The Wright Stuff - right to life at 23 weeks?

[jazz412]

Debate on whether money should be spent elsewhere or on premature babies.

I'm unsure at the moment so debate away and I will listen.

No, no. Asking parents to fund treatment is probably the very worst way to go about it. If the option is there for well off parents to try and save their child it should be there for all parents/babies.

As they said in the docu most prem babies are born to socially deprived people anyway. Sorry, you can't pay, your baby dies. Ugh.

Well ethereality is that lines have to be drawn somewhere.

The 1% is someones child. To that person that 1% is the only issue.

But the cost to the other children is horrendous. The cost to the families in terms of days or weeks of hope and anxiety. The cost to the nhs is substantial. The cost to the children themselves is huge.

Is it not possible to argue that in acting in the best interests of the 1% what we are saying is that the loss of the 90%and the struggles and difficulties of the 9% are just a fair price to pay.?

If a parent is able to make the informed decision that they wish all measures to be taken.if they are fully aware of the substantial likelihood of severe disability. If they recognise and accept that the process in icu may cause the child stress and pain and that it may be for nothing - maybe that could be deemed to be informed consent but it seemed from the programme cast night that that is very far from the way these challenging choices are couched.

I have a disabled child. I am the first in line to argue for the rights of the child, the value of the lives of the disabled and theirvworth both to society and their own right to exist.

If I am questioning if we are doing the right thing then to me that inductees that we should be considering if we are right. The price honestly seems to high.

The ability to have a baby preterm and have them end up safe and healthy gets earlier and earlier with every new day with new medical procedures. I would hate for doctors to just stop saving babies because it's expensive. Hopefully they will continue to learn and create new ways of helping to saving people's babies. I couldn't imagine the trama of losing a child that way.

"As they said in the docu most prem babies are born to socially deprived people anyway."

Why is that?

Diddl: poorer antenatal health I presume. More likely to smoke etc... their opinion. Not mine. Just a statistical fact. The less well off you are the more likely you are to have a premature birth.

other prematurities are not relevant, however, this is purely about moving the line to 24 weeks because the results aren't good enough at 23. i have a 33 weeker here and remember being frightened enough by that, tbh, until she came out and was fine. (good luck storm, btw, hope your baby stays in the warm for as long as possible.)

personally i am swayed by the nnu nurses here, it's not just a financial argument, there is a pain and suffering one as well. 9 out of 10 die anyway, but rather than being cuddled by their parents it's in an incubator, never having been off the tubes etc.

I'm with BoB - paying for care (effectively preventing lower income parents from accessing the same treatment higher income parents would have access to) instinctively feels like a step backwards, rather than forwards.

How can parents possibly be expected to make a rational decision relating to their child's care? I know I would struggle. My every instinct would be to protect my child and keep him alive at any cost - but what if this only prolonged his life and he was in terrible pain during this time? I might selfishly want to keep him with me for as long as possible, but this might actually not be the right thing for me to do. Surely it is for doctors to make a decision on how to proceed based solely on the best interests of the child?

Thanks for the best wishes folks - baby doing well at 27 weeks and also measuring ahead (over 28 weeks) so hopefully his prognosis would be good if he puts in an early appearence. Hoping he will make it to at least 34 weeks though.

Vajazz

The evidence seems to be that whilst improving medical knowledge seems to be massively improving outcomes for 24 weeks and above, the 23 week limit seems to be the breaking point for viability and success rates are not improving for this group.
The 'viability' line seems to be drawn here which is possibly why the abortion limit is around this level.

Storm, with every passing day he stays put his chances get better and better. 27/28 weeks is milessss ahead of a 23 weeker. Good luck!

Diddle - the main causes of premature birth are:

?pre-eclampsia
?multiple pregnancy
?antenatal haemorrhage
?illness in the mother, such as diabetes, high blood pressure or heart disease
?cervical incompetence
?foetal abnormalities or death

and those especially at risk are young, single or unsupported mothers, and those who smoke or are underweight.

There has also been some recent research linking prematurity to heavy drinking in early pregnancy, so i'm guessing that unplanned pregnancies are probably more at risk of this.

Thanks BoB - that's reassuring to hear. Keeping everything (especially my legs) crossed!

