MFM and OB disagreeing on delivery

ksgsmu

I love both my OB and MFM... They work together well but are in some disagreement on when I should deliver. My OB has scheduled my section for 38 weeks and my MFM said I shouldn't go past 36-37 weeks. I have toxemia, GD and we have had some growth and fluid concerns with baby a. I have appointments with them both next week and feel a bit trapped in the middle. Who should be making this call? I am thinking my MFM as he is the specialist and has way more twin experience, but my OB is the one actually performing the C. Of course they could decide to come on their own and this whole issue won't matter just trying to figure out what to say at my appointments next week.

Rynleigh

With early onset pre-eclampsia (it isn't called toxemia anymore due to the confusion with toxoplasmosis and toxification), most professionals never want you to go beyond 37 weeks. The risks of seizure and death increase substantially and blood pressure changes and platelet drops can be sudden and life threatening - removal of the placenta(s) is the only way to end pre-e. I would side with the perinatologist / MFM on this one. I also had GD and pre-e. My platelets took a sharp turn for the worse and I nearly bled out after delivery, and I was only 37w2d. I would not want to wait until 38w, if it were me. 

rlk2

My mfm and ob fought on how long to let me labor. Personally, I felt more comfortable listening to the mfm because dealing with high risk patients is what they do. Ob's always seem to want those babies to cook longer even though that isn't always the best answer.

Bigboneded

If they aren't talking to each other, I would ask both to explain their rationale and risks/benefits to their recommendations. Then advocate for yourself by asking for the care that makes the most sense to you.
You cant make anyone perform surgery they dont agree with, but you can argue to schedule earlier if studies show better maternal and fetal outcomes. I'm sure your OB wants to provide the best care. Good luck! :-)

Brummy14

I tend to believe that the MFM gets the trump card in a high risk scenario (this is exactly why I'm not even seeing my OB at all this pregnancy.)

ksgsmu

Thanks ladies! I had to hospital with high BP this morning. NST and lab work came back good but my BP is climbing quickly. I see OB tomorrow and MFM Wednesday so I'm gonna talk to both about the situation. The L &D nurse said she be shocked to see me get past 36 at current rate. So we shall see! I just want whatever is best for the babies of course.

dal2aus

I was in a similar situation.  My OB and MFM finally talked to arrive at a date. 

Hope all is well with your BP and the babies keep cooking.  Despite the high BP, you could be in for the long haul.  I had a couple of spikes here and there in the last weeks, but my babies were perfectly comfortable inside and showed no signs of wanting to come out.  We had to schedule the CS at 38 weeks.

ksgsmu

dal2aus thanks for our input! yes my bp is all over the place.  I was in the hospital for monitoring over the weekend with it but then my labs came back pretty good so they sent me home.   I know they won't let me go past 37 weeks for sure.  I was told by both this week that it will be a week by week decision at this point.  My cervix also shortened quite a bit so was told I could easily go into labor on my own at this point.   who knows!