VIABLE GESTATION - TOO YOUNG TO BE SAVED
When a soap broadcast a heart touching story earlier this month it halted the nation’s attention to something that has been simmering away in the background for a number of years. The need for lowering the threshold of gestation viability to 23 weeks. It has been in and out of the media with many stories of baby who have survived at 23 weeks even when the doctors did not want to try. So, why is it the policy is still yet to be debated and amended to reflect the change in recent years of more and more younger babies living and thriving? Why are they still be considered as too young to be saved? So we asked Vicki Cockerill, mummy to a NICU warrior, this mum has her own outlook on the gestation threshold.
What is viable gestation?
Simply, the term refers to the specific time frame in pregnancy where a baby can be born and have a chance of survival. This is generally recognised as 24 weeks.
To put it into perspective survival rates for premature babies have increased in recent years. More and more premature babies are surviving at a younger age. From 53% in 2006 to 80% in 2011. Survival rates of course increase every week the baby stays inside the womb. More than 80,000 babies are born prematurely each year. Out of 10 pregnancies at least one will be born prematurely. Babies born as young as 23 weeks have a 15% survival rate. That’s 15 babies out of 100 being born at 23 weeks who are now surviving something only a few years ago was unheard of. So why is it, that a postcode lottery is being played with these babies lives. If you give birth to a baby that is only 23 weeks it will normally be down to the hospital’s viable gestation policy if they will intervene or resuscitate the baby. It will depend on the hospital you give birth in. Smaller local hospitals do not have the facilities a level two or three hospital with Neo Natal specialists do. Unfortunately, this means some babies are at a greater chance of being saved than others. Generally, 24 weeks is considered as viable gestation and babies have a 55% chance of survival and 25 weeks+ is rises to 80%. However, if there is the smallest chance, why are we not doing more to intervene? The legislation is dependent also on country, Japan has lowered their threshold of viability due to more and more babies surviving from 22- 24 weeks. Many European Countries have it set as 26 weeks due to the risk of disability and the UK is set at 24 weeks for several years now. Like many things as we evolve, our technology evolves, our medical techniques become more developed surely, we need to reconsider the legislation?
What is extreme prematurity?
Extreme prematurity is the term given to any baby born under 37 weeks’ gestation.
Most of us will get to over 37 weeks and give birth, and think nothing of it. But, for those who do give birth prematurely at 23 weeks or under you are then faced with a whole range of issues. However, if you gave birth just one week later, the baby would be considered viable and full medical support and intervention is provided in a blink of an eye. The NHS have a published patient fact sheet that advises parents at risk of giving birth prematurely at 23 weeks that 2-3 babies out of 10 will survive and half will have a severe to moderate disability. Intervention is provided at 23 weeks at the request of the parents, and if a Senior Doctor/ Neo Natal Doctor feels it is appropriate. Otherwise, ‘comfort care’ is provided,
with no active intervention. In stark reality letting the baby die. As the baby is born under 24 weeks it will not be issued a birth certificate and is classed as a, ‘late miscarriage’. The mother gave birth, lost her baby but they will still not be recognised as being born. These are the hard-hitting issues, so many parents are having to face, including Kym Marsh herself which shows action must be taken. It is not just a soap storyline it is real life. If you would like to sign the campaign to issue birth certificates from 20 weeks onwards and to recognise the birth of these premature babies you can do by visiting; https://www.change.org/p/department-of-health-uk-allow-registered-birth-certificates-for-children-born-from-20-weeks.
There are many things that are considered when deciding whether to intervene medically for a baby born under 24 weeks. It is not just whether that baby has a chance of survival but also their prognosis of thriving too. They may be left with a disability. However, from the medical advances that have been made in recent years so much more could be done. I know this first hand, they saved my child, they repaired his heart. He may have been left with a disability after his stroke, it was something they could not predict but he is thriving. I would have loved him never the less, and I believe every baby should be given the chance to fight. These babies will surprise you, they may have been through more than most do in their whole lives but here they are today, proof of how strong they are. When Elijah was in NICU he was surrounded by premature babies, and we see them now at check-ups, around the local area and you would not even recognise them, walking, talking and just like any other child. The NHS report advises that 2-3 babies out of 10 born at 23 weeks will survive, but out of the 7-8 other babies, how many of them were given the chance to fight? Could more have been done? Would the statistics of survival increase if we provided intervention at 23 weeks as we do at 24? Dependent on location of birth could they have been transferred to a level two or three hospital for a better chance? Was this option even considered or were they written off and given their death sentence?
At 23 weeks, the baby is practising their breathing by swallowing fluid, moving around and recognising sounds at this stage they tend to weigh around a pound. Their heart is pumping blood all around the body. This is a baby, who responds to you, to the outside world so why is it we are still deeming them too young to be saved in many cases? There are some controversial issues associated with lowering the threshold of viability to 23 weeks, it would mean that abortion legislation would likely need considering too. Currently, you are legally able to abort a pregnancy up until 24 weeks, however there must be significant risk to the mother’s mental or physical health or a fetal abnormality. This must be agreed upon by two different doctors. However, in the time where someone like Donald Trump is signing executive orders over women’s reproductive organs whose decision is it to really make and does it need to be changed? That argument, I think is for another day as it is one that needs exploring fully in its own right to do it justice.
There is currently a petition underway to be sent to Jeremy Hunt the Secretary of Health to bring the debate of lowering the threshold of viability to parliament. You can sign this by visiting www.change.org.
Your signature could really make the world of difference to get the support and help all babies born early breathing and showing signs of life deserve. Help spread the word on Social Media, tell a friend, the more we speak of these issues the more we can do to help our future generations. Who is to say a premature baby of 23 weeks isn’t the next Prime Minister, Nobel Prize winner or curer of a terminal illness? Who is to say these babies are too young to be saved when they have proved just the opposite?
Coping with the loss of a baby can be heart wrenching and difficult but you are not alone. These helplines are available for anyone who has lost a baby and offer a support and listening service to those who may want it.
The Stillbirth and Neonatal Death Society (SANDS)
Helpline: 020 7436 5881
The Miscarriage Association
Helpline: 01924 200 799
Tommy’sHelpline: 0800 0147 800