Reply to Evelyn Muhlhan - another homebirth midwife bites the dust?

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[quote=Anonymous][quote=Anonymous]"I've been musing about what I would do if I were to go into preterm labor. The answer is obvious if the baby were 30 weeks: go to a hospital with a good NICU. My own cutoff for an out-of-hospital birth would be around 36-37 weeks, depending on the particular situation, access to oxygen and a midwife skilled at recognizing signs of respiratory distress or other prematurity-related complications."

"But what about 28 weeks? 26? 24? 22? At what point would I allow the baby to pass on peacefully, rather than attempting heroic efforts at resuscitation with a small chance of survival and high likelihood of major disabilities if the baby were to live? My own gray area is between 24-28 weeks. By time a baby hits 26 weeks gestation, survival rates are between 80-90%, and about 15% of those surviving babies will have major disabilities as a result of prematurity. I think this would be the earliest point at which I would consider intervening."

"Still, survival rates and even major disability rates are not the only practical or moral considerations that I would have to account for. Having a very premature baby, in my own family setting, would mean I would have to commute to a hospital with an advanced enough NICU: probably 40 minutes away and most likely an hour or more. The stresses on our family, the realities of trying to spend my time in a NICU while caring for a nursing toddler, and the emotional and financial drains that an extremely premature baby would entail are all things I'd have to carefully think about."  -From a natural birth blogger

Late to the conversation here. I started my pregnancy under the care of very good CNM and then was transferred to OB/hospital care when my pregnancy got very complicated.  I'm very sympathetic to natural birth and I believe strongly in a woman's right to choose or decline her own medical care.  I'm also the mom of a 29w preemie who is everything to me.  When I read the quote above on a blog it just made me sick to my stomach that someone (and someone who obviously loves and want children) would consider withholding care from a 28w preemie.  I don't quite know where I'm going with this-I guess I do believe in the right of women to choose their own standard of care, but I'm also personally pretty horrified by what some of hose choices look like.[/quote]

But how is this all that different from contemplating what you'd do if you found severe defects at the 20wk sono or an amnio?  Personally, my husband and I agreed that I would carry to term (or it's natural end) any pregnancy that did not threaten MY life, even if the pregnancy itself was not viable.  However, while we did not talk about it, I think we would also consider withholding care in the form of drastic interventions for a birth at 24-25 weeks without some certainty of survival.[/quote]

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