Risks of twin gestation

My wife and I are having twins, and the doctor said they might be "monoamniotic." He also said there was only a 50 percent chance of both of the twins making it. Our doctor has told us that he has never handled this type of birth. He said if he handles the delivery he will take the babies at 34 weeks. He seems to be a truly concerned doctor and has delivered one of our children already. We live in a small town with a hospital that doesn't have a neonatal intensive care unit. Should we seek a second opinion?


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I understand completely the concern that you must be feeling about your twins. As I discussed before, these babies are at higher risk than fraternal twins. I also understand what delivering outside your community and away from the comfort of a physician and care facility that you have come to rely upon.

The fact that your care provider admits to having little experience with monoamniotic twins should cause you to investigate alternative options for the birth of your babies. Monoamniotic twins are often delivered prior to 34 weeks because of cord entanglement and compression problems.

My recommendation is that you make an appointment with a perinatologist (an obstetrician specially trained in managing higher risk pregnancies). Such doctors can be found in larger metro area or in University centers or the local chapter of the American Medical Association should be able to help you find one.

Bring all your data, charts, doctor reports, lab reports, ultrasounds with you. Tour the unit that physician works with and ask the staff questions about past experience and care with high risk twin births.

Yes, I would recommend that you deliver at such a center, one equipped with a neonatal intensive care unit. The likelihood of getting transferred to such a site anyway is great and this way you already know the doctor and the layout.

The local United Way or March of Dimes or the newborn intensive care unit staff may know of a place where families can stay during a high risk pregnancy, especially toward the end.

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