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Life at 25 weeks gestation

October 6, 2012

Trigger Warning: sometimes premature babies get really sick. In order to make my point, I get a bit graphic.

So, everyone and their dog seems to be talking about abortion today after our former Hulture Secretary (who presumably hopes that his new job title will save him from accurate spoonerisms) decided that what goes on in other people’s bodies is his business, and not theirs. 

Two of my favourite people to read, Laurie Penny and Zoe Stavri, have both written on the subject this morning, variously on the distraction this announcement provides from the wider attack on the welfare state and the fight that feminists need to engage in, now more than ever. Please read both. Well, on everything, but start with those two posts.

I’d like to talk about the children.

People reading this who know me personally may know that I used to work in a neonatal unit as a secretary. In this position, I got to know quite a bit about what can go wrong with babies. 

The current abortion limits are ostensibly set at the limits of viability. I think this gives the impression that, if a baby is aborted at 25 weeks, you end up with a perfectly formed chubby little cherub, which someone then has to cruelly murder. 

I’ve seen babies born at 25 weeks. I’ve seen the intensive care necessary to keep them alive. Let me tell you a few things about life if you have the misfortune to be born at 25 weeks gestation. 

Before around 23/24 weeks gestation, a fetus’ skin hasn’t developed properly and is gelatinous. This is the absolute limit of viability, because how can you insert a central line for total parenteral nutrution if every time you try to put a needle in, you wreak a whole load of skin? 

By 25 weeks though, the skin is merely extraordinarily delicate, so it can (just about) support the multiple lines and complex breathing apparatus required to sustain life without causing the flesh and musculature to fall away from the skeletal structure.

The lungs, however, are far from finished. Wikipedia doesn’t even give us the figures on how many babies at 25 weeks suffer from infant respiratory distress syndrome. That’s because they all do. Their lungs are not supposed to be working yet.

I remember very clearly an afternoon in my first month on the neonatal unit. I had heard that there was a ’25 weeker’ in intensive care. I had never seen a baby that young, and having not yet typed my first death summary and having only seen the babies on the special care end of the ward, I still kinda thought they were all cute. So I invented an excuse to be down on the ward, go to intensive care and have a look. 

I aged 10 years in as many seconds. 

I do not have big hands, but this baby could have fitted in one of mine. Well, she could have done if it weren’t for all the equipment. There were monitors stuck, ventilators strapped and lines running into every available inch of skin on this child. Except her chest and abdomen. Which were rising and falling twice a second, each time doubling then halving her chest circumference, in a mechanical effort to push enough oxygen enriched air to the few bits of her lungs that were working to keep her alive. When I got back to the office I looked it up and learnt that when when she had been born 2 days earlier, she’d weighed 560g.

But that isn’t the worst thing. The worst thing is their guts. 

A fetus isn’t supposed to have to deal with food. A baby born at term can only really deal with breast milk for the first three months of life, but what do you do if you have a baby born 3 months early? The solution is to give it total parenteral nutrition via a central line to the heart. This provides sufficient calories that they don’t die, but nothing to grow with. In order to grow, they need milk. Orally administered. Now, obviously these babies can’t swallow, so again, a naso-gastric tube is used to pump specially developed preterm formula milk into unprepared intestines. 

My first death summary was a child killed by his intestines. This is the really icky bit. If you feel a bit queazy already, stop reading now.

This child’s guts had rotted within his belly. You could see the black through his skin. There were pictures in the file. No one warned me about this before I opened it. I managed to get to the loo before throwing up. 

And in the middle of all of this trying to keep them breathing and growing stuff, there’s the special monitoring and treatment to ensure that their eyes are not damaged by the early light, the regular cranial ultrasound scans to see if their brains are developing without hideous injuries and the perpetual care to keep surroundings as quiet and calm as possible to avoid too much noise, which can lead to problems later.

But what about the ones who make it, you cry? Surely there are success stories! I see it in my local paper, ‘my miracle baby’ reads the headline. You ever stop to think about the ones who weren’t miracle babies? How many there were? How many anxious months those poor parents had to spend in intensive care, then high dependency units, then special care, then transitional care, then the home visits from the health visitor, then the years of monitoring appointments? 

So, when you talk about medical advances, know what you’re talking about. And remember, in this post, I’ve been talking about a baby born at 25 weeks, a week after the abortion cut-off.

A fetus at 24 weeks is not yet a baby. It is a bundle of cells that might turn into a baby. In a nice warm womb where it is a welcome visitor, it is absolutely likely to turn into one. If it is an unwelcome visitor and the unfortunate owner of the womb has been unable to get the eviction notice before 24 weeks into the stay, it won’t magically overnight turn from a ball of gelatinous cells into a bouncing healthy baby. It’s still mostly a gelatinous ball of cells. 



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