Give them a chance?

Sarah - posted on 03/02/2010 ( 17 moms have responded )

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Should babies born before 23 weeks be given the chance to be saved?
I was reading a magazine article about a women whose baby was born at 22 weeks (only missing the 23 week cut off point by 4 days) no attempt was made to resuscitate her baby. 2 hours later, her baby died.
She is now campaigning to have the law changed so that babies born before 23 weeks should at least be assessed to see if they could be saved.

Should the law be changed?
Your thoughts?

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Mary - posted on 03/02/2010

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I work at a hospital with a Level 3 NICU (this is one equipped to handle these micro-premies).

To answer Sharon's question...if a patient is in pre-term labor prior to 34-35 weeks, a hospital without a NICU will normally try their damndest to transfer her out to a facility capable of caring for the infant. My hospital routinely accepts transfers of women in preterm labor from one of the community hospitals that is about 30 miles away. We have an established agreement with them, as well as a transfer protocol in place (including a transport team). It typically works pretty smoothly. University of Maryland, in the city, takes transport from the Eastern Shore, and even has a medevac helicopter for their transports. Unless things are moving to quickly for transport, or the mother is too unstable for transfer, a baby in this gestational age range should NEVER be born in a facility unqualified to handle them.



The way that we handle the above situation is on a case by case basis. Actually, the true cut-off for viability is really still 24 weeks. Anything prior to that is really dicey...at 23 weeks, NICU will, if possible speak to the parents first about potential survival, likely complications, and long-term quality of life, so that they can make as informed a decision as possible. They are present at delivery, and assess the infant prior to initiating heroic resuscitative measures. They will not intubate any baby less than a certain weight (can't remember exactly what it is now), or if the infant appears to less developed than the estimated gestational age. If the eyes are still fused, chances are pretty poor of a good outcome.



We have had patients in that gray 23-24 week window, who were measuring small or had suspected fetal issues to begin with, who, despite being told the liklihood of a poor outcome, insisted that everything possible be done. It is heartbreaking...those infants were basically tormented with machines, and still died within a few days. Even some of our 24 and 25 weekers spend MONTHS in the NICU on vents, oscillators, feeding tubes and IV's. Many of them develop ischemic bowels, or subdural bleeds, and require surgery (often more than one). They 'survive', but will spend their entire life requiring 24/7 nursing care. It's a horrific situation for any parent to face, but I know that I personally would not have allowed any heroic efforts before 24 weeks. I would have held my baby in my arms, and had her know love and comfort for however many hours God granted us, and freed her from a life of pain and suffering. But, that's just me.

Esther - posted on 03/03/2010

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Wow Dawn. Way to blame it on universal health care. Good thing nobody dies because of lack of insurance (except of course those pesky 45,000 a year. But I'm sure there are no kids among those).

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Maggie - posted on 03/03/2010

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I agree with Mary as well.

For those who say they would regret not doing everything they could ... if after days or months of machines and surgeries and drugs your child were to die, wouldn't you regret not just holding them?

I know all babies are different - my son was delivered at 36 weeks (just) and did not require any NICU visits even though I was told there was no chance he would be able to stay with me. I know he was way beyond the age discussed in this post but my point being that I do agree with case by case assessment.

Rosie - posted on 03/03/2010

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i'm torn on this one. i believe that every child should be given all measures to save their life, i know damn well that if it were my kid, i'd be horrified if they didn't at least try. i couldn't live with the fact that i gave up on my child, no matter what the consequences or outcome.



what about people that know that their child will die shortly after birth? should we tell them that they shouldn't have them, because we know that their childs life will be horrible, the few days it is alive? i recently watched a thing on youtube called 99 balloons. it was a dad recalling the 99 days his child was on this earth, his child had edwards disease. it was so heart wrenching watching the videos, and looking at the pictures of the child. but that child blessed that family in ways that only they could fully understand. is it selfish, maybe, but i would want my child to have every opportunity to have a normal life, and would want to beat the odds.

