Posted by My OB said WHAT?!?.
Jul
14
Posted by My OB said WHAT?!?.
“…Technically This Would Be A Miscarriage.”
“Technically this wouldn’t be preterm labor, technically this would be a miscarriage.” -OB to mother who called about contractions at 24 weeks.
There are 51 comments to this post.
“Technically, I want to know what you with your medical prowess are going to do to stop the contractions. Remember the whole ‘lifesaving’ thing? If I wanted a definition, I’d have called Webster’s Collegiate Dictionary, not Women’s Health Center Of West Cupcake.”
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Brittany G. had this to say,
Jul 14, 2010 @ 4:40 am (Quote)
Wow. There is this thing called “professionalism”, doc. Apparently you haven’t heard of it, but do us all a favor and go take a class or two in it.
I have never heard of babies surviving before 20 weeks (that’s what’s considered the “age of viability”as well). I remember the news coverage when the first baby survived at 20, si I’m assuming I believe that’s why the age of viability is now 20 instead of 24.
You know, perhaps this doc didn’t have the facilities to care for a baby that early, which is why he told poor mom that, but if that was he case he should have sent her somewhere that did.
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The Deranged Housewife had this to say,
Jul 14, 2010 @ 4:51 am (Quote)
Technically, it’s neither, because the mama didn’t say if she went into labor or not. But of course doctors are trained to expect the worst. I’d be curious to see what happened. For all we know she could have been talking about Braxton Hicks.
And what is he saying, that he wouldn’t bother to stop contractions if they happened? WTH?
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Brittany g: 21 weeks is considered by most obs and the acog as age of viability but there are a handful of babies that have lived at 19, 18, and even a few at 17 weeks gestational age (counted from conception not lmp) just in the u.s. if you do an internet search you can find the name of a healthy 6 year old in fl who was a 19 week micropremie. (Don’t have comp acess or id post it here for u I’m on my cell) just over 17 weeks, like 17wk 2 days is the record I believe.
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KushielsMoon Reply:
July 14th, 2010 at 3:31 pm (Quote)
I’ve google searched previously and I did just now, and couldn’t find anything about an infant surviving at 17 weeks. Do you think you could provide a link once you have computer access? I found a story of an infant born 17 weeks premature, but that means she was born at 23 weeks.
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Lisa Reply:
July 14th, 2010 at 5:43 pm (Quote)
The youngest surviving preemie in the world is Amillia Taylor born in 07 weighing just 10oz at 21 weeks 6 days.
http://www.growingyourbaby.com/2007/02/22/amillia-taylor-miracle-22-weeker-finally-goes-home/
There have been thousands of babies that have been resuscitated at 23 weeks that have gone on to survive.
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Wow, I don’t think she was asking you for a definition. I think she was asking you what she needed to do or where she needed to go. Even at 24 weeks you CAN try to stop contractions, you can at least TRY.
OP- I hope things went well and that you dealt with someone else other than Dr. Webster.
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Should we be thankful that he choose the word miscarriage rather than spontaneous abortion. Relly now, how much of a jerk do you have to be DOC? When I read the title I was expecting this to be a conversation that took place after the baby had been delivered and died and some jackass was going over the medical records and explaining the technicalities. This baby is still alive inside mommy and you better get off you techincal butt and determine whether or not she is actually in labor or if it is only BH, and then do something if needed. Nobody cares about your technicalities. It is time to run in circles, scream and shout! Isn’t that what you are an expert out. Oh ya, only when it is your idea, right!
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Technically... had this to say,
Jul 14, 2010 @ 7:24 am (Quote)
Ummm, technically miscarriage = 20wks… Sounds like she’s in preterm labor!
So this is an example of a failure to maintain standard of care regardless of how we define viability.
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Ob’s like this shouldn’t be allowed to care for pregnant women!!!! I went into labor at 23 weeks, I was experiencing bleeding and contractions, and my OB said to come in right away.. I had a 27 week stillbirth (or wait.. should I say ‘miscarriage’..*rolls eyes*) the pregnancy before so, I was already high risk. There was no talk of stillbirth/”miscarriage” at 23 weeks, instead I was given hope and encouragement from my OB who said he will do everything in his power to stop this preterm labor or have me carry as far as possible. My cervix started dilating, so I was transfered to a hospital who could care for micropremies. Thank God, a stitch was put in and my labor was stopped. I had a placenta abruption at 28 weeks, but it was monitored by doctor (no emergency c-section there, thank God!) and THEN I developed pre-eclampsia at 33 weeks. I tried the Brewer diet, and my ended up being induced at 36 weeks and now have an extremely healthy and active 1 year old boy!
