September 9, 2009

"I was sitting there, reading this leaflet about planning a funeral and thinking, this is my baby, he isn't even born yet, let alone dead."

Doctors following guidelines — "If gestational age is certain and less than 23+0 (i.e at 22 weeks) it would be considered in the best interests of the baby, and standard practice, for resuscitation not to be carried out" — answer "No we don't," to a woman in labor who begs "You have got to help."

This story, from Britain, has been a top center link at Drudge for perhaps a day, right under "Daughter claims father wrongly placed on controversial NHS end of life scheme." (Under the scheme, those deemed close to death are deprived of fluids, which "an mask signs that a patient's condition is improving.")

131 comments:

paul a'barge said...

You might want to rewrite that last sentence (the one in the parentheses). It's a bit stilted.

Aaron said...

Darn that reality! It keeps screwing up democrats' spin.

Roger J. said...

While I am sympathetic to the mother's concerns, this story is a non-story. All physicians practice according to guidelines from their respective colleges based on best practices.

Honestly, a 22 week fetus might make it, but only with extraordinary measures and no guarantee of a long term favorable prognosis. I will defer to MDs on this medical issue, but it seems to me this story is nothing but sensationalism. These decisions go on every day in every OB office in the US. The difference, of course, is they are left to the doctor and the family. But the guidelines are there whether enshrined in a NHS bureaucracy or College of OB best practices.

Paul Zrimsek said...

"You're not fooling anyone, you'll be stone dead in a moment."

peter hoh said...

Here's a different story of birth and death. I'm not putting it up to advance a position.

http://www.dallasnews.com/s/dws/photography/2009/thomas/

Laura(southernxyl) said...

There was a time when babies born at 30 weeks were not considered really viable. My nephew, now 13, was born at 30 weeks, and thanks to some aggressive care during his month in NICU, he's just fine.

If we give up on these babies and don't try to save them, we'll never find out what works.

MadisonMan said...

Yet another story on the importance of putting down in writing exactly what you want as you move inexorably towards death.

But the stories make me want to buy the newspaper! How could such an awful thing happen! I MUST purchase this paper to read more!

vw: vencer

garage mahal said...
This comment has been removed by the author.
New York said...

The ruling liberal elites now regard those who believe in the "sanctity of life" with the same condescension that they exhibit to the drinkers of sugary drinks, climate change deniers, etc.

Bissage said...

I stopped wanting to be a veterinarian once it hit home I’d have to put animals to sleep.

garage mahal said...

Also sad are all the comments from Drudge morons. Callous, intrusive, and utterly uninformed. How embarrassing.

ironrailsironweights said...

How life works:

1. We grow old.
2. Our bodies deteriorate.
3. We die.

Nothing in the world is ever going to change that, no matter how enormous the nation-bankrupting amounts we spend on health care.

Peter

peter hoh said...

We can agree that we don't want this kind of policy to be in effect in this country.

At the same time, we need to accept that open-ended promises to cover hospitalization come with a price tag.

rhhardin said...

One size fits all doesn't work efficiently.

I could go into how it's disagreement over value that produces wealth. If people agreed what stuff was worth, we'd all be living in caves today because there would be no trade at all.

Build any economic system on disagreements, not agreements.

In this case, an age cutoff.

Mother pays, no age cutoff, works perfectly, for example. She'll do what she's happy with, and the doctors will be happy with it too. It's magic.

rhhardin said...

Putting animals to sleep never bothered me. It's the form respect for life takes, far from being opposed to it.

You do discover in an hour or so how many times a day you had gotten up from work to visit the dog without noticing it.

On the other hand you're pretty busy contacting breeders and cleaning up the house for a new puppy, which might take a month or so.

Ern said...

This sort of thing is one reason that US infant mortality is higher than that in other countries; our threshold for trying to keep babies alive is lower than other countries'. I don't know the exact gestation period, but we'll try to keep a baby alive who would simply be counted as born dead in, say, France.

Florida said...

Look folks ... it's too expensive and time-consuming to save everyone.

