Q: How do I choose a doctor for my multiple pregnancy?

A: Higher-order multiple pregnancies are automatically and unquestionably considered high-risk. Women expecting triplets or more should work with a doctor they are comfortable seeing, but more importantly, with a doctor who has the level of experience and educational background necessary to manage a high-risk pregnancy of triplets or more. Parents basically have three options:

  • General Obstetrician – may or may not be board certified
  • High Risk Specialist – an OB who has some training in high-risk pregnancies
  • Perinatologist or Maternal-Fetal Medicine Specialist (MFM)– an OB who has completed two to three years of Maternal-Fetal Medicine fellowship after completing four years of Obstetrics and Gynecology residency

The American College of OB/GYN gives no definite regulations stating that a Maternal-Fetal Medicine (MFM) specialist must oversee a triplet or more pregnancy, but they will agree that a higher-order multiple pregnancy is considered high-risk. A MFM is an obstetrical sub specialist concerned with the care of the mother and fetus at higher than normal risk of complications. These specialists are much more experienced managing a complicated higher-order multiple pregnancy.

Raising Multiples’ Position
If at all possible, Raising Multiples strongly recommends an expectant mother of triplets, quadruplets, quintuplets, or more be under the primary care of a board certified perinatologist during pregnancy with experience managing triplet pregnancies if the mother is carrying triplets, quadruplet pregnancies if the mother is carrying quadruplets, and quintuplet experience if the mother is carrying quintuplets. If a specialist is not available in their area, expectant parents may want to consider relocating for the duration of the pregnancy. Raising Multiples has resource volunteers who can help families with questions about relocating for care during pregnancy.

How to Find a Maternal-Fetal Medicine Specialist:

  1. Most OB’s have a MFM Specialist they recommend, but be sure to ask for two in case one is not available.
  2. Call or check the website of a university hospital in your area. Find out if they have a Maternal/Fetal Medicine Department and which physicians are affiliated.
  3. Call a hospital with a Level III Nursery (Special care nursery for high-risk infants) in the area.
  4. Ask nurses from the local hospitals who they would recommend if they were expecting triplets or more?
  5. Locate a local triplet or more support group and ask the members who they used/recommend.
  6. Search the Internet, but note that not all Perinatologists or Maternal Fetal Medicain Specialists are found under those categories. Try looking under OB/GYN and then through the list of specialties:
    • Visit the website of the Society for Maternal-Fetal Medicine: www.smfm.org
    • Check the website of your State Board of Medical Examiners or State Medical Board
    • American College of Obstetrics and Gynecology (ACOG): www.acog.org

Suggested Interview Questions for Obstetrician:

  1. Are you a Maternal-Fetal Medicine Specialist?
  2. If not, will you be consulting one?
  3. How often will I need to have appointments?
  4. How often will I need to see the consultant?
  5. Under what, if any, circumstances will my care be transferred to this specialist?
  6. How many sets of triplets (or quads) have you delivered within the past two years? (NOTE: this question is to the doctor alone, not his/her practice or the hospital.)
  7. What is the average gestation of these births (average is 33.3 weeks for triplets, 32 weeks for quads)?
  8. How aggressive will you be at preventing preterm labor?
  9. At what gestation will you use these procedures?
  10. What if there are problems with the pregnancy or the babies before they are deemed viable (usually considered 24 weeks)?
  11. What hospitals can you admit to?
  12. Does this hospital have a Level III NICU Nursery?
  13. If not, where will the babies be transferred to and how will mom see them?
  14. Ask about hours and how to contact the physician after hours.
  15. Find out about the physicians who take calls for this doctor.

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