What is a Maternal-Fetal Medicine specialist?

Maternal-Fetal Medicine (MFM) specialists are obstetricians with extra training, qualifications and experience in the management of very complicated pregnancies – they are high-risk pregnancy experts.

There are only a handful in Sydney; in fact, out of nearly 600 obstetricians across NSW, less than 20 are qualified MFM specialists.

With so few around, we get lots of questions asking “What is a Maternal-Fetal Medicine specialist” and “What do MFM specialists do”? We’ve tried to answer some of the most common questions here.

All MFM specialists are obstetricians

Firstly, all MFM specialists are fully qualified and practicing obstetricians. They look after women before, during and after pregnancy, deliver babies and perform operations.  In major teaching hospitals, MFM specialists often supervise the labour ward and run specialist antenatal clinics.  They also play a big role in teaching trainee obstetricians to safely manage pregnancy and birth.  They do everything a normal obstetrician does, but have some additional skills and knowledge.

It is important to realise there are different types of obstetrician out there.  Some obstetricians specialise in infertility, others in laparoscopic surgery or pelvic floor problems, while others mainly look after low-risk pregnancies.  MFMs specialise in high-risk pregnancies.

What’s the difference between a “high-risk obstetrician” and an MFM specialist?

People often use the terms high-risk obstetrician and MFM specialist interchangeably, but they’re not the same.

In Australia, any obstetrician can call themselves “high-risk,” without needing any additional training or qualifications. It just means that obstetrician is happy to see patients who might have some complications.

In contrast, an MFM specialist has to complete their obstetric training and then do an extra 2-3 year advanced fellowship.  They train under other MFM specialists in major teaching hospitals, focusing specifically on the management of high-risk pregnancies. At the end of their fellowship, they have to pass an assessment and be certified by the governing body in their country (e.g. RANZCOG in Australia or the RCOG in the UK).

So an MFM specialist is a genuine, qualified high-risk obstetrician who is formally recognised as an expert.

What does an MFM specialist do and who do they look after?

In private practice, MFM specialists look after both low-risk and high-risk pregnancies.  You’ll see them for all your regular antenatal visits, they manage your labour and deliver your baby, and see you in the first weeks of motherhood.

Women with chronic health problems often see an MFM specialist for antenatal care. Pregnancy causes lots of changes in a woman’s body, which can affect any pre-existing medical conditions.  Medications can also affect the pregnancy and the unborn baby.  If you have a medical condition, it’s a good idea to meet an MFM specialist before you conceive, to prepare for pregnancy. During pregnancy, you and your baby may need extra monitoring, special tests or treatments, and special birth plans.  An MFM specialist is an expert in how medical problems affect pregnancy; they will work out the best plan to keep you and baby as healthy as possible.

MFM specialists also look after pregnant women who run into unexpected problems, such as high blood pressure, a short cervix or early labour. MFMs have special training and experience in managing these complications.

MFM specialists also look after unborn babies. Babies can become unwell while still in the womb – they can have a congenital abnormality, get an infection or anaemia, or be very small.  An MFM specialist will provide close monitoring with advanced fetal ultrasound, special tests such as amniocentesis and even special treatments like transfusions, until baby is ready to be born.

Twins and triplets are always high-risk, especially if they share a placenta.  Twins need regular specialist ultrasound to monitor for complications like poor growth or Twin-Twin Transfusion Syndrome.  Mothers of twins are also more likely to develop problems during pregnancy, like high blood pressure and diabetes.  For this reason, doctors are increasingly recognising that twins and triplets need to be looked after by an experienced high-risk obstetrician.

MFM specialists are also the go-to people for other doctors who need advice on tricky pregnancies.  Most big hospitals will have an on-call MFM specialist, who obstetricians can phone to discuss complicated patients.

MFM Specialist Consultation

Can I still see an MFM specialist if my pregnancy is low-risk?

If you are a private patient, you don’t have to be high-risk.  You can choose to see an MFM specialist for all your antenatal care and birth.  Remember, MFM specialists have a lot of experience looking after entirely straight-forward pregnancies – they just have the extra training to look after extremely complex pregnancies as well.

If you are low-risk and wondering what an MFM specialist might offer for your pregnancy, these are some of the points to consider:

  • MFM specialists are very experienced in all types of birth, from straightforward vaginal deliveries to complicated situations like vaginal twin birth or difficult caesarean sections. Most MFM specialists are very supportive of natural childbirth and often have extra skills like ECV for breech babies.
  • They are fetal ultrasound experts. They can do all your pregnancy scans themselves, including the advanced diagnostic scans at 12 and 19 weeks, as well as highly specialised monitoring of baby’s growth and wellbeing.  (While most obstetricians offer their patients a scan at every visit, general obstetricians only have basic ultrasound experience.  General obstetricians can’t do advanced scans or diagnose problems on ultrasound).  So with an MFM specialist, you get the highest level of ultrasound monitoring that’s available for your baby.
  • If you run into any unexpected medical problems, you are already seeing the most qualified obstetrician to safely negotiate the issues.
  • Because MFM specialists have such a broad range of experience, they really understand that normal pregnancy is a spectrum! Small bumps in the road are kept in perspective, so you can feel relaxed and confident, while knowing your obstetrician will switch gears quickly if things become more serious.

Should I See an MFM