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Wednesday, July 26, 2006

Questions for a High-Risk OB

Questions for a High-Risk OB (Maternal Fetal Medicine or MFM/high-risk OB)
By Tina

A pregnancy is classified as "high-risk" when a mother and/or baby are deemed in danger during any part of the pregnancy. For a baby, this means either being born prematurely and all the problems/risks involved with it, or defects/conditions found by prenatal testing that may or may not endanger the child’s life. For a mother, this means serious health issues that can threaten her life/her baby’s life or are known miscarriage risks, such as high blood pressure, blood clotting disorders, thyroid disorders, diabetes, etc.

Most women end up meeting with a high-risk OB once they are already pregnant and issues develop with the pregnancy. For women who are found to have conditions that cause recurrent miscarriage, they are usually sent to meet with a high-risk OB prior to pregnancy for a pre-conception consultation.

My list of tips and questions stem from my personal experiences in dealing with a homozygous MTHFR gene mutation (and high homocysteine levels) and elevated anti-thyroid antibodies (specifically, Anti-Thyroglobulin Antibodies [Tg-Ab]).

I ask that as other women read this list of questions, you e-mail the Town Criers to add any questions you think need to be added (and you be credited for your additions) – I can’t possibly think of all questions to ask, especially because I have not yet reached the hurdle of getting pregnant yet.

For your pre-conception consultation/first appointment:

Keep a running list of questions prior to your appointment (especially if this is a pre-conception consult, since you will most likely have a wait before the appointment). As your appointment date comes closer, re-read your questions and prioritize them so they are organized for the doctor. If you are sent to a high-risk OB on an emergency basis, try your best to remain calm and organize your questions as best you can. Have your partner help you with your list.
Bring/have faxed over any relevant medical records: Surgeries, results of any tests run, list of medications, etc. You cannot guarantee your referring ob/gyn’s office (or other specialists involved) sent over everything the doctor will need.

If the clinic/doctor does not send you the medical history/insurance paperwork ahead of the appointment, request that it be sent to you. You will have more time to complete it and bring it with you – and your doctor will have more accurate information to review.

If the clinic/doctor you are seeing has a web page, try to find it prior to the appointment so you have some working knowledge of the office. It will save you time in the appointment from simpler questions on office hours, etc. for the more important issues that need to be discussed.

If possible, have your partner accompany you to the appointment. Since family history will most likely be taken during the appointment (even if you fill out forms prior to the appointment), it is good for the doctor to assess both sides.

If you specifically are going in for a pre-conception consultation, find out about how much time is allowed for the appointment. You do not want to be rushed through your questions.
Always take notes during the appointment – and write down/highlight anything that is unclear so you can ask the question again.

Questions about the facility (specifically if this was not on the web or given to you by your referring ob/gyn):

  • How long has this office/clinic been open?
  • What are the office hours?
  • What is the location of the office? If the office/clinic is located in a hospital, ask about parking and parking validation.

About clinic/office communication:

  • Is there a case manager that handles each patient?
  • Who is available for call-in questions?
  • How can I leave a message directly for the doctor for questions?
  • Is there a number for off-hours problems and emergencies? What is the protocol for emergencies?

About the MFM doctor specifically:

  • Where did the doctor(s) earn his/her degree(s)? What is his/her training in high-risk OB?
    What hospital(s) are he/she/ affiliated with?
  • How well does he/she/ know the referring ob/gyn?
  • Will the doctor met at the consult appointment be the primary doctor for all appointments? If not, how many other doctors are part of the group? What are their rotations?
  • Will all treatment and procedures be performed by the doctors or technicians?
    How often will I get to meet with the doctor face to face?
  • How open is the doctor to discussing information learned about from other sources?
  • Is genetic counseling recommended? (if this has not already been done)
  • What books are recommend for reading?
  • What is the doctor’s view on alternative treatments (acupuncture, vitamins, etc.)?
  • Will the MFM doctor be present during delivery with the referring ob/gyn?

About treatment and procedures:

  • What additional tests need to be performed to evaluate me/us?
  • Will my treatment be individualized or will set protocols be followed?
  • What procedures are performed at the clinic/office? Which in a hospital or ambulatory center?
  • Are there set office hours for specific procedures (ie: Blood tests, ultrasounds)

About success rates:

  • May I contact any of your patients who have had similar risks/treatments?
  • What are your statistics for couples with our diagnosis?
  • How do your statistics stack up against national averages for live births?
  • What would account for these differences?

About specific tests:

  • Will the doctor run a color doplar ultrasound to rule out a condition called Vasa Previa(women who conceived via IVF have a higher risk of this condition)?--added by Linda.

Personal tips and things to keep in mind:

If you know you have a condition prior to pregnancy that will ultimately make you high-risk and your ob/gyn does not suggest seeing a MFM clinic prior to pregnancy: Insist on it. The more eyes watching over the high-risk pregnancy, the better – even before the pregnancy occurs.

Your ob/gyn and MFM doctor may not always agree on care when you see them individually. If you hear one thing from your ob/gyn and something else from the MFM doctor later, ask that they confer on your case so 1) you get a straight answer and 2) you get the right answer.

You will be seeing your health practitioner more often - possibly every two weeks instead of every four weeks from the start because you will alternate between your regular ob/gyn and your MFM doctor. Nearing the end of your pregnancy or if some other issue(s) comes up, your doctors will want to see you more often - possibly once a week. If you are working or need to arrange for childcare, you should keep those visits in mind.

Ask if you can set up appointments in advance so you can coordinate them with your ob/gyn and other specialist visits.

Make sure you continue to see any specialists that you need to treat pre-existing medical condition(s). These specialists can work closely with your doctors to help supervise your pregnancy.

Ask for all copies of reports on tests run, bloodwork, etc. so you have it with you when you need it, including when you go in for delivery. Remember: No question is to small or too “stupid” when it comes to high-risk ob. Don’t be embarrassed by any questions you may have. As with a non-high-risk pregnancy, it is vital you quit smoking, drinking alcohol or taking illegal drugs, or anything else that would be detrimental to the baby.

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