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.

bottleofbeer - I think I agree with you!

they're all such hard issues to have a full opinion on I think. It's too hard to say one thing is right in every case - for me at least!

I think it should be the parents decision, Im a 26 weeks twin girl, me and my sister are healthy.

There is a big difference between 23 week and 26 weeks though.

I had my son at 32 weeks and my God, he looked HUGE compared to the little babies on last night's programme. Every day makes a difference, so an extra 3 weeks is a huge difference.

I was on bed rest for 3 weeks before having ds and the consultants were just itching for me to get to bang on 32 weeks then I was whisked off for a section. Apparently by 32 weeks everything is developed and that last 8 weeks is just the baby laying down fat.

Even then ds had a small brain bleed, a collapsed lung and in infection caused by a tube into the lung. And he was considered pretty healthy compared to some of the wee souls in incubators near him. I remember just wanting to take his pain away, and there is no way I'd want to resus at 23 weeks even though it would break my heart.

As the consultant on last night's programme said - we are not keeping these prem babies alive, we are just managing to keep them alive for a bit longer.

Very sad and I've made myself cry now, so I'm off to compose myself and have a cuppa.

I'm a neonatal nurse and watched the programme with interest. Personally and professionally my opinion has nothing to do with the money, and when the doctors are making these decisions, in partnership with the parents, money doesn't even come into it. We would consider the baby's prognosis (usually based on weight, response at birth and any test results available) and likelihood of suffering when deciding whether or not to continue. It's incredibly difficult to watch these babies die on the end of a ventilator with all manner of tubes coming out of them without just wanting to give them to their parents and letting nature take it's course.

We have to involve the parents in these decisions, it's their baby, how can anyone else say what's right for their family? You give them the facts and discuss their options, and yes, it's so so much to put on them but what else can we do?

As a nurse I would say I wouldn't want my baby to go to nicu at 23 weeks, but as a parent I just don't know, there are no easy answers to this but I think the debate should be about suffering, not money.

My understanding of the argument is that the interventions to keep 23 weekers alive are doing more harm than good; that most of these babies experience pain; that dealing with their resulting disabilities simply cannot be adequately resourced as they grow older; and that the doctors asking parents for their decisions are aware that they really want the parents to say 'no' to interventions but that they end up with parents who say 'yes' because the communication is so inherently skewed; and that the one baby in a hundred who makes it through ok is possibly not sufficient justification for the harm inflicted on all the others.

My Son was born at 29weeks and 6 days and is now 21 yearsold, 6 foot 7 inches tall and healthy!!! One of my daughters was born at 33weeks and has been asthmatic since she was 10 months old. It's a very painful choice to have to make in a very emotional time thrilled that your baby is alive but worrying what the outcome is for it.
I wouldn't want to have to make the choice.

I agree with meliesmummy , this is not about money for me . They put a figure of 10 million on neonatal care for babies born at 23 weeks which is a drop in the ocean when you consider it is UK wide .

It is the knowing when the baby is suffering and in pain and it must be the hardest decision to ever make as a parent .

I do think it would be too hard now too change the rules from 23 weeks . Now people know that there is a chance that their son/daughter could possibly be helped it would be too cruel to just sit by and do nothing .

A friend of mine had her first daughter at 23 weeks. She always said that whilst the decision not to go ahead with aggressive treatment was the hardest one of her life, the one saving grace was that in making that decision she got to hold her baby daughter in her arms and say goodbye.

I agree with the conclusion of the programme, which was that resuscitating 23 weekers should be an exception rather than the rule.

Also - I think more emphasis should be placed on babies weight and reason for early birth - rather than just gestational age in making the decisions, so that a fixed rule wouldn't work.

I think it's an ethical question not an economical question. IMO you can't put a price on a life, no matter how hard you try. Is it in the best interest of the poor baby born so early and their family to be resucitated and kept alive? Each child should be treated based on their own individual circumstances, not on a blanket policy.

I also think the abortion time limit and medical treatment of babies born at or before 24 weeks are totally seperate and should be treated as such. Hardly any abortions are carried out after 20 weeks AFAIK (not sure on the numbers) and these are usually due to there being something wrong with the foetus.

i find it very hard to contribute to threads like this becuase i can never find the statistics.

hardly any abortions carried out after 20 weeks?

i mean how many is hardly any?

I can't remember but aren't the majority carried out long before? Or am I wrong? My GP told me this long ago when I was considering having one. I can accept if I am. Either way, the abortion time limit and the treatment of very early babies are 2 seperate issues and should be treated as such imo.

Custardo - I think you can have an abortion up to 23 weeks if there is something wrong with the baby but 16 otherwise. I asked a friend who is a nurse.

