23 Week Babies: The Price of Life on BBC2

Television should have times when it is uncomfortable viewing. There should be programmes and moments that challenge us and demand that we reevaluate our most firmly held beliefs. Last night on BBC2 Adam Wishart’s 23 Week Babies: The Price of Life was that programme. My conviction that not only my own son – born just past viability at 24 weeks and doing very well now thank you – but any that emerge the week before deserve the chance of life is not shared by Wishart and this documentary, although not flagwavingly partisan to his idea, explained why.

I’ll leave it to others to challenge Wishart’s statistics. His 9 out of 100 23-week babies surviving doesn’t seem to fit with accepted statistics. Bliss, the premature baby charity, has it at 18 out of 100. Of Wishart’s 9 he says only 1 will not be disabled. When my eldest was on his way into the world we warned that disability was highly likely – we were then told that for recording purposes that disability included the need to wear glasses. And that’s actually before we get to whether being disabled is actually such a terrible thing that we best not switch the support machines on in the first place. The truth about numbers and outcomes may be hard to find but the unchallenged narration (by Wishart himself) didn’t match the evidence he presented in the film – where one in three of the 23 weekers made it home. “The only one I saw in six months” he intoned. But given how few are born nationally one in six months from a single hospital might actually be a reasonable expectation.

There were a few other strands woven in. The overall cost was one. For this we had a bean counter explain that she couldn’t cut expenditure on keeping babies alive without any outcry. Well, fancy. The figure given was £10m. Which sounds a lot but is probably up there the NHS spends on putting air freshener in its consultants waiting rooms. There won’t be a cure found for cancer because funding for neo natal care is cut. (I also missed whether it was explained if this figure was for 23 weeks in Birmingham or for all neo natal care nationally, or a point in between).

Another theme – this one more justifiable – was the lack of support given premature babies, and disabled children and adults more generally – after they leave hospital. It takes a lot of banging at doors and asking questions of care providers – alongside tears, frustration and occasional acts of kindness. Very often it helps if you have the means to go private. And it really shouldn’t. The frustration of the therapist working with older children was understandable, and her wider point about funding for unsexy causes one that should be shouted from the rooftops, but using her as the voice explaining just how damn costly premature babies are – rather than an actual neonatologist – betrayed Wishart’s agenda.

We also had a detour to civilised Holland where they give only palliative care to any child born before 24 weeks gestation. Given the size and difficulties the babies face the duration of this palliative care can be measured in minutes. It’s very supportive and I wouldn’t disagree that it’s well meant and delivered expertly and compassionately. I just hope they have perfect scans in the Netherlands. I know so many people whose dates haven’t been 100% guaranteed – and with my eldest son mentioned above they lopped a week off his gestation after he’d arrived. The machine had been wrong. Such a mistake if it were showing 23+6 rather than 24+6 would be the difference between palliative and intensive care in a Dutch hospital.

Much was made of the issues facing parents and seeing how they struggled with being told what the chances were and what decisions they would face. It brought back memories of similar rooms, similar meetings. But the idea that decisions should be best left to doctors and accountants sits uneasily with me. They are hard decisions. Nobody wants to ever have to make them. But to take them out of parents’ hands is to further deny them the ‘normal’ parenthood that their unplanned and unexpected excursion into the neo natal unit has, at best, delayed.

I’ll ignore quite why the documentary dwelled on why prems come disproportionately from poor people and also why it was felt necessary to tell us that one of the fathers had five children with different women already. I can’t ignore the intrusive camera work which at times went beyond invasive and into insulting. You might think a 23 week baby is little more than a foetus but that is someone’s child and filming their eyes whilst they are dying of heart failure is not a nice thing to do. And then there’s zooming in on a grieving mother’s tears – straight out of insensitive journalism 101.

None of which is to say that this programme shouldn’t have been made or that it’s wrong to debate the rights and wrongs of when and in what circumstances care should be provided. Wishart did well to remove unnecessary emotion from the narration but ultimately it was hard not to feel that Wishart really had made up his mind before he even started filming. In his final comments he said that nobody would deny baby Mathilda the right to life – born at 23 weeks and coming home to loving, relieved parents – and then in the very next line he said that he has come round to believing that the Dutch model is best.

That model would see Mathilda receiving tender, loving care for the minutes she was able to breathe. I don’t exactly see that as the hallmark of a modern society.


