As you know, at our 8 week ultrasound we were told that we were having not just one baby but two babies! As soon as the technician finished up the ultrasound, a maternal-fetal medicine specialist (MFM) came to visit with us about our type of twins (monochorionic/diamniotic) and what the plan would be to ensure that they safely arrived in the world. A MFM is often referred to as a high-risk doctor by those of us who are not entrenched in the medical world. If you or your babies are at higher risk for a myriad of complications, chances are good you will get the privilege of seeing a MFM at least occasionally throughout your pregnancy.
Being told you need to be followed by a “high-risk doctor” can cause some initial anxiety, but ultimately, I find it very reassuring that someone who has undergone additional training is looking out for the well-being of our boys.
I had no idea what to expect or what the MFM would do versus what my regular OB would do throughout my pregnancy. I imagine that every MFM has different policies, and I’m sure it varies depending on what you’re being seen for. For mo/di twins, our MFM wanted to see us every two weeks starting at 16 weeks to watch for Twin-to-Twin Transfusion Syndrome. Seeing an MFM does not replace seeing an OB. While I see the MFM every two weeks, I see my OB at a more typical schedule of every 4 weeks until about 28 weeks and then every 2 weeks from there on out.
My appointments begin with an ultrasound with a regular ultrasound technician. They check out all sorts of things, but primarily focus on the size of the fluid pocket in each amniotic sac and the babies’ weight and whether it is more than 20% discordant. I always get really nervous before every appointment. I study the ultrasound screen carefully while they are doing it because I’m starting to get a better idea of what to look for as good and bad signs. Usually, by about half way through, I have formed my own opinion on whether I think all is well. Until the technician tells me the depth of the fluid pockets and their sizes, however, I can never fully relax. One huge perk to being followed so closely is that we always get a collection of pictures, so it’s fun to keep up with how much they change every two weeks.
From 8 weeks . . .
After the ultrasound tech finishes up, she types up her notes and submits the ultrasound photos and notes to the MFM to review. At this point, I usually ask any questions to which she hasn’t previously volunteered the answers. I think it’s extremely important to stay well informed. I want to know the exact measurements of the depths of each fluid pocket, the babies’ estimated weight, whether the blood flow looks good, etc., so I have a comparison point at the next appointment. Much like my own health, at this point, I still have ultimate responsibility for my babies’ healthcare. The only way I can do my job as a mama bear is to be informed and knowledgeable, so I can understand and logically discuss questions, concerns, and plans with my MFM and OB.
At some appointments, particularly the early ones, I didn’t even see the MFM in person, but as my OB says, “You may not see him, but he definitely sees you.” Starting at 20 weeks, my MFM always pops in to tell me in person that the babies are doing ok, ask if I have any questions, discuss any changes in treatment plans, birth, etc.
I view my doctor-patient relationships with the OB and the MFM this way. I apologize in advance, but to use a sports analogy . . . in my mind, the MFM and OB are playing a zone defense. Each has their own area that they primarily focus on, and they rely on each other to make sure other areas are protected. They communicate what’s happening in their area, so the best plays can be called to make sure the team comes out with a win.
The OB is my doctor. He is the one who checks my weight, blood pressure, and urine. He is the one who will do all my cervix checks as I progress. He’s the one who gives me permission to travel, to take meds, to work, etc. He’s the one who is making sure that I’m physically and emotionally doing okay throughout this pregnancy. He certainly also is looking out for the welfare of my babies, but he also relies heavily on the MFM in this area.
The MFM is the babies’ doctor. We see the MFM because of a condition that our babies could develop. TTTS doesn’t really pose a physical threat to me, so our MFM is most concerned with the progress of the babies. He carefully studies the ultrasounds for any warning signs that they are developing TTTS or any other twin complications. He assesses their health and gives us updates on how he believes they are doing and his prognosis for their future development. He’s the one that would identify any issues with the babies and discuss treatment options with us. On the other hand, he has no idea how much weight I’ve gained, if my blood pressure is sky-high, etc.
They (or whoever is on call for each of them) will team up at delivery as the risk for our little guys continues until they are safely out. It’s probably the only time I will ever actually be in the same room with them, even though they each will play an integral role in getting us to that point.
Have you had to see an MFM? I’d love to hear about other experiences!