Tough Choices: Should Doctors Provide Care For Preemies Born At 22 Weeks?

With preemies able to survive at much younger ages every year, do you think doctors should be obligated to provide care to preemies born at 22 weeks?

A recent article from the National Post is making waves. Check out the article: Canadian pediatricians recommend letting 22-week-old preemies die. Should doctors try to save the tiny newborns?  This article is heavy, but an important issue that is affecting the care options for parents of preemies born at 22 and 23 weeks.

The article begins with a story about a baby whose mother’s water broke mid-pregnancy. Doctors warn the mother that the baby is too young for care if born before 23 weeks. Four days later at 22 weeks, the baby was born at home and both are taken to the emergency unit. Both mom and baby are given care, but doctors pleaded to take the baby off life support. Babies born before 22 weeks are recommended by the Canadian Pediatric Society to die naturally as they cannot survive without life support and are prone to many additional health issues. The mother resisted, and now today has a happy six-year-old boy with some physical and neurological disabilities.

Related: Raising Awareness about Premature Babies: Stories from the NICU

Should Doctors Provide Care For Preemies Born At 22 Weeks?

In Favor Of Care

Medicine and science have come a long way, but we still have a lot of learning to do. A recent America study by the New England Journal of Medicine found with care 23 percent of these preemies survived and 9 percent survive without even moderate disabilities. This puts the 22-week cutoff for care up to some serious debate when the margin of error for determining gestational age can vary by up to a week. For those of you who do not live with a scientist in your home like I do, this means that a 22-week old baby is in actuality somewhere between 21 weeks old and 23 weeks old. Science cannot pinpoint down the exact point of conception when determining the age of a fetus. (Knowing what night you had an extra glass of wine is not the accuracy scientists need.)

This makes a hard cutoff at 22 weeks tough and your doctor’s approach can vary. Some doctors will give parents the choice of intensive care in the delivery room if the baby is 22 or 23 weeks old. Others will cite the guidelines and allow the baby to pass with the parents naturally. Without intensive care, these children do not survive more than a few hours. Depending on your doctor’s views, the care you receive can vary. Check out what one of our Facebook followers thinks:

I was a premie our facebook

In Favor Of Peace

Advocates in favor of following the current guidelines feel that support for a 22-week old baby is not helpful to parents or children. If the child does survive, they can be left with severe impairments that hinder everyday life. Nurses and physicians can sometimes find it difficult with these cases, as they know they are aiding a child who will spend much of their life struggling. If the child does survive there is a high risk of disabilities such as blindness, cerebral palsy, and other more severe cognitive disorders.

One parent noted it was easier to let the physician make the decision. When given the decision, parents can be left with many feelings of resentment and guilt no matter which decision they chose. Compassion for preemies that are not yet fully formed and look more sci-fi than adorable complicates the issue.

On our Facebook feed even nurses are grappling with this tough choice:

nicu nuse our facebook

Readers, do you think preemie babies who are 22 or 23 weeks old should be placed on intensive care, or should doctors continue to follow the current guidelines?

(Image Credit: Hey Paul Studios)

39 thoughts on “Tough Choices: Should Doctors Provide Care For Preemies Born At 22 Weeks?”

  1. My daughter was born at 22 weeks. I was told she had 0% chance of surviving due to many circumstances on top of her being born so early. She is now a big happy healthy active 10 month old at home. She has no delays . I was told by the Neonatolgists they have never met a 22 weeker like her before , so we were extremely lucky.

  2. This topic is so rough for people with children. I have a dear friend that begged her Dr and hospital to help her with this decision. Thankful she was able to hold on a couple more weeks and after months and months in the NICU her baby girl came home. The baby has some issues but I know my friend would rather deal with some health issues rather than mourn the loss of her daughter.

  3. This is a really tough but important question you pose.  I’m not quite sure what’s my stance on that but it is definitely a conversation that must be had between the parents and doctors.  Certainly they should find a doctor that agrees with what ever their views are. Perhaps if there any clear and visible indicators (beyond the statistics) that the child will be born with impairment and disabilities that are extreme and cause the child suffering they can opt to let the baby pass but if there’s room to believe that a child could live a decent life in spite of a disability then I think the baby deserves a chance. It’s really opt to the parents to figure out where to draw the line. I saw a remarkable man recently online that is living an extraordinary life without his two arms and legs so anything is possible.  

