Back in the 1970's, I worked at the University of Rochester Medical Center in Rochester, New York. One of my favorite things to do on my lunch break was to wander over to the Neonatal Intensive Care Unit of the associated Strong Memorial Hospital, and watch in admiration as the tiny children fought for their lives. Actually, there were some pretty big infants, too—babies born to diabetic mothers, weighing in at 14 or 15 pounds at birth, but with dangerous complications. My favorites were always the twins, which were commonly born early, and extra small. Not every family had a happy ending, but the best days were when our small "charges" disappeared from view because they had graduated out of the NICU.

I was thinking about this recently because of this story, out of Canada: Doctor Said Mom's Efforts to Save Her Babies Were a "Waste of Time," Now they're 3 and Thriving.

A mom from Canada who went into labor with twins at just shy of 22 weeks gestation was told by her doctor that they would die the day they were born. However, she refused to give up on her babies, and against the odds, her baby girls pulled through, heading home after 115 days in the NICU.

“When I went into labor, the doctor told me, 'The twins will be born today and they will die,'" she said. "I said, 'Excuse me?' and she said, 'Babies this gestation simply do not survive. It’s impossible.' ... She told me she wouldn’t let me see the twins, or hear their heartbeats, because it was a 'waste of time.'"

After four painful days of abysmal care at the unnamed Canadian hospital,

A new doctor entered the room and informed the couple that they could transfer to a London, Ontario, hospital to deliver the twins. ... Luna and Ema were born in London at 9:12 and 9:29 p.m., respectively. Luna weighed just over 14 ounces (approx. 0.39 kg) and measured 11 inches long; Ema weighed 1 pound (0.45 kg) and measured 12 inches long.

The twins were in the NICU for a total of 115 days and were discharged even before their due date. ... Today, the twins are thriving at 3 years old [and] are developmentally caught up to their full-term peers.

Forty years ago, the staff at "our" NICU had told us that they had saved babies born as early as 20 weeks and weighing less than a pound, and expected to continue to improve outcomes and to push the boundaries back. Forty years! I know there has been a lot of progress made in the care of preterm babies since then, primarily from the story of friends-of-friends quintuplets born ten years ago in Dallas.

So how is it that doctors and hospitals are condemning little ones like this to death, and consider 22 weeks' gestation a minimum for survival—and even then only at a few, specialized hospitals. What has hindered the progress Strong Hospital's doctors had so eagerly anticipated?

I can think of a few roadblocks. Number one, perhaps, is that we like to think that progress is inevitable. But there's no little hubris in that. Progress is not guaranteed over time, nor is it consistent.

Then there are funding priorities. Adequate financing may not be a sufficient condition for making progress, but it's a necessary one. Has improvement in preterm baby care been a funding priority over the last 40 years?

And of course there's the most difficult problem of all. Do we, as a society, as a country, as the medical profession in general—do we really want to save these babies? They cost a lot of money: for research, for facilities, for high-tech care, for months in the hospital, and often for special education and care throughout their lives, since babies on the leading edge of the survival curve are at higher risk for lifelong difficulties.

Most of all, does the idea of saving the lives of earlier and earlier preterm babies force us to consider the elephant in the room? How long can a society endure in which we try desperately to save the life of one child of a certain age, while casually snuffing out the life of another child of the same age, based solely on personal choice?

Posted by sursumcorda on Sunday, January 15, 2023 at 3:06 pm | Edit
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