I'm a neonatologist. How lawmakers misunderstand a baby's viability.

[Jilly_in_VA]

By Dr. Rachel Fleishman, attending neonatologist at Einstein Medical Center Philadelphia

The word “viable” means capable of living. Capable sounds definitive. But as a neonatologist dedicated to caring for premature babies born near the limit of viability, I can assure you it is not.

Under the 1973 Roe v. Wade Supreme Court decision, the concept of viability has served as the dividing line as to when abortion restrictions can be imposed on pregnant women. But the leaked draft of a pending Supreme Court decision suggests Roe will soon be struck down. That means determining viability, and how science has advanced the possibility of viability since Roe, could become a central consideration as legislatures across the country weigh new laws governing abortion access.

I worry about lawmakers who may not understand infant intensive care, and who have not supported parents stressed by extreme preterm births. I worry they won’t recognize the nuances inherent in deciphering viability, and how much survival at the limits of viability relies on access to highly specialized medical care, and how it can vary dramatically from case to case. I worry laws will be out of step with what neonatal care can accomplish, since it does not guarantee neonatal survival and comes with potential life-long complications if these children do survive. I worry that parents’ autonomy to decide whether to have their periviable baby undergo painful intensive care that has a very low likelihood of resulting in survival — and an even smaller likelihood of disability-free survival — is at stake as well.

I witness inherent ambiguity when I cradle babies born at 22, 23 and 24 weeks of gestation in my arms. These babies are periviable, meaning nearly capable of living. Because living outside the womb five months earlier than intended is exceptional, improbable, miraculous. I implore political leaders to familiarize themselves with the risks and question marks in neonatal care, as well as the resources required — as it is invasive, expensive and inconsistently available.

While most women deliver healthy babies, maternal health crises resulted in 7,300 periviable babies born in 2020. For a periviable baby to survive entails preparation, planning, coordination and expertise. Preparation begins with identifying the crises that beget periviable births and making sure these crises are managed at hospitals with experience and expertise in this area. Sometimes a crisis announces itself in a gush of fluid or a gaping cervix or a cluster of contractions so early and extreme they do not stop. Sometimes a crisis hides, as in an illness or injury gripping a pregnant body with insidious instability, forcing obstetricans to weigh the risks of their patient remaining pregnant with the risks of preterm delivery.

https://www.nbcnews.com/think/opinion/roe-opponents-babies-born-limits-viability-rcna27557
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This article should be read OUT LOUD to every anti-abortion senator and congresscritter and Supreme Court justice tomorrow if not sooner.

[drray23]

1. Given that the anti abortionists base their opinion

on dogmatic and religious grounds, reading that would not change a thing for them. I have long learned that you can not win an argument with facts against a magat.

[Ilsa]

2. The antichoice politicians don't care. But it is helpful to

educate the rest of the population.

[intrepidity]

3. The slippery slope rears again

how much survival at the limits of viability relies on access to highly specialized medical care

So many other life-threatening situations result in death for humans of all ages for this very reason, yet the GOP gives not two shits about being "pro-life" then. And these are humans who desperately *want* to be alive.

[LeftInTX]

4. It won't matter. They want NO abortions

Viability is not even a standard for them.

They don't want a pregnancy terminated at 1 week, much less at 22 weeks.

I also think much of this is common knowledge and has been for quite some time. They love those "premie" stories. "Against all odds, this 23 week premie survived".
These stories used to appear on the local news when the baby went home.

I am quite aware of the long term problems, (brain bleeds, cerebral palsy etc) but they don't care.
I'm also aware of prolonged hospital stays etc.

[keithbvadu2]

5. They don't 'need' to understand. They believe they have the legal power.

[erronis]

14. Good picture of Randy Paul. Someone who attached a "Dr" to their name.

Not even as qualified as Oz.

