Posted by My OB said WHAT?!?.
Oct
29
Posted by My OB said WHAT?!?.
“Your Baby’s Lungs Don’t Look Quite As Developed As I’d Like Them To Be…Let’s Schedule A Cesarean So We Can Get The Baby Into NICU.”
“Your baby’s lungs don’t look quite as developed as I’d like them to be, so let’s go ahead and schedule a cesarean so that we can get the baby into NICU.” – OB to mother after an ultrasound at 36 weeks.
There are 53 comments to this post.
This makes perfect sense in Bizarro World! I hope the mom told the doctor that she’d prefer to wait until, oh, 40 weeks, and THEN they could get the baby into NICU (if necessary).
Was the hospital planning on closing its NICU the next day and this was the only time?
Is this a numbers thing? I’ve heard that the doctors consider the baby, once born, no longer their concern. So if the baby has problems in utero, they want to get rid of the problem by turfing the baby out to the pediatrics people. :-b
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Kate, Ren's Mama had this to say,
Oct 29, 2011 @ 7:14 pm (Quote)
We haven’t seen the pink link yet, but my assumption was that there probably wasn’t a real problem. Lungs are the last thing to mature, and most babies at 36 weeks would have immature respiratory systems, which is why c-section babies are notorious for having respiratory issues. And if mom was at all unsure about her dates, baby’s lungs could need WAY more time to develop. So let’s exacerbate the problem, or cause one in the first place, by yanking the kid out early?! This makes NO BLOODY SENSE.
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SculptorAlison Reply:
November 1st, 2011 at 2:00 pm (Quote)
Exactly this. I have an acquaintance from high school with whom I am friends on Facebook that had a very dramatic early cesarian/NICU scenario that culminated in her daughter having surgery to remove part of her lung. I don’t really know all the details, but it seemed to me from the Facebook posts that her daughter’s problems could very well be completely iatrogenic. It makes me really sad to think that that little girl most likely had to go through all of the surgeries and separation from her mama for no real reason.
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Or, OR— Stay with me here! We could leave the baby in there til she’s ready to be born! What a freaking consept, right?
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Doc, how would a 36 weeker’s lungs look? Because last time I checked, 36=/=40. Heck, it doesn’t even equal 37! If this is a serious issue, you’d be sending me over to the hospital now instead of “scheduling” me for more than 24 hours from now, no?
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road2vba2c had this to say,
Oct 29, 2011 @ 8:30 pm (Quote)
Makes not a bit of sense. If IUGR was suspected, they would diagnose it. If they are just looking for an excuse to cut her open, they chose a poor one. I hope OP ran as fast as possible!!
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Well, sure! That makes perfect sense!
Can one of you do me a favor? Would you mind running to Home Depot and picking up some plaster for me? I’ll be in need of it by the time I’m done banging my head against the wall.
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I don’t understand. How does this even make sense? Instead of letting your baby stay in the womb where the lungs will continue to develop in a safe environment, let’s pull him out early and hook him up to machine’s where he has a higher risk of infection and dying. Again, I don’t understand.
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Rach had this to say,
Oct 30, 2011 @ 3:47 am (Quote)
Officially the stupidest thing I ever read! Hope the OP ran away without letting mr slice n dice near her!
Even when the lungs are totally underdeveloped ie in diaphragmatic hernia, the absolute worst place to be is NICU! Leave the baby in the one place it doesn’t need lungs!
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::facepalm::
I mean… does this OB believe what he’s saying? Or is this just one of the lines out of his “Bag O’ Bullshit” that he hauls out when he doesn’t feel like waiting for a woman to go into labor?
… I don’t know which of those is scarier. :/
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This one actually made me nauseous. It makes absolutely NO sense at all.
How in heaven’s name is taking the baby OUT and FORCING it to use underdeveloped lungs better than leaving it IN where, at least, (as someone mentioned) it doesn’t yet need said lungs, since it’s getting its oxygen from mom, and where said lungs may even (now here’s a novel concept) grow and mature?!
Another example of either
a-a liar trying to dupe the mom or
b-an idiot who truly believes that an incubator is better than a functioning uterus.
Either way, run, run, RUN!!!