We have to have a democratic conversation and start making some tough choices.

It won't be easy, but we simply can't continue down the road of offering unlimited amounts of health care to children just because they're born a little too early.

We can't keep giving hip replacement to people just because they fell and broke their hips. Just ask Obama about his grandmother and he'll tell you how conflicted he is about whether we should have given her a hip replacement when she fell and broke her hip.

We need to start drugging these people so they'll shut up and stop demanding that we care for them.

It's too expensive and a pain-in-the-ass.

We need change.

rhhardin said...

Walter Williams always tells his organ transplant for money story.

He imagines he dies, and the doctors ask his daughter whether she'd like to donate his kidneys.

She's weeping and says no, she wants Walter to leave the world with all the organs he came in with.

Money isn't the evil it's cracked up to be.

Now imagine it's legal to pay money. A kidney is worth $100,000.

Well, his daughter says, certainly! Do you need corneas too? What can we sell here?

The call screener had secretly lined up his daughter as the next call, and she chimed in with additional organs she'd of his she'd offer.

Pogo said...

Democrats: the Death Party.

rhhardin said...

The problem isn't that the stuff is expensive, but that the consumer is isolated from the additional cost.

The mistake is not letting that cost touch the consumer so that he will make exactly the tradeoffs a one size fits all rule cannot make.

knox said...

Death panels exist. Our media in the States has been utterly derelict in covering this stuff. It should be common sense, common knowledge that gov't health care is both extremely expensive and dangerous.

Yet another story on the importance of putting down in writing exactly what you want as you move inexorably towards death.

MM, I guess I'm not getting your point. What does it matter if the government decides, not an individual or his doctor?

former law student said...

The UK really really sucks. I'm glad we kicked their ass in 1776.

Regarding the stroke patient: how can you sign an advanced care directive to cover every eventuality in advance?

Dogs (and people) stop eating when they want to die.

Putting a dog to sleep is usually the final kindness you can do for them.

Randy said...

This little one was 1 lb. 1 oz. when he arrived prematurely at 24+ weeks. (His twin brother didn't survive the first day.) If you want a good look at reality of premature birth, not statistics, peruse the archive section "On Charlie & the NICU." It tells the story quite well, I think.

Shanna said...

There was a time when babies born at 30 weeks were not considered really viable.

Indeed. Some friends of the family had their daughter very, very early (her mother tried to abort her then changed her mind and then had her early). This was 20+ years ago and would not have been considered viable under any of the current standards, but they managed to save her and she is doing just fine, all these years later. It’s amazing what they can do sometimes. If you just gave up on all these cases, we would not be to the point where babies are saved as early as they are and then standards would not have changed.

knox said...

The mistake is not letting that cost touch the consumer so that he will make exactly the tradeoffs a one size fits all rule cannot make.

YES YES YES

And the more people are exposed to the costs, the more they come down!! It's a lovely system. We all live it every day.

traditionalguy said...

There are a handful of existing end of life Ethics Experts. I talked to one Sunday. She is on the Emory faculty. She talked about "Keeping people under treatment against there will" and she talked about counseling in a Hospice setting after the Patient has been diagnosed as terminal. She sees a need for a new level of comfort that will be socially accepted for a coming Cost Cutting system that will not be the traditional one experienced in America since 1960. But like the early 1900s, when few could afford a Doctor much less teams of miracle medical specialists, there is now planing underway for those old days to to come back to us, whether we like it or not. It is all about control of money folks. By the way, does the new UN world monetary system start this year or next year? The Progressives new rule over us by scary illusions of a Crisis told in faked science stories broadcast as fact by Government media will be coming at us hot and heavy. We will need to hold on to the truth, and not get too tired to resist that pounding of false choices that is about to come our way.

save_the_rustbelt said...

"We can't keep giving hip replacement to people just because they fell and broke their hips."

Usually the fracture is reduced and pinned, if a replacement is done it is because the hip is shattered beyond repair.

Should we let oldpeople lie in bed and writh in agony for years with shattered hips?

(Obama's grandma was dying of cancer)

Nasty, Brutish & Short said...

