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Babyno4

*sensitive* prem baby - were you asked if you wanted them to be resuscitated?

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Babyno4

Hi,

 

Sorry if this distresses as this isn't my intention but my partner and I have been talking about what happens if this baby is another prem. More so what happens if this one is even earlier.

 

Ds3 was 32weeker so not a micro premmie but the doctor has warned me that this baby might be.

 

So my questions are:

 

What happens if baby is born before this? Do they ask you if you want to resuscitate or do they just do it?

 

At what age does this change? (If it does)

 

My next ob appointment isn't for another 4 weeks and I am now 22 weeks so am starting to wonder what would happen should something happen over the next few weeks.

 

My partner and I were under the impression that before a certain age they won't at all, then the next few weeks its up to the parents then there comes a time when they are legally obligated to but I cannot find any info on at what point this changes from one to the next.

 

If someone could please point me in the right direction or share what they have experienced I would greatly appreciate it.

 

Please note that no distress was intended with this post.

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Mcc1985

I'm sorry to hear that you will be most likely delivering another prem.

 

In relation to your question at the time my daughter was born (2 years ago) we were told 22 weeks if the cusp of when Drs will rescusitate and the only reason they would ask is if there is a high change the baby won't survive or complications for the baby (this could have just been the hospital I was at though).

 

My daughter was 27 weeks but weighed 659g (the size of a micro prem), and it was never discussed she had a good chance of survival so Drs just did everything they could.

 

I would also suggest maybe posting a link to the forum on life's little treasures website as there is a large group of prem mums on there that may have more information.

 

Healthy strong wishes for you and your new baby xx

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.Jerry.

I am pretty sure in Australia, barring other health issues, your baby would be revived from about 24-25 weeks.

My baby was a 27 weeker and I wasn't asked. Even when it was likely she'd be born at 25 weeks it wasn't mentioned.

I do know that another EB-er's baby was born at 26 weeks and she asked them not to resuscitate baby however doctors did. (And child is now a beautiful 11 (?) year old doing well :) )

 

Each hospital probably has its viability rules.

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Dani_R

I saw this episode on Insight last year which looked at the gestation for viability and whether or not to resuscitate. They featured families who had made the decision to resuscitate and the outcomes for their babies, and those who did not. Very interesting but so so heartbreaking.

 

From what I remember, 23-24 weeks was considered the cut-off for viability.

 

http://www.sbs.com.au/ondemand/video/470113859605/insight-edge-of-life

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born.a.girl

Due to my potential health issues (which fortunately never eventuated) I was told even before I got pregnant that there was the possibility that they would do a caesar at 26 weeks, so not far past the technically viable stage.

 

When I expressed astonishment at this (which would have been a 'better out than in' case) I was told that it very much depends on the reason for the prem birth, and that a planned caesar of an otherwise healthy baby at 26 weeks had extremely high healthy survival rates.

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Babyno4

Thank you for all your replies.

 

I suppose for me it's difficult to ge try head around having a baby at 24 weeks and not being asked if I would like them to be resuscitated. As I think my partner and I would choose not to at this gestation. I couldn't find anything at all about if we could choose not to.

 

I know it's a personal decision but for us we are on the same page but I wasn't sure if the hospital would ignore those wishes and continue on anyway.

 

And we have a certain gestation in mind before asking for resuscitation to take place but again I am unsure about what the hospital legally needs to do. I think I might call the hospital on Monday and ask what their protocol is.

 

Thanks you everyone for your replies.

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.Jerry.

I think you will find that at some gestations, likely to be 24 weeks +, doctors are ethically expected to resuscitate.

(barring other health complications)

 

My 27 week poem was breathing on her own at first, only needing ventilation a few hours later when she tired.

 

I have all sorts of issues with the long term health implications of prematurity, however the odds are pretty good from 25 weeks now.

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AKAmum

When I was hospitalised at 22 weeks I was told that if my complications continued they would have no choice but to do a caesarean to save my own life and that the foetus would probably not be viable, just to give me warning I guess but it was heartbreaking to hear. They would only resuscitate/ save the baby if I was past 24 weeks. This was at a tertiary hospital with large NICU. My argument was what if my dates were out by a few days. I also have big babies. At 28 weeks when he came close to being evicted again he was already 1.2 kilos. Thankfully it never came to that though. My luck held out to 37 weeks.

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Babyno4

I think you will find that at some gestations, likely to be 24 weeks +, doctors are ethically expected to resuscitate.

(barring other health complications)

 

My 27 week poem was breathing on her own at first, only needing ventilation a few hours later when she tired.

