If you have a chronic medical condition, or a complicated pregnancy, you may want to include a maternal-fetal medicine (MFM) specialist on your care team.
A MFM physician is an obstetrician-gynecologist (OB-GYN), a doctor who specializes in women’s health, with three years of extra training that focuses on medical conditions that occur during pregnancy.
“A MFM specialist can discuss your specific health condition or risks for complications, and make a plan to ensure a healthy pregnancy and delivery,” said Thomas McElrath, MD, PhD, Director of the Preterm Birth Clinic in the Division of Maternal-Fetal Medicine at Brigham and Women’s Hospital.
A MFM physician provides specialized preconception care
A MFM specialist can provide standard preconception care by making changes to medications, tailoring supplements to certain conditions, and suggesting dietary changes.
For women with pre-existing medical conditions, or those who have had complications during a prior pregnancy, a MFM physician can also provide more advanced preconception care that includes:
- Conducting diagnostic procedures (e.g., obstetrical ultrasounds)
- Performing surgical procedures (e.g., inserting a pessary, or cerclage)
- Hospitalization (e.g., a patient at risk of pre-term delivery)
- Counseling (e.g., discussing the appropriate time to deliver)
If you are selecting a maternal-fetal medicine specialist, here are five things you should consider.
1. Choose a MFM physician who specializes in your health condition
The most efficient way to search for a MFM physician is to look for a provider who specializes in your specific medical condition. These may include:
- Cardiovascular disease
- Pulmonary conditions
- Lupus or rheumatoid arthritis
- Multiple sclerosis
- Blood conditions
- Inflammatory bowel disease
These may also include problems that unexpectedly occur during pregnancy or have occurred in a prior pregnancy, such as:
- Placenta accreta
- Preterm birth (delivery <37 weeks)
- Preeclampsia (or hypertension in a prior pregnancy)
“Brigham and Women’s Hospital has a large maternal-fetal medicine practice, so our specialists have experience in nearly every medical condition that can co-occur with pregnancy. If something can go wrong during pregnancy, we’ve almost certainly seen it,” said Dr. McElrath.
Dr. McElrath specializes in neurologic conditions, and directs the Epilepsy Clinic that cares for women with seizure disorders. He and other specialists within the Division of Maternal-Fetal Medicine also represent other health conditions that can occur with pregnancy as well as factors that increase the risk for complications, such as advanced age, prior gynecological surgeries, or having had a pre-term birth.
“Each of our MFM physicians treat several conditions. For instance, I care for patients with epilepsy, but also have patients with Chron’s disease. A colleague of mine sees cardiac patients, but also specializes in cancer,” said Dr. McElrath.
2. Choose a provider who sees a high volume of patients with your condition
When a MFM department organizes itself by specialization, each provider sees a high volume of patients with the condition in which they specialize.
For example, Dr. McElrath sees multiple epilepsy patients a week and thus has familiarity with treating this condition in the context of pregnancy.
“Patients achieve better outcomes when they choose a MFM specialist who sees high volumes of patients with the same condition,” said Dr. McElrath.
3. Choose a MFM specialist who coordinates care
At many medical institutions, an OB-GYN manages the care of pregnant patients. In this model, a MFM specialist is typically reserved for consultations.
However, within larger practices such as Brigham’s, a MFM physician takes ownership of a patient’s preconception care and serves as the single point of contact in managing the healthy pregnancy and delivery.
4. Choose a physician who operates within a large network of specialists
A MFM physician who practices within a large medical ecosystem can immediately refer patients to internal medicine specialists who can help evaluate, treat, and monitor patients with pre-existing conditions, or complications associated with pregnancy.
“When you choose a MFM provider, you also choose their connection within a multidisciplinary team that is dedicated to ensuring the best possible outcomes for babies and their families,” said Dr. McElrath.
5. Choose a MFM provider affiliated with a Level III Newborn Intensive Care Unit
To ensure the safest transition to post-natal care, many pregnant women with pre-existing medical conditions develop a strong relationship with a Newborn Intensive Care Unit (NICU) prior to pregnancy. For example, if a baby has a heart condition, a NICU neonatologist can work closely with a patient’s MFM physician to ensure the health of the baby after birth.
At Brigham and Women’s Hospital, a collaborative relationship exists between the Division of Maternal-Fetal Medicine and the Newborn Intensive Care Unit, the largest in Massachusetts, that provides newborn care for nearly 3,000 premature and seriously ill babies and their families each year.
“Our MFM specialists are always available, because you can’t tell when something’s going to happen during pregnancy,” said Dr. McElrath.