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MFM vs. OB or Both?

Are you considering having another child after preeclampsia? Trying again after preeclampsia can be an emotional challenge. You can find support with others who share your concerns here.

MFM vs. OB or Both?

Postby ellemoon » Thu Oct 11, 2012 11:29 am

We aren't TTC yet but I am trying to get my ducks in a row before we start in April.

When I saw my OB for my pp appointment last year, she basically asked me if I was ready to have my tubes tied. I was shocked. She said that she recurrence rate for me is too high and she wants me to know that. I definitely was not ready for that.

So, I decided to see a MFM a while later. This MFM was VERY inexperienced. I'm pretty sure she was a resident that they stuck with me with or fresh out of med school or something. Anyway, she basically spouted out everything I already knew. It wasn't a great experience there but I know there are other doctors there that are more experienced. They did say they would be my primary OB only. The one downfall of this is this place is 45 minutes away. With frequent visits and NSTs and such, that would be A LOT of driving. She quoted me 50% chance of developing Pre-e again.

I saw a second MFM a few months ago. He actually came to our local hospital to meet me (he consults there) and his practice is an hour away. (we don't have MFMs near by) I LOVED this guy. He made me feel so at ease and answered my questions. The problem is, he would not be my primary OB. I think they deal with consults only. I would probably see him periodically and see my regular OB mainly. He quoted me 25% chance of developing severe pre-e again. He was very optimistic.

My OB is actually at the same doctors office I work at. So, there is a convenience factor there. BUT I feel like because I work with the OB's, last time I was kind of "brushed aside". My BP was really elevated and I had HORRIBLE swelling and they told me it was fine. If I hadn't been so persistent, who knows where we would be today.(side note: My regular OB was out of town when all this went down) I also feel like she wouldn't be very supportive because she thinks I'm doomed to have another preemie. I don't even know if she would feel 100% comfortable mananging my pregnancy. She had me on the wrong BP med last time.So, obviously she isn't that experienced with high risk patients. I do know that I would request to see only her in our practice, not sure if that will cause strife but oh well. I obviously will talk to my OB and see if she feels comfortable, etc. and seeing the MFM in conjunction will also be better because he can make the "important" decisions like increasing BP med, etc. I also know that she would take me very seriously next time and I knoew her and feel comfortable with her.
But what do you guys think? What would you do in this situation?
Leslie (26) DH (28)
Chronic hypertensive since age 17
DD- born April 24, 2011 due to severe pre-e at 29w1d weighing 2lbs, 11oz
Diagnosed with homozygous MTHFR C677T
Pregnant with #2! Due 9/2/13 but will deliver at 36-37 weeks due to classical csection.
(Labetolol, HCTZ, Aspirin 81mg, Calcium, Mag, Zinc, D, Fish Oil, Fiber gummies, Folic Acid)
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Re: MFM vs. OB or Both?

Postby sam10 » Thu Oct 11, 2012 07:12 pm

Most importantly, you need to feel comfortable with your care and trust your doctor(s) and nurses and feel good about the set-up.
I decided to go for the MFM only care. My MFMs practice is used to the panic of high-risk pregnant ladies and this has been really great when I need to call them. I prefer to have one place to go rather than two. I really like my regular ob; just don't care for the nurses and front desk staff that much, which can be a real nuisance. I do need to drive a bit to my MFMs office, but I am ok with that. I think it is worthwhile.
~Julija (40)
MC 3/2009 and 3/2011
Henry (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
Matilda (Nov. 2012, born at 35.4 weeks) - severe PE


Our pain has been put into words, placed into empty cradles, to remember that all our babies lived, that they mattered and always will. - Field of Cradles http://www.fieldofcradles.org/
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Re: MFM vs. OB or Both?

Postby princess purr » Thu Oct 11, 2012 08:32 pm

it's import you feel comfortable and are working with people you would trust with your life (because you are trusting them with your life). I have an MFM and my primary OBGYN, but the two seem to work together really well and are working together with my pre=planning blood work. You are young, and made it to 29 weeks, in my opinion you have a pretty good shot when you try again to get much futher. Don't let one docs opinion get you down, my history was worse then yours, I'm 8 years from the last time I was pregnant, and have autoimmune issues and my doc says I have a pretty good chance of things being okay.
Val (34) & Carlos (32)
Married: April 29th 2011
Veronica Rosina, 11/25/2004-11/27/2004
Born at 26.5 weeks (1 lb 4oz, 14 inches) because of severe preeclampsia (doc says I was on my way to HELLP but not there yet)
Nicholas Robert, 11/22/2013 7 lb 7oz 19.5 inches, born at 36 weeks (due to previous classical c-section) PE FREE!!!!!!
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Re: MFM vs. OB or Both?

Postby Raposa » Fri Oct 12, 2012 08:58 am

I really like my OB, so I'm happy to be dual-managed this time. The way the local MFM group operates, I usually see a different doctor every time, so it's nice to have a constant to come back to with my regular OB.

I think the biggest thing is to have doctors you're comfortable with, who you trust to get things right. When I've had to stop working, I brought all my paperwork to my regular OB, because I know them and how they operate. It's been reassuring to have them there, even as I know I'm also going to an MFM specialist for higher level ultrasounds and their high-risk know-how.

So, if you've found a doctor you're comfortable with, stick with them if you can. If that means being co-managed along with somebody you're less sure of, well at least you have one doctor you can turn to if you have a bad day and need an urgent response.
1st son, induced at 37 weeks due to pre-e, born 6/18/10.
2nd son, c-section at 37 weeks due to hypertension, born 1/15/13.
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Re: MFM vs. OB or Both?

Postby amjon » Fri Mar 08, 2013 01:28 pm

If you saw a MFM they wouldn't be an intern. They have to have extensive experience beyond the regular OB training. I see a wonderful MFM and a regular OB (though I see the MFM FAR more). I saw MFM at two other practices before I went to this one. She was recommended by several of the baby loss moms that were on their rainbow babies. (If you have a group like that I would ask for recommendations.)
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