thinking about adding an MFM/Peri - need advice

nikinikinine

So far I've had three appointments with my OB, none of them have been too stellar, but we live in a small city and this is one of the few offices that deliver to the hospital with the best NICU in the area.

My first visit was with an NP who incorrectly told me I would only be seen for my NT scan, at 20 weeks and again at 35 weeks.

My second visit was supposed to be my NT, but I started bleeding about 3 days early and the got me into an emergency appt. In total I was there for 5 hours that day. Granted, they did my NT scan while I was there so I wouldn't have to come back, but still. My appointment was relatively rushed and I wasn't given a lot of insight as to how future appts would occur.

My third visit was on Tuesday for my Level II. I am high risk because of the unexplained bleeding episodes so I got an u/s then too. In total we were at the office 3.5 hours - most of which was spent in the waiting room.

I am to go back in 4 weeks for my anatomy scan. I've asked the doctors about things like cervical length checks and such and they seemed to indicate that such things are unnecessary until around 24 weeks.

The office is brief and you wait forever, and I worry that maybe I'm not being given the proper attention. But since this is my first pregnancy I have no idea if this is "normal" and I just need to relax.

Any advice is welcome.  

pea-kay

I think it's never a bad idea for a twin mom to be to see an MFM. Maybe not necessary for all of them, but never a bad idea, you know?

If you're not comfortable with the care you're getting, you need to do something about it. No one else will do it for you. (Coming from someone who switched doctors at 23 weeks!)

Omega20

I'd definitely see a peri/MFM.  Based on what my RE told me, I thought they were ALWAYS recommended with twins. 

Just the fact that they told you cervix issues weren't a concern until 24 weeks...that would make me worry.  Both of my doctors have been checking my cervix at every appointment.

caden

I'm all in favor of adding a MFM into the mix, but unless you have issues it's likely you would only see the MFM for u/s's and NSTs. So you'd still have to deal with your OB and their ridiculously long wait times. Though would those be a lot shorter if you only went there for consults?

I'm pretty sure it's normal not to do cervical checks before 24w. The only reason I had one sooner than that (at 21w) was b/c I had a feeling something was wrong and made an unscheduled appointment. My doctor did a cervical check "just to be sure" and sure enough I had problems.

pea-kay

caden:

I'm all in favor of adding a MFM into the mix, but unless you have issues it's likely you would only see the MFM for u/s's and NSTs. So you'd still have to deal with your OB and their ridiculously long wait times. Though would those be a lot shorter if you only went there for consults?

I'm pretty sure it's normal not to do cervical checks before 24w. The only reason I had one sooner than that (at 21w) was b/c I had a feeling something was wrong and made an unscheduled appointment. My doctor did a cervical check "just to be sure" and sure enough I had problems.

This is true. You'd want to look for an MFM who would also deliver you. (My first MFM wouldn't, but the second would and did.)

Mrs.Brink

Our OB is very proactive with his patients....but he's also the father of b/g twins. He told me from the beginning that we'd be seen every 2-3wks for u/s and that he'd refer me to the MFM/Peri around17+wks. Our 1st visit with the Peri was at 18wk1d. Btwn the 2 we're in office every 2-3wks. So far our pregnancy has been blissfully uneventful but we're still being seen quite a bit. But our ob knows that I listen to my body and if I'm feeling "off" I need to call him for anything. The MFM did check my cervix via external u/s...not sure how accurate that is but according to the u/s tech and the docs I'm Fort Knox for the time being.

SoldiersGreenBean

Mrs.Brink:

Our OB is very proactive with his patients....but he's also the father of b/g twins. He told me from the beginning that we'd be seen every 2-3wks for u/s and that he'd refer me to the MFM/Peri around17+wks. Our 1st visit with the Peri was at 18wk1d. Btwn the 2 we're in office every 2-3wks. So far our pregnancy has been blissfully uneventful but we're still being seen quite a bit. But our ob knows that I listen to my body and if I'm feeling "off" I need to call him for anything. The MFM did check my cervix via external u/s...not sure how accurate that is but according to the u/s tech and the docs I'm Fort Knox for the time being.

Mine was too, except he's the father of triplets.

I was sent to the MFM for my Level IIs, and of the 4 I had, I only saw the actual MFM twice.  Otherwise, my OB did bi-weekly cervix checks starting at 18 weeks and weekly BPPs & NSTs starting around 28 or 30 weeks.

leslie13510

I just wanted to add that with twins it is NOT normal to start cervical checks (by u/s) as late as 24 weeks.  Well it may be normal for some doctors to wait that long, but it's not a good idea.  I had my first with the portable u/s machine in my OB's office at 17 weeks and everything was perfect.  At my big u/s at 19.5 weeks they checked again, and we found funneling.  I had another one scheduled at 22 weeks to check on it, and it had shortened to almost nothing, I was sent directly upstairs to be admitted into the hospital, and I got a cerclage the next day that thankfully worked beautifully.  I had no physical signs that told me it was shortening, no pain, no bleeding, no extra mucus, nothing except the BH that I'd been having for a few months at that point.  If we had waited until 24 weeks to check the length, there's a huge chance that I would have lost my babies, or they would have been micro-preemies at best. 

Not to scare anyone with my story, but it's a good example why with multiples (and even singletons in some cases), it's not good to wait that long to have your cervix checked. 

If you feel uncomfortable about the level of care you are receiving, do something about it.  Whether you talk to your OB and they change how they do things, or you add a peri into the mix, or you switch doctors/practices completely, you should feel comfortable with the way you are being treated and cared for. 

MagPie08

If I were you, I would absolutely ask your current doctor for a referral to a MFM. If nothing else, for peace of mind. I have had a fairly uncomplicated pregnancy, but I feel really good knowing that there are lots of eyes on me, and that my OB/MFM are constantly in communication. 

As an example, I had an u/s with my MFM on Tuesday morning, and an appt with my OB at a different location at 4pm the same day. When I got to my OB appt, I learned the MFM had already sent over all the info from my scan earlier that day, AND had spoken to my OB. It makes me feel really well taken care of, and that's how you should feel, IMO. 

4510heather

Hi Niki!

I don't know if I'd feel comfortable with the care you are getting. I see my OB every 4 weeks right now and get an us at every visit.  Starting at 20 weeks, I will see her every 2 weeks, and at some point that will go down to once a week (she said that best case scenario the once a week will start around 32 weeks; if there are problems, it will be sooner).  She seems very cautious about the twins sitiuation and is monitoring me a lot more closely than a singleton pregnancy. I can't remember when cervical length checks starts, but I know it is soon (maybe at my 20 week appt?).

I also got to see that specialists group (which included visits with MFMs) about a month ago and that helped ease my worries and helped to establish a patient relationship in case there are issues down the road.

If you are at all uncertain, I would definitely consider at least an appointment with a MFM.

Good luck!

 

chickaboo1974

I think your OB is nuts- waiting until 24 weeks.  My MFM explained that they start cervix checks at 14 weeks incase you need a cerclage, which they would only do up to week 23. 

I would request a referral to a MFM/Peri- hell I would call my insurance to see if I even needed a referral (mine does not require it I can self refer).

I see both MFM and a OB.  The MFM is just for cervix checks and ultrasounds- but I feel very well taken care of and if needed they would take over my complete care.  I love my OB but I dislike some of the other Dr.s in her practice, but I will deal.

nikinikinine

thanks for all of the feedback, sometimes I feel like an over reactor with this stuff. It's nice to know that I am right to feel the way I do. I'm calling to get a referral now. I really appreciate all of the feedback!