Questions for the first MFM appointment?

Manada

This is a quick question - our first appointment with the MFM is next week.   We're pretty stoked because he runs the multiples clinic at our hospital and is the leading researcher on a lot of perinatal twin studies in Canada.    We have a midwife as our primary care provider, and she has privileges at the hospital where he works, so if we end up delivering early or having complications our care will be shared between this MFM (and his team), and our MW.  

So questions for him - I want to make sure we get as much info as possible, and have been wanting this appointment, but I think I'm going to need a list going in. 

Here's what we have so far:
- We are interested in doing progesterone (P17 shots or suppositories) to prevent preterm labour and support my cervix.  Will he support this even if there isn't clear evidence of benefit (but no existing evidence of harm)?

- If we deliver by C-section will his practice support us in having immediate skin-to-skin contact with the babies if they are medically able?   (the hospital is currently doing research on the benefits of skin-to-skin after c-section births and we really want this).

- When/How will we be seen in this pregnancy again by him?  At what point do we stop seeing him and are transferred primarily back to the MW?

- What is the hospital protocol for twin birth?  Is it possible to labour in a standard birthing room instead of an OR, and use telemetric monitors instead of wired fetal monitors.

- How/When can we book a Fetal Echocardiogram (needed because of an antibody I have).

- What is his experience/recommendations around working and being mobile during pregnancy?  Is there a standard bedrest recommendation?


Am I missing things?  What came up for you?

Aurora1181

Good questions! You might also ask what other bloodwork will he need to do (Mine did a full thrombophilia panel.. my RE had never done this). I wanted to know who I was supposed to call if something came up- him or my ob. At my first MFM appointment, I was put on pelvic rest and modified couch rest, despite my obgyn saying it wasn't necessary at my previous appointment, so in my case, I wanted to know what he was seeing that my OB wasn't. And then I went back to my OB who said to do whatever the MFM said! Sort of confusing.

 

2momsinCA

I asked my MFM how often he would check my cervical length... Might be worth inquiring because he was only going to give me extra progesterone if my cervix showed signs on shortening.

Does your midwife or MFM manage the nonstress tests and regular growth scans in the third tri? I'm starting twice weekly nonstress tests at week 30, but I doubt that's standard protocol for everyone. We also have to do monthly growth scans with the MFM in the 3rd tri. In addition to continuing to see the OB every other week.

I would also hope that if skin to skin was impossible with you as you might be on an operating table getting sewn up after a c section, is skin to skin possible with your partner? My coworker just had an emergency c section and her husband did skin to skin since she was pretty incapacitated.

Maybe ask if it is their policy that both babies must be head down for you to try a vaginal birth. My OB will only let me try if they are both head down but I've read of some MoMs who were able to try vaginally with one head down and the other transverse.

Bloodwork is another great question. My MFM did antithrombin, protein c, and protein s tests to check for possible reasons for my previous losses (which my RE did not check) and determine if there was a potential for a second tri mc based on those results. None of them ended up being positive but it was good to check.