Wednesday, February 21, 2007

A new threshold?

Many have now heard the story of the "World's Most Premature Baby". Born at 21 weeks 6 days, weighing only 10 oz (280g) and 9.5 in long, this baby is a miracle. This post is not about the baby, but some ethical issues that are now being discussed.

To begin with- the mother LIED about how far along she was in her pregnancy. This was a fertility pregnancy. Anyone who has gone through some type of ART procedure can tell you, to the day, how far along they are. But she chose to lie, knowing that resuscitation efforts would not be administered. The story says they thought they were delivering a 23 week baby. Was her OB ever consulted? Interesting because my medical file from my Peri's office was at the hospital the next day when my water broke, with every piece of history in there dating back to my IVF records that were transferred to him. His partner even knew my gestational age.

Statistically, infants born prior to 22 weeks gestational age have 0% chance of viability. At 23 weeks, those numbers only rise to 10-35%. Many hospitals have policies regarding medical intervention at certain gestational ages. Survival rates are just that- survival. There is a another set of percentages which outline the likelihood of disabilities.

Here are my concerns:

The media has glorified this and glossed over the important facts such as likelihood of disabilities etc. How many more women are going to lie about their due date when faced with pre-term labor because of the outcome of this particular story?

If this happens, what is the trickle effect going to be on NICUs across the country? When mine were born, the NICU was very overcrowded and short staffed, plus it was only 1 of 3 in the valley. PICU nurses and L&D nurses were being pulled into the Special Care nursery to help. More stable babies were being transferred to other hospitals. I know for a fact that Dominic, Aspen and Ryan bumped a set of twins out of of the NICU into Level 2. They were the most stable at the time to be downgraded and NICU needed the space. But were they actually ready? Or victims of overcrowded conditions?

Prematurity itself is on the rise. Now, there is talk of rethinking the 24 week viability mark. I do not agree with this. The facts & figures do not support it. It will place additional strain on the doctors and nurses- which also could lead to~ job burnout, increase in human error, diminished quality of care. There is a shortage as it is, without these qualified individuals, success rates could begin to falter.

Developmental services such as occupational therapy are in demand. The support system to meet the needs of developmentally challenged preemies in some areas lacks considerably, with long waiting lists and insufficient staffing. The infrastructure is not ready to meet the demand.

And finally- false hope. When my water broke at 28 weeks, I was told the numbers by the Neonatologist. I was fortunate to be able to hold on another 11 days. And at 29w3d, I still had a library list of issues that my preemies contended with. I saw the mother of the 25 weeker who was told that her baby was not expected to make it through the night. She looked like she just lost her soul, and she had no life left in her.

If only 1 out of 1000 premature 22 weekers survive, that means 999 parents will have their hopes and dreams crushed.

How far are we willing to compromise?


Stacie said...

I don't know. But I do know that I would have lied too, had my twins been born so early that resuscitation efforts would not be administered. I would have said or done anything to help them survive.

Laura said...

i am mostly on the same page as you being a nicu nurse and preemie mom.
i will tell you that the three facilities i worked at will only resus a 23 weeker if the baby is making any effort: heart rate gasping or better respiratory effort.
i know it sounds heartless and cruel and one could say we are playing god but then again the odds ar insurmounatble.
we have had babies straddling fetus-hood and viable where we suspected dates were fudged, whetehr by the ob or the mom remains is up for debate. the outcomes were mostly with severely impaired babies, only one with a "good" outcome.
i don't know about you but i am the first to talk about my miracle million dollar baby but at the same time i will emphasize that he fought from hell and back, spending 132 days in the nicu and nine surgeries under his little belt. he is great but he is challenged too and really there are still unknowns as he is fast approaching school age. only time will tell his future...but wait, the same goes for my full term, "healthy" babies too.
i can only wish that family MUCH luck, patience, prayer and silently growl at the media for their usual warm, fuzzy slant on this story. a happy ending is always wonderful but in this case maybe not so wonderful to those who have not lived or worked in a nicu.
great post!