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This is my post. After a 36 week BPP on my client, the doctor said that the baby’s lungs weren’t practicing breathing movements yet so they needed to do a cesarean. The mom was scared that the baby was not doing well so she consented. Cesarean was performed a few hours later and the baby was in the NICU for several days. Breastfeeding did not go well.
The doctor went on vacation for 2 weeks three days after surgery.
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jess Reply:
October 30th, 2011 at 10:00 am (Quote)
So, this IS exactly what it sounds like? The baby’s lungs (allegedly) aren’t doing what we’d like to see them do, so instead of giving them every single ossible day we can to mature, we’re going to pull them out NOW, totally unprepared…..if there was really a concern about baby’s lung function, wouldn’t it be ideal to let them mature as much as possible before intervening, so that whatever assistance would have (allegedly) been needed would have greater chances of success? That’s common sense talking, not perinatal expertise, of course. But the vacation certainly casts a large shadow of doubt on the motive, doesn’t it?
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Ashley Reply:
October 30th, 2011 at 10:07 am (Quote)
OMG, this makes me want to throw up and/or punch that doctor in the face. How is this not medical malpractice?
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BeckyJ Reply:
October 30th, 2011 at 11:10 am (Quote)
I might throw up. I just might. How SICKENING this OB cleared his/her schedule by using surgery so that the doctor could go on vacation. ERRRGH!
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Jena Reply:
October 30th, 2011 at 2:44 pm (Quote)
How is this not malpractice? “Just” because the baby survived (Which I’m very glad he or she did!) doesn’t make this a sound practice of obstetrics!
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Kristin Reply:
October 30th, 2011 at 7:39 pm (Quote)
What makes me more upset is that the doctor could have gone on his/her vacation and been back when the mother was at 38 weeks. Plenty of time to spare before the 40 week “due date.” The doctor totally (and needlessly) lied to this poor woman so s/he could leave town. It’s disgusting!
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Oh and everything else checked out just fine on the BPP. They said the cord looked good, the baby was measuring fine. But her lungs weren’t practicing breathing movements.
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Toni Reply:
October 30th, 2011 at 6:38 pm (Quote)
Okay, now I’m really confused. A BPP looks at 5 things – FHR, gross body movement, fetal tone, AFV, and practice breathing movements. Having 0 practice breathing movements may be a sign that something is seriously wrong. It has nothing to do with lung maturity (a BPP does not measure lung maturity – that is measured by taking a sample of amniotic fluid and testing for surfactant). A BPP is looking for fetal distress or an otherwise compromised fetus. So what I am wondering here is several things:
First, why were tests of fetal well-being being administated at 36 weeks? That is not standard. Did the mother report decreased fetal movement in general? Was there something else going on? What reason(s) was given for doing a BPP in the first place?
Second, what was the overall score of the BPP – the highest is a “10″, obviously a complete lack of practice breathing movements means the highest she could get is an “8″, but how did the baby do in the other categories (mentioned above), paying special attention to overall body movements (as babies do get “sluggish” when compromised which is why lack of practice breathing is concerning – it may be a sign that an O2 compromised baby is compensating by slowing down movement) and AFV (as low fluid can be an early sign of problems)?
Third was a NST also performed and what were the results of that?
Fourth – was an amnio done looking for signs of lung maturity (ie, surfactant)? What were the results?
Not trying to be a PITA here, but since a BPP is not looking for lung maturaity it seems odd to even throw that out there. Failure to have those practice movements is concerning, not because that is a sign of immature lungs (it isn’t), but because it can be a sign of fetal distress. Just looking for more details as this seems kind of convoluded. Was this a doula client? Are you privy to all her test results and everything that was done? Sorry for so many questions, but this one is really hard to understand.
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Toni Reply:
October 30th, 2011 at 6:47 pm (Quote)
Wanted to add: practice breathing movements usually start at 32 weeks, so the statement that the baby wasn’t doing practice breathing movements “yet” seems wrong. That should have started about a month prior, and it probably did, but if there weren’t any in the time alloted for the BPP (usually 30 minutes) that can be a sign of a problem.
