Does everyone have an MFM?

MamaHook · August 2012

My OB told me she wouldn't refer me to an MFM because there was no reason to. I'm also the only patient right now that she has that is pregnant with twins but she reassured me she "has delivered them before". I'm also overweight but she doesn't really want me gaining anything and said I could lose weight. Now, I'm just kind of nervous reading other posts and wondering if I should ask for a referal from her. I see her Thursday for my 12 week appt.

Rynleigh · August 2012

Our HMO standard policy (which I like to use as an example, since they don't have financial motives for choosing to or not to refer you to a specialist in the network) for healthy di/di twins is to have you see your normal OB until approximately 24 weeks - before then, you see your MFM for your NT scan and Anatomy scan. After 24 weeks, you start seeing your MFM every couple of weeks to have a monitoring session, and an OB prenatal visit every 4 weeks or so until the last month.

Higher risk twins (mo/di, mo/mo, previa/abruption, surgical concerns, etc) or greater sets of multiples they typically have you start seeing the MFM at least once a month as soon as they discover the complication, and see them as often as is deemed necessary for the condition.

ks3pink · August 2012

I never saw one but that doesn't mean you shouldn't. I never had any complications so there was no need for one.

karebearmccroar · August 2012

My OB didn't think it was "necessary" either. But I went to an MFM for the Nuchal translucency genetic testing ultrasound around 12 weeks, and she set up 4 week growth scan appts with me from then on. She is now considered to be consulting with my OB, although OB is still primary care. The MFM looks in more detail at the babies, and she also caught my shortening cervix that sent me to L&D with pre-term labor symptoms and is the reason I am now on bed rest with meds to stop it. The OB just does quick ultrasounds to check heart rates and cervical length, the MFM does the in depth ultrasounds which also found the 21% growth discrepancy that they are now monitoring. I am so glad I see the MFM and that I pushed for it. I think the extra care from a different and more specialized perspective is so worth it, I would push for it if I were you. Oh and my babies are di-di, the lowest risk, but twins are high risk and I still think it is valuable.

leapgirl8 · August 2012

We not only had an MFM, we didn't see an OB at all. Some MFM practices provide all care for both mom and babies, and will deliver as well. It cut down on the amount of appointments and we knew the babies were in very experienced hands.

angelfire02 · August 2012

leapgirl8:
We not only had an MFM, we didn't see an OB at all. Some MFM practices provide all care for both mom and babies, and will deliver as well. It cut down on the amount of appointments and we knew the babies were in very experienced hands.

This. I pushed to only see a MFM and am so glad I did. We had mono/di boys with no pregnancy complications but we were still seen 2x/month until 30 weeks when we went in 2x/week until I delivered. I loved our MFM clinic!

JenScott-4-09 · August 2012

I would want to see one just to be safe. My OB said even if there are no complications, he likes to have a second set of eyes for multiple pregnancies. He will still have me as a patient and deliver my little ones but I have gone to the MFM for the NT scan and plan to start seeing them more often for cervix checks. However, I did deliver my son a month early and so since he was a preterm birth, I guess I have a higher chance of delivering these babies early too.

pixiem38 · August 2012

I will be so jealous of you when they refer you to the mfm!!!! I LOVE LOVE LOVE what Mrs.Lee said and i agree so much. I may write that down and quote from it (if that is okay?).It is much more concise i than anything i could ever manage.

MamaHook · August 2012

pixiem38:
I will be so jealous of you when they refer you to the mfm!!!! I LOVE LOVE LOVE what Mrs.Lee said and i agree so much. I may write that down and quote from it (if that is okay?).It is much more concise i than anything i could ever manage.

I will let you know on Thursday Definitely GREAT advice Mrs.Lee!

MamaHook · August 2012

Thanks so much everyone - this Thursday I am definitely going to ask her for a referral.

I'm just starting to get a weird vibe from her. I really like her and have been seeing her for about 2 years (she didn't deliver my first) but when we told her we wanted to deliver at this one hospital, she said okay. When I got home and started researching it, I realized it didn't even have an NICU! What the heck, why wouldn't she push for any of the other hospitals she delivers at that have Level III NICU's?

I'm also wondering if you all got an NT scan? I realized at my last appt. I didn't schedule one and I called last week to see what I need to do and if I even needed one with twins. The receptionist took my name my name down and said she's check and call me back in a few hours. She never called so I called back the next day and they had no record of me calling. When I asked again, a different person told me, well, it's not needed, only if you want it. I said I did and it was on my paperwork that I'd be getting one at 12 weeks but never mentioned to me. Writing all this out, I'm getting frustrated with everything!

MrsOjoButtons · August 2012

I did not. We do not have any MFMs within a four hour radius, so the one time I did need an MFM consult (because of an SCH), the ER emailed my ultrasound images and records over to an MFM in the next state over. Other than that, my pregnancy was treated as any other singleton pregnancy, with the exception of an extra ultrasound at 34 weeks to check for a growth discordance.

turtle_1278 · August 2012

We did have an NT scan around 12 weeks. The only reason I did was due to our previous 2nd tri loss. They warned me that the bloodwork would be hard to match to each baby but luckily everything came out normal. For me, it was a way to see my babies and know they were okay.

My first ob was not pushing to send me to an MFM. And she did not deliver at a hospital with a NICU. We moved and my new OB sent me straight to the MFM. While I never had any pregnancy complications, I did deliver 5 weeks early and my girls had almost 3 weeks of NICU time. I was grateful for the extra monitoring and for delivering at a hospital with a level 3 NICU!

jquirke9881 · August 2012

I did have the NT scan and I see the MFM every few weeks.

