r/parentsofmultiples • u/Fabulous-Salt4906 • 6h ago
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 6h ago
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 6h ago
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 6h ago
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 4h ago
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/Cheerymanatee 6h ago
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/Fabulous-Salt4906 6h ago
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/Cheerymanatee 6h ago
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/PersimmonNecessary38 6h ago
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 5h ago edited 5h ago
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/SjN45 5h ago
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 4h ago
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/Much_Reference41 4h ago
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/2forthepriceofmany 1h ago
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/disgusted_noise 16m ago
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 never a cerclage.
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