OB-GYN vs. MFM?

bayareagirl2011 · June 2014

Hi ladies - Happy Monday everyone. I wanted to pick your brains on something.

I'm a little over 17 weeks right now, and I just randomly picked an OB right after graduating the RE at 8 weeks that had good reviews since we're a little new to the area. I went to her, and she's perfectly nice, but there have been a few things that she's said that have made me question whether we're a good fit. Since then, I've seen 2 more - and I immediately ruled out the 2nd, and am deciding between the original, and the newest one. Both have pros and cons. My biggest gripe is that I don't feel like I get complete answers to some of the questions I have, whether it comes to test results (I had a protein come back on the low side and the OBs tell me "not to worry, it's not a big deal"), or what certain symptoms may indicate. I also had a small fibroid growing, and is now pretty big, and may end up blocking the birth canal so that c-section may be the only option. I know it's not all on them - part of is just my personality (being naturally curious, a planner, and of course, it being an IVF pregnancy and all). I've seen people mentioning that they see MFMs, and I was wondering if that's the route I should go instead of seeing a "normal" ob-gyn. So my question is: for those who DO see MFMs - were you referred by your OB, do you see the MFM in addition to your regular OB, or in place of? Can you just make an appointment, or do you have to have a reason to see a MFM (referred?) This is a singleton pregnancy, and although no one has said it's "high-risk", the low protein, and fibroid has me a little freaked out. I feel that more specialized care, or more monitoring would ease my nervousness a bit. The "pro" of my original OB vs the newest one is that she does a quick ultrasound every visit so that helps, but I felt like I did get some more thorough responses from the other one I'm considering. I just want to feel good about the decision, before I'm too far long in the pregnancy.

Thanks in advance.

Mrs.McIrish · June 2014

Usually you need a reason to see a MFM and it doesn't quite sound like you need one IMO. I am only seeing a MFM (who will deliver) because I'm having twins, will be 41 at delivery and am on lovenox. Usually you need a high risk "reason" to see one. I totally get not feeling totally comfortable with your OB. I originally went to one in May but quickly switched when I felt she didn't get why I was on lovenox and was treating me the same as if I was pg with a singleton. I called the MFM the next day...
Here are some links to when you should see a MFM: https://www.upmc.com/locations/hospitals/magee/services/high-risk-pregnancy-and-maternal-fetal-medicine/Pages/reasons-maternal-fetal-sub-specialist.aspx

https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/services-treatments/women’s-health/services-we-provide/maternal-fetal-medicine

bayareagirl2011 · June 2014

Thanks @Mrs.McIrish for the information.

To give a little background, I didn't think I needed one, but then, when I got my 11 week blood draw results back on my online portal (they let you see all the results, and health summaries) it actually said "high risk pregnancy with low papp-a" which was the subject line. They said that because of this low protein, that it made me more at risk for pre-eclampsia, or placental problems, and IUGR. Both OBs basically dismissed this saying there was very little evidence to back that up, but the "research" on the web that I've seen seems like most people who have had this did get an extra ultrasound at 28 weeks, and have extra monitoring after 30 weeks to make sure that the baby was growing property and many had the blood flow from the placenta to the umbilical cord monitored as well. When I asked my OBs about this, they said they don't do this...which makes me think that it can only be done at a MFM. Do you think this may warrant it? I certainly won't pursue if I truly don't need to, but at the same time, I want to make sure I don't have regrets later on.

orange1414 · June 2014

I have both. I have my regular OB, who decided that due to AMA, hypo thyroid, previous weight loss surgery and an early bleed from a SCH, that I qualified as high risk and referred me to see an MFM who consults with their group. Without the referral, and my OB labeling me high risk, I would not be seeing an MFM. I see an MFM once a month in addition to my regular OB appts. They consult with each other. My OB and her group will handle the delivery, though. If you're OB doesn't think you're high risk, you don't need an MFM.

Mrs.McIrish · June 2014

Take what I say with a grain of salt bc I've never had a baby before! It seems like you "should" get referred later by your OB "if" you had IUGR etc. I assume that your urine is checked at each appt and if there was protein of a concerning level, someone would do something. When I called the MfM's office, I was told that my OB had to sign off on a referral or I had to transfer my care to the MFM totally. Since this MfM happened to deliver, I just transferred care at 12 weeks. Not all MFM deliver so you may still need the OB for that. I didn't want to have to go to 2 places if I could avoid it.
You can always call a MFM and run by your scenario and see of they will see you!

ttuprincess · June 2014

I see an MFM in conjunction with my OB but we are kind of a strange situation. Around here MFMs are the only ones who do NT Scans so we were referred to the MFM by my RE and my OB for the NT Scan. The MFM was really great and suggested that although I am not particularly "high risk" he wanted to keep monitoring me since he has been helping me manage my migraines. He also said that since I have IR PCOS there is a higher risk for GD so he wanted to keep an eye on the baby's growth. I LOVE the MFM and am glad things worked out the way they have. My insurance also covers unlimited ultrasounds and covers my MFM appts 100% as well as my OB appts so there really has not been a down side for me in seeing one.

If you want to see one I would make sure to check with your insurance because some cover MFMs differently than OBs. You could find one you like and contact their office and see if you meet the criteria to be seen by them and if you need a referral from you OB. It might be worth the peace of mind to look into it if it is something you are thinking about.

Just my two cents.

BabyKsMommy · June 2014

It depends on your insurance on whether you need a referral but usually you are referred. I have a twin pg but as of right now I'm not seeing a MFM. My pg as of today is low risk.

I know some people see one to get an anatomy scan done but my insurance has the genetics department that deals with all of the special screenings.

If you asked your OB and she said it wasn't a big deal then I would be inclined to trust her. I am a huge worrier and a planner myself. I do ask a lot of questions and she's very good about answering them. Most of the time I'm just over reacting and she eases my fear. That's why I like her because she's very practical.

bayareagirl2011 · July 2014

Hi ladies, thanks for your responses - very helpful.

I too, was referred out to the MFM for my NT scan, and have my 2nd trimester screening with them next week as well. I may ask at that appointment whether they think it's necessary that I see them. I would be totally fine with the OB, but my only concern is that the summary came back as saying "high risk" because of the papp-a, and they were the ones who entered that in. It seems like the care/monitoring that I've read about online is only available at an MFM so perhaps I'll ask my OB whether I can get referred when the time comes. I didn't realize that many MFMs don't deliver, I think that's the case here too, so I think I'd be in a situation where I'd need to see both (if needed).

AJC&Maggie · July 2014

I was totally managed by my OB.
AMA
Huge 1st trimester bleeding
Twins
PUPPP
Uncontrolled asthma
Massive edema
Flu & pneumonia

absolutelymaybe · July 2014

I know it's difficult, but OBs are generally used to dealing with "regular" pregnant women. As PAIFers, I've found we're a little...overly informed? Hyper vigilant? Google-happy? :-) And there's nothing wrong with that (except maybe the Google happy part), but you have to learn when to sit back and not second guess everything the doctor does or does not do. As long as you have a competent OB (and one that you like), you should be in good hands.

As for the MFM, those are generally for high-risk patients. I don't see anything in your OP that makes you high risk, so I don't see the reason why you'd need to see one.

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