Dawn - posted on 03/03/2010

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This happened in England. With their Univ. Healthcare system. Their rule is that they will can only help a premie if its 23 weeks or older.

Tah - posted on 03/03/2010

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this is heartbreaking and is why i do not work with peds in a hospital setting and more often than not a home setting either. Just because te child is able to breath on their own does not mean that where was not some other underlying problem that would have gone way beyond that. I have met children that confined to a life of lying in bed, tubes and procedures and all they know is some kind of pain or the other. ANd some of them are ale to breath on their own. and it may stop there. they need routine suctioning, and turning and start the day off with more meds than you can imagine.



It's hard to know what you would do in that situation but sometimes you have to pray for your childs comfort and make the hard deicision in this situation.

Esther - posted on 03/03/2010

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I agree that the interests of the baby should come before the mother. I also agree that any cut-off should not be so hard that a case by case assessment is out of the question. However rare it may be, miracles do happen, as in this case: http://www.associatedcontent.com/article...

I would personally not want anyone to do anything if the best possible outcome would be a severely handicapped child who would be sentenced to a life of pain and discomfort, but I also wouldn't want them to just write him/her off based on policy alone.

Ez - posted on 03/02/2010

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Oh I agree that the 24 week recommendation is probably correct, but I just think it needs to be used as a guideline, rather than have it written into legislation. I agree with the protocol not to vent a baby who is too small, and I personally can't imagine making my baby suffer through days of pain and struggle to only die a few days later. BUT... that is my personal choice. I think the interests of the baby have to come before the mother, even in such terrible grief, but I agree with Amie that a simple assessment would make dealing with the loss a lot easier.

Isobel - posted on 03/02/2010

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I was actually about to say that the babies that make the cut off have extremely limited chances of survival as it is before I read Mary's answer (which broke my heart). It is such a sad situation but...I think that the limitations are there for a reason.

Ez - posted on 03/02/2010

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I've heard of cases like this too.. where the baby is so close to that 23 or 24 week cut off but still refused treatment by the hospital. I agree with Sharon in that I don't think something like this can be legislated. It is not a 'one-size-fits-all' scenario. Everybody's baby deserves to be assessed for viability, whether born at 22w5d or 24w2d, if only to provide parents with reassurance that every avenue has been exhausted.

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Give them a chance on a case by case basis. I remember an article where the baby was breathing without assistance, but the hospital still refused to provide treatment. I'm not saying that the baby could have been saved, but they should have at least considered it.

Dana - posted on 03/02/2010

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Mary, you bring an important and knowledgeable side to this debate. Your first thought is "hell yeah, try and save any baby no matter what!" then you realize that it is only torturing some of them. You need to be the very best advocate for your child and sometimes that means holding them with love until they pass.
It's also hard to tell this particular mother that she is wrong, maybe everyone can learn something from a movement like hers.

Sharon - posted on 03/02/2010

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I'm with you Mary. Its heartbreaking but there are times people have to face the loss.



I don't understand why people cannot think beyond themselves in these cases.

Sharon - posted on 03/02/2010

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Doesn't it take a level 4 NICU (or whatever they call it now?) to save those babies?



What if that hospital didn't have those facilities?



I don't think there needs to be a law. I think there needs to be common sense. People should research WHERE they plan to give birth or be treated. I made sure I chose the top hospital in my city.

Amie - posted on 03/02/2010

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I agree with Sara. It should be done on a case by case basis. I understand it's a long shot but even if it's 1 in a million, that's still 1 life saved.

It would be hard to lose a child regardless but I think having them assessed and knowing for sure that nothing could have been done; that would bring some small comfort.

Sara - posted on 03/02/2010

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With no medical expertise at all going into what I'm about to say, I think that it should be assessed on a case by case basis, yes. But, it will likely still be difficult for people to accept that a baby cannot be saved regardless.

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