Should I be seeing an MFM? — The Bump
Pregnant after IF

Should I be seeing an MFM?

I've noticed that many of you see an MFM.  I am expecting twins and when I asked the NP at my 10wk appt she said that it wasn't necessary unless a problem came up.  I have had several miscarriages but all were before 7 weeks and likely to to a septum in my ute.  So far everything has been going very well but I was just wondering why your OB sent you to see an MFM.  Was it an automatic thing or did cause for concern come up?

TIA!

Me:35, DH:37 Multiple Pregnancies but no take home baby-
Uterine cavity abnormaility (corrected in 2006)
IVF #1: BCP 02/13, stims 03/05, ER 03/16: 13 retrieved/ 6 fertilized, ET 03/19 transferred 2 embies,03/29 +HPT, Beta #1 03/30: 365!!, beta #2 04/02: 1209, u/s #1 04/13: TWINS!! and saw heart bearts, u/s #2 04/26: 2 heart beats 166 & 163 bpm!!! all is well and no more RE for ME(I mean US)/..........We are having TWIN GIRLS!!!............................................................

I prayed for this child, and the LORD has granted me what I asked of him. 1 Samuel 1:27

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Re: Should I be seeing an MFM?

  • I think anyone pregnant with multiples should be seeing an MFM, but that's just my opinion.  I also don't have a favorable opinion of NPs based on past experiences.

    I'm pregnant with just one and my ob sent me to an MFM for the NT scan. I think being AMA was the main reason they sent me out. I'll be seeing the MFM twice more at 20w and 32w, unless something else comes up. 

    IVF #3 = Feb 2012
    beta#1 3/21 (14dp3dt)=413, beta#2 3/23 (16dp3dt)=785, u/s 4/11
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  • From what I've seen, the whole twins/MFM debate can really go either way. My RE and OB said they do not classify twin pregnancies as "high risk" and do not do automatic referrals for MFM unless there is another pregnancy complication in the mix. With that being said, I asked to have the MFM involved because my past job experience (late term loss cases on L&D) messed with my head and I needed the extra monitoring for my own anxiety. I also have marginal placenta previa that was diagnosed at 16w. The OB understood and this is the plan we worked out:

    Routine appointments with the OB on a normal schedule and as needed basis. The MFM will do monthly ultrasounds (transvaginal ultrasound checks, growth scans...) and do weekly BPPS at 32 weeks. With each ultrasound, the MFM will consult on the findings and make recommendations for future monitoring/care, as needed. However, the OB is still responsible for managing my care. If there is any additional cause for concern, the OB will work with the MFM to create a more comprehensive plan. The MFM was also comfortable with this plan and even told me that I didn't even need to be seen at their practice because my OBs were such "great doctors." 

    DH and I are comfortable with the above plan, but I understand that some women may feel better about more/less monitoring. I know my OBs feel I don't "need" to see the MFM, but I certainly feel better by having an extra set of eyes on my case. If I had wanted to, I could have self-referred to the MFM or completely switched over to their practice (they deliver babies too).

    TTC in 2009, Dx: Unexplained IF
    Three TI cycles (BFP...miscarriage), five IUI attempts and 2.5 IVF cycles later...BFP!!
    12dp5dt: 765; 15dp5dt: 1979; 17dp5dt: 3379...TWINS!!!!!
    Our perfect baby boys were born at 36w1d!! 








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  • I'm seeing a MFM only, and i'm just pregnant with one.  Here in NYC, u see either a MFM or an OB.  Not both.

    If i were having twins, i would never just see an ob...frankly, i was not willing to see one w my singleton (i have a compromised cervix).  They just see more of whatever ur issue is, than a regular ob would.  Not worth the risk IMO.