We'll stop making the point of viability earlier and earlier once is it mandated that doctors aren't supposed to even try.

MadisonMan said...

knox -- what does the old man actually want in this case? There's no information given on that. We know what the daughter wants -- but are her wishes the same as her Dad's?

Maybe I've been reading too much Miss Marple lately. I am suspicious of what everyone says :)

campy said...

With a tip o' the hat to the WSJ's Taranto:

... as former Enron adviser Paul Krugman points out, "In Britain, the government itself runs the hospitals and employs the doctors. We've all heard scare stories about how that works in practice; these stories are false."

PatCA said...

"I will defer to MDs on this medical issue,..."

True, but the doctors are deferring to government guidelines, not their own.

I guess she should just buck up and take one for the collective!

Dust Bunny Queen said...

There was a time when babies born at 30 weeks were not considered really viable

There was also a time when women squatted in the corner of a field, with no medical help, no assistance, no drugs and dropped the baby onto the ground. I also don't believe that 'maternity leave' existed then either.

Bender said...

How is it in one's "best interests" to be dead?

The dead have no interests.

Joan said...

Via The Anchoress, here's a story about a very slightly older baby surviving even after US doctors had given up on her, thanks to skin-to-skin "kangaroo care" from her mother.

Yes, I know, anecdotes are not data, but when it comes to babies, each story is a life. The British mother had a baby who was breathing and lively, and who was allowed to die. The American mother had a baby that failed her Apgar test spectacularly, and yet she lives still.

What was most striking about the UK case was that, at least as reported, there was no mention of an Apgar score or any assessment of the child at all. The only determinant was the time of gestation, which is not so easy to pinpoint, especially within a range of a few days.

Fred4Pres said...

We have to lose a few babies and old people to save universal healthcare.

traditionalguy said...

Did you notice the very interesting method used to cut care costs in near death old folks paid for by the Government. They simply remove fluids. That is the opposite of medical care. That is an intentional hostile act. Then when an old man is miserable from suffering from water deprivation, they propose that he "accept" a morphine drip and they send him to the Death area of their facility. This government hates spending money on an old man's life that could be funneled into the pockets of crooks running the welfare state. Now if a patient was carrying heat, then I bet that he could get his fluids restored and recover. Self defense may be the answer when the government is out to kill you.

traditionalguy said...

I wonder what the British thought of Clint Eastwood's new movie, GranTorino? The British are very docile since no one has a gun over there, except for the youth gangs.

Pogo said...

The fewer unproductive mouths to feed, the better.

That's the motto of socialism.

In the UK, your utility taps out at about $39,000.

Heather said...

I’m going from personal experience. I started to have complication with my first pregnancy while on vacation at 20 weeks and days. The small rural hospital was very specific about the date because they would have had me flown to a bigger hospital because the baby would have been considered viable if I was a few more days along.

garage mahal said...

Yet, in 400+ comments at the Dailymail site you can't find one comment saying they'd trade their system for ours. Maybe it's the fact that 20,000 people die here each year because of no health insurance at all, or the fact that insurance companies here routinely deny close to 20% of all claims that hit their desks. They get paid commissions on the amount of claims denied. This, after premiums have doubled since 2001. Great system! Max Baucus just gave his clients on K Street a copy of his latest draft first, before even the WH. Health care reform is up to 6 members of Congress - 3 Republicans who openly admitted their goal is to halt any reform, and 3 Democrats who are in the back pockets of insurance companies. I mean, seriously, WTF.

Alex said...

I agree a non-story. I really wish Althouse would stop sensationalizing this kind of stuff to prove how horrible NHS is. The NHS is bad enough without distortions.

Alex said...

garage - there is such a thing as being brainwashed. I don't want single-payer just because the Brits have been brainwashed into it. They have no objective reason why it's better.

c3 said...

There will always be a cutoff regarding the effectiveness of an intervention. What is the obligation of a doctor/the health system to provide a therapy that won't make a difference? The great difficult is what happens at the bedside.

