The recent BBC documentary ‘23 week babies – the price of life’ represented 6 months of filming on the neonatal intensive care unit at Birmingham Women’s Hospital. Brilliantly filmed and produced, the programme powerfully illustrated the conflicting emotions of parents confronted with a baby struggling for life at 23 weeks. Four words came to mind: pain, hope, love, despair. As a mother cuddled the tiny form of her bruised and dying baby she whispered, ‘Little princess – you are so beautiful…’
So our first response should be one of common humanity – to identify with the pain of the parents, and the extremely difficult dilemmas which delivery at the limits of viability raises. But although the programme showed the heart-breaking reality of neonatal death – ‘when hello means goodbye…’, the underlying theme was expressed in stark form by Adam Wishart, the presenter, ‘Is it worth trying to keep these babies alive?’ The opinion of many of the professionals interviewed was clearly ‘No’.
The clinical decision about whether to commence resuscitation in a baby born at 23 weeks’ gestation is complex and multifaceted. These are not easy decisions and they are too important to be discussed by professionals alone. It is right that all of us should discuss and debate the implications. But in addition to the obvious and difficult moral and personal dimensions there are a number of technical and clinical factors, which were not raised in the programme. I have written about these in detail in an accompanying analysis on the CMF website (see here). These include concerns about inaccuracy in measuring gestational age, the fact that outcome figures vary between different neonatal units, and that banning resuscitation at 23 weeks would have an infinitesimal effect on the resources of the NHS.
Is it worth trying to keep these babies alive?
Each baby deserves the best possible care. Yet the decision whether to commence resuscitation or not is complex and painful. In some cases it is clearly right that doctors say ‘enough is enough’. Just because a treatment is available does not mean that it should be used. But if there is a realistic chance that this particular baby can survive without overwhelming and catastrophic injury, then surely as a rich country we owe it to each child to give them a chance of life. In this situation it is best to start ‘provisional intensive care’. We start intensive treatment in order to give each baby the very best chance of survival but we recognise that if it is clear that the baby cannot survive, or if there are catastrophic complications, then we may change our policy and withdraw intensive support.
These decisions are painful and difficult. The programme showed the depth of the pain and distress experienced by parents and by the staff caring for them. But there is no reason for doom and gloom about premature babies. We should celebrate the successes that have been achieved, value the lives of those who have survived against all the odds, whether disabled or not, and look forward to future advances in the care of these vulnerable citizens.
As a society we need to learn to reflect the words of Joseph Pieper: ‘Love is to say to another, “It’s good that you are alive, It’s good that you are in the world”’.
Here is a YouTube link to the BBC’s promotional video for the programme. http://www.youtube.com/watch?v=tcHKHgih-Nk
Posted by John Wyatt (CMF Blog guest editor)
John Wyatt is Emeritus Professor of Neonatal Paediatrics at UCLH. The opinions expressed are his own and do not reflect those of any body or organisation.