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If you are like me, you have read just about every book you can get your hands on for your pregnancy (singleton or multiples).  Unfortunately, there is not much information out there on what to expect when going to appointments and asking questions over the telephone while making an appointment isn’t as helpful as one would expect.  As a twin momma-to-be, I have been to many of perinatologist appointments and feel as though I am becoming an expert.  Hence, I would love to share my experience of my first perinatologist appointment so as to release some of the stress of the unknown for at least this aspect of the pregnancy.

Picking a perinatologist: In most cases, your OB/GYN will tell you the name and telephone number of the preferred perinatologist in your area.  If you have insurance that allows for you to pick which one, such as ours, you can be selective.  Double check with your insurance company before making an appointment.  Check online or through your insurance company for a certified perinatologist, not a technician.  If you go the technician route, you may have to have all your results sent to your OB/GYN and then wait for a response on the results.  Personally, I find it much easier to have a specialist and not impatiently wait for the results.

First Appointment Paperwork:  Okay so (similar to your OB/GYN Appointment) now that you have an perinatologist and are sitting in the office awaiting your name to be called, be prepared for a slew of questions to be asked on paperwork.  These questions, as before, will inquire of family history of born diseases of your parents, grandparents of not only the mothers’ side but also the fathers.  These are supposed to be born diseases, not any that were found later in life.  For instance, diabetes, heart disease, cancer, heart defects and so on.  This time around I found the questionnaire was much less ‘involved’ however the questions were asked later.  Additionally, your insurance card will be photocopied and your drivers’ license.  Additionally, since it is your first appointment, you may be asked to pay your co-pay upfront but this will depend on the office regulations.

Measurements (Vitals): This probably will not come as a surprise to anyone however your height will be asked (or measured) and your blood pressure will be taken just as it was at your OB/GYN appointment.  These will be conducted each appointment.  It is strange no one has officially measured my height, just asked, but then again I guess it does not matter as much as weight.  Thankfully at the perinatologist urine samples are not required, at least at mine.

Pre-Screening:  After my measurements were taken and documented, I was then asked a series of questions about tests taken and what my expectations were for future tests to be taken.  These tests are the exact same ones asked by an OB/GYN such as genetics tests, HIV/AIDS tests, Glucose tests and etc.  I am not sure why the perinatologist asked for these tests to be taken again but you can gently decline and mention you have already taken then and decline any that you wish to not do (in my case I will not do any invasive tests that could harm the twins).

Official Appointment: Our perinatologist is one of the only ones in our direct area so the office is incredibly busy.  It is uncommon not to wait at least 2 hours for an appointment, 2 hours is even lucky.  So be prepared as these are specialists in the field and might not be as fast as your favorite OB/GYN, which mine takes about 5 minutes.  Finally we were taken into the ultrasound room, a basic doctors’ appointment room with a sink and countertop full of misc supplies for an examination, a large screen tv and the beast of a ultrasound machine.  The room basically looks the same as your OB/GYN minus the tv and machine.  The examination table is the same, complete with stirrups and that thin tissue paper for hygiene.  Again, we were to wait another 30 minutes or more before the ultrasound technician came in to start the long appointment.  The following happened:

  1. Stripping from the waist down while the staff is outside of the room, a thin paper sheet is given as a ‘cover up’ to be placed over the area your pants used to be situated.  Then the staff member will come in and start the questions.  Note:  Since I am having twins, I must do this every appointment however I have been told it is not the case for singletons, as this appointment is most likely just to see the anatomy of the baby.
  2. Questions were asked if we knew the gender of both babies and how far along we were in the pregnancy.  We are fortunate enough to have a certified ultrasonographer, however I have heard there are offices which do have only technicians.  The difference is one has done specialized training and certified and the other is a technician with minimal experience/education.  Look for an office with an ultrasonographer, not a technician if possible.
  3. Once we informed the ultrasonographer we were aware of the gender of at least one baby, from a genetics test in week 10, however not sure of the second, we were ready to get started.  
  4. The ultrasonographer put latex-free gel on my stomach, similar to a normal ultrasound conducted in an OB/GYN office and spread out thinly.  The ultrasound is conducted in the same pattern however many more measurements were taken from the length of the lips to the heartbeat per minute.  For singleton pregnancies, this type of appointment may only be conducted once or twice throughout the entire pregnancy.  However with multiples, it is wise to get used to this type of appointment as you will most likely see your perinatologist just as much as your OB/GYN.
  5. Once all the babies’ measurements are taken, it is time to check out your cervix length and strength.  This involves the ultrasonographer to vaginally put an electronic wand  up to the cervix to take a photo (apparently this is the best method to check the length).  Then he/she will place pressure on your babies and stomach and see if your cervix opens under pressure.  At this time I always pray it does not, as this is a clear sign of pre-term labor if it opens.  (Thankfully mine has been strong throughout this entire pregnancy, even when it shortened.)
  6. Your measurements are recorded into the machine and most likely you will placed in the same room each time, as the machine information can not be shared to other machines.
  7. Finally, once all measurements are in the system, the perinatologist will come in for more measurements, optional.  My perinatologist states he loves to do some of the measurements, especially measuring the photo of the cervix just so he feels safe with his information given to us each time. Apparently not all doctors do this, but, my again places more gel on the baby belly and applies the wand to do some more measurements each time.
  8. Throughout the entire appointment, feel free to ask as many questions as you want, remember you are paying for the appointment so ask away.  My specialist team knows we love information and we are given tons of information and measurements throughout the entire appointment.  Additionally, we are given a printout of the charts and graphs to compare and contrast each week.  Photos are also given each time we go in for an appointment.
  9. Depending on your perinatologist, you will also have a 4D ultrasound conducted, if the office has this technology.  Some places do require extra payment so double check if you want this done.  For high risk pregnancies, our 4D ultrasounds have been free from our insurance but that could just be our insurance.  Again, double check so you aren’t surprised with a large bill in the mail each visit.
  10. Questions requested from our perinatologist after each appointment, usually everything is explained pretty straightforward but if you do have questions, make sure to ask them at this time.
  11. Next appointments will be scheduled.

During our first appointment, we were so nervous to go in to see this specialist, we had no clue as to what was going to happen.  We were told the appointment would be a long one, the first few times as we did have twins.  If you have a singleton, the appointment might take around 15-30 minutes.  Twins take around 2 hours or more!  Twins are considered high-risk, no matter if the pregnancy has been difficult or not, so more measurements are taken and double checked often.  These appointments are vital as we can find out the growth rate of the twins and double check to assure they are growing around the same pace as each other.  Additionally, the hearts and lungs are measured to assure their growth health as twins are a bit more under pressure than a singleton.

Hopefully this information helps all of you feel more comfortable during your first perinatologist appointment.  Remember you have some control over the tests and procedures being conducted at all times.  There are some tests that need to be taken for hospitals to admit you for the birth of your babies and a few that the state may require.  Otherwise you have control over what ultrasounds and other invasive tests are to be conducted.  If you do not feel comfortable, switch doctors and find one that understands your needs.  You are to be a momma, so enjoy the process as much as possible because it will fly by fast.