Or American corollary to some degree is the anencephalic newborn. The child looks normal from brow down. The newborn can be kept alive for some time but there is no likelihood of long term survival.

downtownlad said...

Infant mortality rate in UK: 4.8 per thousand
Infant mortality rate in US: 6.3 per thousand

And why are we talking of the UK system anyway. Is anyone proposing that we mimic the UK system? Is Ann really that stupid?

I guess so.

Alex said...

Infant mortality rate in UK: 4.8 per thousand
Infant mortality rate in US: 6.3 per thousand


Ah statistics without context. What is infant mortality among African Americans vs the rest of the population I wonder?

Alex said...

I bet Japan's infant mortality rate is even lower then the UKs, but that would be another apples vs oranges comparison as they are single-ethnic.

Salamandyr said...

Overlooked is the allegation in the story about the child that doctors even denied the woman drugs that would have stopped her labor and helped her make the 23 week deadline date.

This wasn't a heartbreaking story of a "borderline case", this was a case of neglect by the very agents of care in their society.

Shame.

former law student said...

I really wish Althouse would stop sensationalizing this kind of stuff to prove how horrible NHS is.

Should the US ever have universal health care, the US, being an English-speaking country, will inevitably have health care identical to that of other English-speaking countries. After all, our cars are no better, our food is no better, our homes are no better, our literature is no better, our movies are no better, our scientists are no better -- the list goes on and on. In all human pursuits, the UK has traditionally set a ceiling that we at best may only aspire to reach.

Salamandyr said...

Infant mortality rate in UK: 4.8 per thousand
Infant mortality rate in US: 6.3 per thousand


DTL, As already pointed out in this thread, at-risk babies like this one are not even counted as live births in Great Britain, while they are here in the US. In other words, we're more honest, and you suck at reading comprehenstion.

Darcy said...

This was not a baby to many in this country. Dead souls.

Pogo: Yes.

downtownlad said...

How lovely that Alex wants African American babies to die. That's also called racism.

downtownlad said...

By the way - here are your stats:

"Non-Hispanic black women had the highest infant mortality rate in the United States in 2004 – 13.60 per 1,000 live births compared to 5.66 per 1,000 births among non-Hispanic white women."

Both are substantially higher than the UK by the way. But the infant mortality rate for African American woman is a direct result of the lack of health insurance. And that's supposed to prove your point how?

Oh that's right - Republicans want African American babies to die. Less Democrats that way i guess.

http://www.cdc.gov/nchs/PRESSROOM/07newsreleases/infantmortality.htm

Jason said...

Can we have his liver, then?

downtownlad said...

Life expectancy in UK: 79.01
Life expectancy in US: 78.11

Facts are stubborn things.

http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

Chase said...

I will defer to MDs on this medical issue, but it seems to me this story is nothing but sensationalism. These decisions go on every day in every OB office in the US. The difference, of course, is they are left to the doctor and the family. But the guidelines are there whether enshrined in a NHS bureaucracy or College of OB best practices.

And yet Roger, you do not address whether or not this is the ethical, moral, or right way to do this.

Chase said...
This comment has been removed by the author.
downtownlad said...

Our life expectancy is lower than the country of "Wallis and Futana". I never even heard of Wallis and Futana. . .

Synova said...

"Yet, in 400+ comments at the Dailymail site you can't find one comment saying they'd trade their system for ours."

Do you think, perhaps, that they've been told horror stories about our system just like we hear horror stories about theirs?

I wonder, if someone did a survey, how many people in the UK believe that, oh, infant mortality in the US is actually higher? Or that people are turned away from our hospitals to die?

Who would say they wanted that?

downtownlad said...

We're lower than "St. Helena" too. Another country I never heard of.

We're even lower than Puerto Rico!!!!!

downtownlad said...

And we're lower than "Saint Pierre & Michelon". Yet more countries I've never heard of . . . And "Guernsey" too. Sounds familiar, but not too familiar.

And I thought my geography was pretty good.

Darcy said...

Synova: Just a guess..but I think someone here believes that. ;-)

Michael Hasenstab said...

