Lurking from TTCAL- MFM Question

sunflwra · March 2014

Hi ladies- I hope you don't mind me asking a pre-pregnancy question- I'm trying to gather some opinions before calling my OB on Monday.

I'm 35 (36 in June), have had a successful pregnancy/delivery (some elevated BP in the last few weeks but no protein in urine or pre-e diagnosis) and then had a 2nd tri loss at 20 weeks due to a cord accident about 3.5 months ago. The cord was longer than expected and had a few strictures that would have significantly restricted blood flow. We had the Panorama test done at 12 weeks which came back clear and I had blood tests done post loss to ensure there were no clotting disorders, etc. I've also gotten pregnant quickly both times, so there don't seem to be any issues there either. Overall, I've been told that there's no reason to expect any issues in future pregnancies based on what's happened so far.

We are now TTC and my OB has told me to notify her as soon as I get a positive test so that I can come in for some early bloodwork and testing and that I will have extra monitoring during my next pregnancy. However, it's been shared with me by some other TTCAL ladies that since I have a few high risk factors (AMA, 2nd tri loss, elevated BP), it would be smart to see a MFM. I see in some situations where ladies see one while TTC and then also once pregnant, either in place of or in combined care with their OB.

I'm wondering about experiences of those who may have a similar situation to mine and/or those who went for pre-pregnancy testing with an MFM. I love and trust my OB but want to be smart about my prenatal care as well. Any thoughts, insight, etc you can share would be much appreciated. Thanks!

chucktgirl · March 2014

Hi, my experience was that I was trying to be pro-active, like you, and researched the crap out of MFM docs in my area (not that many to choose from, actually.) When I picked one, I called her office to make an appointment. Apparently, at least in my situation, it was required that I went to my OB first, had a full pregnancy lab work up, and full stats and history recorded. Then, the MFM requires that my OB refers me to her and submits all of my info. At that point the MFM reviews my case and decides if she wants to take me on as a patient, concurrently with my OB. I was accepted and have my first appt with the MFM in week 10. It was all very odd to me and not what I expected. Good luck!

ThereBeDragons · March 2014

My MFM is also only by referral and only in conjunction with my OB. He only handles my high risk issues- all standard care and testing is done through my OB.

I'm not sure what you're looking for in the pre-conception phase. There's one speciality that deals with pre-conception (Reproductive endocrinologists- which generally only handle cases of infertility or recurrent early pregnancy loss). And then there's MFMs who only handle complications during pregnancy- they don't really do preventative care unless there's a major issue (like in the case of a preventative cerclage for women with incompetent cervix) that can be fixed.

For the stuff you have in your history- nothing can be fixed or prevented prior to conception. There's no treatment before the pregnancy exists and so the specialists can't really do anything for you. Your OB is perfectly capable of handling your pregnancy until complications arise- and then you can request a MFM consult.

I understand how scary it is to start over again after a late loss. You want someone who can tell you how to not have to go through that pain again. Sometimes though, no amount of smart planning or forward thinking can safeguard a future pregnancy. I'm a perfect example. Every pregnancy I have costs thousands of dollars to achieve via IVF. But once I get pregnant and for the first trimester, my RE can only triage my bodies utter unwillingness to produce progesterone before the placenta kicks in. And once he has stabilized me enough to get through to the second trimester- he hands off the baton to my OB and MFM who have to sew my incompetent cervix shut and treat me for preterm labour all the way until delivery- and hope that delivery comes after viability. There's nothing I can do to help any of those issues before I get pregnant. I just have to leap into it and hope that my awesome doctors can save my baby from my own body.

Preconception care can absolutely be handled by any competent OB. Get the specialists in once the pregnancy starts.

sunflwra · March 2014

Thanks ladies- I appreciate the insight. I'm sure my OB will refer me if necessary once I get pregnant. I just want to be sure i'm advocating for myself where needed and it sounds like I'm ok where I am right now. Thank you!

ajsweeton · March 2014

Maybe I'm weird, but I had a preconception consultation with a MFM and I never even saw a regular OB with this pregnancy. Although, in the consultation I was referred by my OB at the time. I thought it was great because they were amazingly knowledgeable about everything down to my medications and such. I have a lot of complications though, high BP, diabetes overweight, PCOS etc. and I needed advice on which medications I could keep and which needed to be changed before becoming pregnant. When I went into labor at 22w with my first twins I had been sent to a hospital with a MFM who specialized in prevention of PTL in twins, so with this pregnancy when our RE saw twins I just went straight to the specialist I had seen before and didn't even tell my regular OB until it was time for my annual. No referral was needed, unless my RE counts...

flerlgirl · March 2014

I didn't see an MFM until about 12 weeks with this LO. However, seeing them gives me so much reassurance and I'm so glad my OB sent me to one. My only suggestion is to make sure your MFM and OB communicate well and are telling you the same info. My OB usually defers to my MFM but they are in weekly contact with each other over shared patients and I really value that. I am so sorry for your loss and wish all the best as you continue forward.

MrsL2B · March 2014

My OB happened to mention today that in some states the MFM only handles the high-risk aspects of the pregnancy while the OB handles everything else, but in other states the MFM is the only doctor the pregnant patient sees.

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Mustardseed2007 · March 2014

I definitely also found that my MFM only works by referrals. I was working with my OB in conjunction with my MFM (MFM was to do a growth scan and prescribed me some medication and ordered certain blood tests and then told my OB what his opinion was about certain things) until basically one too many complications were found and then my OB referred me to the MFM for my full care and for the delivery. I would talk to your OB about an MFM at the first appointment and just ask if she thinks you should see an MFM due to your history or perhaps see an MFM for some consults along the way.

iqwedding3 · March 2014

I'm not sure about the rest of your risk factors, but I had a preconception MFM consult for blood pressure issues. At least I thought it was a preconception consult, turned out I was wrong! Her main thing was to get my BP down to a normal level ASAP, and it was really hard to get a baseline measurement and figure out the best drug dosage that I could tolerate while I was pregnant, because pregnancy symptoms kept getting in the way. There were also tests (MRI with contrast among others I think) she was unable to perform once I was pregnant. There's no harm in consulting an MFM in advance, and it'll set you up for a higher chance of success.

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