When I write this, I do it with the intention of showing that sometimes things are not always so clear cut when it comes to morals and beliefs.
I will not tolerate hateful or mean comments from this post. If things get nasty in the comments, I will close comments. End of discussion.
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That being said, I had a patient assignment recently that I chose. I have always stood by my belief that life is precious.
As you can probably guess, I recently volunteered to take a patient assignment that was an induction before viability. The baby still was alive with a heartbeat when we (I) began her induction of labor with medication. However, this baby would not survive much beyond the time of birth. The mother was sick, very sick. In all likelihood, she would become even more severely ill if the induction of labor didn't begin when it did. There simply was no chance to be able to "save" both the mother and the baby. The situation was so dire that if we tried to prolong the pregnancy, even for a few more days, it would undoubtedly result in the death of both mother and baby.
So, the induction of labor began.
The birth came rather quickly. The mother was becoming markedly more ill as the labor progressed. However, she made a rapid recovery after the birth. The baby didn't do quite as well. The wee little one passed away peacefully in his father's arms shortly after birth.
Was this the right decision? Should the medical team have done more to prolong the woman's pregnancy? Absolutely not. This woman would have died from overwhelming sepsis if her pregnancy continued for even several more days, much less the several weeks needed to get the baby to viability.
This little baby was going to die either way: either born too soon and succumbing to extreme prematurity; or hovering at the age of viability on a vent, then passing away from systemic sepsis. A prolonged, painful death.
I think the first option for this baby, the one that happened, was a much more humane death instead of prolonging the inevitable. This baby died very peacefully, in no distress, being held by his parents at the end of his life.
His parents mourned his passing greatly. He was baptized before he died. He was loved, cuddled, held, kissed. He was surrounded by peace and love.
This, my friends, is what abortion looks like. It is not always the ugly picture that it is sometimes made out to be. Sometimes, it is a peaceful, loving passing of a life that was destined not to survive for long on this earth.
45 comments:
i am new to the blog experience; actually just started looking at different blogs because i have a blog assignment for school. ( emerging trends in healthcare technologyg)
was touched my this post. I am currently a labor and delivery nurse... so that may be why i was so touched. thanks for describing this in a tender way.
I don't think I've ever seen this described quite so well... excellent job.
You are awesome at what you do -- both nursing *and* blogging. Hugs, AYC.
I agree that in this case, the induction prior to viability was the right choice. However, sometimes abortion is the ugly picture that is depicted.
how can you not expect mean comments? That is usually NOT what abortion looks like.
What a sad experience for the parents to have to endure. But Im sure it was made better by having loving nursing staff around to assist them through this transition.
I will have them in my prayers. Thank you for sharing this experience with us.
Having my 5 day old son laying in my arms and my 2 year old daughter 2 feet away this was a hard one.
Absolutely the right scenerio for this family. They were able to make an informed decision and make preparations for the baby so far as baptism and care in the first and final hours of life.
What a sad but honorable position you got to be in.
This is an aspect of our profession which is rarely appreciated by the lay public. Not every birth is going to be glorious. Not every birth is going to be perfect. I remember, as a very young nurse, how shocked I was when I saw how a doctor managed the birth of a living anencephalic [no brain] infant to make it appear the baby had been stillborn. The mother was given anesthesia just as the infant was born, and the doctor covered the face of the baby with a towel until its screaming stopped. For those of you who know, an anencephalic looks perfectly awful; it cannot live more than a few hours, and if it feels anything, the exposed nerve ends must be registering unbearable pain. The mother eventually saw her baby, of course, carefully wrapped to spare her the sight of the disfigurement as much as possible. But it was a kindness to spare her the worst of the delivery.
No one likes to lose a baby. But a dead mother cannot give birth again in future. It is toughest when, as in AYC's case, the baby isn't yet viable. Fortunately, such situations are fairly uncommon. I've dealt with quite a few, and what the anti-abortion crowd don't realize is that [1] each situation has to be judged uniquely, and [2] it causes distress to everyone concerned, both the medical and nursing staff as well as the parents, but no one can walk away from taking the tough decisions. Theory is one thing, reality another.
Thank you for this! What a beautiful and poignant way to capture the human experience. You acknowledged the emotion and the complexity of the situation but supported the fact that this was the right decision for the family, and a humane choice for the baby.
This is not about politics - it's about individual health care decisions that are very difficult to make. And they deserve to be supported by sensitive and caring nurses like you!
I don't agree that this is what abortion looks like. To me, this is more of what a miscarriage looks like... one that was assisted medically. I definitely agree from your description that it was the right call, and I'm glad he went peacefully and with love. I hope the mother has a speedy recovery and that she and her husband (and family) can start the grieving process without people giving them their opinion, especially if they don't agree with their course of events. Thanks for being such a caring nurse in their saddest hour.
