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Author Topic: Do not recussitate premature babies before a certain point?  (Read 2915 times) Average Rating: 0
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« on: November 15, 2006, 02:40:22 PM »

I'm not sure how I feel about this... On the one hand, they're taking a pragmatic approach which will probably help the psyches of many parents who otherwise may have been gung-ho about trying to save their very-premature babies (only to have them lost).  On the other hand, setting such rigid guidelines (I know, they're inspired by the statistics and trends) seems very distasteful to me.

Here we go:

http://news.bbc.co.uk/2/hi/health/6149464.stm

'Do not revive' earliest babies

Babies born at or before 22 weeks should not be resuscitated or given intensive care, a report says.

The recommendation is being put forward by the Nuffield Council on Bioethics, which considers ethical questions raised by advances in medical research.

For those born after 23 weeks, the recommendation is that doctors should review the situation with the parents and take their wishes into account.

But doctors warned no two babies born at 22 or 23 weeks would be the same.

The report has been released after two years of research.

It also gives guidance on how parents should resolve arguments with doctors over the fate of their babies.

The report comes against a backdrop of medical advances which have been able to sustain the lives of very premature babies.

However, research shows that many of these babies do not live very long, or go on to develop severe disability.

Part of the problem is that despite advances in modern medicine, it is not always obvious to doctors which babies will survive and thrive.

Professor Margaret Brazier, who chaired the committee that produced the guidelines, said: "Natural instincts are to try to save all babies, even if the baby's chances of survival are low.

"However, we don't think it is always right to put a baby through the stress and pain of invasive treatment if the baby is unlikely to get any better and death is inevitable."

The inquiry also looked at longer-term support for families, and resource implications for the NHS.

But it rejected suggestions that active steps be taken to end life - so-called baby euthanasia - in certain circumstances.

Bliss, the premature baby charity, is campaigning for one-to-one neonatal intensive care, and for decisions to made based on clinical reasoning, and not financial constraints.

The charity said the UK had the highest rate of low birth weight babies in Western Europe.

About 300 babies are born in the UK each year at 23 weeks.

They have a 17% survival rate, compared with 50% for those born at 25 weeks.

Figures suggest that no baby survives at 21 weeks, while only 1% survive to leave hospital at 22 weeks.

Andy Cole, Bliss chief executive, said: "While only a small percentage of infants in the UK are born at 24 weeks or less, it is essential that every baby should be treated as an individual and given the best and most appropriate care at the point of life.

"We strongly endorse the recommendation that assessment of care for the most vulnerable infants needs to be a joint decision between parents and clinicians."

All babies different

Dr Tony Calland, chairman of the medical ethics committee of the British Medical Association (BMA), said much of the report echoed "existing best practice".

But he added: "The BMA believes that blanket rules do not help individual parents or their very premature babies.

"Each case should be considered on its merits and its own context. While we believe that not all patients, including babies, benefit from medical intervention if survival is unlikely, it is important that each patient's circumstances are assessed independently.

"We therefore cannot agree with stringent cut-off points for treatment."

Bert Massie, chairman of the Disability Rights Commission, said: "The decision to treat or not treat should be based on individual assessment.

"To fail to do so would potentially be discriminatory and breach human rights legislation."

There are about 250 units in the UK offering neonatal intensive care, high dependency and special care.

Earlier this month the Royal College of Obstetricians and Gynaecologists said it wanted a discussion over whether "deliberate intervention" to cause death in severely disabled babies should be legalised.

But the report recommends the active ending of the life of newborn babies should not be allowed, no matter how serious their condition.

The Nuffield Council on Bioethics was established in 1991 to examine ethical questions raised by advances in biological and medical research.
« Last Edit: January 05, 2007, 04:06:29 AM by Robert » Logged

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« Reply #1 on: December 28, 2006, 09:37:04 PM »

(bump) No other thoughts on this?
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« Reply #2 on: December 28, 2006, 10:10:26 PM »

I understand the NHS's financial concerns in these situations; however, there is another concern, through these attempts to save these premature babies may always end in falure their treatment does allow for research and advancement of medical knowledge on human gestation. Perhaps the responsibility for caring for these children should be given to the appropriate medical researchers.
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« Reply #3 on: December 20, 2007, 05:35:57 PM »

If no one objects, I'm going to move this to the Family Forum. 