 

I have all sorts of issues with the long term health implications of prematurity, however the odds are pretty good from 25 weeks now.

 

This is where we are where we are at because we are thinking long term complications around the 25-26 gestation period that's where we are questioning what they do.

 

I guess if we don't have a choice then it won't matter. However from the reasearch I have done it is only a 1/3 chance of have a child with no long term complications that scares us most. For us personally where we are at we just don't think it's a risk we are willing to take on. But if we don't have a choice I guess we will just have to deal with it.

I don't mean to be insensitive at all in any way so I apologise if I have been. It's so difficult to have to even have this discussion let alone find out there is the possibility that you won't even have a say anyway.

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.Jerry.

Look, it is a gamble, but one in which you are more likely to "win" than "lose".

 

Lots of the long term disabilities prems suffer are mild.

 

Lots of them are dealt with by the general population too: ADHD, anxiety, mild hearing loss, vision issues.

The more severe can happen even at later gestations: brain bleeds causing damage, cereal palsy, infections causing intestinal issues etc.

There are no guarantees, but I would gamble on a 26 weeker.

 

It's really not that bad in most cases.

 

Good luck. :)

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Soontobegran

There are many variables and much depends on where you deliver your micro premmie and who is attending to take care of him/her.

There is a vastly different outcome for a teeny baby born in a large tertiary hospital than in a regional hospital.

It also depends on the reason your baby is pre term and whether you've been able to have steroids.

If you have a pre term baby because of prolonged ruptured membranes and you now have an infection then the outcome may be worse than if you just come into spontaneous labour and have an uncomplicated delivery.

If you have pre eclampsia, GD etc then all this affects the outcome for the baby.

 

A 25 weeker born in a tertiary hospital has a survival rate of 90+ %

 

OP the decision for resus will often be made at the time of delivery but personally I have seen 23 week babies do better than 28 weekers.

I would expect there to be active resus of most babies 23-24 plus these days if the parents agreed to this.

 

I had a mum have a 22.1 week little boy in a toilet in the A/N ward one night, he must be about 18 now, it was a shaky start but he was eventually good and this was in a time when outcomes weren't as good as today's.

 

Good luck but have the chat with your doctor.

Edited by Soontobegran
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Riotproof

 

 

This is where we are where we are at because we are thinking long term complications around the 25-26 gestation period that's where we are questioning what they do.

 

I guess if we don't have a choice then it won't matter. However from the reasearch I have done it is only a 1/3 chance of have a child with no long term complications that scares us most. For us personally where we are at we just don't think it's a risk we are willing to take on. But if we don't have a choice I guess we will just have to deal with it.

I don't mean to be insensitive at all in any way so I apologise if I have been. It's so difficult to have to even have this discussion let alone find out there is the possibility that you won't even have a say anyway.

 

You can really drive yourself crazy looking at stats.

 

Given that Dd was expected to be premature, I wanted stats on situations that had the same expectation. They don't exist.

 

From what I know, outcomes for micropremmies are by and large, pretty good.

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Fright bat

It is my understanding that in the absence of other major major conditions or abnormalities, that legally speaking, it is parental choice between 22-24 weeks (that is, at this gestation, parents retain the right to refuse resuscitatation). Whereas there is a legal obligation to resuscitate after 24 weeks. I believe that this is be letter of the law... But that the application of that law is allowed to be quite broad, humane, and takes into account the individual child ie a baby with a major untreatable cardiac or brain problem is under no obligation to be resuscitated.

 

We are lucky in Australia that this is the case. I believe that it is much more absolute in the U.S. (in that parents are less likely to have the right to refuse resuscitation).

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elmo_mum

Depends where in oz u r.

Wa and sa regularly have 23weekers.

Everywhere else 24weeks is the norm for resus at birth.

 

 

Dont read stats

 

it alsodepends on weight, colour, and what the dr thinks.

 

Assumi g you know the hospital where the nicu is, ask them.

Call the num and ask to speak to a dr there.

 

They will assist in making an informed decision

 

 

Btw

Im a mum to a 24weeker i was never asked tge question.

 

A friend who had a 28weeker was askec the question. She said resus.

We are nboth celebrati g our 4th birthdays

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luke's mummu

I have a friend who's baby was born at 23 and 1/2 weeks, and the team did make some attempt to resuscitate her, but after a period of time they requested permission from the parents to stop. Very heartbreaking, but she said they could see the relief on the team's faces when they agreed to stop. Just an extra few days ......

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Feralmummacat

OP I would recommend calling your OB and asking if they could give you the contact details of a Neonatologist to talk to.

