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Biophysical Profile - what warrants expectant management v. induction?

post #1 of 10
Thread Starter 

Two weeks after my third son's birth, I'm ready to start building my case against my OB (as in my personal eternal grudge against him, not a legal case).  It's a long story and there are many details I could include, but what I am curious about right now is this (to answer will require familiarity with the test):

 

Is a score of 6 out of 8, with the missing element being the breathing movements, a remotely justifiable cause for immediate induction?  After the initial 6 score, which I'm not sure even counts because he didn't spend the full 30 minutes on it, I was on the monitor for like 2 hours at the hospital and the strip was perfect the entire time.  (Which would give me an 8 out of 10 on the original 10-point BPP that includes an NST.)  The BPP ultrasound was repeated that afternoon and although the tech saw a little bit if breathing movement, it was not the full 20 seconds required to give those 2 points.  To be fair, she had me drink cold water and then juice and get up and walk around to try to get him to wake up, but he was in a resting phase at the time, or so I now believe.

 

So my doctor flipped out, played the dead baby card, and less than 24 hours later baby was born after a pitocin induction.  (I was 38w3d at the time of the BPP and was 2-3cm). 

 

Please don't ask why I was having BPPs to begin with, it was not a good reason and that was part of my many mistakes in this whole mess.  And please don't ask why I went along with it and didn't just leave, I already hate myself enough for being so spineless.

 

I just want to know whether my doctor had a leg to stand on medically in being so cautious or whether, as I suspect, this was much ado about nothing and other practitioners would have just repeated the test in a day or two.  Baby's apgars were 9 and 9, fwiw.  He handled the induction beautifully and breastfeeding is going very well thank god.  I'm incredibly pissed about how it all went down, though, as everything I've looked at online says that an 8/10 score is considered normal and that only at a 6 out of 10 would you consider intervention.  Is that info outdated or incorrect?  I think the induction was not just a very conservative call but wholly unnecessary and I believe there are other reasons the doctor was fishing for a reason to induce (all the classics, perhaps minus wanting to make a golf game).

 

Can anyone help me out?

post #2 of 10

I can't answer your questions, but just wanted to validate you.   I hear you that you are pissed and I believe your intuition about what was going on for baby. As we know, many of these testing protocols are just (mis)educated guessing games from practitioners.   I know if you ask 10 doctors to read the external fetal monitor pages, you'll get a range of predictions as to what is actually going on for baby.   So, it sounds likely that another doc would probably have read your BPP differently.

 

Be kind to yourself in it all, but I'm glad you're beginning the processing of the birth.   Healing and making peace with yourself and the experience *will* happen as a result of your proactiveness.   I hope you get some good info here.

post #3 of 10

Well, firstly, congratulations on your new baby. I think the PP hit the nail on the head, in that different practitioners may have interpreted the results differently, and reacted differently. But perhaps many of them would have done exactly the same thing. The problem is that you will never know what the "right" decision was - because it's largely a matter of personal opinion and comfort level. Perhaps your OB was more conservative. Or perhaps, had he not induced you, you would be discussing a very different outcome.  The baby displayed a reduction in movement/breathing, which may have been a resting time, as you suspect, or it may have been a sign that something was amiss (or could have developed into something, if the pregnancy was not induced.)  Isn't it better to be a little conservative, under the circumstances?

 

I understand the need to feel as though you did everything you could to get the birth that you wanted and felt was best for your child, but I might gently suggest that you focus more of your energy on enjoying these precious newborn times, and less on building an "eternal grudge".

post #4 of 10
Thread Starter 


 

Quote:
Originally Posted by slylives View Post

 

I understand the need to feel as though you did everything you could to get the birth that you wanted and felt was best for your child, but I might gently suggest that you focus more of your energy on enjoying these precious newborn times, and less on building an "eternal grudge".


This is where the additional details might be helpful.  The doctor was going out of town in 2 days after my appointment (was going to be gone for 3 days).  I suspect that he was afraid I would go into labor on my own while he was away and he would miss out on the money from my birth -- I was a late transfer patient, he is a solo, and he told me he usually misses 2 births a year and had just missed one recently and that it's "not good for [him]" to miss a birth. 

 

Second, my husband and I are both lawyers (well, I'm a former lawyer) and there was lots of talk from him about liability -- he was much more frank about it than I ever would have expected.  I'm positive we were treated differently because of having law degrees.  (DH joked that next time, he's a veterinarian and I'm a teacher, and I joked that it's like that episode of Sex and the City where Miranda pretends to be a stewardess instead of an attorney to get a date). 

