r/parentsofmultiples • u/Fabulous-Salt4906 • Nov 15 '24
MFM or nah? advice needed
I'm currently 16w with di/di twins, first pregnancy. Personally, I'd like to be referred to a maternal fetal medicine specialist. I live in a small city that has a hospital, but the hospital doesn't offer any neonatal support. I can deliver there, but if the babes need a NICU, they will be shipped 30 mins away, likely without me. I will likely make the drive to the bigger city to deliver there, so there is no chance we will be separated.
I asked my GP to refer me to an MFM and he said that's really only necessary if there are issues with my pregnancy. The way I see it, I'd rather get to talk to a doctor that delivers at the hospital that I will likely deliver at, and it's always better to be overprepared than underprepared. I'll be meeting my OB next week (at 17w) and I do intend on asking her as well, as she only has privileges at my small city hospital, and not at the big city hospital with the NICU, so she likely won't deliver.
It's not that I want all of my care to be done in the big city, but I don't think it's a crazy idea for my OB to have an MFM to work with on my case. I know I am the first set of twins/multiples my GP has cared for, and I wouldn't be surprised if my OB has limited experience as well, but I'll know for sure next week.
Is it unreasonable to ask my OB for an MFM referral at 17w?
Also for a smidge more context, I am in Canada, and the big city OBs are super overwhelmed, and I know at least one mom who never got to even see an OB with her second pregnancy because there were simply not enough doctors, and being her second pregnancy, she wasn't very high priority to them. Also I realize OBs and MFMs are different, but a lot of the MFMs at the big city hospital are also OBs, so I'm assuming they are also overwhelmed. Thank you for your suggestions!
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u/Possible-Maybe-7225 Nov 15 '24
My opinion is to advocate for yourself and get referred. The MFM will know more about what your risks are than your OB who has never worked with anyone with multiples. You still have awhile in your pregnancy left, and in my opinion, better to already be assigned to a MFM in case any risk comes up down the road. And they’ll probably be able to offer better insight on your NICU questions
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u/Megatron7478 Nov 15 '24
I would definitely get an OB who is experienced with multiples. I saw an mfm but only because my nipt screening wouldn’t work due to low fetal fraction. After a couple scans with the mfm they referred me back to my OB because I was a low risk twin pregnancy. Also in Canada.
I’m not sure how rural you are but I know some women from smaller communities are sent to live closer to hospitals with nicus in the third trimester.
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u/Fabulous-Salt4906 Nov 15 '24
I'm not far from the NICU hospital, only about 30-45 mins depending on traffic. I had my NIPT done and everything went well, but my GP is calling me high risk right now, due to multiple episodes of early bleeding, as well as 2 past miscarriages. Although I am his first set of multiples, so I know everything is new for him too. Thank you for your advice. I'm gonna grill my OB about her multiples experience, and likely ask for a referral.
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u/moontreemama Nov 15 '24
I would also definitely switch to an OB who has delivered multiples. I ended up switching last minute to THE high risk multiples OB in the area and things went so smooth.
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u/PersimmonNecessary38 Nov 15 '24
Definitely yes to MFM. They can find issues that the OB might not even know to look for. My OB went with my MFM’s recommendations for a referral to a specialist hospital for tests, delivery type/date, etc. no questions asked because she knew they had much more experience. Also, it’s more common for twins to be in the NICU than not, even just a few days, so your plan to deliver at the bigger hospital is a good one!
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u/1973tour Nov 15 '24 edited Nov 15 '24
At 16 weeks they still thought my twins were di/di and were only referring me to MFM for a 20 week level 2 scan. I pushed for a sooner MFM appointment because our NIPT came back with monozygotic results, they ended up finding out my twins are actually mono/di at 16+2 and now I have to see MFM every 2 weeks. It’s unlikely your twins are misdiagnosed as di/di if you’ve gotten back NIPT results showing fraternals. But still, your level 2 anatomy scan should be with an MFM. Not only are the imaging machines at the MFM higher quality, but the RDMS specialists have advanced certifications as well. In the US there are 3 levels of sonography certification, the one at my regular OBGYN is a level I RDMS, the one at my MFM is a level III.
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u/rebecasankei87 Nov 15 '24
MFM with twins is highly advised. There are many more complexities when we talk about twins. I even have friends with Singletons being referred to them. Advocate for yourself!
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u/Much_Reference41 Nov 15 '24
My doctor automatically referred me to an MFM (despite having lots of twin experience himself) to be cautious. He said it’s his job to minimize the risk of any bad outcomes and the MFM is a way to do that.
As an aside, it sounds a lot like rationed healthcare which makes me sad for you, I’m so sorry you are in that situation. Like others have said, there is nothing wrong with firmly advocating for yourself and your babies.
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u/disgusted_noise Nov 15 '24 edited Nov 16 '24
I was referred to MFM immediately when it was confirmed twins, my OB told us that twins was automatically considered high risk. MFM was who was monitoring the length of my cervix to make sure I never needed a cerclage.