 

With DS2 we had a amazing Neonatologist that had the best bedside manner. Four years on he still hugs me every time we see him.

 

With DS2 I started to have contraction at 17 weeks so we had lots of talks about likely outcomes. I know they told me at 17 weeks that they were aiming to get me to 24 weeks but earlier would depend on the doctor, a number of factors with the babies condition and delivery.

 

I went into labour at 29 weeks (exactly) with both DS1 and DS2. They did everything to stop each labour. I ended up having DS1 at 34 weeks and had DS2 at 32 weeks.

 

Each hospital is different. I think if you can, it is best to have the conversations early with your care givers.

Edited by Feralmummacat

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Soontobegran

Depends where in oz u r.

Wa and sa regularly have 23weekers.

Everywhere else 24weeks is the norm for resus at birth.

 

 

Every large tertiary hospital in here in Victoria regularly saves 23 -24 week babies. I would imagine it is the same for NSW and Queensland too.

As I said in PP it depends on the reason for prematurity.

 

eta...It is also worth remembering that many more babies are saved but the battle can be long and hard and some type of chronic illness as a result can be a problem.

Edited by Soontobegran

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Dani

Hi ya.....I'm the Mum that Jerry is talking about above. My case was in NSW. pPROM at 25+3 and delivered Mackenzie at 26+0 / 830 gms. I expressly told the OB's *not* to let her live under any circumstances. I am very pragmatic by nature and I did not want my daughter struggling throughout life. Long and boring story short was, well, they ignored me. LOL They explained that whilst they genuinely appreciated the fact that they had my blessing to 'let her go' they were bound by "Duty of Care" laws and had to be guided by that. For my daughter it was all based on her Apgars. Her first was 2 and her second was 7 so when they got the 7 they went for it and ventilated blah blah blah. So yeah that was my journey anyway.

 

Mac is now 11.5 yrs old, 43 kgs, ladies size 9.5 shoe & tallest in her class/year. Yes she has longterm issues relating to her extreme prematurity but first time (and last time!) in my life I'm grateful I wasn't listened to. (o;

 

Hope all goes swimmingly with #4 and here's hoping 36+ weeks. Everything crossed!

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AmazonBabe

My first, I was hospitalised at 28w with P/E, leading to HELLP syndrome, and baby was severe IUGR. Born at 34w, 1.9 kilos, very smart but significant neuropsychiatric issues and ASD (both of which could have happened without his prematurity though!) Had lactose intolerance, significant bowel issues (constipated for 2 years, on medication etc), asthma. He's now physically healthy but smaller than most, and his ASD/neuropsych issues have him struggling significantly.

 

I then lost my second at 18w (no reason found), but was asked by the hospital when I wanted resus. Again, significant P/E.

 

My third - was told by the doctors to expect significant prematurity, and were asked when we would resus. XH and I agreed at 28w - we didn't want a 24-28 weeker. My cousin was born at 28w almost 30 years ago, and I've seen how his parents have struggled with his significant physical and intellectual issues arising from his prematurity.

 

So, with my third, I got to 24w, then (happily) to 28w, and knew the baby would most likely be ok.

By 32w I was surprised I was still pregnant.

By 36w I was the most pregnant I'd ever been.

By 38w I was SO over being pregnant.

By 40w I was ABSOLUTELY over being pregnant and almost begged for a c/s.

By 41w I was totally TOTALLY over it.

He was born at 41+2 by c/s, weighing 4.68 kilos, happy and healthy. Compared to my teeny tiny premmie, he was amazing.

 

He's now 10, 157cm tall and 53kilos, size 8.5 adult men's shoe. He's massive. And he has significant asthma, suffers regularly from croup, and has hypermobility.

 

So although they tell you you're likely to have another premmie, that's not always the case! And full termers can have significant issues, while premmies don't!

 

Each baby is so different.

 

I wish you all the very very best.

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mumz3

It depends on state in Australia. NSW is 24 weeks otherwise they will not intervene. My son is a 26 weeker, but Pprom at 13 weeks.

 

I was admitted to hospital at 24 weeks and had appointments with the doctors every few days with the stats of what complications i could have and the likelihood of the baby surviving if born on that day.

 

I was asked each time if i wanted them to do everything they could medically including resuscitation or just hold the baby straight after birth

 

It was also explained that after each brain ultrasound that i could also withdraw care if the results were bad

 

I don't know if it was because of PProm that they asked as the odds were not good, but he is now a happy healthy 4 y/o with no complications from Pprom or being prem

Edited by mumz3

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