Vajazz - you're wrong, part of the argument is that rates of survival have not improved despite advances in medical care/treatment. The percentage of 23 weekers surviving is the same as it was years ago (sorry, can't link I didn't watch the programme, but heard this recently)

I don't think at such an early stage it should be the parents decision, because how could anyone be expected to make a rational decision about their childs life.
The radio show that I heard also suggested that the medical team who assess these babies know pretty much which have no hope, so surely it would be kinder to the parents for the dr's to explain this and let the parents have peaceful time with their baby until the inevitable happens. There would then be more time/money to put effort into the babies which have a chance.

I typed it so slowly everyone said it all before me, and so much better too!

Faverolles is right. Part of the problem and why they're at where they're at is that survival rates in 23 weekers haven't improved at all. They've pretty much reached the limits of what can be done for such an early baby.

Survival rates in older babies get better all the time. But it's not happening in the 23 week babies.

Vajazz, IIRC in the programme last night it made clear that the chances of surviving at or earlier than 23 weeeks is not actually improving. All that is happening is that we are managing to prolong the lives of extremely prem babies. The same amount die, they just have a longer time alive (possibly in pain) first.

It would seem that there is a biological cut-off which, even with all these new advances in care, we can't circumnavigate.

Sorry BoB - x-post!

My friend had twins at 23 weeks. One died and the other against all the odds survived but she is terribly disabled and will never be able to look after herself. She is a beautiful child and much loved, but the heartache involved is huge and my friend worries about the future when she is not there to care for her daughter any longer. Looking back, she believes the kindest thing to have done was to let her go - as the doctors were sort of suggesting but of course at the time she was desperate to save her baby with little knowledge of what was to come. People who see the odd story in the paper about how a child survived a very premature birth seem to think that it's quite simple and easy - the truth is so different and even those cute babies who do survive might go on to have serious medical problems. I don't think this is just about saving money - it is about what on the whole is best for these poor babies.

oh gosh how terribly sad, fasted.

I'm not sure. But I know certainly most babies born at this age die within a few months. Of those who live, very few do not have severe disabilities.

But the NHS does need to make decisions based on money. We don't have a neverending supply of cash, so some medical care does need to be restricted - and currently is.

Sorry, I get why socially deprived mothers might be more at risk of having a prem, but didn´t realise that they actually had more prems iyswim.

When I was in with my PFB, there were non of us could be called "socially deprived"

Sorry, OT.

Sometimes knowledge is a curse, isn´t it?

Years ago, such babies would have had no intervention and would/would not have survived on their own strength.

Sometimes, just because you can do something, doesn´t mean that you should.

And more and more is expected to be done and I think parents are given false hope, when the kindest thing might be from the outset to know that there is no hope.

However hard it is we can't let our emotions as parents cloud the fact that the NHS doesn't have an infinite pot of money, and services have to be rationed and allocated based on outcomes.

I believe that the money would be better used elsewhere. That's in no way saying that these babies aren't important, aren't loved, aren't cherished and aren't wanted. It's acknowledgeing that a lot of money, time, expertise and effort is put into attempting to achieve something that overwhelmingly has a poor outcome. And I imagine that many of the parents of those 23 weekers that were resuscitated may look back in hindsight with a different perspective.

Unfortunately historically money in the NHS seems to be allocated based on the 'sexy' stuff - HIV, children with cancer, intensive care, transplants - and rightly so.

But the 'unsexy' stuff such as elderly care, mental health, learning disabilities attracts less funding and publicity. And that is wrong.

I think some people are missing the point that 23 weeks is scientifically proven to be unviable, but that 24 weeks and onwards is proven to be viable.

On the whole, babies at 23 weeks rarely survive, live with profound disability, and may be in severe pain whem they are supported after being born.

My sister had a prem baby, 30 weeks so not that premature but her lifestyle during pregnancy was bad. Plus, she drank a lot (she's an alcoholic)

My niece is deaf, and if I'm honest probably has more going on that just deafness. Her development in all areas is seriously delayed. BUT that was because of the drinking so nobody panic that even 30 weekers are likely to have issues because they're generally not.

My point is, it's easy to see why she was born early.

diddl, I totally agree that "sometimes, just because you can do something, doesn´t mean that you should."

It was heartbreaking watching medical staff trying to resuscitate that poor baby for 20 minutes last night.

If the NHS had a blanket rule of no help before 24 weeks then my two boys would have been left to die. No-one looking at them now could possibly argue that the money hasn't been well spent. The trouble is, it's impossible to know at birth which babies will do well, and which ones won't.

My babies are fine, as of today they have no long term problems that we know of.