Mrs. Alice · August 2012

Yes! We found out we were having mono/di twins at 10 weeks. My OB didn't seem all that experienced and confident with twins so that set off some alarms for me. She wasn't going to send me until after 20 weeks but I asked to go sooner. She referred me with no trouble and I started going once a month to both MFM and OB at 18 weeks. I can say with confidence that my babies probably would not be here today without the expertise and close monitoring provided by my MFM. Trust me it was a huge pain in the butt and expensive because we had to drive 100 miles each way. I didn't have an NT scan either.

caden · August 2012

Rynleigh:
Our HMO standard policy (which I like to use as an example, since they don't have financial motives for choosing to or not to refer you to a specialist in the network) for healthy di/di twins is to have you see your normal OB until approximately 24 weeks - before then, you see your MFM for your NT scan and Anatomy scan. After 24 weeks, you start seeing your MFM every couple of weeks to have a monitoring session, and an OB prenatal visit every 4 weeks or so until the last month.
Higher risk twins (mo/di, mo/mo, previa/abruption, surgical concerns, etc) or greater sets of multiples they typically have you start seeing the MFM at least once a month as soon as they discover the complication, and see them as often as is deemed necessary for the condition.

That was our policy too. If I had had no complications I would have only seen my MFM for a few u/s's & NSTs (b/c my OB's office didn't have the equipment for twin NSTs). But I did have complications and ended up seeing a MFM frequently. My OB was still my "main" doctor and consulted w/ my MFM. I loved that my OB wasn't on a power trip about all her twin experience - not wanting to admit they don't know it all about high risk situations. She ran all my complicated issues past my MFM and was happy to coordinate my care. It saddens me that this isn't the standard for everyone b/c it seems like a no-brainer.

pixiem38 · August 2012

Mrs. Alice:
Yes! We found out we were having mono/di twins at 10 weeks. My OB didn't seem all that experienced and confident with twins so that set off some alarms for me. She wasn't going to send me until after 20 weeks but I asked to go sooner. She referred me with no trouble and I started going once a month to both MFM and OB at 18 weeks. I can say with confidence that my babies probably would not be here today without the expertise and close monitoring provided by my MFM. Trust me it was a huge pain in the butt and expensive because we had to drive 100 miles each way. I didn't have an NT scan either.

how wonderful that they allowed you a referral (i am not being sarcastic at all). This post further solidifies the notion that i am.correct in wanting a mfm for my moni-di twins (yet i keep being told it is not necessary). Bah! It should NOT be this hard for me.

amh04 · August 2012

I see an MFM every 2 weeks with mono/di twins and I see my OB every 4 weeks. Every 2 weeks we have a fluid/cervix check and then every 4 weeks we have a growth scan. So it's cervix check, 2 weeks later growth scan, 2 weeks later cervix, 2 weeks later growth.

Just because your Dr has delievered twins before doesn't mean she is qualified to treat high risk pregnancies. My OB has delievered twins, but still has an MFM overseeing my care. From what I am learning, twin (and other multiples) pregnancies are completely different from singletons.

Breezy8407 · August 2012

I saw one for my ultrasounds from 16 weeks on. They happened about every 4 weeks. One different though - they are called perinatologists at the clinic system I go to. At the end, I saw both the perinatologist and my OB for weekly appointments.

We did not do an NT scan. By the time we found out it was twins, we had already decided not to do it.

lovekatespade · August 2012

leapgirl8:
We not only had an MFM, we didn't see an OB at all. Some MFM practices provide all care for both mom and babies, and will deliver as well. It cut down on the amount of appointments and we knew the babies were in very experienced hands.

This is what we are doing as well. It's a little different with di/tri triplets, but I think any multiple gestation warrants the extra care, training, and experience an MFM will provide.

blondek8 · August 2012

I did not. I had an uncomplicated twin pregnancy. I asked my OB and his response was he would refer me to an MFM if my case became complicated. He's a well respected and experienced OB, who delivers multiple births on the reg. I trusted his judgement and felt comfortable with his care.

KarlsSweetie05 · August 2012

Let's be blunt... You wont ever regret not seeing an MFM.

Unfortunately and I hope it doesn't happen to you.. but problems arise out of NOWHERE on multiple pg.

A friend of mine was expecting twins, textbook perfect pg, and BAM! delivered 22 week twins who did not survive.

Another friend of mine was not seeing an MFM, no problems, no complications, then BAM! delivered her twins at 28 weeks totally unexpectedly. Her twins spent 3 months in NICU and thankfully fine today.

Stay on these boards (or similar ones) long enough and things happen out of the blue with twins+ frequently. Better safe than sorry.

As someone on here has said before - An MFM is for your babies. The OB-GYN is for you. Give your babie the best care possible... see an MFM.

Regarding weight... I would recommend reading Dr. Barbara Luke's book about weight gain. Her book has different recommendations based upon your pre-pg weight. Even though being overweight initially, you still need to gain weight for your babies' health. This is NOT a singleton pg and should not be treated as such.

karebearmccroar · August 2012

I didn't feel like I "needed" the NT scan, because we decided we didn't do anything no matter what the results were. But I pushed for it and asked for it because it was my way of getting in to see the MFM, who then scheduled follow-ups as I had hoped. And the genetic testing is covered in CA, I think all states but I'm not positive. So why not do it if it gets you in to see the MFM? My MFM then set up the follow-ups with my OB, who I said previously said it wasn't necessary. But don't ask them, tell them you want it. I think you have to do it ASAP, because the window for NT scans is small, so I would get them to refer you immediately- they sent over my referral and then I had to call and schedule with the MFM myself.

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