Michael Bebbington, MD, is a maternal-fetal medicine specialist and director of the Fetal Care Center. His areas of specialty include twin-twin transfusion, twin reverse arterial perfusion syndrome (TRAP), Spina Bifida and amniotic band syndrome.
Dr. Bebbington sees physician-referred patients at the Center for Outpatient Health, 4901 Forest Park Ave., St. Louis, MO 63108. 7th floor, Suite 710.
What happened in the course of schooling to influence you to choose your specialty?
I ended up in fetal medicine by somewhat circuitous route. It just shows how your career can take some interesting turns. When I finished medical school. I started an internship in internal medicine and then switched to a residency in obstetrics and gynecology. I quickly realized that I wanted to continue my specialization and did a fellowship in maternal-fetal medicine and got a master’s degree in epidemiology and biostatistics.
I was always more interested in the fetal side of maternal fetal medicine and developed my skills in ultrasound and invasive procedures for fetal diagnosis and intrauterine transfusions. Over the last 15 years fetal surgery has developed into a recognized area of expertise. I have had the opportunity to work with some of the pioneers of the field – so it was a natural progression for me to pursue my interests in fetal surgery.
Did you always know you wanted to be a doctor?
Not really. My first degree was in biochemistry but I didn’t want to work in a lab. I did a program in chemical engineering with the intention of pursuing a masters in biomedical engineering. I applied to medical school with no real expectations that I would get accepted but I was and decided that a career in medicine offered more opportunities.
What brought you to Washington University?
I’ve known Dr. George Macones and Dr. Alison Cahill (maternal-fetal medicine specialists here at Washington University) from when we were all at the University of Pennsylvania. I worked at the Center for Fetal Diagnosis and Treatment at the Children’s Hospital of Philadelphia for 8 years. After I left Philadelphia, I went to the University of Texas Health Science Center in Houston. It was there that I reconnected with Dr. Cahill when she came to give grand rounds to our faculty. We had a chance to catch up and I showed her around the Fetal Center at Children’s Memorial Hermann Hospital.
A few months later, Alison called and asked if I would be interested in coming to St. Louis. She ultimately talked me into a visit just to have a look at Washington University.
The enthusiasm that the faculty and administration had for developing a fetal surgery program here was infectious. After some business planning meetings where we discussed the possibilities, it was ultimately just too good an opportunity pass up.
Our new Women and Infant Center (opening summer 2017) will revolutionize maternal-fetal newborn care for the St. Louis area. One of the things I’ve learned through the years is how important it is for mothers and babies to be in the same hospital. Nothing could be worse for a family than having a mother in one hospital and her baby in a separate hospital, some distance away, at a time when important decisions need to be made in their baby’s care. Being able to bond with their baby and directly participate in their care while they are recovering from their delivery is critical to promoting quality care.
We currently have great collaboration between Barnes-Jewish Hospital and St. Louis Children’s Hospital. When the facilities are completed in the new tower, there will be direct access via a walkway bridge that directly connects the maternity floor to the NICU, so mothers and their newborn babies will be in close proximity -- further enhancing the level of care for everyone. There will also be a dedicated fetal surgery OR allowing us to offer an amazing level of care to families.
The incredible number and quality of specialists in the Children’s Hospital and Barnes-Jewish Hospital system are able to offer a continuity of care that begins with expectant mothers and their unborn babies and transitions to newborn and pediatric care and ultimately to care through adolescence and adulthood all in one place. Again, this is something that just doesn’t exist in a lot of places.
Which aspect of your practice is most rewarding?
Definitely it’s the families – I get to be part of a very special part of most people’s lives. It’s this part of patient care that drew me into medicine.
In fetal surgery, we touch families at a very vulnerable time, and we are able to have a significant impact on their lives. At the end of the day, it’s the ability to use my skills to smooth the transition from being in utero to the nursery that keeps me fulfilled and sustained.
What new developments in your field are you most excited about?
I’m very excited that we continue to work towards less invasive ways in which in utero interventions are performed.
Surgery to correct spina bifida is an example of how we can change the natural history of a disease. Currently we open the mother’s abdomen, open the uterus, operate on the baby while still inside, close everything and continue care for mother and baby during the rest of the pregnancy.
