd want to be prepared if there is some sort of chromosomal problem, well, there are ... ok, here's where I don't want to say something scary, but you're reading the twins books ... there are higher risks with a twin pregnancy anyway, so you wouldn't be prepared anyway if they came premature and have developmental problems. But it's just a blood test and I didn't really think it was a big deal. It could be reassurance for you that things at this point are going well.
Originally Posted by sempervirens
When I was pregnant with my twins, we didn't even give thought to what type of a NICU unit the hospital had versus others. Our hospital, like most around here, have pretty good standard NICU units. Turns out I went full term and never needed it at all. I think you may be best with a doctor closer versus having to travel further. Being pregnant with twins is hard enough. Towards the later part of my pregnancy, I couldn't drive (belly too large, felt sick lots), so I got rides to and from.
Testing, we did the early bloodwork stuff and that said everything was fine. So there was no need to do an amnio or anything. I did go for tons of ultrasounds though, I was there at the specialists constantly to be monitored.
My local hospital had a Level 2, which I was fine with. There was a level 3 about 1/2 hour away had we needed it (I went to 38+3)
I didn't do any early testing... I'm a worrier, so I figured the less to worry about the better!!
I chose my delivery hospital based on the NICU. The hospital that was a 3 minute drive from my house was not up to my standards in that area. However, I was lucky enough to have two to chose from. I did not chose Children's Hospital of Philadelphia/UPenn, for exactly the bridge/travel reasons you mentioned. Thankfully, we have one that was the same distance without bridges and traffic to deal with. I was thankful that I chose the hospital that I did. My twins were NICU babies, and may not have made it in a lesser hospital (they were intubated and had other issues at birth).
I declined all testing other than ultra sound, and later fFn. No regrets there!
Good Luck with your pregnancy!
We didn't find out about our twins till 20 weeks. I decline early testing - the Quad screen has a very high false possitive rate. Also, follow up to a questionable test is a level 2 ultrasound anyways - so we just do that instead. There is a new MaternT21 test which has a very high accuracy rate (99%) - but I have not read about it's efficacy/accuracy with twins only singletons.
We planned a homebirth for our twins and had care at the hospital if needed for anything preterm or special circumstances. I would choose a care provider and hospital based on what your wishes are and where you feel comfortable and most compatable - unless you have known concerns, I would not just choose a hospital based on their NICU status. You can always change as needed if complications arise as the pregnancy progresses.