19 Weeks with Non ID twins, with St George's Tooting, feel very under informed

[hollynoble]

Hi all,

Im hoping some people out there will have been under the care of St Georges fetal medicine unit either currently or in the past.

Im 19 weeks on Tuesday with non ID twins and I have to say I feel totally in the dark about what to expect, whats going to happen, labour plans, care, things to be aware of, weight gain, antenatal classes etc etc. I was scanned at 13 weeks and found out it was twins and my next scan isn't till 22 weeks, which I feel is to long and so I have booked a private scan tomorrow as well as a cervical scan to check the length of my cervix. Last week I had problems with a rash that came up all over my body and what I think was a UTI, but they attributed it to round ligament pain. Alot of the cramping/odd sensations I get are apparently all due to round ligament pain......

I had been previously classed high risk due to a problem with my back, before finding out it was twins. I saw the anaethetist last week who said it was very early to be discussing birthing plans with me and pain relief. Im not seeing the consultant till June which panics me further as twins have a habit of turning up early and I don't want to end up in an early labour totally unprepared.

I feel really frustrated through lack on information and wondered if anyone else had gone through this or had any advice? Its beginning to make me feel quite stressed about the pregnancy and making me worry

Anyone with anyone experience of this, would be great to hear your thoughts.

Thanks
Holly

Congratulations on your twins!
Sorry, I don't know your hospital, but I have twins myself, they are teenagers now and back when I had them we didn't get scanned until 20 weeks, so I didn't find out it was twins until then. So, try not to worry.
Towards the end of your pregnancy you will probably have more regular growth scans, every four weeks or so, and they will discuss more details with you then.

Hi, I had both DS (3) and DD (17 months) under St George's and was high risk due to cardiac issues and then subsequent pre eclampsia issues. The care I got was great and although slightly chaotic (clinics always jammed packed and sometimes confusion as to why I was being seen). I always had a scan at 20 weeks but recently had my 20 week scan early for DC3 as I was relocating to Australia and the sonographer made the comment that at 18+6 I was way to early to have 'things checked properly' so I think with demand on services they are pushing the scans back further.
If you are concerned call the midwives (I assume u are under the ivory team) and explain your worries and see if they can help further- I found I sometimes had to take control to get answers or responses to my worries (I think they are so used to complicated pregnancies that they forte it's all new to us!). To be honest I found most stuff didn't kick into gear until 24 weeks pregnant but then it all came together.
There is apparently a great Wandsworth twin group on FB if that would help as u may get more locals commenting.
Congrats on the twins and St George's fetal medicine Consultant and NICU consultant are well known in the field (the obstetrician I saw in Australia knew them by name!)

Hi holly

Congratulations on your twins!
I didn't want to read and run as I don't know about your hospital or the care involving non identical twins.
However, I'm almost 25 weeks with identical twins. Following our 12 week scan where we find out... We were then referred to the fetal medicine unit at UCL.(from our general local hospital) UCL then carried out fortnight scans to ensure everything was ok... And our last scan was at 24 weeks with them. They're now happy with how the twins are growing so have discharged me back to my local hospital where I will be meeting with my consultant.

Just wanted to say you are definitely not alone in the uninformed department! Although I had the reassurance of fortnight scans to check on the babies... Throughout I had no opportunity to discuss birth plan( I wasn't giving birth at UCL anyways), a very brief and non enlightening meeting with my consultant at 14 weeks, no information about antenatal classes other than the midwife reading extracts from the bounty pack at 10 weeks.

However you can always ring up and just double check they don't want to see you again until 20 odd weeks? I don't know if all your care is in one place? Due to two hospitals being involved with me... I found they did get their wires crossed on one occasion where each though the other would be seeing me in a fortnight! Luckily I spotted that!

Also I personally have found my community midwife to not be very helpful... Very nice but upon her first meeting saying "oh twins we don't know much about that so we prefect to let the consultant handle it all" is not very reassuring... Surely there must be A midwife who has experience with twins.

