MFM vs OB? Opinions pls

[mrstang]

I am finally ready. I am having my IUD out on 3/13, which gives me a little less than a month to complete my research and put together my plan.

I am wondering what the benefits may be to see a MFM instead of an OBGYN to follow me during my pregnancy. I do not believe a MFM will follow me any closer than I am going to follow myself, and since PE is such a poorly understood disease, it's not like just because they have additional training in high risk pregnancies they're going to be able to wave a magic wand and make my pregnancy easier. I just wonder why people choose to see a MFM instead of a OBGYN. If you feel comfortable, would you please give me your opinion, why you chose to use a MFM instead of a OBGYN? Or on the flip side, if you chose an OBGYN, could you share why?

[sam10]

Most regular OBs will probably advise you to see an MFM if you have a history of PE and/ or advise you to seek pre-consultation with an MFM before a next pregnancy. MFMs do not necessarily make your pregnancy any more comfortable (unfortunately), but are trained to monitor more closely/often and (usually) with better equipment than a regular OB. I would think that the MFM will more likely keep up with the absolute latest in PE research, and might have some info up his sleeve that a regular OB would not.

In the event of another pregnancy, I will be seen solely by my MFM and his staff (some see OBs in conjunction with MFMs), as it makes it easier to deal with one doctor than two and most importantly, I feel a lot better and more comfortable knowing that I get the best possible care and doctor with the "highest PE IQ/knowledge" available. Some regular OBs get too nervous in my view and that would be the last thing I would want to deal with.
Even if PE cannot be prevented, but improper care can lead to bad consequences.

Have you discussed with your regular OB yet? If so, what was his/her recommendation?

[kerisue]

I experienced severe early onset preeclampsia during my pregnancy. After I gave birth my OB recommended no more pregnancies and said that if I did become pregnant she wouldn't see me. I met with a MFM specialist who did NOT discourage me from another pregnancy and said that he would be my primary physician during another pregnancy- for continuity of care I suppose and like Julija said because I assume he would be the most up-to-date on research and best practices with preeclampsia. If you had preeclampsia in a previous pregnancy then it wouldn't hurt to have a pre-conception consult with a MFM specialist and see what they say. Good luck with trying to conceive!

[tree]

I agree with you about the sad lack of magic wands and the importance of looking after yourself when it comes to PE. I am also considering a consult with an MFM and somewhat unsure if it would be helpful in my case. I think the decision to go with an OB or an MFM really depends on you and your doctor. My OB doesn't think I need to see an MFM, but I could (and may) do so anyway. I am pretty comfortable with the idea that she could get me through another pregnancy. She isn't an MFM, but she does have additional experience in dealing with high-risk pregnancies. I would not be comfortable with an OB without as much experience with PE or access to MFM-level monitoring equipment. I would go for a consult with an MFM if I was definitely set on finding a new doctor anyway. I would also want to see an MFM if I had any underlying conditions or if I had gotten sick earlier in pregnancy.

I am not sure if my indecision will be helpful. What are you inclined to do? What does your OB suggest?

[MaisiesMama]

When my blood pressure rose during my pregnancy, my wonderful OB referred me to an MFM and the rest of my pregnancy was managed by both of them. I felt like I had one more expert in my corner and I had no complaints. MFMs have specialized training and so much experience dealing with hypertensive disorders during pregnancy. For me, when I was told my pregnancy had become high risk, I welcomed the coordinated, specialized care.
Another issue for me if we decide to try again is that the hospital where my OB has privileges does not have a NICU. If I go into a second pregnancy with the MFM coordinated care and do wind up having severe high bp again (or some other symptom), I would be able to go straight to the hospital that does have a NICU, rather than dealing with ambulance rides or delivering an early baby that could have to be transported to a different facility which I would be unable to visit while recovering. It could be something to be aware of, depending on your situation
Personal opinion is MFM - yes!

[angieb]

I saw both. I did not have the option of only seeing my OB, but I could have only seen my MFM. I decided to stick with my OB too because she delivers most of her own patients when she can, even if she's not on call; while my mfm was in a practice with 5 or so other doctors- one of whom I met in my first pregnancy and he was a serious jerk. I wanted to avoid delivering with a doc I didn't know and especially the ones I didn't like and another one in the practice that we had heard really bad things about. My ob did deliver DS, but my mfm helped keep a close eye on me, put me on lovenox, etc. I liked having 2 doctors watching over us, I know they had no magic wand but it still helped me get through it.

[mrstang]

Thanks for your responses guys. In my first pregnancy, my OB did not refer my care to a MFM. In fact, he didn't even realize what was going on until I went into pre term labor and went to L&D and they realized my BP was high (this was at 29 weeks.) *I* knew my BP was NOT normal at 17 weeks when it was still considered "normal" - like 135/70. Still great pressure, but I used to run 120/60 and I knew it was wrong. I was brushed off as "white coat syndrome" (and puh-leeze, my mom and sister are both nurses and I love all things medical, I do NOT get nervous when seeing the doc.) My doc was doing the rounds and saw my chart and called me back in for a 24 hour observation because he followed his gut.

That being said, I cancelled my first appointment and called a practice that has a MFM on staff. I will be seen by the OB group AND the MFM because I feel better being with someone who might know more than I do about PE.

Plus, the more preparations I have in place, the less of a chance I will have PE right? Murphy's Law and all...

[sam10]

I like Murphy's Law... ..

for us "special" ladies, two docs are better than one...

Good luck and let us know how you'll like your MFM!

[tree]

That being said, I cancelled my first appointment and called a practice that has a MFM on staff. I will be seen by the OB group AND the MFM because I feel better being with someone who might know more than I do about PE.

Plus, the more preparations I have in place, the less of a chance I will have PE right? Murphy's Law and all...

Seems reasonable to me! Your question got me thinking about the MFM vs. OB decision, and you might have changed my mind. My OB did a decent job handling my pregnancy and delivery, but I am a little surprised that I survived post-partum care. We all got lucky on that front. I think I will want someone who has treated many HELLP patients in charge of my care when/if I get too sick to tell them what to do. Thanks for sparking an interesting discussion.

[LalaPants]

I saw both an OB and a MFM in my first pregnancy (because we knew I had lupus as well as a potential cervical issue). I felt like the OBs were really just rubber-stamping everything that the MFMs said and weren't really doing anything. I thought the MFMs were good, but they didn't even take my blood pressure at the practice - I went a week before I lost my son and I wonder if we might have been able to do something if my blood pressure was being monitored. After I lost my son, the OB told me that I shouldn't get pregnant again and spent my 6 week pp appointment telling me options for sterilization.

Needless to say, I won't be seeing either practice in the future. I was referred to a lupus specialist at a teaching hospital about an hour away, and when I called to make an appointment with the MFM group there they directed me to a MFM that specializes in managing lupus pregnancies. He will be my main doctor and will coordinate with the lupus clinic there. As a bonus, they have one of the best NICUs in the USA. I have a coworker who used the high risk practice there for her second pregnancy (after initially seeing the local MFM practice) and she told me that they were just worlds better than our local group.