OB vs. MFM

For my last pregnancy, I used an MFM who also delivers, so no OB. We are considering trying for one more kiddo, and are looking for an MFM closer to home than our last one. We met with a great one yesterday, but he doesn't deliver, and said it's rare that MFM's/perinatologists do. I guess our last experience was unusual.

So, I have a questions for you all who are currently pregnant or have kids. If you used both an OB and peri/MFM, how did it work? Was it confusing to coordinate between the two? When your OB delivered, was the MFM involved at all? (I'm considering doing another c-sec rather than a VBAC, so luckily, the insulin issues would be less than when I was pushing for two days with the failed induction...). During your NST's/BPP's, did you see much of the MFM? Did you have trouble finding an OB who would take someone w/ T1? The MFM said probably only the bigger practices will.

Thanks for your help ladies!

When I got pregnant with my 1st, my endo referred me to a high risk OB perinatologist. They take care of everything diabetes related and pregnancy related. And the best part, is my OB is also a T1, so she just "gets it". I could not imagine having more appts during pregnancy, so I am glad that they do it all.

Yeah, I feel the same way, that just one person would be easier! That's why I'm a little concerned. But, I saw my MFM once a week for an appt and twice a week for NST's at the end last time, and it sounds like this would be twice with the MFM for NST;s and once with the OB for an exam, so the same number of actual appts. But, seeing an endo, an OB, and an MFM frequently makes me worry that there could be too many different people giving me advice...

For both pregnancies, I was managed by a perinatologist (MFM) until delivery. However, in the OR, it was an OB-GYN resident who performed the c-section (with the MFM assisting). The first pregnancy was initially managed by OB-GYN and there was a big difference. I didn't think she had a good handle on the situation and was much more lax with recommendations.

I think some MFM docs are trending toward purely managing pregnancies and leaving the procedures to the OB-GYNs. I think this is fine provided that the MFM is the one calling the shots. I had NSTs every other week from the 3rd trimeseter for my first and every week for the second (I was anxious). All of this was dictated by the MFM. They are specialized in this and know what to screen in their patients with diabetes, as well as what indices to follow to determine if something is wrong.

I like to think of it like this (and this is in rough terms - just for illustrative purposes): To build a bridge, you need both an engineer (MFM) and construction workers (OB-GYN). For safety, the bridge is designed by the engineer because that is their expertise and they have a specific skill-set to do so. However, when it comes time to build the bridge, the construction workers are a better choice. They are used to building/working with their hands and know how to do so gracefully with minimal problems. Certainly an engineer could work in the manual labor and the construction worker could design the bridge. Each may have even participated in the other process at one time. However, for the best outcome, it is optimal to let them do what they do best.

Likewise, many MFMs have narrowed their skillset to managing the medical aspects of complicated pregnancies. They know HOW to do the surgeries, but if they do them less frequently than an OB-GYN, they are not going to be as good. Similarly, the OB-GYN physicians do a LOT of surgeries. However, they have limited exposure to complicated pregnancies simply due to the variety of patients that they see each day.

I think using the MFM to delivery is fine and using OB-GYN for the surgery is great too. Make sure (and they should do this anyway) that they are on the same page.

Hayley - thank you for explaining the differences between the two.  I didn't really "get it" until I read your explanation just now.

I am planning on trying to start getting pregnant in the next couple of months and have started having the appropriate appointments.  So far my endo and and OB/GYN Endo.  What is a MFM?  And what is your advice for which docs I need to be seeing prior to getting pregnant?

RSalla - I am in the midst of planning pregnancy too, so I'm right there with you.  I have seen my PA (who I see instead of an endo) and an OB, and the OB referred me to a MFM doctor, who I saw for the first time yesterday.  To my understanding, the MFM (which stands for Maternal/Fetal Medicine Dr.) is important because they are the ones who specialize in high-risk pregnancies (which any type 1 woman would be classified as, if pregnant).  They do some extra screenings and ultrasounds that the OB might not have the proper equipment for, because most "healthy" women don't require that level of detailed attention.

I also have seen a dietician to get an idea of what my nutrition/diet should look like during pregnancy.   I also just saw a CDE this afternoon, but that's because I haven't seen one in a loooong time.  I'm trying to find someone who will be willing to manage my insulin adjustments during pregnancy.  (Just found out today we have a new endo in town, so I'm excited to try her!)

It's a lot of appointments - my boss actually asked if I was "okay" recently because of all of the time off I've been taking, and when I reassurred him that it's just T1D maintenancy-stuff (because, technically, it is until I'm pregnant!), he said he was "glad it wasn't anything major".  Ha.  It's only going to get more and more appointment-heavy from here on out!   (I hope...)

RSalla, Sometimes, you'll also see the MFM referred to as a peri(natalogist). From what I've managed to figure out from various online sites and my own experience is that the drs you see for a diabetic pregnancy (and what they're called) really differ from place to place and provider to provider. Basically during the pregnancy, you'll need someone to help you mange BG's, someone to do ultrasounds and non-stress tests (special ultrsound testing), someone to do basic OB work including delivery, and someone for a one-time fetal echocardiogram. I would meet with both your endo and OB. I'd ask if they feel okay with you trying to conceive now, which specialists they recommend follow you (and for what aspects), and if they could refer you if necessary to someone who's familiar with T1's. Your endo should be very familiar with the process for his/her patients if s/he's been around at all. Also, you'll need a retinopathist / eye dr to follow you each trimester if you don't already have one.

