What is a Maternal-Fetal Medicine Specialist and Why Haven’t I Been Referred to One?

When you are pregnant, your antenatal care is crucial for the health and well-being of both you and your baby. Typically, your pregnancy will be monitored by your general practitioner (GP) and midwife, with occasional visits to an antenatal clinic. However, in some situations, you may be referred to a specialist called a maternal-fetal medicine specialist (MFM). If you haven’t been referred to one, you may wonder what exactly an MFM does and whether there’s a need for you to see one. In this article, we’ll explain the role of a maternal-fetal medicine specialist, why they are involved in certain pregnancies, and what it means if you haven’t been referred to one in the UK.

What is Maternal-Fetal Medicine?

Maternal-fetal medicine (MFM) is a subspecialty of obstetrics that focuses on the management of high-risk pregnancies. MFM specialists are obstetricians who have received additional training to care for women who have complex pregnancy-related conditions or other risk factors that may affect the health of the mother or baby.

In the UK, an MFM specialist is typically involved in antenatal care when there are medical, genetic, or pregnancy complications that require expert management. For example, an MFM may be needed if you have conditions like gestational diabetes, hypertension, multiple pregnancies (e.g., twins or triplets), or if your baby has been diagnosed with birth defects or other abnormalities that need specialised monitoring.

When Might You Be Referred to a Maternal-Fetal Medicine Specialist?

1. Pre-existing Medical Conditions

If you have pre-existing conditions such as diabetes, hypertension, autoimmune diseases, or thyroid disorders, an MFM specialist might be involved in your antenatal care. These conditions can increase the risks of complications for both you and your baby. MFM specialists have the expertise to closely monitor your pregnancy and manage any complications that may arise from these conditions.

2. Pregnancy Complications

Certain complications during pregnancy, such as pre-eclampsia (high blood pressure and damage to organs), gestational diabetes, or placenta problems, may require more specialised care. A maternal-fetal medicine specialist can help manage these conditions by coordinating additional tests and providing appropriate treatments.

3. Advanced Maternal Age

In the UK, women who are 35 or older when they conceive are considered to be of “advanced maternal age,” which can increase the risk of complications such as chromosomal abnormalities or miscarriage. If you’re in this age group, an MFM specialist may be recommended for more detailed monitoring and genetic screening to help ensure the health of both mother and baby.

4. Multiple Pregnancies

If you are carrying twins, triplets, or more, there are additional risks associated with multiple pregnancies, such as premature birth, low birth weight, and twin-to-twin transfusion syndrome. An MFM specialist is often involved in the management of these pregnancies to ensure careful monitoring and timely interventions if needed.

5. Fetal Abnormalities or Concerns

If abnormalities or concerns are identified in routine antenatal scans (such as the 12-week dating scan, the 20-week anomaly scan, or other specialised tests), you may be referred to an MFM specialist for further evaluation. Conditions like congenital heart defects, cleft lip, or neurological problems may require specialised care, which MFM specialists can provide through advanced testing and follow-up.

6. Recurrent Pregnancy Loss

Women who have experienced multiple miscarriages or preterm births may be referred to an MFM specialist to evaluate the causes of these losses and to discuss potential treatments or interventions for future pregnancies.

What Does a Maternal-Fetal Medicine Specialist Do?

Maternal-fetal medicine specialists provide a range of services to manage and monitor high-risk pregnancies. They work closely with your obstetrician, midwife, and other healthcare providers to ensure the best possible outcomes for both mother and baby. Here’s an overview of what an MFM does:

1. Advanced Monitoring

MFMs are experts in high-risk pregnancy monitoring. This may involve additional antenatal scans, such as 3D or 4D ultrasound to assess the growth and health of the baby. They may also use Doppler ultrasound to monitor blood flow in the placenta and umbilical cord, which is essential for detecting issues like restricted fetal growth or problems with placental function.

2. Genetic Testing and Screening

If there is a concern about the baby’s genetic health, such as potential chromosomal abnormalities (e.g., Down’s syndrome), MFMs are skilled in offering genetic testing and counselling. This may include CVS (chorionic villus sampling) or amniocentesis to gather more detailed information about the baby’s genetic makeup.

3. Fetal Surgery and Intervention

In certain cases, MFMs may be involved in fetal surgery if a condition is detected that could benefit from in-utero intervention. This could include procedures to treat spina bifida or other serious birth defects. While fetal surgery is rare, MFMs are the specialists who would lead such interventions.

4. Managing Complications

If you experience complications such as pre-eclampsia, gestational diabetes, or placental abruption, the MFM specialist will help manage your condition. This could involve closer monitoring, prescribing medications, or recommending lifestyle changes to minimise risks to the baby and improve your health.

5. Team Coordination

MFMs work in multidisciplinary teams, often alongside antenatal care professionals, obstetricians, and paediatricians, to provide the best care possible. Their role includes coordinating care between all healthcare providers involved in your pregnancy, ensuring that you receive the necessary interventions at the right time.

Why Haven’t I Been Referred to a Maternal-Fetal Medicine Specialist?

If you’re wondering why you haven’t been referred to an MFM specialist, there may be several reasons why this hasn’t occurred:

1. Your Pregnancy Is Considered Low Risk

Most pregnancies in the UK are considered low risk, and for many women, the care provided by a midwife and obstetrician is sufficient. If you have a healthy pregnancy with no underlying medical conditions or complications, there may not be a need for an MFM referral. In fact, many women go through their antenatal appointments without requiring any specialised care.

2. The Standard Antenatal Care Is Sufficient

In the UK, antenatal care is comprehensive and structured, designed to monitor your health and the baby’s well-being through routine scans and blood tests. For many women, routine antenatal care is sufficient to detect any potential problems early on. If no complications are identified, a referral to an MFM may not be necessary.

3. Referral Criteria Are Based on Specific Risks

Maternal-fetal medicine specialists are typically involved when there is a higher-than-average risk to either the mother or baby. If you haven’t been referred, it could be because your healthcare provider hasn’t identified any such risks during your antenatal checkups. However, if you’re concerned, it’s always okay to ask your midwife or doctor about the need for specialised care.

4. Availability of Services

In some cases, access to a maternal-fetal medicine specialist might be limited depending on your location. While most major hospitals in the UK have MFMs, smaller or rural hospitals may not have direct access to these specialists. However, your GP or midwife can arrange a referral to a larger facility if necessary.

When Should I See an MFM Specialist?

If you have any concerns or feel that you need additional care, it’s important to speak to your antenatal care provider. You have the right to discuss your concerns about your pregnancy and seek further advice if you feel it’s necessary. In cases where you have a medical condition, a pregnancy complication, or a family history of genetic disorders, you may request a referral to a maternal-fetal medicine specialist for further peace of mind and support.

A maternal-fetal medicine specialist is an expert in managing high-risk pregnancies, and they play a vital role in ensuring that both mother and baby receive the best possible care. If you haven’t been referred to an MFM, it could be because your pregnancy is considered low-risk, or because standard antenatal care is sufficient to monitor and manage your health. However, if you have concerns about your pregnancy, always feel empowered to ask your GP or midwife about the possibility of being referred to an MFM for further evaluation and support.