[Beartracks]

6. Should be read as a statement at every legislative hearing on the matter.

==========

[SkylineChili]

7. They don't care. Period.

They don't care about nuance, science, long-term health issues, or impact on families. They don't care. What people who are not privy to the minds of the evangelicals, radtrad Catholics, etc. do not understand, is that THEY DON'T CARE. They care about control. That is all. Making logical or pastoral arguments is a waste of breath. They. Don't. Care.

[halfulglas]

8. So that brings us to a problem these mothers might face.

Because modern medicine says the infant CAN live if born extremely premature, what happens if the periviable baby doesn't survive? Is some busybody going to report this to the police and some prosecutor brings charges of causing the prematurity and thus the death? So many of them may be high risk to begin with. Who is going to pay the medical bills of the mother and the infant?

[LeftInTX]

10. This happens fairly frequently and I don't see the connection to abortion

Mom has a condition that results in preterm labor....

I never heard it framed as an abortion alternative....
Most women in that predicament don't think of that option either....
They're too stressed...

I have heard of "letting babies die" in the delivery room
Performing "no heroics", but I don't think that happens anymore.
But that isn't abortion, that's something else....


There used to be a few telltale body landmarks, but that was 35 years ago.

The technology has gotten better and more intrusive since then.
There is also mandatory electronic charting...

[erronis]

16. I'd suggest delivering the periviable baby to the care of the state immediately.

The child becomes the state's ward and is responsible for keeping it alive.

Heck, if the scrotus thinks that all embryos at 5-10-15 weeks are viable, just deliver said sacks of protein to the back door of the SC. They can nuture and love their little problems. (Not that a single one of them has a lick of nurture in them.)

[Docreed2003]

9. While I totally agree this message should be hammered home

If Covid has taught us anything, it's that these nutters won't listen to any specialist who is trying to share medical expertise because "they did their research" and "their God is greater than your medicine". My apologies for the cynicism

[Alwaysna]

11. Many of these nutters lack understanding how

pregnancy complications happen. For example, you cannot transplant an ectopic pregnancy as has been suggested.

[MuseRider]

12. The babies do not matter, not at all.

It is their way of putting us in our places, what THEY think our places are anyway. We have women in government can you believe it? Women who do not marry so they can just walk away, can you imagine?

This is about us. The rest is candy to pull in different groups.

[Major Nikon]

13. Viability is and always has been an arbitrary standard

Undoubtedly it’s been used to kill and otherwise negatively affect the health of pregnant women when used in public policy to restrict access to reproductive health care. All because too many people believe in attaching metaphysical properties to human protoplasm and injecting mythological nonsense into the debate.

[housecat]

15. I think their inability to understand, or at least listen, precludes any meaningful (or even

meaningless) discussion. An absolutest needs no facts, just something to stand behind like "religion" or political propaganda.

[area51]

17. Possibly the only thing that could change nazi minds on this

is charging them the maternity and birth costs with the world's most expensive healthcare.

[BumRushDaShow]

18. They don't care about "science"

witness the fiasco that was COVID-19 that lead to a million Americans dead.

There was an old term that is obviously still used today for these people - "zealots" (first definition) -

zeal·ot
/ˈzelət/

noun
noun: zealot; plural noun: zealots; noun: Zealot; plural noun: Zealots

1. a person who is fanatical and uncompromising in pursuit of their religious, political, or other ideals.

Similar: fanatic, enthusiast, extremist, radical, Young Turk, diehard, activist, militant, bigot, dogmatist, sectarian, partisan, fiend, maniac, ultra nut

Opposite: moderate

[CaliforniaPeggy]

19. My God! Horrible, horrible, more horrible, most horrible! They don't care is RIGHT. n/t

[NullTuples]

20. Silly article; this is not about the baby, or the pregnant person, or parents. It is about control.

"I worry about lawmakers who may not understand..."

They don't care. They do not understand, and no matter what you say they will refuse to understand. Understanding deprives them of power over others.

[pansypoo53219]

22. don't forget genetic fuckups. my mom had an old medical book w/ photos of DNA soup.

XXX, XXY, XYY etc.