Anyways didn't mean to go off I a tangent... But double check with the hospital that the gap between your appointments is procedure for twins. Also when you do have our appointment. Definitely raise your concerns with the consultant. That's what I'm planning to do at my 25 week appointment next week! And for more traffic you may want to post under multiple births :)

Good luck and congratulations again! Sorry for the awfully long post!!

Sorry, also forgot to mention that important decisions about the birth etc will probably need to be made once more facts are apparent, such as the growth and progress of the twins, their position in the womb as term approaches (breach, transverse etc) your general state of health as the pregnancy continues.
It's difficult to make decisions now, as there maybe a lot of change in the next ten weeks or so.

It does seem to be a bit chaotic! Because im having twins i come under the fetal medicine unit which only has 2 midwives, and there has been a bit of confusion over my appointments etc.
I have also joined the twins club so may ask round and get some feedback. i know that St Georges has a great reputation i think i just feel a bit in the dark and the only way im finding relevant information is on the internet and its really negative on having twins, it just lists all the bad things that can happen.

Thanks for your responses though, both are really helpful :)

So I'm 34 weeks with non ID twins originally under UCH until I moved two weeks ago and I would describe what you're experiencing as normal sadly. At UCH you have the usual 12 week scan, see a consultant at 16 weeks then the anomaly scan around 20 weeks. After that you have scans every four weeks with midwife appointments at the same time and don't see the consultant again until 32 weeks which is when you discuss your birth plan. I never saw a community midwife as I was the responsibility of the two high risk/multiples specialist midwives. It was only when I asked one of the midwives at my 28 week appointment about the next appointment that they went through the options for birth for me but until then it was a great big gap in my knowledge. If I'm honest, I wasn't so worried because I knew the decision would be made for me at the 32 week scan if twin one was breach as it would be straight to section. The conversation with the midwife just allowed me to discuss the vaginal option in more detail which as it turned out was wasted as twin one is breach so no option.
Don't know whether it helps to know you're in the same position as at other trusts but for what it's worth, out of London I'm now under a community midwife, haven't even met the consultant yet nor been to the hospital and am now a bit nervous about baby coming early with no preparation but the pregnancy has been uneventful so there's no reason to suspect they will make an impromptu appearance....fingers crossed! Hopefully yours will be the same. Use places like this to get the info you need and go armed to any appointments with facts and questions-if you don't ask, they don't tell you but seem happy to answer questions.
Good luck

A friend had her mcda boys at St George's and was happy with her ante natal care and delivery.

I had dcda twin in 2012. My ante natal care was fantastic. I saw my consultant (the same one at each appointment) at 14,20,24,28,32,34 weeks. I was scanned every 4 weeks. I was seen by a medical professional every two weeks from 20 weeks. This alternated between my consultant and my midwife.

No birth plans were discussed with my consultant until 34 weeks. At 34+0 I was booked in for induction at 38+0. The babies had other ideas and were delivered by emcs (both transverse) at 34+5. I saw an anethetist at 32 weeks to discuss pain relief/c section.

19 weeks is very early, try relax and enjoy not being the size of a whale.

Thanks for all the info everyone its much appreciated.

neversleepagain - its interesting to hear you saw your consultant that often. I haven't met mine yet and won't be till June. Also, my first meeting with the twins unit was the same day i had my scan (13 weeks) and the next appointment and scan was scheduled for for May 5th which is roughly 22 weeks for me. It seemed odd that I wouldn't see anyone for nearly 10 weeks so I eventually contacted the team and asked for another appt before week 22.

Everyone's care seems to be different according to the hospital. Also i know 19 weeks seems early but when you have people telling you that twins can turn up early and all the complications that can happen it makes you want to get things confirmed.

I really appreciate everyone's responses though, its really helpful.

God, I had twins in 2013 and I can't remember when I had my first consultant appt or when my more regular scans started happening!