Thank you for providing care to this family at a time when they so badly needed it. And thank you for giving people a picture of what many late term abortions really do look like.
Antigonos,
Babies with anencephaly many times are stillborn, and those who are born alive often die within a few hours, but many live for many hours, even days, months, and in one case I know of, over a year. It is simply horrible and disgraceful that this baby you speak of was left to die in such an inhumane way. We treat animals better than this! I've seen numerous pictures of babies with anencephaly, and the head is always wrapped -- partly to hide the disfigurement, but partly with bandages to keep the head as sterile as possible, to reduce the risk of infection. From the eyebrows down, they look like perfectly normal children. Please don't dehumanize them by calling them "it." This is the sort of barbaric treatment Ina May Gaskin discovered over 30 years ago, when Baby Ira was born on The Farm. They took him to the hospital, assuming the hospital would care for him; instead, they found that the hospital ignored him, gave him no food or water, and were just waiting for him to die so they could dispose of the body. When Ira's mother went to visit him at the hospital and discovered their horrendous "treatment," she took him home and loved him until he died.
Perhaps the baby you spoke of was not screaming because of pain (indeed, most people say that babies with anencephaly cannot even feel pain, although I disagree with that), but he or she was crying for the same reasons that normal babies cry after birth -- wanting his/her mother, comfort, touch, feeling cold, hungry, lonely, etc. Maybe he or she was crying from pain and needed comfort, not being ignored under a towel.
-Kathy
Isn't the term abortion used medically? I know when I had my miscarriage it was referred to as a spontaneous abortion, or when you receive a D&C it can be considered one as well...right?
Either way, this was a beautiful post. I am glad that the mother's life was able to be spared. I hope she heals well and can recover to have more little babies! These parents obviously would have wanted to keep the baby if it was a healthy pregnancy and the mother wasn't at risk.
Beautiful post until I got to the abortion part. I am aware of the medical usage of the term abortion, and I do agree that this story is a great illustration of second trimester loss or abortion. But it is nothing like abortions that happen at clinics, I can tell you that much.
If you haven't read it already, Cecily's story at Uppercase Woman also humanises late-term abortion to save a woman's life http://www.uppercasewoman.com/wastedbirthcontrol/2004/10/home.html; and a father's perspective on a late-term abortion for a condition incompatible with life http://www.daddyfiles.com/2010/07/12/flying-solo-2/
In this case, was there no treatment option? No antibiotic would help...or would the antibiotic also damage the baby? What's normal treatment for the sepsis you mention? Was the baby already dying?
Just a few questions you may not be able to answer for privacy's sake.
I am VERY prolife, and am also aware that women have to abort for ectopic...it's not a typical situation when it's the life of the mother and also no possible way for the baby to live...in my opinion. This is an abortion to save a life, an odd conundrum but it had been a part of medicine for as long as it's been possible to determine the abortion could save mom's life. It's really not about choice in these circumstances but about action. So the political word "abortion" doesn't apply...only the medical term here.
Blessings!
Dawn
Blessings!
Dawn
Bless you, AYC, for helping this family. @ Anonymous: Yes, situations like this have been a part of medicine forever but there are people out there who are trying to outlaw this procedure even when necessary to save a woman's life.
I can't give more details - I apologize. But believe me when I tell you that if we tried anything else to prolong both of their lives - both this mother and this baby would have died. There was no other solution other than inducing labor.
Thanks for writing this, really, I mean it. I have some very strong opinions about this, which I will spare you --- suffice to say the debate around TA contains infinite shades of grey, not the absolutist black and white.
Yet I suppose there are those reading your post who would have prevented this procedure, and killed the mother because for a principle.
I am interested, AYC, in the gestational age, if you can give it.
To the public, abortion means intentional ending of pregnancy. Not to the medical world. There are varieties of abortion: threatened abortion [when there are signs of the pregnancy ending spontaneously, prior to the 20th week of gestational age, but it has not yet happened], missed abortion, when the fetus dies in utero but there are no apparent signs of imminent expulsion of the products of conception; partial and complete abortion, which is defined as the loss of the products of conception; and termination of pregnancy, which is NOT spontaneous and is what the public thinks of as an abortion. Any fetus which is born prior to 20 weeks gestation is "aborted" whether there is medical intervention or not. Technically, ALL births from 20 weeks onward which result in a dead fetus are stillbirths, so the term "late abortion" really isn't accurate.
I agree with your post.
This is a situation that, while not common, probably happens more than people realize.
