I reread through my post after the consult and I can see where I think the confusion started.

The original MFM I saw will be my primary because my OB has already said that she would feel more comfortable with a MFM watching my pregnancy. No OB for me. MFM said she will also deliver baby (scheduled c) unless there is an emergency and she is not/cannot get there in time.

Because of what my OB said about wanting a MFM to handle my care, I don't know if she will continue to see me if I choose the new MFM. That means I'll have to find a new OB, which I really do not want to do.

Coincidentally my OB's office called today and they made an appointment for me at the other practice. I will see them in about a month on May 24th. Another month to get some weight off, I guess. I could have gotten in one week sooner, but the appointment on the 24th is at an office that is seriously 5 minutes away. I'll take that over a 45 minute drive just for a consult any day. The appointment is with the head of the practice, which I am happy about as well.

I guess I'll update after I see him. My fingers are crossed, though I'm not sure for what yet.

No problem.

Honestly, based purely on my observations here, the MFM situation with the first doctor is a little unusual. It's actually pretty normal for MFM's to either be a primary doctor by themselves with no regular OB in the picture at all, or MFM's that co-manage with the OB doing the typical OB stuff while the MFM keeps an extra eye on things and directs the plan. Many MFM's don't deliver at all. My personal MFM situation is my MFM can do either, she is comfortable being a primary and delivering her patients, or co-managing (although she confided to me that she will not co-manage with just any old OB, it has to be someone she feels is a quality OB.) I've not heard of an MFM that co-manages but takes the delivery except in emergencies...I don't really understand the OB's role with the first MFM. In any case, as long as you have an OB that you like and trust to deliver you, as far as my non-expert understanding, there's no reason they can't deliver you whether your pregnancy goes smoothly or not unless there are issues with delivery privileges at the hospital or something. Obviously if issues come up, then the OB can/probably will/probably should consult or follow the MFM's lead...but delivering babies is not *usually* really a major role of MFM's, they manage the issues and may decide *when* to deliver, but it's not uncommon for MFM's that don't do deliveries. (And if you see an MFM that doesn't deliver, there's not really a reason that you would need to have a different MFM deliver once that's decided, your OB should be able to do it.) Anyway, it's late and I'm rambling but I hope that makes sense. The rotating MFM thing would definitely be a concern of mine and I would address that with them when you meet, but the "consulting" thing would depend on how often you would see them and such.

I also had elevated protein c. My ob and MFM dismissed it as not meaningful at all...my MFM said, "yeah, you were pregnant, that's not surprising".

The lovenox thing is tough. We have had plenty of members who weren't on it who did fine. But I do think you are absolutely within your rights to ask the first MFM you met more about it and why or why not it would be appropriate for you (and possibly even bring in the study to discuss). If they are offended by you asking that, they aren't going to be a good medical provider for your next pregnancy anyway because you are going to have all kinds of questions and concerns and possibly tests that you would like done or at least ask if they are appropriate and so you want an MFM that isn't going to be bothered by that sort of thing. (I asked my MFM for a blood flow study, I asked my MFM for monitoring at 28 weeks, I asked my MFM to skip the 3 hour and just treat as if I had GD, I asked my MFM for steroid shots even if things were going smoothly, etc. etc. etc. She saw me weekly from 28 weeks on and every other week before that, and even seeing her that often, I usually had a list of questions and concerns. She'd laugh and say "what else?")

[quote="angieb"]I would try to see someone from a different practice, ideally.

One thing that differed between the different MFM's I saw besides their opinions on lovenox was that with my MFM, I will only always see "my" MFM. With the other MFM practice, they rotate MFM's so I would never (or not typically) see the same MFM two appointments in a row. That would have made me crazy! (One of my friends had an OB practice who did that with her first pregnancy, it was a mess. One doctor would change her due date. At the next appointment a different doctor would change it back. Etc.) Did you happen to ask or find out about that?