As a new mom, I would be absolutely furious if a medical team didn't do anything to help my baby if she had been premature.  I know if they're too premature there's not a lot you can do if they're just not thriving, but I would be crushed if this happened to me.  And if I were the doctor involved, I would hate to make that kind of decision. 
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« Reply #4 on: December 20, 2007, 06:33:23 PM »

Did any of you read the article about a baby given up for dead that was saved by her mommy?

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=500430&in_page_id=1770

If born premature, or with a life threatening condition, I wil ALWAYS do everything I can to save a childs life.
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« Reply #5 on: December 20, 2007, 06:52:37 PM »

As a new mom, I would be absolutely furious if a medical team didn't do anything to help my baby if she had been premature.  I know if they're too premature there's not a lot you can do if they're just not thriving, but I would be crushed if this happened to me.  And if I were the doctor involved, I would hate to make that kind of decision. 

With the increase in advance directives concerning medical care for terminally ill or persistently vegetative patients, I wonder if perhaps similar directives concerning premature infants will be the next step.  Dealing with what to do with a premature infant is undoubtedly emotionally traumatic; sitting down and thinking through what to do in that event ahead of time would likely help parents with what to do when actually presented with the situation.  I think it would be far less difficult for a person to go back and reaffirm a decision they have already made than to try to think their way through to it in the midst of emotional turmoil. 
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« Reply #6 on: December 20, 2007, 07:29:08 PM »

Did any of you read the article about a baby given up for dead that was saved by her mommy?

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=500430&in_page_id=1770

If born premature, or with a life threatening condition, I wil ALWAYS do everything I can to save a childs life.

Wow, incredible.  It just proves that no amount of medical training can best God's purposes.  And yay for the mom to have the compassion to do that for her daughter!  I totally agree with you, every measure should be taken to save a child's life.
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« Reply #7 on: December 20, 2007, 07:34:29 PM »

Wow, incredible.  It just proves that no amount of medical training can best God's purposes.  And yay for the mom to have the compassion to do that for her daughter!  I totally agree with you, every measure should be taken to save a child's life.

The article made me cry like a little baby. It is simply beautiful. We have lost 4 children at various points in pregnancy. There is no "line to draw" in saving a child. Now, if there are flat brain waves AFTER they have recussitated, that is another story. We would really have to pray about where to go from there. But every effort should be made to save EVERY life.

My second child spent almost a week in the Special care nursery after she was born because of low blood sugars due to a tied tongue, and almost another week when she was 5mths due to severe RSV. I HATE having a child in the hospital. But it is preferable to visit your child in a hospital rather than a cemetary. I would hate myself if there was a chance of survival and I didn't persue it fully.
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« Reply #8 on: December 20, 2007, 07:40:30 PM »

With the increase in advance directives concerning medical care for terminally ill or persistently vegetative patients, I wonder if perhaps similar directives concerning premature infants will be the next step.  Dealing with what to do with a premature infant is undoubtedly emotionally traumatic; sitting down and thinking through what to do in that event ahead of time would likely help parents with what to do when actually presented with the situation.  I think it would be far less difficult for a person to go back and reaffirm a decision they have already made than to try to think their way through to it in the midst of emotional turmoil. 

We're already there.  Before our daughter was born, Mr. Y and I attended a few childbirth classes and one of the many papers we received was a birth plan.  While it wasn't an official advanced directive (which has to be notorized before it's binding), it gave us an idea of what kind of care we could request.  If I remember correctly, we could request of the staff that they take every measure to save the baby or not if she was beyond any hope of recovering.  To me, though, that's akin to having her blood on my head if there was something that could have saved her and we elected not to do it. 