The case described would make it easier for some people since it was clear that mother's life was at stake.
It can definitely happen in many varying shades of this situation as well... water broken before viability & mother not (yet) sick or not very sick, but high probability of it happening, water broken and already dilated a good bit, broken but not dilated, anomalies incompatible with life, baby otherwise healthy, etc. etc. etc.
Of course things like HIPAA prevent the disclosure of a lot of the details, but this story reads to me like the mother had chorioamnionitis or some other kind of infection in the uterus that would have killed one or both of them if she hadn't had the pregnancy terminated when she did. There are many other possibilities, certainly, (severe pre-eclampsia also comes to mind) but when you have a situation like this one where the mother's life is in grave danger and there's no chance of the baby surviving to viability, then there should be few qualms about a medically induced abortion. Prolonging a pregnancy when you know it's likely to have disastrous effects to both mother and baby is never the right thing to do from the perspective of the health care professional; it goes against the ethical foundations upon which the practices of nursing and medicine are based.
In my opinion it's still sad that a son was lost, but his mother is alive and recovered, not lost to whatever complication that pregnancy posed that threatened her health and life. Yes, it would have been wonderful if both had survived this tragedy, but sometimes that's just not possible. It was far better that they had the chance to love their baby and grieve his loss than to lose two lives attempting to prolong a pregnancy with uncertain outcome.
Such are the problems with trying to make these issues so black and white. Clearly they aren't and never will be. Your compassionate perspective that shines through in this kind of post is often what's missing in the heated debates over abortion; it's fantastic to read here.
AYC I am so glad that you were there for this family.
It makes me ill that people consider this sad situation the same way as they consider abortion by choice.
I had a hard time with the little anencephalic baby scenario too. I'm a former wellborn/post-partum RN..it was possible to keep these babies comfy...and yes..some of them went home.
Thank you so much for writing this...if only my black & white thinking family could lay their eyes upon the love you so gracefully conveyed in your post.
Thank you for serving this family.
This is a horribly tragic situation and as pro-life as I am, I would not consider this 'abortion' in the layman since of the word. In my mind, 'abortion' is intentionally killing a baby, where as in this case the baby was born and died. Yes the family and medically staff induced labor, with the knowledge that this baby would not survive, but they did not kill this baby boy. To me there is a difference and I would have lovingly cared for this family as their nurse in a heartbeat, where as I will not assist with an 'abortion'.
atyourcervix,
Thank you for clarifying that there was no way to save them both. I was curious. I am prolife and still do see that this situation is definitely a time when abortion is permitted. The mother had only two choices here, die or live. From what you wrote, baby was dying too. I don't think asking a mother to sacrifice her life for her child's is fair, nor is asking her to sacrifice her life for a child that will die anyway. I see this like I see tubal pregnancy. At this point there is really no way to save both, so saving one is a duty.
I pray for the mother and father, this has to be so terribly hard. If I were in this situation, it would likely harm me emotionally and mentally to such an extent I may not be effective in my day to day. It's not something I could cope with...the guilt would kill me inside.
Blessings!
Dawn
@Antigonos: I disagree with your comment, "It was a kindness to spare her the worst of the delivery," regarding the anencephalic baby.
My little niece had anencephaly and lived for 59 hours last fall. She was loved and prayed for by her entire family while she was with us. We knew she wouldn't live, but we enjoyed the time we had with her. I know most doctors will say babies with anencephaly can't feel or sense anything, but my niece was calmer when she was in either her father or mother's arms, and she would reach for their hands to hold on to. I don't see how "sparing" that mom moments with her child by anesthesia would have helped her with the greiving process, or how that could be kind in any way! I also am horrified by the fact that doctor covered the face of that baby with a towel instead of having a nurse like AYC provide loving and supportive care to the family during such a hard time.
@AYC: Thank you for a thought-provoking post.
Sorry...there is no "edit" button..
While I think in this case, this was definitely the right thing to do, I don't necessarily agree that 'this is what abortion looks like' - I know it's more a question of semantics than anything. But when you consider that the majority of abortions are performed for matters of convenience, it's not a wonder most of us see terminations in that sense only. What percentage of abortions are *truly* performed for reasons such as this one?
If it was really a medically necessary abortion as you say, then there's no need for justification. A prior commenter said it's hard to make this black and white, but this is one of the few cases in bioethics that does seem black and white.
I agree with what most others have said- I don't agree that this is an abortion in the sense that most of us define as abortion. There were obviously circumstances that led to this couple not being able to save this baby, but the baby was loved and wanted. The majority of abortions that are performed are done so because the baby is not wanted, or not enough to continue the pregnancy (whether for health or financial reasons...etc). I would consider this to be more of a medically-aided miscarriage.