    TTC 12/2009 Dx Severe MFI/azoo 6/2010


    IVF 1 (long lupron): mc 7w4d, D&C 11/23/10


    IVF 2 (antagonist w co cultures): cancelled 2x due to no sperm


    IVF 2.2: ER 6/9/11 3dt of 2 (1 frostie :), BFN

    IVF 3 (EPP w co cultures): 9/2011 (cancelled, irregular pap) LEEP 9/2011

    IVF 3.1 (11/2011) EPP w co cultures: 3dt of 3- BFN Again

    Natural sFET 1/2012: -ET of the "lone wolf (Wolfie)" 1/29

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    dx GD @ 28 wks, insulin dependent






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  • You should be going automatically bc of the twins. I went the day after seeing my OB the first time. They call all the shots especially now that I'm at the end when it's gotten serious. 
  • I only see an MFM when I get my u/s.  It's just the way my OB practice is set up.  The OBs do most of the care, but they don't do U/S in their office.  So for all my u/s (so far 2: NT & A/S), I go to the MFM dept in the hospital to get them done.  The way the MFM dept is set up is that after the tech is done with the pictures & measurements, the MFM doctor (whoever is avail that day) comes in, reviews the scan and goes over the results with me. 

    Also, the genetic counselors are part of the MFM dept, so when I chose to do the MaterniT21 blood test, I had to see a GC first at the MFM dept before I could get the blood test done.

    TTC since 10/2008  RE consult 6/2010 Dx:Unexplaied IF

    Failed multiple cycles of Clomid+TI and Clomid+IUI

    3/2011 inj+IUI #1 BFP. 4/2011 missed m/c. 

    Fall 2011 inj+IUI #2&3 BFN

    Jan/Feb 2012 IVF#1 BFP 2/23  EDD 10/31/2012 ~~~ Halloween ~~~

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  • I think it depends on the OB.   My OB has a lot of experience with twins so she left it up to us to decide whether we wanted to see an MFM or not.  She does send triplets or more directly to an MFM.  We've been to the MFM twice so far; A/S at 18w, 22w, and will see him next at 26w, so pretty much once a month.  MFM said OB was still in charge of everything unless something came up, then he would take over calling the shots.

    They do communicate with each other.  The OB has followed the MFM's suggestions on 37w being the end so she scheduled the c-section for then.  I am happy to be seeing extra doctors and not complaining!

    Once in a while you get shown the light in the strangest of places if you look at it right.

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  • I see an OB once a month, and then I have an ultrasound every four weeks or so with the MFM. So far, the MFM has only come in at the end of the ultrasound to look at my cervix and the babies, and to answer any questions that I have. I think I will be meeting with him a little more regularly as I get further along in the pregnancy. My OB is my main contact person on everything related to the pregnancy, though.

    Frankly, I'm not super impressed with my OB...she's very competent, but she seems to be treating my pregnancy/answering my questions like I'm having one baby instead of two. Also, every time I call her office and speak to a PA or nurse, they give me extremely vague answers and again, they don't seem to have a lot of experience with the twin thing. I like having the MFM...I trust his advice on twin-related issues more than I trust my OB's. 

    Twins November 2012!


  • My OB referred me to a MFM early on.  It was an automatic thing.  MFM monitors everything much more closely and will call the shots when it comes time for delivery.  OB is leaving it up to MFM to advise when the babies are ready.

    Later I was diagnosed with gestational diabetes and MFM is closely monitoring that as well and tweaking my meds as needed.

  • Not every twin mom sees an MFM but I personally think it's a good idea.  Even with an OB who is well versed in twin pregnancies, they are different from the norm and an MFM is going to be more in tune with the risks associated with twin pregnancies.  Additionally, the MFM and OB will stagger appointments so you would see more doctors more often - a nuisance perhaps but more opportunities to confirm all is well.  I don't know that I've ever heard of anyone saying they regretted seeing an MFM, but the multiples board has certainly had a lot of examples of people regretting not seeing one.
    Dx. annovulatory PCOS Cycle #3 - follistim, ovidrel trigger - TI
    BFP at 10DPO & 11DPO. Beta at 11DPO 27, 13DPO 85, 17DPO 510.
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  • maby22maby22
    Third Anniversary
    member
    Thank you ladies for all your advice, I will definitely speak with the Dr about it at my appt next week.
    Me:35, DH:37 Multiple Pregnancies but no take home baby-
    Uterine cavity abnormaility (corrected in 2006)
    IVF #1: BCP 02/13, stims 03/05, ER 03/16: 13 retrieved/ 6 fertilized, ET 03/19 transferred 2 embies,03/29 +HPT, Beta #1 03/30: 365!!, beta #2 04/02: 1209, u/s #1 04/13: TWINS!! and saw heart bearts, u/s #2 04/26: 2 heart beats 166 & 163 bpm!!! all is well and no more RE for ME(I mean US)/..........We are having TWIN GIRLS!!!............................................................