I do know that you can call the consultant and ask these questions. That's what they're there for. I was always hesitant to do this and then fretted for weeks. Don't. Give them a call. My MW was a bit useless so that's why I went straight to the consultant, if your MW is ace, give her a call and let her talk you through the process. There IS a procedure for how often you get seen and when with DCDA twins!

With regards to labour and them coming early. In my hospital the rate for EMCS with twins was so high (I think it was 34%) that I preferred to have an ELCS to take away that stress. However my waters broke early and an ELCS wasn't an option. I personally stuck my head in the sand a bit re birth, it was all a bit daunting having to give birth to not one but two! And as a result I knew jack all about labouring etc. Not great. So I would say, try and read up about birth a bit, well in advance, how to breathe through contractions for example. And should you find yourself in the position of going in to labour prematurely, for me it was defined by feeling like I had to do a poo but couldn't and apparently that's quite common. I am sure it will all be fine though.

Good luck!

Hi Dildals

Thanks for the info, a question though. How do I find out who my consultant is? I have only seen the twins midwife who is very knowledgable but quite forecful and can make you feel a bit silly for asking questions.....

Also, will definitely read up on the birth options! Thanks

The risk of an early arrival is probably the one worry you can't avoid with twins but you can do everything you can to minimise the risk. I found only focussing on one milestone at a time helped managed my anxiety-so at your stage it was about the anomaly scan, then getting to 24 weeks, then 28 weeks etc. My midwife also quite brutally told me I needed to slow down at work unless I wanted to meet the twins early. Frightened the life out of me and seemed to be based on anecdotal experience but it gave me the kick I needed at the same stage you are to slow down a bit and put myself first (something I found very difficult to do because that's not my normal default at work). I'm now 34 weeks and apart from problems with my hips I have had a relatively uneventful pregnancy. Whether it due to that I don't know but I felt better knowing I was doing what I could.

To find out your consultant you could either look at your appointment letter or call a secretary within antenatal/obstetrics and ask. There's likely to be a named consultant who specialises in multiples.

And as for the midwife, honestly there's no such thing as a silly question and if they're knowledgeable then that's the best thing. The more you ask, the more you'll feel happy asking more questions next time.

Someone at work asked me before I went on mat leave whether I'd enjoyed the pregnancy. I honestly couldn't immediately answer her because it is so hard to shake the worry of it being termed a high risk pregnancy. Looking back, I now can see that apart from there being two little folk growing inside me, there was nothing else that has made it high risk in that my blood pressure has so far always behaved, my urine has been fine, the babies have been growing well at each scan, I didn't develop GD nor any other pregnancy side effect so far. I now realise I perhaps should have celebrated these facts rather than worry about the high risk tag.

Keep asking away here x

Phone the hospital and ask which consultant you are under. I requested an appointment with the same consultant each time. My midwife told me who my consultant would be at my 13 week scan on discovering I was expecting twins.

Most hospitals run a twins information evening, ask about that too. If your hospital doesn't offer that find out if your local twins club does, I know ours does. We get a lot of pregnant mums visiting our twins group, it is the best place to get lots of advice, a cup of tea, a variety of buggies to try out and you get to witness first hand loads of little twins running around :)

The MW noted it on my pregnancy notes this time round (I am with St Thomas's) and the first time round I was told I would be under Leonie Penna (King's) who is the Twin God (not that I ever saw her or that it did me any good!).

My twin pregnancy also was totally uneventful but they still came early. (I'll stop scare mongering now :-)). On the upside - even if they come early, the care at the neonatal unit is absolutely fab and v likely your twins will be absolutely fine (although the drs will not want to tell you that in the beginning!). Being in NICU/SCBU is a baptism of fire all right, but it's not the worst that can happen.

I went to a twins info evening as well, run by the local twins group. I found that helpful.