I think it's a little unusual that the MFM will be co-managing but also will do the delivery in a normal pregnancy. If you had a typical c-section and not a classical/vertical incision on your uterus, I don't think it would be too hard to find an MFM who would be more okay with a VBAC. I do think they prefer 2 years between pregnancies after a c-section for a vbac, but in our area we have some pretty vbac-friendly mfm's, since repeated c-sections will ultimately limit how many children you can have without raising the risks of repeated sections. (With a vertical/classic incision, they never consider VBAC an option.)

The website http://www.smfm.org is a good resource for finding MFM names in your area, at least.

Oh, and 18 months between conceptions sounds more like the norm, I thought you meant 18 months from the time you delivered Gracie until the time you can conceive again. I've heard anything from 6 months, 9 months, 12 months, between pregnancies, so that falls right in the middle with about 9 months between pregnancies. (My MFM also thought the same thing about weight loss and she was right, I actually had a healthier pregnancy at a heavier weight than I was at with my first preg.)[/quote]

Angie, I really appreciate all of the advice. Thank you so much.

I reached out to another group of MFMs and received an e-mail from the head of the practice, saying that he'd meet with me after a referral. Today I had my annual exam with my OB and she asked if I didn't like the other MFM she referred me to. I told her that I actually really liked her, but that I just wanted a second opinion. I like her so much in fact, that if the other MFM recommends the same thing that she did, I will stay with her- despite the new MFM being only 5 minutes from where we live.

Anyway, my OB said that she will absolutely send the referral, but she told me some interesting things about the other practice. The other practice is a consultative practice, so they will only co-manage my next pregnancy, versus the original MFM who will be my primary. There are 3 MFMs at the new practice who will all share my care, which I don't like too much. I also don't like that it is only a clinic, so if things get crazy and I have to be hospitalized or (God forbid) have to have an emergency c, the new docs will have to send me to the hospital where my original MFM works anyway.

I know I have a lot of decisions to make, but it's starting to wear on me. At this point right now, I want to stay with the original MFM I saw. However, what if the new doc says yes to Lovenox? I told my OB today that I understand that it is not a guarantee that pre-e and HELLP will not show, but I also don't want to have something terrible happen again next time and regret not having done everything possible. Ugh!

I thought about asking the original MFM if she'd be willing to prescribe it anyway, but idk how that will go.

OH, my OB told me today that the bloodwork my MFM ordered came back mostly normal. Only hiccup was elevated protein c activity, which I cannot find much info on. She is going to contact my MFM to see if this will change her recommendations, but since it's not a deficiency, it probably won't change anything. I'll find out soon.

Lovenox is an injectable anticoagulant (blood thinner). Many women who have experienced IUGR early in a pregnancy have it prescribed for them. If you test positive for a clotting disorder, you may have it prescribed as well.

I am not going to start LDA until a few weeks before we officially start TTC, probably near late June/early July. I would definitely wait until you get the green light from your MFM before you start taking anything on your own, just to be safe.

What is Lovenox? When do you start LDA? I'm a few days past ovulation now and hoping for BFP this month. :) I lost my daughter at 27 weeks. HEELP and clotting factors are suspected, but nothing has been confirmed yet. I met with a MFM, but haven't received any test results back yet, but she did say clotting and auto-immune can come and go and may not show up in tests. Should I ask about Lovenox? I did ask about asprin, but we haven't gotten back the results yet. I'm thinking I should go ahead and start that before the fetus implants.

Glad the appointment went well! I hope TTC a lil' sib for Gracie goes just as well!

I would try to see someone from a different practice, ideally.

One thing that differed between the different MFM's I saw besides their opinions on lovenox was that with my MFM, I will only always see "my" MFM. With the other MFM practice, they rotate MFM's so I would never (or not typically) see the same MFM two appointments in a row. That would have made me crazy! (One of my friends had an OB practice who did that with her first pregnancy, it was a mess. One doctor would change her due date. At the next appointment a different doctor would change it back. Etc.) Did you happen to ask or find out about that?

