Remember, this information is not direct medical advice.
When you are at risk for delivering prematurely between 22 and 25 weeks it is very hard for doctors to predict outcomes. It is actually difficult to make predictions for preemies in general, but is even harder before 26 weeks. At 26 weeks 85% of babies survive, it is 90% at 27 weeks, and it the odds just continue to improve from there. Although it is not possible to predict which baby will be in the 85% or 90%.
Before 26 weeks there is a wide variability in outcome, with some babies doing very well and others facing immense challenges that lead to profound disability. At this extreme of prematurity it is important for parents and doctors to look at factors beyond gestational age. In addition to how many weeks you are (gestational age) that birth weight, sex of the baby, whether the pregnancy is multiples (twins, triplets etc), and whether the mother received steroids all play a role.
The National Institutes of Health has developed a gestational age calculator, a tool to help identify the chance of surviving and the chance of surviving without a moderate or sever disability. Being at the worst end of the statistics and seeing your baby’s chances distilled to a percentage is one of the worst things in the world. I know. I ruptured my membranes at 22 1/2 weeks. At my sons’ estimated birth weight his chance of survival without severe impairment was in the 1% range, so we elected to only provide him with comfort measures.
The calculator is not a crystal ball, it will not tell you what will definitely happen to your baby, just the odds of survival and of survival without moderate or severe disability.
The numbers may mean different things to different parents depending on life experience, religion, family beliefs, finances, previous premature deliveries, and even the number of children at home. It is not wrong to consider all these options. Raising a child with a profound disability is an incredible life-long challenge and letting your baby go is heart breaking. It is the ultimate Scylla and Charybdis.
If you are between 22 and 25 weeks and want to/need to look up the statistics on outcomes you can use the calculator tool provided by the National Institutes of Health.
Remember, there are no rights and wrongs. We are all writing our own stories. All you can do is gather the information, apply your values, and try and make the best decision for your family. For each one of us that will mean something different, and that’s OK.
Hi Jennifer – Lisa Parker here of Mill Valley, CA. Just came across your site and am mother of 2 preemie sons, not twins. I had a few ideas – I went into preterm labor both times in Lake Tahoe, not sure if you’ve found studies about altitude/dehydration contributing to preterm labor, but I’m pretty sure both of those affected me. I am also wondering (given you work at Kaiser as an ob/gyn) if you might consider taking me on as a patient. I am potentially switching to Kaiser from United PPO and may consider trying for a third, so am interested in Kaiser’s ability to help me through this….would love your advice and to chat or help with your website anytime. I’ve been through a fair amount with my 2 (therapies, failure to thrive, eating issues) and have some Bay Area contacts if you need them…Best wishes, Lisa
Unfortunately, parents are often not given the choices you refer to above. The Sidney Miller case, the Messenger case among others come to mind. The book “Baby at Risk” talks about lack of choices given to parents of extremely preterm infants, with the Baby Doe laws cited as reason. Perhaps it is more d/t parents having good insurance. . .
Hi Lisa. Kaiser has wonderful high risk OBs and I know they use progesterone, close cervical monitoring, and cerclage when indicated to reduce the risk of premature delivery.
I do know a lot about altitude as I practiced in Colorado where most of the altitude studies are done. Overall, the risk of premature labor and ruptured membranes (most common causes of prematurity) is not higher, however, there is more IUGR and that can lead to more indicated premature deliveries. Airplanes are pressurized to about 8,000 feet, probably about as high as Tahoe, and there is no increased risk of premature delivery with air travel that I know of. There may be other factors involved. Often these things are so multifactorial it is hard to know.
I don’t do OB any more so I can’t take you on as a patient! I only do GYN now, and my practice is just for women with pain or vulvar problems (I run a speciality clinic in the city). However, we have some great OBs in the city and 2 wonderful high risk OBs, just hired one away from Stanford and one from UCSF!
Hope that helps.