Honestly, I am so sorry to this OP. What a mother needs is hope and encouragement, anything else will just worry the mother and the stress can make things worse!! Shame on that OB.
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Something I’m wondering about is when this was said, as in what year. That could make a *huge* difference, not in the dr’s lack of compassion, but in the accuracy of his statement.
If it had been said many years ago, say when I was having my children, it would have been true. Technically speaking. But it still would have been a completely inappropriate thing to say to a mother at that point. Even then, there were ways to attempt at least to stop preterm labor, which at 24w would have been a reasonable choice. Just got out my pg wheel, and I was evaluated for preterm labor at 21 weeks in 1979, so even then, some considered ctx at that point a symptom PTL rather than one of miscarriage.
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Um, actually, the changeover is 20 weeks, doc. That’s when you’re supposed to stop labor, you great heartless jerk. Sure, at 19 weeks, 6 days, you can ignore me and the terror I’m going through as the baby I’ve bonded to for over 4 months tries to come too early.
I started having increasing contractions at 19 weeks, 4 days with my fourth pregnancy (for reference, I have two kids). They said if it were 3 days later, they’d try to save my baby and if I managed to make it 3 more days and this was going on, to come back. Thankfully it stopped.
The moral of my story is to lie if you’re close to dates and never talk to your regular OB about it. That’s how one woman saved her baby who they would have let die if they’d known her true gestation, but because she lied, her baby is now like 3 years old.
It’s horrible that so many “caregivers” don’t go case by case, but act like it’s all numbers. Like we’re all numbers 
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CCindy Reply:
July 14th, 2010 at 9:13 am (Quote)
They do WTH? I’ve never had a problem with ptl or miscarriage. So this is news to me. They would actually just let you go ahead and deliver and wouldn’t try to stop the labor if it is before a cut off date? How is that ethical? I would think they would always try to stop labor as long as they could find a heartbeat! that is disgusting!
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Rachel Reply:
July 14th, 2010 at 10:37 am (Quote)
In the UK apparently they won’t even save a preterm baby that’s born before 24 weeks. I just read this story while googling for that 19 week florida micropreemie that a previous poster mentioned. Warning – it’s very sad.
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KushielsMoon Reply:
July 14th, 2010 at 3:41 pm (Quote)
What’s really strange is that your article, from 2010, says:
“According to the guidelines, any infant born before twenty-four weeks gestation should not be resuscitated. Alexis was one week shy of a chance at life.”
But this other article I’ve read, from 2009 says:
“Baby Jayden was denied medical treatment… – just because he was born two days before a 22-week limit when he could have been given a chance to live.”
http://www.mirror.co.uk/life-style/real-life/2009/09/09/baby-denied-medical-treatment-and-handed-back-to-his-mother-to-die-115875-21658263/
How can the limit be pushed *back*? Or are they just without a unified standard?
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Sarah Dorrance-Minch Reply:
July 15th, 2010 at 9:19 am (Quote)
_The Mirror_, like _The Daily Mail_, is a bit of a rag. I generally got my news from _The Guardian_, or from the weekly magazine _The Economist_ (the latter if what I was searching for was international news). I also used to read _The Times_, but that was before Rupert Murdoch bought it out.
Anyway, the slant of most of the tabs is EXTREMELY hard to the right, also sensationalist, and they like to report on things like falling-apart clinics, poor service, refusals to keep micropreemies alive if they are in fact born alive, etc as standard events, when in fact such cases are more exceptions to the norm. The general medical care I got when living in England and availing myself of NHS was far better than what I got back at home, not least because it was free (or, for my prescription meds, cheap) and therefore something I could actually use without first asking if I could go for a week without food or something.
