“And how old is Alec?”
“Just over 4 weeks old, but not yet 28 weeks’ gestation.”
“And he was born when?”
“Ohhhh, on the cusp.”
This was our exchange with the anaesthetist as he discussed with us how he was going to look after Alec. We’d just kissed him for the first time and were about to leave him in an operating theatre, with what looked like about 20 green scrubbed up medical professionals, for a major operation on his bowel. He was very very sick, still weighing less than 1kg, and we didn’t know if he’d survive the operation.
As we left theatre, making our way towards the food court, where we’d wait for the next few hours, we thought again about what had just been said. The anaesthetist had been very kind and well meaning, but we knew exactly what was meant. On the cusp. Of what? Viability.
Viability. A word we heard a lot. The point at which, during a pregnancy, should a baby be born, there is a chance that they could survive. This used to be 28 weeks, but, with advances in medicine, it is now considered to be 24 weeks.
A few weeks before, I had gone into hospital with complications when I was 23+3 weeks’ pregnant. The registrar explained to us that with the contractions I was starting to have, there was a risk of miscarriage. The doctors and midwives were very caring – at one point, in the middle of the night, I was offered the option of a paediatrician visiting me to talk about what would happen if the baby was born, which I declined as I didn’t think that would happen.
As the next day went on, it became clear that 24 weeks was the magic number, and protocol was determined by this. For example, they weren’t “allowed” to give me the steroid injections (which dramatically improve the baby’s lungs) until 23+6. The lovely consultant overrode this and started them at 23+4… I was put on bed rest, trying to get me to Monday when I’d hit 24 weeks and the baby would be considered viable.
The consultant spent the Friday trying to find a hospital that would be able to take both me and the baby – Peterborough NICU is able to care for babies born at 28 weeks’ gestation. The thought was that if I did go on and give birth, I’d already be in the right place and we could avoid an ambulance journey for a tiny baby. Addenbrooke’s were only able to “accept” a baby under 24 weeks if they weighed over 500g. Again, potentially viable if heavy enough. I had a scan and the baby looked well and healthy, and over 500g – Addenbrooke’s agreed to take us. We met with a paediatric doctor who explained that our baby had a 10% chance of survival if it was born.
Alec weighing over 500g (a “hefty” (for a 23 weeker) 714g) meant that a paediatric team was present at the birth to resuscitate and treat him. I’ll be forever thankful that in the weeks leading to his birth I’d had an insatiable hunger for all things sweet and had been dousing my food in sugar and syrup (horrifically unhealthy I know!), unknowingly fattening my boy up and potentially playing a part in saving his life.
Before this happened to us, I had no idea of the vulnerability of a baby who starts to arrive between 23 and 24 weeks’ gestation. At 24 weeks, they are considered viable. Before 23 weeks, my understanding is that generally, there wouldn’t be a paediatric team called for the birth. But between…
“People kept on using the word “viable” all through the time in hospital. To me that didn’t make sense; I’d felt him kick! And now he was still alive…..” (Sam, 5/3/16)
We are under no illusion that we walked a knife edge for those two days. We’re grateful that I was able to get a scan (I was told that we might not be able to on a Friday). Grateful for a wonderful consultant who did everything she could to set us up should the baby arrive, even going against some protocol. Grateful to the midwifery team for looking after me – the quick arrival was a shock to everyone! Grateful to the paediatric team for coming to the birth and saving our little boy’s life. Grateful to Addenbrooke’s for accepting our baby. Grateful to God for looking after us and hearing our desperate prayers…
Yes, Alec was “on the cusp”.