Kim has a good point about time off from work. When I got pregnant, I had to tell my boss right away, even thought we weren't telling anyone else but our families. Luckily, she was wonderful about working out a schedule for me to take off. By the 3rd trimester, I had 2x/week non-stress tests, once a month ultrasound/fetal growth tests, weekly OB appts, 2x a month endo appts, and the once a trimester retina check. I have since started going to a different hospital for my medical appts because I got so sick of driving to the one I used to use!! (:

Congrats and good luck! Keep us updated. (:

RSalla, I just clicked onto your page and noticed you're in Rockville. I'm in Alexandria. For my pregnancy, I used Dr. Collea at Georgetown as both my OB and MFM. (He did the high risk stuff plus the delivery). His bedside manner was okay (not terrible, but didn't explain as much as we would have liked), but they're very knowledgeable about T1 pregnancies at G'town. Send me a message if you think you'd want to go into DC and I can tell you more about the pros and cons! I know another lady w/ T1 who delivered at Sibly, and she had more trouble finding an OB who would follow her and deliver there b/c they're less used to T1's.

Kim-  That is comforting to know that you are on the same path as me!  Thank you for explain the MFM thing because I had no clue!

I actually already talked to my boss and let her know that I will have to be going to a lot appointments leading up to pregnancy and once pregnant.  I think the people at my work already thought I was pregnant because I never used to take sick time off to go to the doctor and then all the sudden I started going.  Haha.  But luckily my company though very large is a very family oriented place and she told me to do whatever I had to do to have a healthy pregnancy so that is a relief knowing I can take care of business. 

Will this be your first pregnancy?

Yes, very comforting!  It's nice knowing there are others in the same boat.  Maybe we can compare notes down the road!  Hee hee.

My boss is a dude, and very passive/not gregarious.  He's super nice, just not very outgoing.  So, I kind of don't want to be like "Soooooo, I'm trying to get knocked up...."  It would be weird.  I'll tell him when I have something to tell him.

Yep, this will be our first time trying!  :)  You too?

 

Yea that is understandable.  He probably wouldn't get it.  Haha  I feel very lucky that I have an understanding workplace about all the appointments I will have to go to.

Yes this is our first as well.  I am definitely ready!  I think my husband was a little worried at first from a I don't want my wife to be harmed during this process standpoint, but once he has gone to the doc appointments with me he definitely feels more secure that as long as we do the right things everything will be fine.

This is my first pregnancy and I am seeing both a OB and MFM. Is that unusal?

Stephanie,

This is my first pregnancy too and I am also seeing an OB and a MFM.  From my understanding, the OB delivers and the MFM helps manage your health and baby throughout the pregnancy as well as the regular monthly checkups from your OB.

Nicole,

    Thanks so much I wasn't sure if i really even needed an OB after reading some of the post on here. But thank you again how far along are you?

I think it takes a team to take help with a great delivery and a village to help you through your pregancy in between LOL.  I am right at 7 weeks.  I am still in the scary stage since I had a ultra sound yesterday and did not hear a heartbeat I began to worry about miscarrying...

Oh no, Nicole. Is everything okay? Was the baby just "hiding"? Hope the next ultrasound is okay!!

I'm currently 5 months pregnant with my second and I've seen a MFM and an OB for both pregnancies.  I see my OB once a month for the first 2 trimesters, twice a month for weeks 29 - 35 and then once a week for the remainder of the pregnance (I went to 37 weeks with my first daughter).  I see the MFM once a month for growth scans for the first 2 trimesters and then start weekly NST's at 30 weeks and then twice a week NST's starting at 34 weeks.  The MFM office has a CDE that sees type 1, type2, and gestational diabetics for insulin adjustment and blood sugar monitoring so you can just tack that portion onto the growth scans. 

However, I opted not to be treated by the CDE.  I thought she seemed to have WAY more experience with T2's and gestationals and was sort of trying to treat me like one.  At my first meeting with her, she berated me for eating too many carbs and told me we'd have to overhaul my entire diet.  I was pissed because I've always had excellent control and an A1C below 6.5% (even before pregnancy) and my latest A1C at that point was a 5.7%.  I decided not to see her, so in addition to the OB and MFM visits, I also see my endocrinologist every 2 weeks for diabetes managment, and increase it to once a wekk in the 3rd trimester.  I have a GREAT working relationship with my endo and trusted him completely to manage me through pregnancy.  But I know not every endo feels comfortable with the process and so they'll refer you out.  But he had focused on diabetics and pregnancy during his fellowship and his wife (who he has two daughters with) is a T1, so needless to say, I felt very comfortable with him.  It makes for a TON of appointments, and it's definitely been harder the second time around, but it's been worth it for me to do it this way.  I think you just have to assemble the health care team that makes YOU most comfortable.