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How will my medical care differ with twins?

Most doctors consider twin pregnancies higher risk, compared to a single pregnancy, but this doesn't automatically mean you'll have problems. Certainly your healthcare provider will monitor you carefully, more so than if you were pregnant with one baby. You and your provider are a team, working together to ensure that your pregnancy goes full-term--or as close to full-term as possible. Roughly half of all twins are delivered before week 37, but unless and until you're forced to deliver early, keep your goal of going the distance firmly in mind.

Expect more prenatal appointments, usually every two to three weeks in the first and second trimesters, and weekly visits beginning early in the third trimester. Besides monitoring your health, your doctor will want to keep close tabs on the babies' growth. You'll probably have between four and six ultrasounds just to make sure the twins are developing properly. You'll also undergo what's known as fetal surveillance (tests to monitor the babies' movements, heart rate, and breathing) or evaluations such as the nonstress test (which allows your doctor to listen to the babies' heartbeats) in the third trimester.

Geri Martin Wilson of Palo Alto, California, had two sets of boy/girl twins within four years. Throughout both pregnancies, she was free of any serious problems, but her doctor monitored her closely and gave her another round of tests every time he suspected a problem. "A lot of times, a half-hour appointment would turn into a three-hour ordeal," she recalls. "I had my bags packed and in the car because you never know when they'll admit you."

Do I need to switch my doctor to a maternal-fetal medicine specialist?

Probably not. Most women carrying twins don't need to see a maternal-fetal medicine specialist, also known as a perinatologist (an obstetrician who specializes in high-risk pregnancies) unless their pregnancy poses a complication their doctor doesn't feel comfortable handling.

Remember, doctors' training and experience vary widely. Get a sense of whether your doctor has cared for a lot of women pregnant with more than one baby. Most obstetricians routinely take care of patients with twins, but they may consult with a maternal-fetal medicine specialist if faced with an unfamiliar complication. However, if you have a rare or serious condition or if you're pregnant with triplets or more, you'll probably need to meet with or switch to a specialist at some point in your pregnancy.

Can I see a midwife instead of an obstetrician?

Sure, but probably not exclusively. If you belong to a group practice or an HMO, you may be able to schedule some of your prenatal visits with a midwife, particularly if you want some of the more personalized care that is a midwife's specialty. But you'd be wise to have an obstetrician check your progress in at least some of your prenatal appointments. When the time comes to deliver, a midwife will most likely be able to do the birth, especially if both babies are positioned head-first.

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