I don’t know what current NHS policy is regarding age of viability, etc but based on the philosophies of the doctors I’ve encountered, I imagine a lot more weight is given to the wishes of the parents, and the beliefs of the caregivers about what is the best way to handle each individual situation as it comes up.
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Jane Reply:
July 14th, 2010 at 4:39 pm (Quote)
My husband’s brother died a day after birth in a British hospital because they refused to give the baby oxygen. He was about 35 weeks, I believe, but they had a “no oxygen for babies” policy. >:-( This was in the early seventies.
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Amy W. Reply:
July 15th, 2010 at 11:57 am (Quote)
Jane, that is absolutely terrible! I think it is horrific to refuse life-saving treatment to a baby of any viable gestation, but 35 weeks! It just really hits close to home with me, having had pre-term labor at 34 weeks and subsequently spending 10 days in the hospital thinking about if my son would arrive early or not. He ended up being born at 38 weeks and he was perfectly fine, but I can’t even begin to imagine the pain of having a late term preemie and then having the hospital refuse to care for him.
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Ugh, how horrible for this mom. I hope everything turned out ok.
I have a friend who started preterm labour at 18 weeks and they stopped her labour each time it started up again until her water broke and they found she had an infection at 24 weeks so they did a cesarean and her boy is now nearing 2 years old.
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Sheva had this to say,
Jul 14, 2010 @ 8:48 am (Quote)
What I want to know is, what did doc have scheduled that day?
Because usually, they’re all in a tizzy to break out the lifts and whistles and the machine that goes ‘bing’.
But here he’s all blase’, as if there nothing he could do.
Inknow one womanwith a 9 cm subchorionic hematoma, PROM at 20 weeks, preterm labor at 30 weeks that they couldn’t stop, placenta previa that turned into an abruption, a real emergency cesarean, hemorhage, and mom and baby are fine today.
Can’t do anything??
Doesn’t say much for you, doc.
And someone else mentioned that maybe he really can’t help her so he should find someone who could.
That’s a very important point. Someone I know had ptl at 30 weeks. Do did an ‘emergency cesarean’, in a hospital with a tier 2 NICU, and no steroid shot for baby’s lungs because they didn’t have any. She was having contractions, not bleeding or any other real emergency. There was time to go somewhere else. Doc was just too full of himself to back away. Baby did not make it.
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Could someone please post links to these 17 week babies who have survived? Because from what I’ve read the YOUNGEST is 21 weeks, and she is considered a miracle. Typically no one tries to save a baby born before 23 weeks because it’s not considered to be in the baby’s best interest, as their survival rates are VERY low and the technology needed to save them is VERY invasive, painful and uncomfortable, not to mention horribly expensive. I have never read or heard of a baby surviving before 21 weeks, and even then it’s like a shot in the dark.
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CCindy Reply:
July 14th, 2010 at 11:31 am (Quote)
Sorry I don’t have any links see Rachel’s post above.
But this baby isn’t born! If they can stop labor and continue the pregnancy to 30+ weeks then why wouldn’t they do that? I can see forgoing all out measures to save a baby that has been born and is looking extremely fragile if those are the parents wishes. But not stopping labor is just unbelievable. Are they saying they don’t really believe that their labor stopping drugs work so why bother? Is he really saying I have a golf game that I’m not giving up so that you can suck up all my time trying to save a baby that will just die next week instead of today. You deal with it and I’ll do a D&C next week. He certainly doesn’t seem to care.
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Nicole Reply:
July 14th, 2010 at 12:38 pm (Quote)
I remember that story from a while ago and in it it stated that 21 weeks was the earliest.
I do agree entirely with you here, that THIS baby was viable, firstly and secondly that if it was labor it should have been treated. The doctor’s response was totally wrong for the situation.
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Sarah Dorrance-Minch Reply:
July 14th, 2010 at 12:01 pm (Quote)
But the poster isn’t talking about a seventeen week old fetus, or even a twenty one week old fetus (and yes, it is a miracle for a fetus to emerge that early and survive – not impossible, but *highly* improbable, and when people talk glowingly of “miracle” babies, they seem to be forgetting that miracles are not common and fly in the face of what is usually reality – otherwise, they would not be miraculous or “acts of G-d,” they would simply be uncommon. Depending on a miracle to happen is like considering Aslan a tame lion, for those of you who, like me, are big C.S. Lewis fans and forst discovered his writing through a series of childrens’ allegorical fantasy books).
