Viability

I just read an article about a petition going to change the viability of an unborn baby from 24 weeks to 22 weeks.  Being that I am a mom of a baby born sleeping at 22 weeks 2 days, you would think I would be jumping in line to sign this, but I am not sure how I feel about it.  I really can't wrap my head around it.

I could still feel Kayla kicking at least 30 minutes prior to her being born.  I know she was still alive then, and since there was nothing wrong with her, just that my body couldn't keep her in where she could safely grow, I believe she was alive up until whatever moment in the birth canal her sweet little body just couldn't withstand the trauma.  So whether she passed one minute before she came out, or ten, I have no idea.  I was in labor for at least 24 hours but I do not know how long my active labor was, I don't know how long I was dilated to ten before she was born.  My water broke about 3 minutes before I started pushing, and she was born at 10:11am with no signs of life.  So I know that at least as of 9:30am, she was still alive.

So it was basically the trauma of being born that killed her.  Her sweet little 1 lb 1.6 ounce body couldn't withstand it.  Had she been born via emergency C-section, would she have made it?  I don't know.  If she was considered viable at 22 weeks 2 days would I have been a candidate for an emergency section so that she could have a fighting chance?  I don't know that either.

In the few minutes she had before I started pushing, my doctor explained that she may or may not be born alive.  I personally know, and know of many babies that were born alive at 22 weeks or even prior, so of course it was not a definite that she would be born sleeping.  But I clearly remember asking, through tears, if there was anything they could do if she was born alive, and she said no, it just wasn't possible.  I love my doctor, and I think she was an amazing doctor and person, so I have no doubt in my mind that had Kayla been born alive, she would have attempted to save her despite her not being viable.

I just cannot see her letting her suffer, or not try when there could be a chance, however slight.  However she told us there was no possibility, because I think she wanted to prepare us for the very high possibility that she would be born sleeping, which she was.  I think had Kayla defied the odds, then she would have resorted to whatever plan B would have been, but I think she didn't even want us to think plan B was possible because it wasn't very probable.

But let's say she had lived, and they were able to save her.  At what cost though?  I am not saying I would not have wanted her if she had problems, or disabilities.  She was my little girl, of course I would have wanted her no matter what.  But I guess what I am trying to say is, just because modern medicine can do some amazing things, should it?  Maybe in our case, or maybe in lots of other cases, the baby could have been saved and went on to live a perfect or almost perfect life with no repercussions of being a micro-preemie.  But what if statistically, it is better to leave viability at 24 weeks?  Isn't there a reason it was set at 24 weeks to begin with?

I hate to talk statistics because when it happens to you, stats don't mean shit.  I don't care if stats show that 95% or maybe higher won't make it at less than 24 weeks, when it was my baby I would have wanted everything humanly possible to be done.  But in the bigger picture, in the best interest of saving as many babies as possible, what if pushing that line too much actually causes the reverse to happen?  Micro-preemies need a level III if not a level IV NICU.  Not every hospital even has a NICU, let alone one to accommodate babies that fragile.  If hospitals are forced to try to save babies as young as 22 weeks, wouldn't that take up valuable resources that are already needed for babies born at 24, 25 and 26 weeks who very badly need the care, but have a better chance of pulling through than a baby born a full four weeks earlier than this baby who was born early?

That sounds cruel and I am not intending it to be.  I don't mean that any one person's baby is more important than someone else's, I am just afraid lowering the viability would cause more heartache and stress that already exists.  A lot of people that signed the petition already say their 22 week, or 23 week or 24 week preemie survived and are now a happy healthy 5 year old.  I think that's wonderful, I cannot imagine how horrible it must have been for them to go through that, but how wonderful for them that their little ones survived and are now thriving.  But how many babies born alive at that gestation do not make it, and simply cannot make it no matter what?

By changing the viability to 22 weeks, is that going to give people a lot of false hope that because their baby was viable at birth, that must mean they will survive and if not, it was the doctor's fault?  When I was pregnant with Emily, I celebrated getting past 22 weeks because that was when we lost Kayla, and I celebrated again when I reached V day at 24 weeks.  My SIL said my brother was so happy when I reached V day and he asked her, so she could come any time now and be ok?

She had to explain to him that while yes, 24 weeks is better than 23 or 22 or what have you, you certainly don't WANT your baby to be born at 24 weeks.  It wasn't a guarantee, just a chance.  For most people, the idea of their baby coming anytime before 37 weeks is terrifying, but in my mind, anything at 30 weeks and beyond was amazing.

The very fact that you hear of babies surviving when born at 21, 22, and 23 weeks is proof that there are doctors who will attempt to save them if they are born alive even though viability is currently 24 weeks.  Believe me, none of these babies born that early are just placed on their mother's chest and make it on their own.  All of these babies that survive is in part by the doctor who did something, who put them in an incubator or intubated them or took other life saving measures.  I don't think it would be going out on a limb to say NO baby born at less than 24 weeks could survive without some kind of medical intervention.

So I feel like keeping the viability at 24 weeks was kind of what my doctor did for us when she told us there was nothing that could be done.  She prepared us for the worst, and the worst happened.  Had Kayla been born alive, I believe with all my heart she would have done whatever she possibly could, I cannot imagine any doctor who has taken an oath to save lives, would just stand there and let a baby suffer because it was born at 23 weeks 5 days.

