Seeing an MFM on Thursday!

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.

Re: Seeing an MFM on Thursday!

Postby angieb » Sun Apr 08, 2012 05:58 am

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.)
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/
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Re: Seeing an MFM on Thursday!

Postby MomTimesThree » Mon Apr 09, 2012 01:32 am

Glad the appointment went well! I hope TTC a lil' sib for Gracie goes just as well!
2008-Our Baby Girl, PTL born too early at 30w6d, Fought so hard... Forever Loved & Missed
2010- Lil' Bro, Pre-E at 29 weeks... Induced at 36w6d, Born 37w
2012- Lil' Sis, Super-imposed pre-e at 25 weeks, PTL & GD at 35 weeks, Evicted 36w
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Re: Seeing an MFM on Thursday!

Postby amjon » Mon Apr 09, 2012 11:10 pm

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.
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Re: Seeing an MFM on Thursday!

Postby flori » Fri Apr 13, 2012 03:07 am

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.
Flori, 30
Mommy to Gracie- born at 25 weeks 03/15/11, 11 inches, 1.1lbs, and absolutely beautiful. Became my sweet angel the next day.
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Re: Seeing an MFM on Thursday!

Postby flori » Fri Apr 13, 2012 03:39 am

angieb wrote: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.)


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.
Flori, 30
Mommy to Gracie- born at 25 weeks 03/15/11, 11 inches, 1.1lbs, and absolutely beautiful. Became my sweet angel the next day.
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Re: Seeing an MFM on Thursday!

Postby angieb » Sun Apr 15, 2012 11:32 pm

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?")
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/
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Re: Seeing an MFM on Thursday!

Postby flori » Tue Apr 17, 2012 07:00 pm

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.
Flori, 30
Mommy to Gracie- born at 25 weeks 03/15/11, 11 inches, 1.1lbs, and absolutely beautiful. Became my sweet angel the next day.
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