How to Freak Out Your OB

So the OB/GYN practice I go to has a rather extensive website, including pictures and bios of all the doctors/midwives. The bios say where the doctor went to school, what their special medical interests are, and if they're married and/or have kids they note that too (I guess for the personal touch). My OB, in case you were dying to know, is married with three kids. Among his medical interests is "high risk obstetrics." So Dr. B came in to talk to me and said, "wow, you just don't do anything half-way, do you?" (No, in fact, my last pregnancy made it a third of the way, so I didn't even do THAT halfway!)

"Well, I see that you're interested in high risk obstetrics, so I figure I'm doing you a favor!"
"Wow. Yeah. So, what happened?"

I gave him the history of the cycle, how it was almost cancelled, how IUI was supposed to avoid the cost, invasiveness and trauma of IVF (and look where it got me!), that we've got three little heartbeats. Lovely. He freaked the heck out. I mean, he was calmish, but very clear that this was not an ideal situation in his book. He's delivered healthy successful triplets before. He's not worried about how to manage a patient with triplets. He's concerned about me... "You're so little! Where are you going to put them? You're only 5'1"!!" (5'1" is a bit of a stretch, by the way.... and by little he meant short, not you know, little) He actually seemed to think that was one of the biggest problems with me having triplets. He said with as short as I am (and therefore, I have a shorter torso/abdomen) I'd be lucky to have 3 pound babies. He wasn't saying it's impossible. He wasn't saying I should reduce. He was very clear that the absolute biggest problem I'm going to have is managing pre-term labor. If I make it to 32 weeks, he said, I'll be lucky. He warned that if I went into preterm labor too early, I could lose all three (a thought that I've definitely had myself).

Typing it out, it sounds as though he was cruel, but that's not how it came across. He was concerned. He knew I'd already had an unexplained 12 week loss. He was worried that I'm facing a potentially enormous loss. He also wanted to make sure that I understood the importance of following whatever instructions I'm given regarding activity level in this pregnancy. He was very clear that I wouldn't be likely to avoid bedrest and he confirmed that I can definitely count on not working after I get to 20 weeks. That's three months from now. That's frightening.

I really don't want to tell my manager or client about the pregnancy before I get to 12 or 13 weeks (remember that 12 week miscarriage? Yeah...), which would basically give only 2 months notice of my imminent disappearance. I wouldn't normally feel badly about this, except it will take probably 3-4 months to find a replacement for me. I'm in a field with far more jobs than professionals (good for me, bad for my client) and it's quite difficult to find folks who are looking for jobs in my field right now. I have six years experience, which doesn't sound like much, but it meant a very short learning curve for me when I got here. If I'd come in with 2-3 years experience, I would have had a very steep learning curve. But I digress...

Dr. B. said he didn't want to discuss reduction with me. He recognized that I first need to speak with my Rabbi (appointment set up for Sunday evening, time TBD). And he also recognized that it was more important that I speak with the perinatologist about the risk/benefit involved. He wanted me to go talk to Dr. P (the perinatologist) about what I could expect with a triplet pregnancy, what my specific health risks are, and so on. I should return the week after I see Dr. P. and we'll talk about how to proceed.

Assuming I don't reduce and all three embryos make it (which I can't entirely count on, either), I asked how I could expect my care to be managed. Dr. B. emphasized that I would be seen far more often than if I had a singleton. He said that I would probably see Dr. P. as much as I see the OB practice, if not more. My care would be managed jointly, which I'm comfortable with. It was obvious that Dr. B. would defer to the perinatologist for critical care decisions and that his own role would essentially be to monitor growth and development. Both doctors would likely be at the delivery. I have a guaranteed C-section. No possibility that they will allow me to attempt to deliver vaginally. While occasionally doctors will allow an attempt at a vaginal delivery for triplets, it's rare, and Dr. B said for me, the risk would be too great to warrant even attempting it. He reminded me that I don't have a lot of room for babies to grow and that even if I'd managed to deliver one vaginally, I'd most certainly end up with a c-section for one or more. Safer bet, he says, to skip the risk all together, particularly given that odds are high that I'll be in preterm labor, which has enough problems already.

I know it sounds like he was being all kinds of alarmist, but he wasn't. He was comfortable with the possibility of managing my care with triplets, but obviously concerned about my ability to carry triplets safely and optimally.

I'm scared. I don't want to reduce, because I'm afraid I'd be doing it for all the wrong reasons. I know I would love all of my babies. But what if they don't make it? What if I don't? How am I going to take care of three babies while recovering from a C-section? C-section recoveries are far worse after prolonged bedrest, which I can count on. I'm really scared. I'm not concerned that I won't get appropriate medical care. I have full faith in my OB and I know I will receive excellent care from him and from the perinatologist. I also know that the greatest risk I'm facing is preterm labor. Dangerously pre-term. I'm terrified.