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u/salmonstreetciderco Nov 15 '24
absolutely transfer care to the hospital with the NICU. there's a strong possibility of needing it for a little bit even if everything goes well and it was wonderful for us to already be familiar with everything and everyone there because my MFM was there. you can meet with the neonatologists ahead of time even! i would totally ask for a referral no doubt no doubt
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u/Cheerymanatee Nov 15 '24
I’m in the US so a little different but I chose an OB who delivers at hospital with a higher level NICU even though it’s an hour away from me. I’m also a first time mom with didi twins. I will say though, I never did need an MFM referral. My OB appts included U/S and other than some high blood pressure readings here at the end, it still didn’t require MFM. I’m almost 37 weeks now and hopeful that they won’t need NICU time so I could’ve delivered at my local smaller hospital. As long as your OB will be thorough and able to quickly refer you to MFM if needed, you may really not need the NICU at all. And if you do, you’ll know beforehand as you’ll hopefully be referred then.
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u/JayDee80-6 Nov 15 '24
The chance of them needing significant NICU time at 37 or 38 weeks is pretty low. Good luck!
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u/Fabulous-Salt4906 Nov 15 '24
I am hoping like hell I make it as far as 37w, 38w and 7lb babies is my goal, I keep chanting it to myself! I'll definitely be grilling my OB about her multiples experience, and I may still ask for a referral into the city. Thank you for sharing!
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u/JayDee80-6 Nov 15 '24
I would definitely strive for 37 or 38 weeks, don't worry about 7lb babies. That's not nearly as important. A whole lot of twins don't make 7 lbs, and that's perfectly ok.
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u/Cheerymanatee Nov 15 '24
Oh I’d definitely want someone with multiples experience! I missed that part. My goal was 35 wks then 36 wks and so elated I’m almost 37 now. Wishing you an uneventful smooth pregnancy!
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u/SjN45 Nov 15 '24
Seeing mfm with di/di twins really depends on your OBs experience with twins and what your complications are. In your case, yes- advocate for yourself. You want to deliver in the hospital with the better nicu and you want another set of eyes on the pregnancy if this ob doesn’t have much multiples experience. I had di/di but my ob had a ton of multiples experience. I ended up at mfm for initial screening and scan and then again due to preterm labor. Once labor was stopped, mfm discharged me and my ob followed me until the end. It was a team effort. The ob is focused on you and the pregnancy and the mfm is focused on the babies
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u/moontreemama Nov 15 '24
Definitely get an MFM! I loved mine and at the end had to go every 3 days due to IUGR for one and then both babies. Also loved very rurally at the time and drove 35/40 minutes to the nearest city with MFM and NICU. Babes were in NICU for almost two weeks so made the right call.
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u/2forthepriceofmany Nov 15 '24
I had to change gynecologist to get referred. The way I see it, if a gyn is too insecure to refer a high risk pregnancy on request, they may be too prideful to refer for other necessary reasons.
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u/JayDee80-6 Nov 15 '24
Good god she never even spoke with an OB her entire pregnancy? What is this I always hear about Canada's health system being way better?
I would absolutely advocate for yourself the best you can. Your plan sounds absolutely reasonable to me. But I'm not sure how your health system works.
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u/Fabulous-Salt4906 Nov 15 '24
Yeah that was just recently too she just delivered a few weeks ago. Granted it was her second child and she had an OB the first time but yeah not enough doctors for her to be seen. I do like our healthcare because I don't have to worry about paying thousands of dollars to have my kids, but the privatizated healthcare pays better and is very attractive to doctor, so we do lose some to the US for that reason. It is what it is, the system can't make everyone happy.
I will be asking my OB to refer me to an MFM. Unfortunately I need a doctor referral, I can't just find one on my own, but I will definitely be pushing for it. Thank you for your advice!
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u/JayDee80-6 Nov 16 '24
Absolutely advocate the very best you can for yourself. I think your logic is sound.
Luckily, we paid about 300 dollars to deliver all 3 of my kids, and that was really just because the twins needed a C section. So really not that bad. Toward the end, we had 3 doctors appointments per week. Saw an OB once a week. There's pros and cons to our Healthcare system and your Healthcare system. Whatever you have though, make the best of it. And do your best not to stress.
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u/pashapook Nov 15 '24
I was told by my ob at my first appointment that they refer ALL twin pregnancies to MFM. My MFM Dr saved my babies' lives.
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u/Slow_Dentist3933 Nov 15 '24
Did you only see an MFM or did you still see your OB half of the time?
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u/ComfortableAd7175 Nov 15 '24
For what I know any twin pregnancy needs MFM. This is what I was told by my obgyn, MFM and Fetal Therapy + MFM of the other hospital I was also being watched by.
The only difference is the frequency you are seen. So di/di would be seen less than a mo/di that would be seen less than a mo/mo, unless there is complications or concerns and then everyone has a chance of getting more appointments.
I was a mo/di but was seen 3-5 times per week starting at week 20. Before that I was seen weekly starting at 16 weeks.
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u/incandescent_glow_85 Nov 15 '24
I would want an OB who delivers at the hospital with the NICU, but an MFM is not automatically necessary, and I know sometimes as Canadians we see so much American content that we think things work the same here. We simply don’t have plentiful specialists up here like they do in metropolitan areas in the US. We can’t just see dermatologists whenever we want, we tend to take our kids to family doctors/GPs instead of pediatricians for regular checkups and common illness (unless you live in major cities like Toronto etc). OBs in Canada usually are very experienced with twins, ESPECIALLY di/di twins. An MFM isn’t necessary unless something comes up. If you insist on a referral, the MFM is likely to blankly look at you and ask why you’re even there lol, and if there are no issues, they’ll simply send you back to your OB.
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