    I prayed for this child, and the LORD has granted me what I asked of him. 1 Samuel 1:27

    <a href="http://www.thebump.com/?utm_source=ticker&utm_medium=HTML&utm_campaign=tickers" title="Ovulation Calculator"><img src="http://global.thebump.com/tickers/tt164a1b.aspx" alt=" Baby Birthday Ticker Ticker" border="0" /></a>

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  • Uh oh...I've only been seeing an OB because I too was told twin pregnancies aren't automatically considered high risk unless there is another complication. Luckily, everything has gone really well so far, but maybe I will ask at my next appointment.
    After 5 TI Clomid cycles, 5 IUIs, and 2 IVFs we finally got our BFP!
    Beta#1 (12dp3dt)= 353, Beta#2 (15dp3dt)= 1466, Beta#3 (22dp3dt)= 14,139, First u/s: TWINS!!
    After 10 weeks of bedrest, our two little ladies joined us at 28w6d
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  • I would highly recommend it. Especially if your OB won't be doing extra ultrasounds. I would have deliver much earlier than 30 weeks had I not had a watchful MFM. OB is more for the mom and MFM is more for the baby.
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  • my OB sends you to MFM for a consult and/or NT scan at 12 weeks (regardless of singleton or multiples).  That way the MFM makes a decision if you need to come back to him.  I had a SCH after my NT scan and I was sent back to my MFM and have been seen every three weeks since 
    S/PAIFW
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  • I am pregnant with twins and AMA, but I am not seeing a MFM. 

    My OB and her entire practice have extensive experience with twins and high risk pregnancies and my OB is a twin mom herself. I chose her specifically for these reasons. I get an ultrasound at every appointment.  

    However, she did say she would not hesitate to make a referral to a MFM should there ever be a reason.

    So far, I feel very comfortable in her care.  

    Single Mother by Choice. Life didn't work out the way I planned so I did it on my own. IUI #s 1-3, unmedicated = BFN, IUI #s 4-6, 50mg Clomid, Ovidrel = BFN IVF #1: 23R, 20M, 17F. 5 day transfer 2 blasts. 2 Snowbabies BFP 6dp5dt, Beta #1 7dp5dt = 58, Beta #2 9dp5dt = 114, Beta #3 10dp5dt = 187 1st Ultrasound = 5/3, not much to see yet. 2nd Ultrasound = 5/17, TWINS!!! Hospital Bed Rest at 32 weeks due to pre-ecclampsia and severe edema. Audrey Grace, 5lbs9oz, & Lydia Louise, 6lbs, born via emergency c-section on 12/6/12 at 36w1d My IVF Journey
  • I am not having twins, but I see a MFM for GD, High B/P and AMA. My friend who used the same OB as me when she had her twins was sent to the MFM a couple times for scans, but she mostly saw her regular OB. 

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  • image vanessagorc:

    I'm seeing a MFM only, and i'm just pregnant with one.  Here in NYC, u see either a MFM or an OB.  Not both.


     

    I'm in NYC and this is not true at all.  Most MFMs do not deliver.  The majority work with your OB to provide your medical care.  There are some MFMs who deliver, but this is generally not the case.  I see my MFM every 2 weeks and he confers with my OB about my care.  I see my OB monthly right now. 

     

    To the OP: multiples + hx of IF = MFM in my book 

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