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Details Reply:
October 31st, 2011 at 5:51 am (Quote)
Or maybe the doctor was just a jerk who pulled a reason out of his behind so he could go on vacation and should be in jail now! Keep in mind that if it was a real crisis it wouldn’t have been submitted HERE! I would be interested to know if the doctor ordered the test to see if it was okay for him to go on vacation or if there was an actual suspected problem. I do know a woman whose cascade of intervention started with her reporting low kick count. I will never know if she caught a problem early or if the doctor over reacted since her next “bad result” was based on something that hasn’t been proved, but as always has been accepted as a sign of trouble. Not that anybody can exactly say x leads to y. Just I don’t like the look of it. Then they feel they are under the gun and must do something, even if the something doesn’t insure a good outcome. But hey, they did something!
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Toni Reply:
October 31st, 2011 at 6:45 am (Quote)
I’m interested in a response from the OP. It obviously wasn’t the patient who submitted this, so I don’t feel safe in saying that it wasn’t a “real crisis”. This is a third party’s interpretation of what happened. I don’t even know if this person (doula?) was present at the appointment where the testing was done or the results were discussed. Heresay can be misleading. And the vacay aspect doesn’t make much sense as a motivating factor – the doc would be back during her 38th week, when the vast majority of women will still be pregnant It doesn’t say if this was a FTM or a multip; if it was a primip all the more reason to believe she’d still be very much pregnant at 38 weeks. Since they went straight to c-section there seems like there must have been something else going on, and they did so within “a few hours”, it wasn’t scheduled for 3 pm two days later….. That signifies a sense of urgency that goes beyond “Gee I’m going on vacay and don’t want to miss the delivery/don’t trust my colleagues to handle the case in my absense”.
Look, I like this site and most of the statements are obviously wrong, rude, or cringeworthy. But this one, especially with the back story that has been provided thus far, just doesn’t add up. (and before I get slammed for “doubting” remember that anytime you post something like this in a public forum it may be questioned, and since it wasn’t the actual mother who submitted it (she feels grateful, remember?) I feel a lot more comfortable questioning it). Point is, I can see, in a case where early delivery is needed for whatever reason, a doc saying “The lungs aren’t as mature as we’d like” (cuz at 36 weeks they very likely wouldn’t be) in an attempt to prepare the mother for the possibility that her baby may have breathing difficulties upon delivery. It’s not horrible. It’s honest. But without more info this is all purely speculative and I’d really like to here back from the person who submitted tis to find out what, if anything, else was going on….
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Jane Reply:
October 31st, 2011 at 9:38 am (Quote)
If the doctor was going on vacation for two weeks, the doctor might have made the decision to section now because the doctor had concerns that the baby’s condition might take a nose-dive in the next two weeks. The doctor would have had other doctors to cover patients during that time, but (sad to say) we all know that some of these covering doctors don’t take their jobs that seriously. We’ve seen on this site how some doctors who are “covering” for other doctors just blow off legitimate concerns.
If the doctor was sectioning just to get this patient off her roster prior to going on vacation, then the doctor would have had to section or induce ALL patients, right? And that would have gotten noticed.
So the vacation may well be a factor in the doctor’s decision, but more along the lines of “I can’t trust Dr. Smith to monitor Jane Doe as much as she’s going to need, and while I would repeat the BPP every three days to get a better sense of what’s going on, Smith isn’t going to do that.”
Thanks for clarifying what a BPP looks for. It sounds to my uneducated mind like an APGAR score done in-utero.
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Toni Reply:
October 31st, 2011 at 11:18 am (Quote)
You guys could be entirely right in the assessment. I guess in my, pehaps naive, mind I am sincerely hoping this was just a misunderstanding (and not a case of a doc putting a mother and child at serious risk for his/her own convenience, though it wouldnh’t be the first time we’ve seen that happen here 
). If the *only* problem with the BPP was a “0″ on the practice breathing part, then yeah, that’s a score of 8, which is considered normal and no further action would have been needed (I suppose to be cautious doing another BPP a week later might make sense). And maybe the doc here didn’t trust her colleagues to do adequate follow up Even a score of “6″ is considered ‘equivocal’ and needs more testing/repeat testing before action is taken. I can’t see going straight to induction/section unless the score is below 5.