You have to see this for what it really is. Dead people increase the Dems voter base.

It's worked in Chicago for decades.

Roger J. said...

DTL: your statistics are meaningless from an epidemiological standpoint. Why? the heterogeneity problem that comes with a diverse population. You have to disaggregate the data and compare like groups to like groups.

Chase: You are right. I did not make a moral judgment. That judgment in my opinion is best left to the parents in consultation with their doctor. Its is an intensely personal decision and it would not be my place to pass judgment.

downtownlad said...

We're lower than the "Faroe Islands" too. I've heard of them, but quick - where are they located? No cheating.

downtownlad said...

Actually Roger, the United States has one of the highest gdp's per capita in the entire world. We shouldn't be behind any of these countries.

You might be find with being number 50 in the world. I think it's pathetic.

Jason said...

downtownlad: Fat, drunk and innumerate is no way to go through life, son.

Your grasp of statistics is worse than useless.

Michael McNeil said...

How life works:

1. We grow old.
2. Our bodies deteriorate.
3. We die.

Nothing in the world is ever going to change that, no matter how enormous the nation-bankrupting amounts we spend on health care.



How days pass:

1. The Sun rises.
2. Daylight wanes in the afternoon.
3. The Sun sets.

Nothing in the world is ever going to change that….

And yet suddenly there's a great blaze of light blossoming in the sky — a supernova, followed by no more sunrises and sets — and then later, people far across the galaxy read of star “PSR B1257+12 [which] is still the only burned-out corpse of a dead star known to have a planetary system. […] The masses and relative positions of the three planets are ‘shockingly similar to our inner solar system.’”

Shades of Arthur C. Clarke's most poignant short story “The Star”!

Sometimes things do change and happen differently for the first time ever — and that may indeed occur not only to the Sun (ending our sunsets) but on Earth, to human life itself, for us or our children or grandchildren.

Because there's nothing about the nature of life that says that we must die — indeed life is fundamentally capable of repairing and restoring itself, if only we learn how to train our bodies to do so. Someday we may do just that, and then — like all those folks who, prior to the middle of the last century, thought men (life) traveling to the Moon for the first time in the 4.6 billion year history of life on this planet was mere “science fiction” — many people who believe and make confident assertions like that at top, simply because that's the way things have always been, may well be proven quite wrong.


Reference: Robert Irion, “The Pulsar Menagerie,” Science, Vol. 304, Issue No. 5670 (Issue dated 2004-04-23), pp. 532-533.

XWL said...

Like crime statistics, health statistics when comparing different countries aren't as comparable as they first seem.

As others have pointed out, when it comes to infant mortality, few countries (and none in Europe) count infants the way the United States does.

In the UK, only 'live births' count. They do not count still births or other complications, even during labor at a normal term against their infant mortality rates. Here in the United States, any attempted delivery, even for a very premature birth counts as an infant.

That difference in counting also partly explains the differing health expectancy rates on the other end of life between Europe and the United States. It also stands to reason that states with nationalized, bureaucratized, socialized medicine might massage their numbers to make their health service seem like a worthy investment. It's pretty damn easy to lie with statistics. Or do folks really believe that people live longer and healthier in Cuba, or that the plummeting life expectancy in Russia compared to the Soviet Union only has to do with the stresses of attempting to adopt a market economy?

When comparing apples to apples, I bet our life expectancy, and more importantly, our quality of life in the 'sunset years' is superior to what you find in Europe

Remember when tens of thousands of oldsters died cause of ,by our standards, a mild heatwave? A few weeks of temps near 100 is rough, but not like that doesn't happen in one region of the US or another every year, and when you get more than 30 or 40 deaths it's big news, yet in Europe between 35-50,000 mostly elderly die in 2003 and somehow that doesn't reflect poorly on their health system.

Joe said...

Nearly half (46 percent) of infant deaths to non-Hispanic black women and 41 percent of infant deaths to Puerto Rican women were due to preterm-related causes of death. The percentage was somewhat lower for other race/ethnic groups

From CDC report. Note that in many first world countries, none of these would be counted on infant mortality statistics.