I think it is best to keep it at 24 weeks, and if born earlier and alive, doctors will likely do what they can anyway.  But by lowering it, it is going to raise people's expectations.  I see lawsuits happening when a micro-preemie cannot be saved, I see parents being put through hell as they fight to save their babies life, but then she dies anyway because there was just nothing that could be done to save them over and above whatever was already done.  I guess in short, I feel that doctors know better than I do.  It would be one thing if doctors delivered a live micro-preemie and said well, he/she is alive, but they are only 22 weeks 3 days so there is nothing I can do, and walked out of the room, but I don't think that is happening.  Of course I cannot speak for any case but my own, but like I said, since there are babies that were born prior to 24 weeks that have survived, or at least survived past birth, obviously there are doctors who are attempting to save them despite how early they were born.

But, if I heard about this two years ago, when I was laying in the hospital about to give birth, would I have been for a viability of 22 weeks?  Most definitely.  It seemed like a cruel sick joke that I was about to lose my baby because she was coming less than two weeks before viability.  But 24 weeks viability was not set by doctors because they felt like choosing an arbitrary number and are too lazy to work on babies younger than that.  It was set for a reason.  If they do succeed in lowering it, would people petition in another 20 years to change it to 20 weeks?

Before I ever got pregnant, my only exposure to child birth was what I saw on TV.  The woman was in labor for however many hours, the nurses assisted her until she was almost ready and then the doctor would walk in, say ok push push and weee, catch the baby as it popped out.  But that could not be further from the truth.  I think my doctor is pretty much the most amazing person on earth.  It only took about ten minutes of pushing, if that, but that entire time my doctor and the nurse worked very hard.  She encouraged me to push when she wanted me to, but then she would tell me to stop and take a break, she would tell the nurse, ok hold on, gently gently, ok Amy stop pushing, ok go ahead and push, keep pushing keep pushing, then she would give the nurse more direction.  Despite Kayla being so small, it wasn't as simple as pushing and out she came.

They had to be careful to get her out the most gentle and easiest way they could.  She was also breech so that added to the complications, and they were trying to be as gentle on her delicate body as they could.  I know that her first priority was to get her our safely for both me and the baby, and on the off chance that she would be born alive.  But even if in her mind, she was 100% sure she was delivering a stillborn, she still treated Kayla with the care and soft touch that she deserved.  She had done this before, she has delivered countless number of babies, and who knows how many of them were with complications or sad outcomes like mine.

Who knows what all criteria she was using to make her decisions, but it was a hell of a lot more than I knew anything about.  All I knew was, I was in a lot of pain, I was scared, I was about to go through the worst thing a parent can go through.  She was sad for me, I know she was, but she was also a professional doing her job.  She knew better than me, that Kayla would likely be stillborn.  She probably also knew that even if born alive, chances were, even with doing everything she could, Kayla would not make it.  So I feel like taking that power from doctors to do what is best for their patients, and give it to the parents who would literally sell their soul to the devil just to make sure their baby survives is sort of an insult to doctors.

I know my doctor did everything she could, and I know she would have done everything she could to save Kayla.  If you don't know what, you probably should find yourself a new doctor.  I think people should be advocates for their own health, but this might be the wrong way to do it.  Now I would definitely be in favor of routine cervix checks, even if the patient has no known reason to have an incompetent cervix.  Of course there are many other reasons a baby could be born that premature, but since my reason could be, and was preventable with Emily, it seems a better option would be to try to stop women from going into pre-term labor in the first place, rather than trying to save a micro-preemie when they do.

In the days before my mom died, her doctor was speaking with us about the next steps.  She had been diagnosed with leukemia, so to any lay person, it would seem chemo would be the next logical step.  But he explained that in her state, he could not ethically give her chemo.  Chemo is horribly hard on the human body, it is hard for people in relatively good health (aside from the cancer of course) who can walk and talk and move about on their own.  But my mom was not ambulatory, she was in a hospital bed....was she in a coma?  I honestly don't know.  It was one of the many things I never thought to ask at the time, or found out since.

I suppose as her family that loved her dearly and did not want her to die, we could have insisted they give her chemo, or maybe found a doctor who would.  But her doctor knew better than we did, he knew her body could not handle it, so he chose to let her die in peace, or give her the chance to recover from whatever was making her non-ambulatory so she could receive chemo; he refused to go the chemo route when it would just put her through torture and probably not be enough to save her.  So I kind of feel like this is similar....just because they can lower viability to 22 weeks, does it mean they should?

Despite everything I have said, I am still not sure of the answer.  I won't be signing the petition because while I am not sure that it shouldn't be lowered, I know I am not sure it should either.  Of course many things could influence my opinion....if this was a year ago, or two years ago.  If this was the days I sat there staring off into space, trying to wrap my brain around the fact that I was no longer having a baby that July, or the many months I spent crying on my way to and from work every day, the days when the pain is so raw that you feel like you cannot breathe, maybe my opinion would be different.

If I wasn't at a place of acceptance that I am today, where the pain is still there but it has just become your new reality; maybe if I was sitting here, still childless except for my angel in heaven, maybe if I wasn't so lucky to go on to have another baby who survived, I would say yes, absolutely lower it.  I feel for these parents.  I feel for them so much when they are told their child likely will not survive because they are not yet viable.  I wish nobody had to go through this, I wish all positive pregnancy tests ended happily.  But they don't, and I can't shake the fact that when I read about the petition, my gut feeling is that it should not be changed.