Really I’m just curious about what precisely happened. I’m trying not to make judgements about it before having more info….
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Jane Reply:
October 31st, 2011 at 11:31 am (Quote)
Is the BPP score a qualitative thing? I mean, let’s say a baby scores a zero on two categories and a two in the other three, that’s not really the same as a baby who scores a one in four categories and a two in the fifth, right?
Doctors are many times control freaks. They like being in control and they like knowing things. It might be that the doctor did not trust her colleagues *or* the doctor wouldn’t have been able to relax for two weeks wondering what was going on with the baby and whether the baby was going to crash and die. Maybe the doctor delivered a stillborn baby once and in hindsight the only thing she could think of was that the baby hadn’t been doing practice breathing motions.
I’d like to think the doctor wasn’t engaging in depraved disregard for the baby’s prematurity. The story as-is doesn’t indicate that proper medicine was followed, and in my scenario, the vacation probably did play a part in the decision-making process, but not an evil “I want the money for this delivery” kind of way.
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Toni Reply:
October 31st, 2011 at 12:29 pm (Quote)
They do put more emphasis on the NST portion (if needed; if you get “normals” on the four parts measured by u/s then you can skip the NST, as an “8″ is an acceptable score), the AFV, and the practice breathing movements than the other two (gross body movement and tone). So if your “0″s were in practice breathing and, say, NST, that’s more concerning than if “0″s were in practice breathing and, say, fetal tone. The scale is somewhat misleading because you can really only get even numbers (a “2″ is assigned to a normal result, “0″ is abnormal, so either you pass a segment or you don’t…. they could just do a scale of 0-5, but that would be too easy, lol).
Now, a LOT can effect this test (hence the high false positive rate) – baby being in an awkward position, low (or high) blood sugar (have a small snack about 20 min before the test – it wakes the baby up making him more likely to be active), medications mom may be on, even mild dehydration (this effects AFV specifically), and mother lying flat on her back during the test (insist on being semi-reclined or side lying, if they tell you they need you to be flat on your back to measure AFV, ask that they do this first, then adjust the bed or roll to you side; we all know what happens to baby’s blood supply when mom is flat on her back).
I really hope this was a simple misunderstanding of what went on, as this submission seems a bit more sinister than most I’ve read here. Without further info the optimistic part of my nature want to believe the baby really was compromised and the doc only said the line about lung maturity to prep the mother for the fact that her baby might need resuscitative efforts upon delivery.
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Details Reply:
October 31st, 2011 at 10:09 am (Quote)
Toni you have a point. I can’t just go by “but it was posted here so it must be horrible” if it isn’t posted by the mom. There may very well be something missing here. Still interested to know whose idea the BPP was. Is that standard at 36 weeks and when did they start doing them?
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Toni Reply:
October 31st, 2011 at 11:29 am (Quote)
“Still interested to know whose idea the BPP was. ”
That was, and still is, my first question. BPP is NOT standard at 36 weeks. It usually isn’t done until 41 weeks, unless there is a suspected problem. There are a number of reasons to do a BPP, some include: carrying multiples, previous stillbirth, problems with amniotic fluid (too much or too little), suspected IUGR, and certainly if the mother notes a marked decrease in fetal movement that warrants further testing too. If the provider notes a decrease in FHR between visits (say this baby has been consistantly around 150 bpm, but this vist he/she was around 130…. could be nothing, but it is a noticable drop that warrants further eval). So yeah, I’m suspicious about the reasoning for the test, and why, if the only thing wrong was lack of practice breathing, they went straight to c-section (tho I can see where impending vacation could unfortunately factor in to that). Tests of fetal well being are much like CEFM in labor – when it is reassuring, you can feel very confident that all is well, but they do have pretty high false-positive rates, so when it shows a potential problem that is a very good reason to repeat the test or perform additional test(s)… not a good reason to immediately act.
I’d just really like more info because, unlike the typical rude, mean, or just plain idiotic things that get submitted here, this one seems borderline criminal Part of me hopes that it was just a matter of the OP not having all the info. Here’s hoping!