(Edited for grammar.  Wink)
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« Reply #9 on: December 20, 2007, 07:43:37 PM »

Yep, that is part of my birth plan every single time. Although with the next baby, I may not have to do that since I am shooting for a home birth.
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« Reply #10 on: December 20, 2007, 07:47:11 PM »

We're already there.  Before our daughter was born, Mr. Y and I attended a few childbirth classes and one of the many papers we received was a birth plan.  While it wasn't an official advanced directive (which has to be notorized before it's binding), it gave us an idea of what kind of care we could request.  If I remember correctly, we could request of the staff that they take every measure to save the baby or not if she was beyond any hope of recovering.  To me, though, that's akin to having her blood on my head if there was something that could have saved her and we elected not to do it. 

Is that sort of thing commonplace, though, or was your case the exception than the rule?
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« Reply #11 on: December 20, 2007, 07:47:48 PM »

Wow, home birth. You have more courage than I!   laugh
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« Reply #12 on: December 20, 2007, 07:49:28 PM »

Is that sort of thing commonplace, though, or was your case the exception than the rule?

It's commonplace at Sisters of Mercy hospitals (which are Catholic), so I'm not sure if it's an industry standard or if it's just a Catholic hospital thing.  I would think it's pretty common, though.  The paperwork is sort of like a worksheet to get you thinking about what sort of care you'd like so you don't have to make those decisions on the spot.
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« Reply #13 on: December 20, 2007, 07:49:45 PM »

Wow, home birth. You have more courage than I!   laugh

No, not really. I think that women who get epidurals are braver than I am. Three pain med free deliveries. I am TERRIFIED of getting an epi and having to have a cathader. But I have been blessed with really fast deliveries (last one was 1.5 hours "active" labor, and like a minute of pushing). If I need pain meds, I will go straight to general Grin
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« Reply #14 on: December 20, 2007, 07:50:38 PM »

It is common place here in Seattle too. I have instructions in my birth plan to move me off the birthing floor immediately if I have a stillborn child. Being around newborns after losing one would drive me insane. Cry
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« Reply #15 on: December 20, 2007, 07:59:33 PM »

The article made me cry like a little baby. It is simply beautiful. We have lost 4 children at various points in pregnancy. There is no "line to draw" in saving a child. Now, if there are flat brain waves AFTER they have recussitated, that is another story. We would really have to pray about where to go from there. But every effort should be made to save EVERY life.

My second child spent almost a week in the Special care nursery after she was born because of low blood sugars due to a tied tongue, and almost another week when she was 5mths due to severe RSV. I HATE having a child in the hospital. But it is preferable to visit your child in a hospital rather than a cemetary. I would hate myself if there was a chance of survival and I didn't persue it fully.

Oh, I am sorry to hear that.  Sad  I totally agree, there's no line to draw with a child's life in danger.  Until they can make their own medical decisions, it's the parents' responsibility to take care of the child.  I think if I was in a situation where I had to make such a decision I'd wonder for the rest of my life if I didn't allow my child to die needlessly.  My sister's second daughter was born with a hole in her lung and she spent a few weeks in Newborn ICU... it is a really awful thing to have a baby in extended hospital stays, but definitely better than the alternative!
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« Reply #16 on: December 20, 2007, 08:03:01 PM »

No, not really. I think that women who get epidurals are braver than I am. Three pain med free deliveries. I am TERRIFIED of getting an epi and having to have a cathader. But I have been blessed with really fast deliveries (last one was 1.5 hours "active" labor, and like a minute of pushing). If I need pain meds, I will go straight to general Grin

You're lucky!  I was in early labor for three days (yes, days) with contractions 5-10 minutes apart and 4 cm dilated.  I had to be induced and was in labor for 12 hours with 1 hour of pushing.  I got the epidural at the 5th hour in and that was when the pain was so bad I had no concept of time, place, or self awareness.  The epidural wasn't bad at all compared to the contractions!  And the catheter... not a big deal at all.  They did that after the epidural, so I really didn't notice it at all.
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