Melbourne maternal fetal medicine is a private practice for women with higher needs during pregnancy and/or birth. By concentrating largely on this group of women, we have time to provide extremely individualised care. There is no one visit schedule that will be appropriate for all. Depending on pregnancy progress, some women attend several times a week as delivery approaches.

How does ‘maternal fetal medicine’ differ from ‘high risk obstetrics’?

To gain specialist recognition as an obstetrician gynaecologist, one must study for six years, in all aspects of women’s health. Each specialist will have completed placements in diabetes clinics, multiple pregnancy clinics and manage many preterm deliveries in public hospitals. All of these pregnancies lumped together are deemed ‘high risk’. We all have equally spent time in infertility clinics and caring for women with cervical cancer.

The Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) credentials training and certification of all specialists. The College also awards sub-speciality recognition in maternal fetal medicine (MFM), obstetric and gynecological ultrasound (COGU), oncology (CGO), infertility (CREI) and urogynecology (CU). Recognition as a subspecialist in MFM requires a minimum further two years of study, undertaken while working clinically in a tertiary hospital. Rigorous exams must be passed in ultrasound in conjunction with exams covering knowledge of the theory and evidence around maternal fetal medicine. Subspecialists in maternal fetal medicine are skilled to the highest level at ultrasound and prenatal diagnosis procedures, and typically manage the most complex cases in public tertiary hospitals..

Maternal fetal medicine specialists do not offer consultation or procedures related to gynaecology or infertility, and will refer on to colleagues as the need arises.

Emily, Ini and Stefan have RANZCOG recognised certification in Maternal Fetal Medicine (CMFM). They also hold the Diploma of Diagnostic Ultrasound in Obstetrics and Gynaecology from the Australasian Society for Ultrasound in Medicine. Ultrasound examination is performed at each antenatal visit on a machine of similar standard to those used in obstetric and gynecological ultrasound referral practices. This integrated approach ensures fetal growth is carefully tracked, breech babies are always identified, and placental complications are recognised early.

We all work in the public sector, in addition to work in private practice. We provide advice for women with fetal abnormality, and perform prenatal tests including amniocentesis and chorionic villus biopsies.

Part of the intent of maternal fetal medicine as a craft group is the expectation that we will be leaders in our field. We all have roles within the Consultative Council on Obstetric and Paediatric Mortality and Morbidity, other Victorian Health department committees, or professional organisations, and work to ensure optimal care for all Victorian women. Equally we are all involved in research and education to train the next generation of doctors and specialists.

Women who may particularly benefit from care by a subspecialist include those with:

• multiple pregnancy
• prior fetal loss (at more than 12 weeks) or stillbirth
• prior births of growth restricted or very premature babies
• pregnancies complicated by fetal anomaly
• complex infertility history
• a risk of cervical incompetence
• maternal medical disease likely to complicate pregnancy