 

Third, he spoke to me condescendingly and harshly after I had been on pitocin for 6 hours, AND I hated the way he treated the nurses.  Plus, more than one of the nurses all but told me that the induction was unnecessary.  Finally, he had a bit of a gleam in his eye when he told me how well I was tolerating the pitocin (before he broke my water, after which it was much less tolerable).  Almost as though he enjoys seeing women suffer.  I know that sounds melodramatic or paranoid, but I just came away from the whole thing with the feeling that my trust in him was greatly misplaced and that he has some type of personality disorder.  I've had run-ins with such characters before, and there is just something off about him that reminds me of encounters with other people I would now classify as sociopathic. 

 

Saying all that to say, I have many reasons to believe that this was not a run of the mill conservative call, but that he knew the induction was unnecessary and knowingly lied to me to get me to go along with  it.  It's impossible to convey all the intangibles of our interactions on the internet, but I suspect that he intentionally coerced me to do something not in my or my baby's best interest for his own selfish and potentially malicious reasons.  I would have had no problem whatsoever with being induced if it was medically necessary, but I hate that my baby was exposed to pitocin and then to the epidural drugs if it wasn't necessary. 

 

That having been said, I am spending plenty of time enjoying my newborn, and the unfortunate circumstances of his birth do not change my feelings for him one iota.  I am not depressed and am not sad about not having a certain type of "birth experience".  I'm angry at the doctor in much the same way I would be angry in any situation where I felt lied to and taken advantage of ... though certainly less angry than I would be if his actions had caused any discernible harm to either of us, which fortunately they did not.  (I suppose we will have to wait on the adhd diagnosis, though...).

 

post #5 of 10

You alive . Baby is alive . Breastfeeding is going well. Yes , OBs and Nurses are risk averse  and kind of like attorneys is some ways.  Doctors are very determined to have low mortality rate.  It is more about goals than experiences in the hospitals and that is totally true. However, hospitasl are changing and are concentrating on being more patient centered.

 

The reality is that if baby died, the OB knows it would be his fault, you would sue him . And if hospital found that was in fact negligent...well, lets just say hospitals are very afraid of the Join Commission.

 

People like to say how evil OBs, RN and hospital in general are, but the majority  health providers,  go into profession to help and heal  and to provide comfort.

 

I understand you frustration but  may I make a suggestion?  You are well educated assertive adult. Make an appointment with your Doctor and have discussion with him. Ask him the kind of question and you posted here. See what he says and what was a foundation for his clinical decision.

 

One mistake doctors make is that often they actually have very good reason for thing they do or proposed but they are not good in explaining things to patiens. This something Medical Schools are working on.

 

I had to deal with it when my son was ery ill. I simply told the doctor "You should tak to me as educated adult. Go ahead,  and use the big words". We had great conversation, and what was scary before become apparent . IVIG treatments save my son and .

 

 

post #6 of 10
Thread Starter 

Did I post on the wrong site?  I never expected to get "a healthy baby is all that matters" here of all places ...

 

I definitely won't be going back to this doctor, to confront him/ask questions or for any other reason.  Not after how he talked to me.  It wouldn't be any use anyway -- he would never admit to any wrongdoing.  His articulated reason for the necessity of the induction was "breathing movements are the first thing to go when a baby is getting compromised."  I remember hearing him tell the nurse to send the placenta to pathology, I guess so he can "prove" there was something wrong.  Gah.  I can't prove on a message board that something was off about the way this happened ... I probably can't prove it at all.  But I know I will continue to believe that is the case unless I get some reliable medical information indicating otherwise.

post #7 of 10

Assumptions , assumptions. Yes, it is more fun to vent than  have an actually conversation with someone.

 You have a right to all your medical records. Get the pathology report on the placenta. No, he can'sdt just "prove something". Lab is a lab.

 

The other point you made is how he treated you and and the nurse is very important one. Bedside manners matter. Write a letter to the hospital. They need letters like these to change internal culture. They actually listen.

 

You can write a letter to the doctor too.

 

Yes, I am in the  "baby matter more than my personal experience".  To me, this is the essence of motherhood. If I had to have c-seion or amputate my right arm to save my babies, I would .

 

My birthing happened long time ago....but my kids are with me every day and all those days so far have been precious in their own way. The more far away I am form the day of their birth, the less important that entire experiences compare to outcome seems to me. 

 

post #8 of 10
I agree with the suggestion to write a letter about his bedside manner. I also agree with those PP's who have said that you'll probably NEVER know. Reading test results is often very subjective. Did you make the best decisions you could at the time with the information you had available? Then you did the best you could do.