But someone said up thread that they are carried out up to term, so I am a bit confused.

Anyway as saffy says, 2 separate issues.

Don't be confused.

Termination is possible up to full term for disability.

HFE act of 1990.

i am confused.

apart from disability then, are there any stats on late abortions as a % of overall abortions? ica n't find any

Stats are hard to find custy.

I remember an substantial item about this on the radio but buggered if I can remember the stats.

Just found this but need to read it

it hurts my eyes!

why are these stats so hard to find?

In 2009 331 (5%) abortions after 20 weeks

actually got that wrong

20 814
21 742
22 559
23 1 535

24 and over 136

24		30
25		18
26-27		27
28-31		32
32 and over		29

where is that from?

and what percentage is it of overall abortions?

Someone in another thread about this posted a link to a Guardian article today in which a Professor in Neonatology who was actually involved in the Epicure study suggests statistics given in the programme were misleading.

www.guardian.co.uk/commentisfree/2011/mar/10/premature-babies-price-life

From the article:

Claiming that only one in 100 survives without significant disability is stretching a point, quite frankly," says Neil Marlow, professor of neonatal medicine at University College London and chief investigator of the Epicure study, which compares the survival and outcome of over 1,000 babies born between 22 and 26 weeks in 2006 with those born a decade earlier. "We know from the 1995 data that 11% were surviving then, with half of these ? 5.5% ? free of significant disability. Survival has doubled across the country since then, and it's widely known that survival in 2006 at 23 weeks was 20%, with half of these with no serious disability."

Moreover, in hospitals with the best neonatal intensive care facilities, survival rates are about 30%. His own hospital reported 45% survival rates at 23 weeks ? around half of whom have significant disability, defined as cerebral palsy with motor impairment; learning difficulties with an IQ of less than 70; and, in a small number of babies, blindness or deafness. "I do think parents need to be given data which is really honest," Marlow says. "On a national basis these are not figures that are put in the public domain."

The more I think about it, the more I think the programme could have been much better and was very biased. They stated only one 23 weeker survived to discharge in the 6 months they were making the programme, but they didn't say how many 23 weekers had been admitted. They also didn';t mentioned how many babies had had antenatal steroids as fairly recent evidence has shown they have a benefit even at 23 weeks.

I also wonder how much statistic are skewed by taking into account 23 weekers who get no intervention.

I think also the programme made it seem like the decision to resuscitate/intervene is left entirely up to the parents, but this isn't really the case. Ultimately it is the parents decision, but there are sadly many, many cases where parents fought for intervention only to be refused and left holding their baby to die.

there was a very good discussion on this on Jeremy Vine this week - about an hour in.

Very few abortions are carried out over 24 weeks in theis country, very few.

that's utterly bizarre to have got that so wrong.

fwiw, here is the press release for the show, while inexact, the figures are clear enough.

"Science writer and award winning director Adam Wishart filmed this new one hour documentary over six months in and around a neonatal ward at Birmingham Women?s Hospital
Babies at 23 weeks are born on the very cusp of life ? one week earlier they would normally be considered a miscarriage and left to die; one week later and they would have a good chance of survival.
But for these babies, 9 out of 10 die before they leave hospital. And, of those who survive, three quarters are disabled.
Adam asks whether keeping babies alive at this gestation is medicine at its most pioneering and brilliant or is science pushing the limits of nature too far?
The documentary follows several patients and Adam speaks to medical staff in the unit, most of whom believe that if they were placed in the same situation that they wouldn?t ask for their babies to be resuscitated at 23 weeks. The documentary also interviews an NHS commissioner who is concerned about whether this is a cost-effective use of funds.
Holly is a 23-weeker born by caesarean after her mother Claire contracts a severe infection.
Despite the doctors' best efforts, Holly dies a few hours later.
Simone is the only survivor of triplets. At 10 days? old the doctors begin to worry that she isn?t developing as they would wish. They need her parents to agree that should she deteriorate further then treatment should be withdrawn but her parents feel strongly that everything which can be done should be done to keep her alive. At 18 days Simone?s heart suddenly stops and the doctors try to resuscitate her but she doesn?t survive.
Heather was born 21 years ago at what was then the limit of viability, 26 weeks. She is quadriplegic and can only control the muscles in one arm. She has considered suicide.
Molly was a miracle baby, born in the 23rd week, she's now 11 and loves skiing and trampolining. Her father is an advocate for keeping babies like her alive.
Matilda, born at 23-weeks in May last year, survives a very risky heart operation and leaves hospital at five months, covered in medical paraphernalia. "

Midori, there is not much difference. You say 10% survive with no significant disabilities. That is 90% who don't survive or have such disabilities, ie. 9 in 10.

In an average hospital