Oh, one more thing I would add about labour. In labour they monitor the babies hearbeat with a CTG. It's a belt around your tummy with two white discs. With twins this is a frikkin nightmare ... it's hard to find and keep the two separate heartbeats monitored. If it should happen that they can't find one heartbeat, it doesn't mean there is a problem, quite likely they're just struggling to locate the second one. In my case twin one was quite deep in my pelvis and it was hard to locate her HB.

There are 2 things the MW can now do. First she'll get a second colleague and determine whether the other MW can find it, between the 2 of them they can then decide that they found 2 heartbeats. If however you feel at that point that that is not quite right (in my case the MWs decided that twin 1 had 'all of a sudden' moved from deep in my pelvis to high on my left side) do insist they get the scanner out. The same thing happened to me the night before and the MW immediately got the scanner out saying 'with twins I don't mess around'. And quite rightly so. Some MWs are a bit reluctantly to get the scanner because (or so I have been told) they need to get the SHO (a Dr) to look at it with them, which SOME find a bit of a faff (not all of course) ...

In addition to that, now that I am thinking about it, in hindsight I really wish I had case load care, ie a MW with me that I knew and who knew me. I was in hospital for 3 nights before I finally delivered and it can be a bit hit and miss with which MW is on duty that day/night.

This time round I have been moving heaven and earth to get on to case load care. I live in the King's catchment area and am giving birth at St Thomas which means that my choices were very limited, unless you know how the system works. (Don't get me started.) In the end I emailed Streatham Valley Midwives with why I was keen to get case load care and they were LOVELY and happy to take me on (even though I don't live in their catchment area). PM me if you would like their email/phone nr (given your at St Georges you may be in their area?).

Hi Holly, I'm 20 weeks tomorrow. I had my first at St Georges. I was very happy with my care, and although I've moved into a different borough I have chosen to have my second baby at St Georges. St Georges is a very busy hospital with one of the highest birth rates in the country! This makes them experts in my opinion! I found them extremely helpful and attentive if I asked questions they would be happy to talk it through and have never felt rushed. That being said, if I didn't ask anything then perhaps they wouldn't have volunteered the information. The generally follow a fairly standard procedure, booking appointment at 10ish weeks, 13 weeks for first/dating scan (some places don't even offer this as routine), 16 wk midwife appointment and 21-23 weeks for anomoly scan. I am high-risk so I have also seen a consultant, which happened to be around 16 weeks, and may have a couple of extra scans later on too. I think the pattern of care would be slightly different for multiple pregnancies but probably not until a bit later on. Having said that I had an extra scan or two late on in my first pregnancy due to reduced movements. They are very good and don't make you feel bad about going in if you're worried. They also seem to be happy to provide extra care and I never felt like they were trying to save money by not doing certain things, which I have felt in other NHS settings.
The only thing I would say is that if you're under the ivory team (at the hospital) you don't tend to have a specific midwife and I saw a different one each time I went. I didn't really matter but I was a little envious of some of my friends in community led care as they would tend to get the same one each time which is quite nice (if you get a good one!). Also the aftercare can leave you feeling a bit shell shocked but I think it's the same at all hospitals.
Try not to worry too much. It is a very good hospital and you have plenty of time to find out all the things you need to know, just don't forget to ask.

Hi everyone,

Just wanted to say a huge thank you for all you responses, they've been incredibly helpful and have put my mind at ease. I actually had a private scan yesterday and saw a twin specialist who was really helpful and outlined the things I need to go back and speak to my midwife about.

Dildals- I live in Streatham so will dim you for those details.

Again thanks everyone, really appreciate it

Holly I assume living in Streatham u are part of the FB Streatham Mums network- if not a hugely valuable resource for now and later once the twins arrive

SaBearOz - no I'm not, I hadn't heard of it before. Is it a FB page?

Yes I'm on it too - another streatham dweller! Just do a search on FB for streatham mums network.

Yes Holly it is a Facebook page- I am still on it despite moving to Australia a few weeks ago and cannot find a good Australian equivalent- one of many reasons I miss Streatham!

Thanks both! Will have a look