I will be diving into an aspect of the “Previable Birth” and “ Antenatal Corticosteroid Therapy for Fetal Maturation” articles by ACOG and doing a bit of a deep dive for those interested to read.
I started writing this over a year ago. 2-8-2020 (3-12-21 reflections As I’ve looked over this blog again a little I’ve seen something that’s huge. I found this quote to be interesting because I do not look at anything of ACOG’s from face value but see that they come at it from two views as while maybe factually they sadly have a strong pro abortion anti life leaning so always taking this into account as I read what they write. They state in the article I will state from later on, “ When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Decision making often needs to adapt to changing clinical circumstances before and after delivery. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including both declining and accepting interventions and therapies, based on individual circumstances and patient values.” (https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2017/10/periviable-birth) Some doctors treat the preborn patient regarding the treatment they give the child basing it on what the parents are told of how to view the child’s outcome. This is huge as we see this can be ok for other fields sometimes but it all depends on the intentions of the medical profession of ACOG, which is never usually a pro life position-wish it was, and then also it depends on the mindset maybe the parents and the doctors of what they have been telling either from a pro life or not pro life views told to the parents regarding the outcome of their child and how much they then feel the need to fight. Again though, seeing with another situation that somewhat fits the bill with (Thea’s situation her parents-friends I have) wanted to fight but the medical professionals wouldn’t allow it. I want to understand why are pediatricians not allowed in the delivery room and why at least from the research I’ve done does it sound like they are not allowed to resuscitate the child before viability?) As I’ve been reading the ACOG article about PPROM the consistent theme is the wrong standard of ACOG is they believe that one will and won’t fight for a child simply based on if the child has a health condition. ACOG says in the same article, “Because of the wide range of outcomes associated with periviable birth, counseling should attempt to include accurate information that is as individualized as pos- sible regarding anticipated short-term and long-term outcomes. Nevertheless, it is important to realize that outcomes that have been reported in the medical litera- ture may have some biases because of a variety of factors, including study inclusion criteria (eg, whether studies include all births or are limited to liveborn infants, non- anomalous newborns, liveborn resuscitated newborns, or neonatal intensive care unit [NICU] admissions only), variation in management between centers, and changes in NICU practices over time (eg, administration of ante- partum steroids, resuscitative efforts, NICU admission criteria; see Table 1) (5, 9–11, 15–20). In addition, a precise understanding of outcomes in survivors is fur- ther confounded by differing definitions of “major” and “minor” disabilities used in studies.“(ACOG) This is a valuable quote to realize that there are so many factors that go into it. I do see, yes, we need to inform parents on the stats but I also believe that maybe the doctors should never look at the stats as an excuse to not fight but just fighting for the child because they see them as their patient as well not just looking at the children as statistics but I also see the value in what they say. I see though to my first point the story of Lyla, her story shared on Live Action, who a doctor who never fought for babies at 21 weeks ditched all that he ever knew and fought for this one little girl. (Born at 21 weeks, this preschooler is the most premature baby to survive (liveaction.org)
He did not see her as a statistic who of a child who would die but as a person worthy of being fought for. Again, as I say for the ending abortion topic. “We fight not that they may live but because they are already alive.” This doctor fought for Lyla seeing her personhood and then just fighting for her defying all he was ever told to do to see the personhood of her life and to see a mother’s plea to see her girl fought for, just fought for. Doctors need to fight and parents need to fight no matter what. Again, “We fight not that they may live but because they are already alive.”
I feel that ACOG’s “counseling” to parents is biased as they do not always want the parents’ to fight for their children in the womb. We see the following quotes, “Administration of corticosteroids for pregnant women during the periviable period who are at risk of preterm delivery within 7 days is linked to a family’s decision regarding resuscitation and should be considered in that context.” https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/antenatal-corticosteroid-therapy-for-fetal-maturation