What is the role of the MFM?

EndPreeclampsia Web Team · 2023-01-04T13:50:53.395Z

What is an MFM? An MFM is a Maternal Fetal Medicine specialist, also called perinatologists. They are OBs with extra years of specific training and education in complicated and high risk pregnancies, either from the maternal or fetal side. Read more here. (https://www.smfm.org/whatwedo) Do I need an MFM? Having at least a consult with an MFM is recommended for women who previously delivered before 34 weeks or who have certain underlying conditions such as chronic hypertension or preexisting diabetes. It may be helpful for other women as well, but this is a good question for your OB. How do I get to see an MFM? How do I find one? Can I just call and make an appointment? You should check your health insurance to see which MFMs in your area are covered. You should also check with your OB to see if your OB has an MFM they recommend. MFMs tend to be affiliated with larger or teaching hospitals with high level NICUs or children's hospitals, so you can check those websites, or search by area in this link.(https://www.smfm.org/members/search) Most MFMs do require a referral, so you will need to ask your OB for one. A midwife or PCP may be able to write a referral also. If you saw an MFM in the hospital at all during your previous pregnancy, you may be considered an established patient and may not need a new referral. You should ask your OB first, and they can tell you how a referral and scheduling an appointment will work. Will the MFM take over my care completely, or will I still see my OB? This will depend on your situation and the practices. Most MFMs share care with OBs, so you see the OB for routine prenatal care and the MFM for managing chronic conditions, complications, and/or ultrasounds and NSTs. Many MFMs leave delivery to the OBs. Some MFM practices do handle their own patients even for routine prenatal care and delivery, no OB, although this is less common. If you have other specialists involved with your care such as a cardiologist or endocrinologist, an MFM can coordinate care with those specialists and should be the final authority with input from the specialists. How often will I see the MFM, and when will care begin? Again, this depends on your situation and how the MFM does or does not share care with the OB. There isn't necessarily a lot an MFM can do before about 20 weeks, unless you have chronic conditions, so it isn't necessarily uncommon to wait to see the MFM until or after your anatomy scan around 20 weeks. Your MFM and OB will make a visit schedule personalized for your needs. My OB has referred me to an MFM. What should I expect from that appointment? When the OB wants clarification, it is the OB's responsibility to refer to MFM. The MFM can review your chart, talk with you about the concerns, and decide how involved to be with your care going forward. This initial appointment is generally a long one and may include a physical exam, detailed ultrasound, doppler testing, blood testing, steroid shots, fetal monitoring, discussion with a genetic counselor, discussion with a Fellow (OBs currently studying to become MFMs), and a subsequent discussion with an Attending MFM. The MFM may decide to take an active role in the rest of your pregnancy or may decide that the OB can handle everything and that the OB can contact the MFM again if there are any further questions. If the MFM feels a preemie is likely, they may be able to coordinate a time to talk to someone from the NICU. If this is your first visit to an MFM, it may be helpful to have your partner or another support person with you, if possible, to help absorb all the new information. You may want to take notes, and please do ask any questions you think of or for clarification if anything is confusing. MFMs have seen parents in many sorts of situations and understand that you may be worried and emotional. Also, ask how you can reach them later if you have additional questions or concerns. I've been seeing both OB and MFM throughout my pregnancy, and now they disagree on course of action. Whose advice should I follow? Because of training and education, the MFM outranks the OB, and the OB should defer to the MFM. In addition, the MFM likely sees many more hypertensive disorders of pregnancy than the OB does and should be more familiar with the latest guidelines and recommendations. When they disagree, you can ask the OB why they do not concur with the MFM, and if need be, you can ask the two to talk and come up with an appropriate plan of action. I think I should see an MFM, but my OB doesn't think it is necessary. What do I do? Tell the OB that you would like a consult with MFM for your own peace of mind. The OB should not be offended that you want extra reassurance, and many insurances do guarantee your right to a second opinion. If the OB will not write the referral, you may see if a different OB in the practice or your PCP will write the referral. If nothing else works, you may try contacting the MFM directly and explaining the situation to see if they have any ideas. I think I should see an MFM, but there aren't any in my area. What should I do? In this case, your OB may handle more than an OB in an area with MFMs readily available, but do ask your OB what they can do. Technology now allows MFMs to read data remotely, even ultrasounds and NSTs, and email, video, and phone allow for easy communication. Some MFMs travel to satellite offices periodically as well, but sometimes mamas do just have lengthy drives. Especially if this is the case, you should ask the MFM specifically what criteria mean you should call the OB vs. the MFM or go to a closer hospital vs. a higher level one where the MFM has privileges. Can I see an MFM for a preconception visit? Yes! Many MFMs do preconception visits, so ask your OB about a referral. Here are some questions to ask. (https://www.endpreeclampsia.org/forum/trying-again/questions-to-ask-your-doctor) Bonus: MFMs in the UK, courtesy of our UK Senior Moderator In the UK we have Maternal Fetal Medicine consultants as well. These are consultants (often within the Maternity department) who deal with complex cases concerning mother, baby or both. You can see a Fetal Medicine consultant if you pay privately for preconception appointments. You can also ask your GP to refer you to the hospital for a preconception appointment - this is likely to be with gynae/obstetrics who will be able to speak to you about risk. They may also talk about what your care may look like, and they may then speak to the fetal medicine department for input. You can also ask for a post birth debrief with the midwife team. Here you can discuss your last delivery and pregnancy - this can also assist with getting plans together should you wish to have another baby.

What is an MFM?

Do I need an MFM?

How do I get to see an MFM? How do I find one? Can I just call and make an appointment?

Will the MFM take over my care completely, or will I still see my OB?

How often will I see the MFM, and when will care begin?

My OB has referred me to an MFM. What should I expect from that appointment?

I've been seeing both OB and MFM throughout my pregnancy, and now they disagree on course of action. Whose advice should I follow?

I think I should see an MFM, but my OB doesn't think it is necessary. What do I do?

I think I should see an MFM, but there aren't any in my area. What should I do?

Can I see an MFM for a preconception visit?

Bonus: MFMs in the UK, courtesy of our UK Senior Moderator