When is viability

He's so frail. No mother or father wants to see their child suffer. Because of the choices I have made I feel he has suffered, and still does.

A premature baby is defined by the World Health Organisation as an infant born before 37 weeks of gestation. For those, such as Nathan, who are born earlier, the odds are far, far shorter.

And with the numbers of overs having babies doubling in a decade and IVF multiple births also on the rise, premature babies are becoming more common. Last year, researchers from University College Hospital, London, found that premature babies were more sensitive to pain. All pre-term babies are more at risk of a lower IQ, poorer cognitive functioning, learning disabilities and behavioural problems such as attention deficit disorder than full-term babies. It makes the area of where to draw the line a difficult one for medical professionals.

Dr Bob Welch, neonatal consultant at the Royal Shrewsbury Hospital, said: "It's uncomfortable for all of us, all of the time. When I first started in this area in , basically babies born at 28 weeks weren't even looked at as possibly viable. Now you expect most babies born after 26 weeks to survive and survive quite well. Some will accept the inevitable, and some will want to push on. Likewise with the babies.

Some come out screaming and demanding to live, others are much more lifeless. Many survivals will come at a cost, but of course all parents are hoping their baby is the one who beats the odds.

For Pearce, Nathan is a much-loved part of her family, a family that against the odds has managed to stay together. She was moved to talk about her situation after watching a BBC2 documentary earlier this month that provoked questions about the resources being poured into neonatal units.

He can always make him laugh and he wants to help care for him, helping to bathe him and change his nappies. It has made him a very kind little boy. But I never wanted him to go through this either.

One day he had a full-time mum and the next I'm at the hospital all the time. He's coped with it so admirably so far. Our lives just changed so dramatically; that's the human cost. Statistics show that many marriages founder under the strain of having a disabled child and of mourning for the child that was expected, but Pearce and her husband have managed to come through it together.

It's not. But you wouldn't put an adult through that. You wouldn't put an animal through it. Eighty per cent chance of survival may sound great but not when taken together with per cent chance of long term serious handicap.

This was Ed Dorman, a consultant obstetrician and gynaecologist at Homerton University Hospital and a specialist in fetal care, quoted in the Telegraph on 3 September. His comments address the issue that tends to be glossed over in discussions about the survival of very premature babies: the degree of morbidity illness or disability these babies may face, when they are born and also as they grow older.

The article by Costeloe et al. The authors concluded that:. Predictors of mortality and morbidity were similar in both cohorts. In other words, while survival of babies born between 22 and 25 weeks' gestation has increased since , 'the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged'.

The authors further note that 'These observations reflect an important increase in the number of preterm survivors at risk of later health problems'. The study found 'improved survival to the end of the first week, with little difference thereafter':. Increased survival in the first week could result in a population entering the second week at higher risk of complications because of the survival of babies who would previously have died.

This is supported by increased reporting of sepsis confirmed by blood culture and necrotising enterocolitis as the primary cause of death in those surviving the first week. The EPICure studies have also closely monitored the progress of those babies that survive to the point where they are able to leave hospital, and grow into toddlers, then older children, then adults: the cohort will now be aged In , Johnson et al.

However, for the remaining 50 percent, the situation is much harder. The EPICure 2 study discussed levels of disability observed in children at the ages of two and three, and compared these findings to those from the cohort. Here again, there is some really good news. In , there were few differences between babies born at 23, 24 or 25 weeks; in , babies born at 24 and 25 weeks now have better outcomes than those born at the threshold of viability.

However, the contrast with babies born at weeks is stark: only a quarter of these extremely premature babies have no impairment at the age of three, and the same proportion has a severe impairment. This indicates that, as with survival rates, improvements in the care of extremely preterm babies have had most impact for those at the upper end of the extreme prematurity spectrum; for those of threshold viability, the prognosis remains very uncertain.

EPICure also points out that 'the proportion of babies who have the most serious problems is similar in in both studies and because the number of babies receiving care has risen that means that the number of children with problems related to their prematurity also has risen. This is very important information as services need to be planned to be able to provide the support that the children and… their parents, need.

Improvements in neonatal care do not reduce the resources required to care for those children who have disabilities as a result of their prematurity; arguably, as more extremely pre-term babies survive, the need for specialised health, care, and educational resources will become greater.