I think it's a little unusual that the MFM will be co-managing but also will do the delivery in a normal pregnancy. If you had a typical c-section and not a classical/vertical incision on your uterus, I don't think it would be too hard to find an MFM who would be more okay with a VBAC. I do think they prefer 2 years between pregnancies after a c-section for a vbac, but in our area we have some pretty vbac-friendly mfm's, since repeated c-sections will ultimately limit how many children you can have without raising the risks of repeated sections. (With a vertical/classic incision, they never consider VBAC an option.)

The website http://www.smfm.org is a good resource for finding MFM names in your area, at least.

Oh, and 18 months between conceptions sounds more like the norm, I thought you meant 18 months from the time you delivered Gracie until the time you can conceive again. I've heard anything from 6 months, 9 months, 12 months, between pregnancies, so that falls right in the middle with about 9 months between pregnancies. (My MFM also thought the same thing about weight loss and she was right, I actually had a healthier pregnancy at a heavier weight than I was at with my first preg.)

Thanks for the replies, everyone!

I didn't really think about seeing another MFM. I thought about it before this appointment, but maybe I was so happy with our meeting that I let it slip my mind. I think I [b]will[/b] get a second opinion, just in case. I'm pretty sure she knew about the IUGR I had with Gracie, though I didn't think to ask if she thought Lovenox would help. A bunch of the other MFMs available are in her "group" (not sure if that's the right word). Do you guys think that they will all have the same approach as her or should I try to see someone that is not affiliated with their practice?

Angie, I'm not too hung up on the 18 month thing. This month will make 18 months since I conceived Gracie. At this point I'm more interested in getting pregnant again before next March (the sooner the better, obviously).

Lala, thanks for the omega-3 supplement info.

Jules (jules2) is another one who had early onset and was only on LDA and had a great 2nd preg.

But conversely, here's a slightly encouraging study on the flip side:
[url]http://www.preeclampsia.org/forum/viewtopic.php?f=28&t=41553[/url]

[quote][i]Low molecular weight heparin versus no treatment in women with previous severe pregnancy complications and placental findings without thrombophilia.Low molecular weight heparin (LMWH) treatment has been recommended for pregnant women with previous adverse pregnancy and who were diagnosed as having a thrombophilia. We now examined the effect of LMWH on pregnant women without thrombophilias who had severe pregnancy complications and placental vasculopathy in an earlier pregnancy......[skip to the conclusion]:Treatment with LMWH may reduce the rate of the recurrence of severe pregnancy complications and significant placental vasculopathy in women without thrombophilias.[/i][/quote]

Yes, I was on lovenox with no clotting disorder, as have been handfuls of other posters (especially those who have delivered in the 20-26 wk timeframe with IUGR.) ( riehlism....something like that, sorry if I messed up her screenname) , Ashley (nolansmom maybe? She hasn't been on here in forever), several others. But it does vary widely by MFM and don't be afraid to get another opinion from another mfm. I met with 2. One said yes, absolutely lovenox.The other said absolutely not. (A friend of mine who had severe pre-e 2x and delivery before 30 wks, recently met with a popular mfm in our area that I have not met with. He planned to put her on lovenox regardless of her clotting tests but told her he'd feel more confident it would help if she had a clotting disorder. She did have mthfr which a lot of mfm's don't treat with lovenox anymore.)I didn't want to later regret not doing it,I have enough regrets from my 1st preg, so I went with the lovenox plan, it worked out for us. I'm on it again for our 3rd preg.Whether it made a difference or not is unknown, certainly we have had plenty of members not on it who have healthy pregnancies, my MFM is of the opinion that there are more clotting issues/disorders than they have tests for and just because they didn't find it with the tests doesn't mean there isn't one.

(Osteoporosis is a risk, they have me increase calcium by 1000 mg when I am on lovenox, and this time she expects me to be off it by 20 or 24 wks, once the placenta is totally established and everything looking good, I will stop. I stopped last time about 28 wks, we were more paranoid and I had blood flow notching.)

Personally, I'd probably try to talk to another mfm if I were you. The 18 month thing seems pretty excessive.