The poster was talking about a twenty four week old fetus. Twenty four weeks is viable, if fragile.
And there are drugs that can sometimes stop premature labour. They don’t always work, but they do sometimes work. When they don’t work, it is common practice to administer IV steroids to help the preemie’s lungs mature a little more.
Calling a threatened premature birth a “miscarriage” is tantamount to saying “The baby will die, because I don’t see any reason to get involved in this birth. I have better things to do.” If the obstetrician has better things to do than his/her job, then the OB is in the wrong line of work.
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Nicole Reply:
July 14th, 2010 at 12:40 pm (Quote)
ITA. Just wondering where the evidence is of 17 week fetuses surviving, because as much as I want to believe it, I have never heard of it before.
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Sarah Dorrance-Minch Reply:
July 15th, 2010 at 9:25 am (Quote)
I wouldn’t rule it out, but for a seventeen week old preemie to survive would take a genuine miracle. I imagine there would be quite a lot of traumatic brain damage as well – such a young fetus isn’t even fully grown enough to have functioning pain centres, and being able to sense pleasure and pain is a very basic neurological function, as far as such things go; and at that young an age, the lungs would be so immature that even if the baby were kept on a respirator and so on, it’s doubtful enough oxygen would get to the various body parts to allow them to develop properly.
Since I believe all miracles come from G-d, if by some miracle such a preemie even survived birth, it is possible that the preemie would be a functioning human being rather than a vegetable, but again, that would take a real miracle.
Not the “miracle of modern science,” which is not miraculous, merely remarkable.
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Sheva Reply:
July 18th, 2010 at 1:24 pm (Quote)
It could be that the 21 weeks is being counted from the LMP and the 17 weeks is counting from conception, in which case they’re the same thing.
I also never heard of a baby born at 17 weeks from LMP and surviving.
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Nicole Reply:
July 18th, 2010 at 3:37 pm (Quote)
The difference between gestational age (LMP dates) and fetal age (conception date) is either assumed to be 2 weeks (not 4, as it would be in this case) or is known by the mother/care provider through charting or fertility monitoring (such as in IVF rounds, etc). Even in the case that the LMP date and the conception date are 4 weeks apart, the woman would still be said to be the number of weeks of her gestational age, which would be calculated, instead of off of the LMP date, off the conception date, minus two weeks. Does that make sense? So even if a woman had her LMP 4 weeks before she concieved, she would still be 20 weeks pregnant 18 weeks after she concieved.
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The Wheel says so.
Sarah Dorrance-Minch had this to say,
Jul 14, 2010 @ 11:54 am (Quote)
Technically, your foot is stuck in your mouth, Doc. What are you planning to do about it?
Also, your sloth is showing, and I’m not talking about the kind of sloth that lives in trees. It’s only a “miscarriage” if the baby emerges early and is either stillborn or dies shortly after birth. There are drugs that can help stop premature labour, or failing that, at least help to mature the baby’s lungs and improve the baby’s chances of survival. As a micropreemie, the baby will have a high risk of certain health problems, but twenty four weeks is definitely viable.
What you are saying in your “technical” comment is that you really just don’t want to be bothered, so to heck with the mother and to heck with the baby. I wonder what the medical licensing board would think of your technical interpretation of the Hippocratic Oath?
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Jane Reply:
July 14th, 2010 at 1:49 pm (Quote)
It’s not sloth, I would bet. This is burnout too, but in a different form. This is the emotional wall someone puts up between himself and what he perceives as tragedy by giving it a technical term and making it so he can justify not feeling anything about it. That way he doesn’t have to invest himself in this woman’s pregnancy and baby just in case the worst happens. He can tell himself (assuming it’s a guy for sake of verbal clarity, women do it too) that it was just something that wasn’t worth grieving about and then keep on going with his life.
(Not to say women shouldn’t grieve miscarriages; they can, do and should to the extent they need to. But to a doctor, it seems like less of a loss because doctors see so many of them.)
But this is a dodge. It’s a way the doctor can excuse his own lack of caring and distance himself from what’s happening.
