If your baby has been diagnosed with a congenital lung malformation such as CPAM, BPS, or another CLM during pregnancy, one of your biggest questions is likely what will happen when your baby is born. The good news is that the majority of babies with congenital lung malformations are born without complications and breathe on their own. However, your medical team will want to be prepared. This guide covers what to expect from your delivery, including birth planning, who will be in the room, and when your baby might need NICU support.
Before you go into labor
Your medical team should discuss a birth plan with you based on your prenatal imaging and what they expect for your baby. This includes where you will give birth, what level of monitoring your baby is expected to need, and who will be in the room. If these conversations haven't happened by your third trimester, we recommend you push to ask for them.
We also recommend writing down anything that matters to you — your birth preferences, your anxieties, specific requests — on a piece of paper that you can hand to your nurse when you go in to give birth. Nurses will likely change shifts several times during your stay and having something written down means you don't have to repeat yourself during labor. It can also sometimes be easier to hand someone a piece of paper than try and explain yourself during an emotional and stressful situation.
Where to give birth
One of the things a lot of parents with CLM babies ask is: where should I give birth? This can be an especially difficult question if you live far from a specialist hospital or high-level NICU. There is ongoing debate in the medical community about whether women carrying babies with CLMs should deliver at a tertiary specialist center or whether, for small lower-risk lesions, delivering locally is a reasonable option.
The answer depends on your prenatal imaging, what your care team feels the risk is to you and your baby, and your own preferences. Some families with small, low-risk lesions that have not grown during pregnancy still choose to give birth at a major hospital with access to a high-level NICU. That is completely valid.
For other families, that would mean a significant financial burden, relocating away from other young children and support networks, extended time off work, and real emotional, financial, and logistical stress. They choose to deliver closer to home. That is also valid.
This is a personal choice that should always be made in collaboration with your medical team.
How you will give birth
Most women with CLM pregnancies are able to give birth vaginally. A C-section is not normally indicated just because your baby has a lung malformation, though it may of course be indicated for other maternal medical reasons. The exception is in cases where there is a serious predicted risk that the baby will need immediate stabilization or surgery at birth — sometimes called a "section to resection." This is a rare scenario.
Babies with larger lesions (typically a CVR consistently greater than 1.6) are more likely to be symptomatic at birth, but this is not a simple equation. Your care team will discuss what they expect based on your specific imaging. It is worth remembering that the vast majority of CLM babies — around 90% — are born breathing normally on their own.
Who will be in the room
If you are giving birth in a hospital with a NICU, it is likely that several members of the NICU team will be present when it is time to push. This can feel overwhelming when you know in advance that there will be more people than usual in the delivery room. But most women, by the time it comes to pushing, aren't really thinking about that. You probably won't even notice.
After birth: skin-to-skin and the first few minutes
Depending on the risk level for your baby, and if your baby is breathing when they are born, you may be able to hold them and have a few minutes of skin-to-skin contact. If this is important to you, we recommend having this conversation with your OB-GYN or MFM team in advance, and then raising it again when you are checked in during labor (you can add it to your list to hand the nurse).
Within a few minutes of birth, your baby will be taken to the side of the room to be evaluated by either the nursing team or the NICU team.
Going to the NICU
It is common for CLM babies to be taken to the NICU for monitoring in the first few hours after birth, even if they are breathing normally on their own. Your partner or support person is normally able to go with the baby and stay with them in the NICU while you are recovering.
We recommend talking to your partner or support person about this ahead of time so they know what you would prefer (whether you'd rather they stay with you after the birth or go with the baby). There is no right answer. We just recommend having the conversation before you're in the moment.
A note about this experience
A lot of moms describe the moment when the baby goes to the NICU as one of the hardest parts of a CLM birth. After all the intensity of pushing, after all the people in the room, suddenly everything is quiet. You are more or less alone, maybe just with a nurse, and your baby — and probably your partner — is somewhere else. It is a significant thing to be separated from your baby at birth, even if it's only for an hour or so. We are here to support you.
What happens in the NICU
In the NICU, your baby will be evaluated for how they are breathing. All CLM babies will typically have a chest X-ray within the first hour after birth, whether they are symptomatic or not. This is to check how the lungs are handling the transition to breathing, whether they are retaining fluid, what has expanded, what hasn't.
It's important to know that this X-ray is not a diagnostic test for your baby's lung malformation. It is very likely that the malformation itself will not actually show up on an X-ray. This can cause a lot of confusion for parents (and, in some cases, for clinicians too). The purpose of this initial X-ray is to assess how your baby is breathing right now. If the lung malformation is not visible this does not mean it has resolved or disappeared. A CT scan is still recommended a few months after birth to properly assess the lung malformation.
If your baby is symptomatic, the NICU team will begin breathing support. (You can read more about this in our section on babies who are symptomatic at birth.) If your baby is asymptomatic and breathing well on their own, you should be able to have them back with you in your room after a few hours. For asymptomatic babies, they are then usually treated as any other newborn and you should be able to take them home in a day or two.