  4. This is a hard conversation. I have to start by saying that I’m not a mother, however I’ve done work in the area of infant mortality and my concern is more complicated. When it comes to mothers and infants of color, particularly African American and Hispanic, care is not always equal to or as thorough as our white counterparts. With the health care disparities and iniquities that exist in these communities already and often due to systematic and stereotypical racisms, I don’t feel comfortable allowing a physical to make the choice about whether my brown baby should live or die. In my mind, I would continually question if this same decision would be made if my baby were white. Would a doctor taking on the role of God decide that a white baby deserves to live more than my brown bundle of joy. Overall, I’d live with whatever decision I make but the decision should be mine and mine alone. It’s bad enough I have to deal with the possibility of not getting the same quality of care as white women, but to think you’re going to decide if my baby is worth saving or killing. Nope, I can’t roll with that one.

  5. This is such a personal decision. For all involved parties. It is important to give all of the pros and cons, then allow the parents to decide the next steps. It is a tough call either way. Not one I feel I would be equipped to make.

  6. There are definitely good arguments on both sides of this. As a student nurse, I was so may tiny preemies, and have had friends with 24 week babies survive and thrive. Ultimately I think it should be left up to the discretion of the parents and their doctor.

  7. Wow! I knew this happens, in the US I think it’s even later. It definitely makes you think. We’ve had 3 m/c and it’s crazy to think a baby that small could survive without extreme measures.

  8. This is a very hard topic, I can see both sides. As a mom we want our kids to live but the doctors have seen the risks and the quality of life for some of these babies. I don’t know that we will ever have the right answer.

  9. Wow, this is so hard to think about. Being a mom, you have so many more emotions when reading this. It makes me think of my own children and what would have happened to them at that stage of the game. I love my boys and couldn’t imagine my life without them.

  10. I’m confused why this is even a question. Should a doctor provide care? Of course they should! Why not? Because it will be harder, take more time to care, and possibly even harder to care for the baby in years to come because they are so behind others…. does that mean they shouldn’t have the right to live. Again, not even sure why this is a question.

  11. It’s a tough call. I was depressed when I had a miscarriage at 15 weeks. I say leave in God’s hand because miracles do happen all the time and you just never know if the child will survive with or without problems. It’s also up to the strength of the parents can they handle it mentally if they didn’t try to do all that they could

  12. This is a heavy topic and wow a bit stressful to even read. My opinion is to give medical help. Like you said medicine have come a long way and continues to do so. I know mothers who gave birth to premies who grow up to be very healthy. I think every baby deserves a chance whether they come at 22 or 40 weeks.

  13. It’s a tough choice to make on for others… I do think parents should make the choice, but I think non-health professionals are often not informed enough about the implications of their choices.

  14. This is a horribly difficult question I hope never to have to answer. I think it depends on the situation, but either way its not an easy one and I don’t think there’s one answer that suits everyone.

  15. Whew this is a tough read for mamas everywhere. That baby no matter how small is a baby. I know that if they could have saved my 14 weeker and fixed his heart I would have had it done.

  16. wow, I am not sure what that would mean not provide care I am not sure what that means. If a baby is born and lives then it is cruel in my eyes not to provide care but it is ultimately up to our Lord whether the baby lives or not

    1. angie- From reading the article “providing care” means providing life support plus any extra medical procedures necessary. Since these are preemies, they are underdeveloped (they need more time to grow!) and usually have extra health issues that go along with that right from the start. These babies would not survive outside of mom without full life support right after being born. Right now the Canadian Pediatric Society recommends babies before 22 weeks of age not receive that extra medical treatment as the survival rates is low. So if you do nothing when these babies are born (no life support or other procedures – which is recommended right now), the baby will not survive. If you do provide life support, the Canadian Pediatric Society is saying that the chance of survival is very low.

  17. I think that once the baby is born that I would want the medical services available to everything they possibly could to give the baby a fighting chance. That is what I would want for my child.

    1. I think the controversy comes from since these babies are so young and underdeveloped, they require much more care and life support then even your average preemie baby. Science has come a long way, and more and more preemies today that are a little closer to their due date are surviving and living happy lives.

  18. Yes Definatley All Babies Deserve A Fighting Chance We Are All Gods Children. I’m Sure There Is Alot Of Debate On This!

  19. that is tough. as a mom who has had a child and lost a child it is a decision that is truly hard and for the parents to decide.

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