Did he lie to you to get you to agree to an induction so he could be present at your birth? Maybe. Will you ever know for sure? No.

It sucks that you didn't get the birth that you wanted, that you now feel you were pressured into decisions you did not like, and that you feel you were treated unfairly by your doctor. It sucks, and I hate it that women all around the country go through experiences like these where they find they have to question the information they were given, that they can't trust their care providers. I hate that the maternity care system is the way it is. I hate that liability plays a HUGE role in maternity care - and it does whether or not your doctor knows you're a lawyer. Every woman deserves a care provider who she feels she can trust, who treats her like an adult thinking human, who doesn't hide or manipulate the facts, and who has basic good bedside manner. I'm sorry you didn't get that.
post #9 of 10

I agree, OP, that the replies are very atypical of mothering.com replies.  Interesting.   Sometimes we hear exactly what we don't want to hear / weren't expecting, and it either helps us see a new perspective, or in your case, dig in your heels in and know that your gut is right!

 

Your gut is right.  This is just one of those times that you have to go with your gut, screw what everyone else says, find a good counselor (professional or friend) who will just listen and validate, help you process and reframe, and eventually accept and own your experience.  What you decide to do with follow up at the hospital is important, but in this case, I think important for *your* healing, not necessarily to change their culture.   So, do what you need to do.

 

If you have another child in the future, this path will be instructive for you in how you want your next birth to go, and who you want to be with, and the rapport/trust you need to develop.   If this is your last baby, I'm choosing to hope that your experience and your processing of the experience will eventually serve a greater purpose.   Maybe your sister/best friend/neighbor will hear from you exactly what she needs to get out of an abusive/controlling relationship with a care provider. 

 

And lastly, for all others:  it's not about healthy baby and nothing else!  It's about healthy baby AND mom.  It's the critical piece that OBs (and other providers) all over this country are missing.   Healthy moms don't feel the way this poster feels.   They don't feel disempowered, lied to, abused, and traumatized.   Sometimes healthy moms *do* feel disappointed, and have to cope with a birth experience that was unexpected.  Sometimes interventions are necessary.   Sometimes it's hard to tell, in retrospect, when an intervention is necessary.   But I think we're in a crisis at the way we treat our new mothers, and it doesn't help to tell them:  "All that matters is that your baby is healthy."   That's not true. 

post #10 of 10
Thread Starter 
Quote:
Originally Posted by Alenushka View Post

Assumptions , assumptions. Yes, it is more fun to vent than  have an actually conversation with someone.

 

Yes, I am in the  "baby matter more than my personal experience".  To me, this is the essence of motherhood. If I had to have c-seion or amputate my right arm to save my babies, I would .

 

 

 

As to the first comment above:  I did have several conversations with him, including  before and during the induction.  I am telling you, he is not a normal human being with whom you can have a two-way conversation.  He is a manipulator, and I swear at times he stated the opposite of the truth with absolute confidence and conviction.  I never in a million years expected this to happen, to encounter someone like this in this setting -- I had placed my trust in this person.  I have never encountered a situation like this in a medical setting before.  I realize that it is unusual, but it is what it is.  This is not about "bedside manner" in the typical sense of a doctor being too brusque or not explaining things thoroughly.

 

The second comment above is just plain insulting and offensive.  As I clearly stated in a previous post, I would have no problem whatsoever with any type of birth scenario IF IT WAS MEDICALLY NECESSARY.  It is my suspicion that this was medically unnecessary that has upset me.  And I'm not really *that* upset (not for myself, anyway).  I just want to know what a typical OB would do in the situation I was in, and whether what my doctor demanded I do is inside or outside the mainstream within the medical community.  I don't see what's so offensive about that.  Stop projecting your stereotypes of natural childbirth advocates on me. 

 

This inquiry (which I clearly should have kept to myself and just kept up my google searching) is not about missing out on an "experience".  I had the natural childbirth experience twice.  I do not treasure those moments, particularly.  Birth is a painful, messy business.  It was all the moments after that are meaningful.  (I shouldn't even have to say that on this site -- it should be understood).  I did it that way because I believed, and still believe, that in the absence of complications it is safest for the baby and most likely to lead to a successful breastfeeding relationship.  And that's all.  I don't need to feel empowered, and nothing that happened during this birth was particularly traumatic for me, physically or emotionally.  But the idea that my baby's health and well-being were put at risk potentially for a doctor's non-medical selfish agenda -- that's where the mama bear comes out. 

 

I hope this clarification will put an end to the insensitive comments.
 

 

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