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Racheal Reply:
October 31st, 2011 at 11:45 am (Quote)
keep in mind that not all babies do things on textbook levels. If my babies had been judged based on things like ‘kick tests’ it would have been a whirlwind cascade of ‘this baby must be dead already’ interventions. B/C other than at night when I layed down to sleep (and sometimes not even then), I seldom felt them move. Even at 39 weeks (1st born (unneeded c/s – hindsight & all that) at 42 wks, 2nd born (hbac) at 40 wks) I could go a few days without feeling more than a couple kicks… but that was totally normal for me & both babies were born in their own time, perfectly healthy.
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Becky Reply:
October 31st, 2011 at 8:16 am (Quote)
Hi Toni,
I just wanted to say thanks for posting these questions, and explaining what is looked for in a BPP, including lung movements. Your comment got me to start thinking about this more. It would be nice to have more info about this quote. 
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Anonymous Reply:
November 4th, 2011 at 8:19 pm (Quote)
Yes I am the doula for the client that had this done.
The BPP was ordered for “advanced maternal age” – 36. The BPP score was 8 – the only issue was the lungs not practicing breathing movements. They did not opt to do an amnio – they went straight for surgery.
In her prenatals the doctor had told the mom that she was certain that she would have the baby early because of her age, and based this on absolutely no evidence. This doctor has admitted to few of my clients that “natural birth is not really her thing.” This mom desperately wanted a natural birth but stuck with this doc anyways because she was nice.
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Usually on here you can at least TRY to give the HCP the benefit of the doubt – maybe they aren’t actually maliciously TRYING to harm the patient, and are just stupid or socially inept.
Not this time. There is no excuse for this. None. This OB needs to be sacked, sued and preferably imprisoned for such a reckless disregard for the life of an infant.
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Let me get this straight. The Almighty Doctor decided to purposely cut open a mother to have a baby out dangerously prematurely rather than leave baby in the womb till it was ready so he or she could go on VACATION? In what universe is this okay?
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Sorry but this doesn’t make sense as stated. Lung development? Biophysical Profile? Why? What was going on that they needed to be assessing those things in the first place? The timing of the vaca is suspicious but the other info just doesn’t make sense at all, and it could be that with the lung comment he or she was simply trying to prepare mom for a nicu stay (you would be surprised how many parents think kids born 1 to even 2 months early can go home when mom goes home.) I (a NICU RN) get really angry when OBs don’t mention NICU stays to the moms that they decide to deliver preterm – the parents come in and are SHOCKED that the NICU cannot cure their kids prematurity. We can only support them as they “cure” their own prematurity! By growing!
Anyway, this is just an educated guess, but to me, it sounds like something was going on to show the baby was compromised, and that info didn’t get completely passed on to the OP. (Who wasn’t the mom, and possibly was not present for the discussion.) And the BPP was done to evaluate HOW compromised the kiddo was. And since the BPP showed a problem – they made a judgement call that 36 weeks was good enough and staying inside was too dangerous.
The vaca could be coincidence. Docs do need to take vacations. (Believe me, RNs would like them all to take more time off, not less.) However the good ones have practices that cover their patients with seamless uninterrupted care. There should never be the impression given that the doctor’s clinical decision making is influenced by his or her vacation plans.
I had to laugh at one of the above comments about it “being posted on this site” as proof of anything. This is an entertainment site on the internet. (And I thoroughly enjoy it as such.) No one here is under any type of oath!
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I had Gestational Diabetes with my last pregnancy.
They started BPP at 36 weeks on my daughter.
They would “stun” or “shock” with this machine that would mimic the sound of a helicopter over your house to the baby to make her do her practice breathing.
None of my BPPs were longer than 30 minutes. Most were under 15. As long as they see what they need to see, they are done.
My daughter absolutely hated the BPP, they would start the ultrasound and she would hide. If they hadn’t done that trick, she would never have showed them that she could/was practicing breathing. If I remember correctly, they had to see like 30 seconds of practice breathing.
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Add Your Comment.
What th… I… who… why… GAH!!!
I do believe this may be the stupidest thing I have ever seen on this site. Kudos, Dr. Crazypants!
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