Pregnant with Twins? Ask for a Referral to a “High-Risk” Specialist!

For an expectant mother, the news that she is carrying twins can be both exciting and frightening. The thought of planning for two babies rather than one, the thought of delivering two babies rather than one, and the thought of raising two babies rather than one, can immediately send thousands of thoughts swirling through a new mother’s mind. While these things are important, the most important consideration is keeping the twin babies safe throughout the pregnancy, labor, and delivery.

An expectant mother has the right to expect that her physician has the proper background, training and experience to manage a twin pregnancy. Further, a physician and his or her medical staff has the duty to advise patients of their experience dealing with high-risk twin pregnancies, and also to refer patients to high-risk and/or twin specialists if this is not their primary area of expertise.

Consider this situation. An expectant mother learns early in her pregnancy that she is pregnant with twins. Despite the physician’s lack of experience with twin pregnancies, he fails to refer this patient to a specialist.  Further, he does not even take the time to see her when she comes to the office for her appointments. Instead, he allows a mid-wife and/or nurse to see her. Because of his failure to confirm that a properly-trained specialist is monitoring the pregnancy, he fails to timely recognize the development of Twin to Twin Transfusion Syndrome, a condition that can be life threatening for both twins. As a result of his failure to recognize this complication, treatment is not provided and one of the twins dies during the pregnancy.

Or can you imagine this scenario? A young mother not only loses one of her twins, but also has a surviving child with severe and permanent brain damage as a result of her doctor’s failure to recognize complications which were developing during her pregnancy. This mother goes to her local obstetrician immediately after taking a home pregnancy test. The doctor performs an ultrasound and tells her she is pregnant with a single baby. She continues to return to her local doctor’s office over the next several months and is repeatedly told everything is progressing well. Several weeks into the second trimester of her pregnancy, she is admitted to the hospital for cramping. At this time she is finally seen by a specialist and advised that not only was she pregnant with twins, but that one twin had recently passed away. She is advised to continue on with her pregnancy. Shortly after the single baby is born, she learns that not only did her daughter have severe and permanent brain damage, but also that her other baby could have been saved if the proper equipment had been used, and proper diagnostic testing and screening performed early in her pregnancy.

Whether it is while watching the news, television shows, or through other forms of media, we are constantly hearing about birth trauma, brain injuries, genetic defects, cerebral palsy and other complications which can occur during pregnancy. The potential risks and complications increase exponentially in a twin pregnancy. There are many reasons for the increased risks. For instance, in an identical twin pregnancy, each of the fetuses may have their own placenta and amniotic sac (called dichorionic diamniotic), the fetuses can share one placenta and have separate amniotic sacs (called monochorionic diamniotic), or they can share the same placenta and amniotic sac (called monochorionic monoamniotic). Each of these presentations can carry the risk of unbalanced-sharing of nutrients between the fetuses. Unbalanced-sharing of nutrients can lead to growth restriction and other developmental issues in the fetuses. In addition to growth and development, the labor and delivery process itself carries increased risks in a twin pregnancy. Both fetuses are stressed during labor, and are at an increased risk for suffering from hypoxia and/or asphyxia as a result. These conditions can lead to brain injury, cerebral palsy, or even death.

Due to the increased risks and complications associated with twin pregnancies, it is important for an expectant mother to be followed by a physician who not only specializes in Obstetrics, but also a physician who has received additional training in Perinatology and/or Maternal-Fetal medicine. These specialists have spent additional years beyond medical school in education and training which focuses solely on “high-risk pregnancies” and all of the complications that can be associated with these pregnancies. These physicians have knowledge of all of the diagnostic testing that can and should be performed on an expectant mother, understand the importance of consistent and routine monitoring during the pregnancy, understand the increased risk for pre-term labor and an early delivery, and are equipped to make timely treatment recommendations if complications arise. In addition, these physicians routinely practice at institutions and medical centers with medical staff who are also equipped to provide the best care and treatment to both the mother and the infants both before and after delivery.

As the stories above demonstrate, an expectant mother’s entire medical team must act as her advocate when it comes to managing a twin pregnancy. The medical team has a duty to recognize her as a high-risk patient, has a duty to refer her to the proper specialists, has a duty to refer her for all necessary diagnostic testing, and a duty to ensure that a proper treatment plan is in place.