However, I hope that I am never in this situation as the mother, because even given the choice to let the baby die or die myself, I don't think I could make the decision to end the pregnancy myself. I don't feel that it could ever be my decision to make.
Perhaps this is semantics - but this is the same "abortion" that legislation regarding late term termination is trying to ban. Remember that.
Perhaps I'm naive but I thought that abortion{in laymans terms} was the intentional ending a pregnancy where the fetus dies before birth. Am I misinformed? And I thought "late term" abortions would occur after the age of viability. Is that right? I'm not trying to be snarky I just don't understand all the semantics. Anyways this story touched me. Thank you so much for sharing. The little one ended his life with dignity and surrounded by love.
Nik
i applaud your courage and support of this couple through this difficult time. abortion, whether medically indicated or not, is never an easy decision for a woman. thank you for supporting this patient in her time of need. we need more providers like you out there.
p.s. to Nik - late term abortions refer to second trimester terminations, prior to viability. abortions AFTER viability are not legal. late term terminations refer to those between 14-23 weeks. viability starts at 24 weeks.
This was a late term abortion, before viability. After viability (24 weeks), abortion is not legal in my state.
@Nik, In layman's terms, if the fetus dies before birth, it's considered either a miscarriage (prior to 20 weeks) or a stillbirth (after 20 weeks). [There are cases of babies being born alive prior to 20 weeks gestational age [18 weeks post-conception], but it's extremely rare (most cannot survive the birth process) and none have survived to my knowledge, with most if not all dying within a few minutes.] Most of the time when a baby dies before birth, the mother's body will go into labor within a few days of the death, whether that's at 12 weeks, 24 weeks, or 40 weeks; sometimes the body doesn't, and she will have a procedure to end the pregnancy, whether an induction of labor or a D&C.
In medical terms, an "abortion" is any early termination of a pregnancy, whether natural (what ordinary folks call a miscarriage) or intentional (medical and/or surgical).
While post-viability abortions are technically illegal in most if not all states, there are some abortionists who will perform them, because of the Supreme Court's broad ruling of what constitutes a mother's "health" which can even include her financial situation. I've also read several stories of women who were given difficult prenatal diagnoses (their baby had some genetic or physical anomaly), and were pressured by their doctors to abort up until the age of viability, and then were pressured to consent to a "pre-term induction" for weeks thereafter. It may not be a technical abortion at that point, but the end result is the same.
-Kathy
Thank you for being so brave and sharing your story. I don't know if I could have taken such a case.
I was asked if I wanted to terminate my third pregnancy so I can relate to this family. My daughter and I were lucky to have survived.
I don't think the poster that talked about the anencephalic baby meant any harm. She stated that she happened years ago when she was a young nurse ~ she was just repeating a story.
AYC, I too am a L&D nurse and I too have dealt with these situations. It is one of the hardest things we do, but when we do it and we treat the patients with respect and dignity and we cry with their loss, they remember and they appreciate our kindness.
Thank you so much for posting this...
L&D RN from MN
abortions can be termed VTP voluntary termination of pregnancy or STP spontaneous termination of pregnancy...a miscarriage, ectopic pregnancy, blighted ovum are all still considered an abortion in terms of FPAL ( full term/Preterm/Abortion/Living currently)
This is a case that could potentially have resulted in two deaths without some latitude given to health care providers. May we never completely lose that.
Thanks for sharing. Dialogue is so important.
AYC, you said, "After viability (24 weeks), abortion is not legal in my state."
So, what if the mother had developed her complication after 24 weeks gestation? Would this same scenario have played out but been given a different name, like "early delivery," and the baby would have been treated in the NICU? It would not be the case that if they were past 24 weeks gestation, the mother would have forced to continue the pregnancy despite the risk to her health, or would it?
Katherine - everything depends on the specific situation. If the mother's life and health is at stake, her baby would be delivered ASAP, and the baby would get full NICU level 3 care. If the baby had an anomaly incompatible with life, and is beyond 24 weeks gestation, the NICU provider would discuss the pros and cons of full resuscitation vs palliative (comfort) care. Then it would be up to the parents to decide what level of care they want done for the baby.
Tough situation for everyone involved. Thanks for sharing. There's often no outlet for provider or staff grieving unfortunately. I tend to just ball my eyes out on the way home after catching a 'fetal demise' or stillbirth.
I know it has been said, but I think it bears repeating, AYC, I am so glad that you were there to perform this service for this family. Sounds like a heartbreaking and medically scary situation for this family. You are a gift to your patients.
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