Either that or the doctor just wants to prove his intellectual superiority over the mother by telling her the technical term (the fact that he’s wrong is laughable) and implying that she’s Just A Hysterical Female Who Doesn’t Know Anything.
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Sarah Dorrance-Minch Reply:
July 15th, 2010 at 10:00 am (Quote)
“Either that or the doctor just wants to prove his intellectual superiority over the mother by telling her the technical term (the fact that he’s wrong is laughable) and implying that she’s Just A Hysterical Female Who Doesn’t Know Anything.”
In that case, the doctors technical terminology is wrong (as has been pointed out by others, a baby born this late in the game would be pronounced a stillbirth if born dead, not a miscarriage, partly because the chances of survival are so good).
To me it sounds like the doctor wants to punt this one to the resident or intern on duty because he just doesn’t want to be bothered. Whether it’s inconvenience/laziness or ennui/burnout or both is almost academic. A twenty four week old preemie is highly likely to survive, although it will need intensive care to remain alive.
So the doctor has basically said, “If the on-call staff wants to get involved, that’s their business, but I myself do not want to be involved with this birth. Your baby being born prematurely and needing the NICU afterwards isn’t my concern. I’m not going to assist at this birth.”
Pronouncing death before death has even occurred is gross malpractice and negligence. I imagine so is refusing to assist at a client’s birth without good reason. If the doctor were reported to the state licensing bureau, I don’t think s/he would be able to weasel out of this one.
Although I could be wrong.
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Brittany G. had this to say,
Jul 14, 2010 @ 12:41 pm (Quote)
The age of viability must vary depending on the institution (but what doesn’t?) because I was in nursing school last year and all our textbooks say 20 weeks. I know it used to be 24 but according to our books, it was changed after the birth and survival of a 20 weeker.
I would really like to have a link to any story about a baby born any earlier, because I have never heard it.
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Sarah Dorrance-Minch Reply:
July 15th, 2010 at 10:05 am (Quote)
I wonder if this is something that varies from state to state? Not in terms of what is possible, but in terms of what a medical professional is required to consider a preterm birth rather than a spontaneous abortion (or a legally obtained deliberate one) or a stillbirth. Sometimes law and medical reality don’t seem to quite agree.
I’m going to go with the Guinness record below unless proven otherwise. And as I stated above, I would not rule out an act of G-d, but counting on miracles is presumptuous. They’re wonderful when they do happen. They’re not something to expect. And they *almost* never happen.
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Once I get access to computer I will post links to the ultra young preemies I have found in the past. Pls note I’m not saying that survival at 19 weeks is common, or even statistically relavent, it is, however something that has happened and is (miraculously) possible. If u want the links directly, as it may be sometime before I have access to a comp to find/post them here pls send me an email on my yahoo handle tigaseren1224. Pls guys don’t spam or hatemail me.
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Amelia Reply:
July 14th, 2010 at 9:44 pm (Quote)
I’m sorry, but no, it has not happened. The youngest preemie on record is Amilia Taylor, mentioned above, who was born at 21 weeks 6 days.
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Rachel Reply:
July 15th, 2010 at 6:15 am (Quote)
Fully agree. Although according to Guinness the youngest preemie ever is James Gill born at 21 wk 5 days http://www.canada.com/topics/bodyandhealth/story.html?id=db8f33ab-33e9-429f-bedc-b6ca80f61bdc
And I believe Amellia Taylors date was actually based on conception so technically that would make her (roughly) 23 wk 6 days and just 1 day shy of that 24 week viability threshold.
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Lindsey Carr-Ruck had this to say,
Jul 14, 2010 @ 9:56 pm (Quote)
Excuse the profanity, but that’s complete and utter bull shit!. A 24 week-er is viable (though very, very fragile) and is no longer considered to be in the “misscarriage category”.
