6 November 2006

Let them die?

| johnboy
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The Canberra Times has a story on new guidelines for the ACT which would make it standard practice that “Babies born before 26 weeks’ gestation should not be resuscitated unless the parents request it”.

This would seem to weigh against babies with less educated parents unaware they can insist on treatment.

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Key point here: we’re not talking about a few weeks early. We’re talking about babies that are just past half-baked. They cannot breathe, suck, regulate their own body temperature, their internal organs are still being formed. This is why it is a miracle that any of them actually survive, let alone live a healthy life. A very small percentage do, and it’s wonderful when it happens. But more could be done to prepare the parents of the majority of these extreme premmies for the effect it’s going to have on their life, whether the baby survives or not.

Now, on the topic of education: it makes an incredible difference to obstetric care. Women who are well educated tend to have babies later in life, and choose private health care with an obstetrician. Having babies later means more chance of complications in pregnancy. Choosing a private obstetrician correlates with higher rates of medical intervention (more tests, more inductions, more surgical deliveries). Higher rates of medical intervention often include poor outcomes (eg side effects of drugs, staph infections from hospital) and makes it harder for women to choose natural birth for subsequent pregnancies.

On the flip side, women with lower education levels are less likely to know their legal rights. But not having access to expensive doctors means they’re less likely to have medical intervention that may require them to know their legal rights.

The best place in Canberra to have a baby (based on stats at the ACT Health website that show outcomes and medical intervention rates) is the Birth Centre at TCH. Free under the Medicare system.

Because in these bureaucratic situations, unless you know what you’re entitled to demand, the system tends not to volunteer that information.

Why would parents with less education make a different decision from those with higher education?

bighead how early were you born?
I think it is only in recent years that babies born at under 6 months survived due to modern technology.

bah….that means i may not have been born!!!! I’m fine now 😀

I think its a responsibility to do the best they can to help anyone. Wouldn’t that be an almost underlying factor?

The article also says parents with complications are to be given councelling during the pregnancy – presumably about some of these risks.
I don’t see a problem with the guidelines.
What a tough choice to have to make.

Woody Mann-Caruso9:51 am 06 Nov 06

The ABC has a different spin:

“The authors say that for babies born between 23 and 26 weeks of gestation, it is acceptable medical practice not to initiate intensive care, if parents wish.

Anybody seen the actual guidelines?

On the flip side, higher education goes with the older parent demographic, which increases the chance of pregnancy complications. Add to that the increased likelihood of those parents choosing private obstetric care, which also correlates with higher rates of medical intervention in pregnancy and leads to more intervention in future pregnancies.

Also, have you seen the stats on quality of life for babies born before 26 weeks? It’s scary stuff. It’s a great thing that some survive, but only 25% of survivors have no major health issues. Should parents be put in a position where they have to make a conscious decision to try and save the baby’s life against the odds, or make a conscious decision to allow the baby to die? Either way, the parents are going to be messed up – best thing in those guidelines is that they should be given better counselling.

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