Questions to ask when interviewing a new OB

Now that we are having twins, we need to switch from my wonderful midwife who delivered DS2 to an OB who delivers at an in-network hospital with a good NICU. I am meeting with one next week who has a very good reputation, but wanted to see what questions the experienced multiple moms recommend asking.

Some background: both boys were born vaginally, one with an epidural, one without (by choice). Both were born in hospitals. I separated my pelvis at DS2's birth, and am at risk for that again. My ideal birth would be vaginally with no drugs, but I don't think that is likely at all to happen. More realistically, I'm almost leaning now towards a planned c-section to try to avoid the chance that I'd have to recover from a vaginal birth plus an emergency c-section plus a separated pelvis.

So, what questions to you recommend that I ask, particularly given that I know about having babies in general, and am more concerned about stuff specific to twins this time.

Thanks!!

I think the most important thing is figuring out how much experience the Dr. has with twin pregnancies and how his philosophy fits with your own.

I chose to see an OB. While I have never met with a Perinatalist (Fetal Maternal Specialist), I get my monthly ultrasounds at that clinic and a Peri reviews them and sends comments to my OB. Some people see a Peri and and OB regularly.

I was really disappointed that my OB will not do a vaginal delivery unless both babies are vertex (some will deliver a breech baby B), but he feels strongly that it is safer. If that is a deal breaker for you, that is something to consider.
The other point my OB feels really strongly about, is bed rest (house arrest) after 26 weeks. I really, really balked at this. But I'm still hanging in at 35 weeks and really do credit reduced activity. Honestly, there is no way I could be doing my "regular" life right now anyway. In someways it's nice to have a "Dr.'s note" so that I don't feel obligated to cook, clean do laundry and be responsible for my toddler.

I feel like my Dr. is pretty on top of things, and "monitoring" in this pregnancy is exponential to what my singleton pregnancy was. Like I said I have had an ultrasound every month, and once I was diagnosed with Gestational Diabetes we started doing ultrasounds (Bio physical profile--checking amniotic fluid, placenta, fetal breathing, movement etc) weekly as well as Non- Stress Test. I'm glad he is watching things so closely. I didn't realize GD was such a big deal...and especially with twins making sure one isn't growth restricted.

I guess, I would just start out by asking how often your Dr. delivers twins, if he has a Peri monitor ultrasound scans, or refers you out, and how he treats a twin pregnancy differently than a singleton.

I'm so, so happy to be having these babies. But it has been a much more difficult pregnancy than a singleton.
Good Luck!

The Barbara Luke book on multiples has a section on choosing a doctor that might be helpful, but she highly recommends using a perinatologist. I am also just using an OB and only see the perinatologist as part of my ultrasounds.

About no-drugs.... you're not going to find someone who will do that, I suspect.

The issue is that if the twins are being delivered naturally, there's a risk that baby B will go into distress -- for instance, by his/her cord coming down the birth canal with baby A.

If that happens, it's an emergency C-section for baby B. For that reason, even a vaginal twin birth will likely be in an operating room, just in case. And if you're not already being medicated and they call for an emergency C, you will get a general -- they have to work too fast for anything else.

I struggled with that... but felt like I had no choice but to get an epidural. As it turns out, twin B turned transverse in between my last ultrasound and the day my water broke, so I ended up with an "urgent C" -- which led to a spinal block. (I was at 4cm and fully in labor when I arrived, and they wanted to get the C started before baby A arrived vaginally...)

BTW, I didn't have an epidural with DS1, so I can't compare epi with spinal, but I didn't like the spinal recovery at all. Lots of headaches and pressure -- the solution to which was caffeine...

As far as the doc -- make sure you find someone you like and feel that you can trust. You'll be seeing them a lot more often than you did with your first two.... :D

Yeah, I've pretty much accepted that this birth will be nothing like DS2's, that I'll be stuck getting at least an epidural. (Note to self, don't spend time reading birth stores on MDC, especially living in Illinois, which is incredibly unfriendly to anything outside of a hospital birth with an OB...)

I had a vaginal birth with my twins. Twin B was breech and an epidural was needed in order to get him out quickly and effectively. I was very against having a c-section because I had a difficult labor with my first and successfully avoided a c and wanted to be able to lift my two year old.

With the twins, I delivered in the OR though with a high risk ob, maternal fetal medicine doc. All that said, I switched mid-pregnancy, around 26 weeks to the high risk group, comprised of all MFMS. I didn't feel that my regular ob "got" a twin pregnancy. He had never heard of Dr. Luke which was shocking since her ex husband was on staff at my ob's hospital, and he is considered the "father" of twin pregnancy. The two of them actually collaborated on a ton of research. She is amazing, by the way, and you should try to follow her advice - my boys were 7 pds 6 oz and 5 pds 2 oz (baby b had a two vessel cord). Baby A was bigger than my singleton! I also took her advice on resting, etc.

So I think you should ask specific twin pregnancy questions about a mother's weight gain, when that should occur (20 pounds before 20 weeks). These questions below highlight a doctor's knowledge about a twin pregnancy.

Here are some questions:

How do you treat a twin pregnancy different than a singleton? Are there significant differences?

What should I know about the differences? When will I have to stop exercising?

Are you familiar with Barbara Luke? What do you think of her weight gain strategy?

What are complications of a twin pregnancy that I should be aware of?

I agree with pps. Just ask how familiar they are with twin pregnancies and how many they have delivered. My ob (did not do peri) was very familiar, and I felt comfortable. She did ask for lots of tests, regular ultrasounds, etc. Unlike pp's doc, she did not recommend any reduced activity - told me I'd work up until I delivered! I did deliver early, though, but I don't think I can blame her!
She did not want to do a c-section unless absolutely necessary (it wasn't) but I did deliver in the OR with an epidural just in case. You might want to join your local twins group and ask there for local recs for doctors. I didn't have much use for my group after the babies came, but have heard they are good for questions during pregnancy.
good luck!