She is absolutely right

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that we don't know all the facts.
Over at Elena's blog, Anne posts this comment:

There is no age of "viability" for my baby. She is not viable. I would give my own life to change that. With all due respect, Alicia is a nurse midwife. Not a doctor, not my doctor, not my priest, councilor, or any other person involved in my care. Nor does she have all of the information in my case. I pray that when I go in, a miracle will take place, and that my baby will be perfect and whole. But you don't know, either, what physical condition I am in, or what risks this presents to me. I am not taking my baby apart, only delivering her peacefully, should that be the ultimate outcome. It has not been yet. And the catholic church does not teach that I should carry my baby if I am at risk.

Thank you for respecting my wishes on my blog. But I'm starting to believe what people say about opnions and everyone having one. I am fiercely pro-life, and would protect my babies rights to the end of the earth, even if she could live only a short time. That is not what we know to be true right now.

I hope your blissful ignorance of your baby turns out great. I wish you all the best. But I wish to GOD people would stop judging my situation as if they know what's going on when they don't.

I only know what Anne chooses to post. I only know what I have learned through my 20 years in OB. I know from experience that there are many ways in which the process of fetal development can go wrong, sometimes horribly wrong. I've personally seen moms with prenatal fetal diagnoses of Exencephaly with encephalocele (Part of the skull missing and the brain protruding into the amniotic fluid), heart outside the chest (can't remember the
long Latin name for that one), total renal agenesis, Trisomy 13, Trisomy 18 and a whole host of other less serious conditions like spina bifida, Down syndrome, clubfoot. I've also seen moms with pretty severe health conditions go through some pretty high risk pregnancies.

But without all the facts, I am not competent to have an opinion on this particular case. That is why my post below was aimed at discussing the general moral and ethical principles that the Church calls on us to follow - and maybe a little bit of a call to all of us, myself included, to be willing to embrace suffering.

I also have a bit of a quibble semantically. Viable is a term that is being tossed around a lot, and it seems that we have some very different definitions of the term. Obstetrically, we usually mean the gestational age at which a baby, if born, might have a fighting chance of survival. When Roe V Wade was handed down, the bottom age of viability was pretty generally held to be 28 weeks, and the stratification of allowable state intervention into a woman's personal decision re: abortion was based at least partly on that. The question being posed (and I think it is a valid one) is "Can a baby who has anomalies incompatable with prolonged extrauterine life properly be said to be viable?" I think that another question that may arise would be,"In the case of a baby with these conditions, does that placenta (and thereby the mother's body) constitute ordinary or extra-ordinary life support?"

Twenty-five years ago I was in the camp that held it didn't make a real difference when in pregnancy one delivered a baby with life-incompatable anomalies. I no longer believe that.

Maternal-fetal conflict is an area of biomedical ethics that I have studied extensively. It covers not only situations like EIFWAIL but also matters like does the court have the right to order a mom to undergo a cesarean for the health of her baby. In reality, there is very seldom a true conflict between the needs of the unborn and the mother, but those rare cases make for anguish and agony all the way around.


The viability issue provokes many questions in my mind. In my personal research, I have found that most states have statutes (or whatever, not sure what the right legal terms would be) outlining "viability" age and defining fetal death, the invisible line between what is considered miscarriage and what is considered stillbirth, which happens to be right around 20 weeks.

Given the same prognosis on the opposite side of that 20 week mark, I wonder if doctors would even *consider* inducing, or if a woman in this case would be urged to try to allow things to happen in its own good time. I don't intend to probe any further into the current situation, but rather reflect on my own loss five years ago at 18 weeks. Straddling that hump, being pregnant with little to no hope for your baby's life, is agonizing emotionally. I don't wish it on anyone. Maybe if I can get my thoughts together in a coherent fashion, I'll reflect at length on Peter's death on my own blog.

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This page contains a single entry by alicia published on February 21, 2005 7:20 AM.

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