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lilredmommy had this to say,
Jul 16, 2010 @ 6:03 pm (Quote)
This was my contribution, it involved my now 4 month old daughter. This was my second pregnancy and with my first I had preterm labor at 27 weeks. When I started feeling mild contractions at 24 weeks this time I was very scared, called my mom and of course she said “call the doctor”. I had been going to this practice for a few years because I liked the nurse practitioner(who did all the routine paps and was very sweet- I never even met one of the Drs until I was 18 weeks pregnant). I hadn’t really been fond of the OB when I met him, although he was mostly respectful and I figured I could work with him. I called the practice and of course he was not available, they said they would have the “on-call” partner call me back. 20 minutes later I got a call from this man whom I have never met before, I explained my situation, and said I was very afraid of going into preterm labor like I had the last time. He didn’t even allow me to finish my sentence! He interupted me right after I said the word ‘labor’ with this comment. Then proceeded to tell me that contractions were normal throughout pregnancy and I should call back if I started bleeding. I was so taken aback that I didn’t say anything, just hung up the phone and called my mom to cry about it. A few weeks later I switched practices (for more than just this, but its a long story so I won’t get into it- needless to say I was not comfortable there anymore).I did not end up having any issues with preterm labor, so looking back I would call those contractions BH, but I was so scared and I fail to see why pointing out how the death of my child- whom I could already feel moving and had named and loved- would be classified was even necessary. I’m so happy I got away from both of these OB’s who made my life harder. My daughter was born healthy at 41 weeks 2 days, weighed 9 lbs 8oz and was 22 inches long. Born by wonderful VBAC with the help of my awesome support system. I hope every woman learns they have the right to change providers if they are uncomfortable, I shudder to think what might have happened if I had stayed with these men as my PC.
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Does anyone else find it interesting that the youngest preemie ever to survive was born Vaginally?! It kind of goes against conventional wisdom, and I can’t help but wonder if he would have survived if he was born via cesarean.
During our hospital tour the nurse, when queried by me about the hospital’s c-section rate, hemmed and hawed and said that the rate had been higher lately because more preemies were born “32 and 33 weekers, because their little bodies can’t handle vaginal birth”. I was a little incredulous at her remark because my sister and i were born vaginally at 31 weeks and the method of our birth was never a concern to my mother- our bodies handled it just fine.
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Sarah Dorrance-Minch Reply:
July 17th, 2010 at 11:13 am (Quote)
The two reasons doctors want to go straight for the abdomen with preemies (my second daughter, Liesl, was a 32 weeker, and the more I read, the more I think I got lucky because she was practically coming out once I was rushed into the maternity ward; maybe that was another factor in why my OB bawled me out for forcing him to attend my VBAC, although I don’t think he ever had any intention of letting me have one to begin with even if I’d carried her to term) are 1) IT’S AN EMERGENCY! WE HAVE TO SHOW THAT WE DID EVERY HEROIC MEASURE WE COULD! QUICK, TO THE O.R.! and 2) greater chance of prolapsed cord.
Or so I gather.
And nurses oversimplify it even further: “Premature birth is just too dangerous for the baby.” Well, yes, it’s very dangerous for the baby.
The biggest danger comes from respiratory distress syndrome due to undeveloped lungs (which Liesl did indeed have when she emerged). Vaginal birth helps to clear the lungs and prepare them for breathing. Delaying cord clamping/severing also ensures that the baby gets as much oxygen as possible.
Surgery and premature cord cutting pose more danger to a preemie than vaginal birth.
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Well this one isn’t mine, but I had a nurse say the EXACT same thing to me. If I hadn’t been so shocked I would have cried. I was a few days shy of 24 weeks, the nurse said “well, at this gestation we don’t do anything to stop the labor, it would just be considered a miscarriage”.
Thankfully it wasn’t real labor, just lots of Braxton Hicks (which continued, along with true PTL, until I delivered). If it had been real labor, I would have left AMA and gone to a different hospital.
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What a jerk. Has he not heard of micro preemies? I heard an OB say just yesterday that they’ve had babies live as early as 17 weeks gestation.
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Kayla Reply:
July 14th, 2010 at 7:33 am Kayla(Quote)
Really?! I never knew there were any micropreemies to live before 22 weeks, and I still thought the “standard” age for viability was 24.
Either way, yes, ob is a jerk.
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Nicole Reply:
July 14th, 2010 at 10:39 am Nicole(Quote)
No, the youngest premie to live is 21 weeks. At 24 weeks the odds of survival are pretty good… about 80%, but before 23 weeks they are dismal and there is no way a 17 week baby could survive with our current technology.
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