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Nebraska’s abortion
law rests on sound justification
By Sean P. Kenney,
M.D.
Editor’s note.
This
op-ed
first appeared in Omaha World-Herald newspaper and is
reprinted with permission. I first wrote about this
tragic case on March 7 (“Baby Elizabeth and the
Pain-Capable Unborn Child Protection Act” at
www.nrlc.org/News_and_Views/March11/nv030711.html).
I read with great
interest and concern a March 7 World-Herald article,
“Heartache shared to help other families.”
Although my heart
goes out to the Deavers, as a maternal-fetal medicine
specialist who has cared for several patients in similar
situations and who testified on behalf of the
Pain-Capable Unborn Child Protection Act, I think it is
imperative to make clear that their understanding of the
facts is wrong.
My comments are
based on the information as presented in the
World-Herald article and another article, in the Des
Moines Register, regarding their case.
Danielle Deaver
was diagnosed with pre-viable premature rupture of the
membranes (Pre-viable PPROM) at 22 4/7 weeks. When I was
a resident at the University of Nebraska Medical Center,
patients with Pre-viable PPROM could not be aborted
because it was not considered to be a lethal condition
and, without clinical infection, was not considered a
significant risk to the mother.
An abortion that
late in pregnancy, without a significant maternal health
risk, would have been against Nebraska law, regardless
of whether the Pain-Capable Unborn Child Protection Act
had been passed.
While the
World-Herald article said there was a less than 10
percent chance of the baby’s survival, over the years of
my practicing I have seen the edge of viability drop
from 24-25 weeks to 22-23 weeks.
Survival at 24
weeks is fairly typical. The baby weighed 1 pound, 10
ounces, about 740 grams. The edge of viability is
usually thought to be around 400 to 500 grams.
Based on an
estimated gestational age of 23 weeks, a female infant
and 740 grams, the National Institute of Child Health
and Development-National Research Network would quote
Mrs. Deaver a 37 percent chance of survival without
profound neurodevelopmental impairment, based on data
prior to 2003.
What most
specialists try to do in these situations is maintain
the pregnancy for as long as possible. If Mrs. Deaver
had delivered two days later at 24 weeks, the baby’s
chance of survival without profound neurodevelopmental
impairment would have increased to 50 percent, 65
percent if she had received steroids.
The major
long-term complication of Pre-viable PPROM, pulmonary
hypoplasia, varies from less than 1 percent to 27
percent of cases and is rarely encountered after 24
weeks, which was only 10 days after Mrs. Deaver was
diagnosed. The American Academy of Pediatricians in its
Neonatal Resuscitation Program recommends resuscitation
of all neonates after 24 weeks (barring known lethal
conditions), regardless of parental wishes.
Tragic as the
outcome was, the pessimism that predicted inevitable
death for the baby was certainly unwarranted. One of my
greatest success stories is a 22 6/7-week infant whom I
wasn’t planning on resuscitating, but at delivery I
heard him cry and ran him to the neonatal intensive care
unit. Several years later, he was helping to translate
for his mother, looking very neurologically intact.
Again, my heart
goes out to the Deavers, and any information presented
in this essay is not intended to criticize them. As I
read between the lines, I think they would have liked to
hear that there were better odds of survival.
They are obviously
still grieving with their loss, and I hope their
suffering eases. However, their situation provides no
basis to challenge a law that was based on science and
basic principles of human rights.
Dr. Kenney is a
maternal-fetal medicine specialist.
Part Two
Part Three
Part Four |