7 thoughts on “23 Week Babies: The Price of Life on BBC2”

  1. Thanks for your comment – I’ll have a look over his data (as I need to do for those putting forward counter arguments). I note that he does say that dating gestation is difficult – and this is one of my key issues if you have a fixed cut-off point.

  2. Thank you for your well written article about last night’s program. I have shared it on my facebook page (I hope you don’t mind).

    I’m mother to an ex 24 weeker, now nearly 3, who came through it all comparatively unscathed.

    I was saddened by Wishart’s reporting and felt from the outset that it was skewed toward the suggestion that 23 weekers are practically non-viable, and a drain on the NHS. I have left feedback both on Twitter and on Wishart’s web page to reflect this.

    If you look at this link, it clearly shows he’s used the EPICure study, written in 1994/5. How on earth can this data be used some 17 years later with validity?

    Anyway, once again, thank you for your article.


  3. @queensbishop5 Thank you for your kind comment! I can see that there are also many excellent points made on Adam Wishart’s page so thanks for the link to there.

  4. queensbishop you are one of the lucky ones. Even 18 in 100 surviving is not good odds. I had a 25 weeker, who despite all the best efforts of everyone involved, lived only a few days. If I had the option to go back, I would have let nature take its course, and not put him through all those interventions. On the other hand, my own brother was preemie, due to intrauterine growth restriction, yet has no lasting effects, so I do understand both sides.

    I am now a midwife, and I do discuss these things with my clients when they book in. I don’t do it to distress anyone, I know it is a difficult thing to contemplate. Every mother is entitled to her own decision, however I believe every woman needs to think it through BEFORE it comes to the crunch. We all think that our baby will be born at term, and be perfect – but nature is cruel at times, and women do need to think about what they would do if the worst should happen. It is a very emotional time, and to have to think through the hormonal influences, the emotional response, and then make a rational decision in your child’s best interests is not fair on anyone. Especially if you have no medical knowledge and rely on others, who may or may not give you their own opinion on the matter.

    But, interestingly, here in Australia, neonatal intensive care costs far less per day than adult intensive care – I can’t remember the figure but I think it’s around $4000 compared to $10000 or something. And here in Australia everyone gets care whether they are rich or destitute. So some unemployed, homeless man who’s never had a job and bums off benefits, who is dying of lung cancer from smoking gets ICU – is he any more important than a 23 week preemie who hasn’t had a chance to show the world what they can do? Or the drinker whose liver has failed? Or that woman who had a transplant, then went right back to her drugs and expected transplant number 2, went overseas for a transplant and then died?

    I do not think there has been enough LONG TERM study done on the effects of prematurity. Most follow up until the child is 4 or 5 at most, yet there may not be manifestation of some problems until later.

    There will always be 2 sides to an argument, but for this one – where do you draw the line? If we say ok, we’ll try to save 23 weekers, what about that little 22+6 who just doesn’t make it by one lousy day? What about 20 weekers? When will it stop? Sometimes humans just need to step back and say “ok, this is nature. It’s cruel but we cannot beat nature, no matter how much we want to.” We need to draw a line, no matter how heart-rending and difficult it might be.

  5. @Sooz – thanks for your comments. I’ll leave aside the somewhat sexist nature of your post which seems to go out of its way to exclude fathers from any decision-making about their children but it’s interesting what you say about the costs of adult vs child intensive care. The NHS here sounds similar to Australia in that its free for all users – but the debate is around how much care it should provide in the first place.

    There are some interesting comments about the figures and comments on the Adam Wishart page linked to above – needless to say if you’re heading into 30-45% survival for 23 week babies then I’m in complete disagreement with Wishart who appears to have gone out of his way to manipulate the figures to reach his ‘rational’ conclusion.

  6. My son was born 23+6 weeks weighing 563g on 1st Sept 2016, he is today 24+4 weeks actual age, (8+3 adjusted I.e past his due date) And now weighs 3.71 kg

    He has had a number of infections along the way, And due to being ventilated so long has Sublottic stenosis caused by ventilation tubes (any baby can get from being ventilated for just Prem’s).

    He came home on 18th January 2017 after 139 days in NICU he has had a few appointments to check his airway, but he’s had no operations, And is now longer oxygen dependant

    He had my Brest milk for the first 19 weeks, And boy expressing for that length Of time was hard work, he then had to go into nutriprem 2 as my supply completely went

    My son is proof that 23 weekers do survive and not always have long term illness or Conditions

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