That approach is associated with potential maternal risks. There is some very exciting work being done to try and adapt that surgery to develop a minimally invasive approach utilizing endoscopic techniques. While it is better for moms, we have to prove it provides as much benefit for the babies as the more complex “open” surgery. It is still in the early stage, but it is a good example of how the field is continuing to evolve.
What is your most common in utero surgery?
The most common procedure we perform is laser surgery for Twin to Twin Transfusion Syndrome. This develops in a particular type of twins -- monochorionic diamniotic twins (identical twins who share a placenta). In this type of twin there are connections between the blood supply of the twins and blood is exchanged between the fetuses. Normally, as long as the exchange is balanced, there are no problems. But if the exchange becomes unbalanced, the twins develop twin to twin transfusion syndrome.
We use a fetoscope to map the placenta of affected pregnancies and then use a laser to clot the blood in the blood vessels that connect the twins. This separates their circulations so that all the adverse changes are reversed. Without treatment, this condition has a greater than 85% mortality rate. With treatment, it has a greater than 85% survival rate.
What are the signs of a twin to twin transfusion?
Many mothers will not notice anything, so it is something that is diagnosed mainly by ultrasound. Usually by the time a mother becomes symptomatic, the process is usually very advanced. Typically she might notice her abdomen is enlarging very rapidly as amniotic fluid accumulates inside the uterus. Sometimes it’s only diagnosed afer preterm labor develops or after premature rupture of the membranes. Typically at that point it’s too late to do any interventions.
One of the most important things is to make sure that monochorionic twins are diagnosed early in pregnancy. It’s very difficult to know which monochorionic pregnancies will develop twin to twin transfusion. That is why all monochorionic twins have ultrasound surveillance every two weeks, beginning at 16 weeks and continuing throughout their pregnancy. Regular surveillance is important to detect early changes of twin to twin transfusion. This allows us to offer intervention with laser therapy.
Where are you from?
I’m from Canada. I trained at McMaster University in Hamilton – just outside of Toronto. I did a fellowship in Maternal-Fetal Medicine on the west coast, in Vancouver. That’s where I became interested in the fetal side of maternal-fetal medicine.
I’ve had the opportunity to work at Albert Einstein College of Medicine in New York City and spent several years at Children’s Hospital Philadelphia as part of the fetal surgery team there. Before I came to Washington University, I spent five years at University of Texas in Houston as part of their fetal surgery team.
Is there a particular award or achievement that is most gratifying to you?
In terms of awards or achievements, I received a teaching award which I highly valued. One of the really important things that give longevity to new specialties like fetal surgery is to teach. You have the privilege and responsibility to share the knowledge you’ve acquired so that other physicians can take your place and carry it on.
What is the best advice you’ve received?
Spend time with your patients. I’ve been very fortunate over my career to always be able to spend time with my patients and their families. Fetal surgery can be a complex specialty and families are called upon to make difficult decisions. Families need to have their doctor spend time with them. I enjoy being able to give them as much time as they need to understand the situation affecting their baby and ask questions.
If you weren’t a doctor, what would you like to be doing?
That’s not a difficult decision. I went to culinary school because of my love of food and cooking and I worked in catering. Apparently interest in food and cooking is very common for surgeons, I’m not sure why. So I would probably be somewhere in the food and restaurant/hospitality industry. My mother once gave me a piece of advice -- she said, If you know how to cook, you’ll always have friends. It is very true, especially now, because people get so busy and it’s hard for them to take time to cook for themselves.
Do you have a cooking specialty?
Spending time in Texas, I’ve become interested in Texas barbeque. I was given a smoker a few years ago as a kind of challenge. In Texas, it’s all about beef -- beef brisket for barbeque. They are very serious about their BBQ and won’t hesitate to remind you that there is a difference between grilling and barbeque. Grilling is turning on the gas grill and throwing on some steaks. Barbeque is a much slower process and a BBQ brisket is a 12-14 hour undertaking – cooking it enough, but not too much. It’s been a whole other area of cooking that has been quite fun, and delicious to master. Let’s just say no one turns down an invitation to dinner!