Many countries, Britain included, impose legal 'time limits' on the gestation at which a fetus can be legally aborted. In Britain, this limit is 24 weeks: unless a serious fetal anomaly has been detected, or unless there is a risk of 'grave permanent injury' to the physical or mental health of the pregnant woman, or to her life, in which case it is available up to term. The argument that is often used to justify the week limit is that this is the point at which a fetus becomes 'viable'; therefore, it is treated by law more as a baby than a fetus.

Ninety-nine per cent of all abortions in England and Wales take place at under 20 weeks' gestation. There are a number of problems with using ideas about viability as an argument against abortion. First, as noted above, the situation of a woman going into premature labour with a wanted pregnancy, and that of a woman needing an abortion in the second trimester, are very different.

By the same token, the status of a baby spontaneously arriving too early, and the status of a pregnancy that a woman is still carrying, are very different: legally, morally, and emotionally. The reasons why women need late abortions, and the other arguments marshalled against late abortion, is discussed in a separate briefing.

With regard to often-made media claims that the improved survival of extremely pre-term infants raises questions about the legal time limit for abortion, we should be clear that this is a politically-motivated argument that exploits our very human desire that very premature babies survive and thrive to make us equate abortion with 'killing' born babies.

Yet as the Guardian's Polly Toynbee wrote on 1 September , 'The date at which a fetus might be viable has nothing to do with a woman's right to choose.

Some day an embryo might be reared in a test tube to full term, but that changes nothing for a woman's right not to be a mother. Accidental pregnancy or change in circumstance once pregnant crosses all classes. Abortion is very, very ordinary and a mark of civilisation — liberty for women and every child wanted. In the process, they would deny abortion to the most desperate cases who leave it the latest — the very young or the middle aged who thought they had gone through the menopause.

The callous politicisation of improvements in the survival of extremely premature babies is damaging to women who need abortions in the second trimester of pregnancy.

It is also damaging to the discussion about how we, as a society, best care for very premature infants. By talking up the extent to which survival of very premature babies has improved, and glossing over the actual statistics and the problems that these babies are likely to face, parents of extremely premature babies can be provided with false hope.

Other factors that can affect the survival of very pre-term infants are often ignored. A girl is much more likely to survive than a boy, for instance, and the heavier the better.

If we can give parents an individualised chance of survival, we really would be getting somewhere. John Wyatt is well known for his opposition to abortion — yet he recognises that collapsing together the issues of premature babies and abortion time limits profoundly distorts the terms of the discussions that we need to be having. Meanwhile, those who wish to restrict women's access to abortion in the second trimester of pregnancy need to ask themselves one simple question.

Why would a woman have an abortion at 22 or 23 weeks, if she didn't really need one? Home Contact Us. Book an appointment Call Find a clinic. Book appointment. Toggle main menu. Touch to call us on 30 40 Toggle main menu Abortion care Abortion care Considering abortion? Pregnancy options discussion Advice and counselling What is abortion? Pregnant women naturally produce this hormone on their own.

Some obstetricians prescribe corticosteroids to speed up lung development and prevent other complications in growing fetuses that are at risk of being born early. When and how a fetus gets these corticosteroids in the womb is something that doctors determine on a case-by-case basis. Early evaluation and consultation in our clinic will help you start this process.

Getting medical care early on in your pregnancy will reduce your chances of having a preterm birth. Any woman who is pregnant should have an appointment during the first 12 weeks of her pregnancy, regardless of her chances of having a preterm birth. Your first visit in the Utah Preterm Birth Prevention Clinic should take place between 10 and 18 weeks gestation. This helps doctors estimate your due date and give you a physical exam to identify risk factors, including any risks that are caused by earlier preterm deliveries.

Coming to our clinic when you are 10 to 18 weeks pregnant also lets us detect any inflammation or infection. This will help us lower your chances of having another preterm birth. You could ask your current physician for a referral to our clinic, and we would be happy to see you. For women over the age of 40 looking to get pregnant, it is important to start working with a fertility specialist sooner than later.

The treatment options available become more limited as we age, so finding the right do What You Need to Know About Fertility Treatments: Between Age 35 to 40 If you and your partner have been tying to get pregnant between 35 and 40, you may want to speak with a fertility specialist. The fertility treatment If you and your partner have been struggling to get pregnant, it may be time to consider speaking with your doctor about fertility treatments.

During pregnancy, your top priority is to keep your child safe and healthy.