Life expectancy in UK: 79.01
Life expectancy in US: 78.11


Life expectancy in Hawaii: 80.0
Minnesota: 78.8
Utah: 78.7

Once corrected for the infant mortality rate, all three of the latter would be higher. (I would like to see life expectancy after age 1, but couldn't find such a chart. I did find a chart that showed the US was way ahead of Germany when using a baseline of 70. Also the death rate due to accidents and firearms is higher in the US. It would be interesting to see that worked into the numbers. (In Utah, if you factor out Hispanic and Indian mortality, I suspect the number would also go up.)

Oh and Andorra: 82.51

And the UN puts UK at 79.4. "Facts" are tricky things.

* * *

All that aside, it is clear that mortality rates amongst blacks is much higher than whites. In some categories of non-accident/homicide deaths it is astronomically higher. Rather than make a knee jerk response of revamping the entire health system, perhaps we should first understand the reasons behind these rates. (Is there a genetic factor in this? In other words, are blacks whose ancestors came from one part of Africa more prone to specific types of maternal complications leading to mortality than from other parts of Africa? Even if the maternal mortality rate amongst American black women is high, what is the disposition of those who suffer complications, but don't die?)

My biggest concern about many of the proposed health care "solutions" is that they haven't even bothered to identify the actual problem. (If ER visits by uninsured are a problem, what if we change how ERs operate? What if we put clinics next to ERs? Are government regulations mandating that ERs care for everyone regardless of ability to pay part of the problem?)

The point is that it's fine to throw around life expectancy numbers, but if we don't understand what those numbers mean and why they are what they are, then all we'd be doing is throwing money around.

traditionalguy said...

The diverse collection of cultures living in America are happy to be here, but they bring down the averages somewhat. Remember to factor out our highway accidents and drug culture enforcement murders, and then see what the statistics say for us. The individual rights we all have been willing to fight for in every war we call our freedoms, but the British call them being rude. They should enjoy life as best they can in England, because it will be very short once they reach age 68 when they are deemed rude to ask for more.

Laura(southernxyl) said...

But the infant mortality rate for African American woman is a direct result of the lack of health insurance.

Proof please?

Prudential did a study in Memphis some time back to find out why black women with insurance did not avail themselves of prenatal care, thus contributing to the very high infant mortality rate in that population.

ironrailsironweights said...

Remember when tens of thousands of oldsters died [in Europe] cause of ,by our standards, a mild heatwave? A few weeks of temps near 100 is rough, but not like that doesn't happen in one region of the US or another every year, and when you get more than 30 or 40 deaths it's big news, yet in Europe between 35-50,000 mostly elderly die in 2003 and somehow that doesn't reflect poorly on their health system.

If air conditioning weren't nearly universal in many parts of the United States we'd probably have much higher death rates in heat waves.

Peter

Hey said...

I love downtownlad using his ignorance as evidence for his argument.

Also, St. Pierre et Miquelon is not a country. It's a French overseas territory between Newfoundland and Nova Scotia. Guernsey is an island in the English Channel and one of the UK's offshore banking centers. Like its sibling island Jersey, it also has an eponymous breed of dairy cows.

The funny thing is that using faked up infant mortality statistics will hugely affect life expectancy. A 1.5 difference in infant mortality works out to a 0.12 difference in life expectancy.

Well trying to argue with a leftist as ignorant and obtuse as dtl is pointless, especially when he is so maliciously innumerate.

madawaskan said...

New York-

The ruling liberal elites now regard those who believe in the "sanctity of life" with the same condescension that they exhibit to the drinkers of sugary drinks, climate change deniers, etc.

Because there is no Higher Moral Authority.

That' s what people don't get-all of these schemes where what's best for you or the common good end badly.

Why?

Well right now they'll let you have your religion because it's helping them to use that to make you feel guilty....

As soon as the Health Care "debate" went bad who did Obama call?

By now you've heard of the Obama conference call telling the religious leaders how this bill and being for it was about being for God...

Or whatever.

That doesn't last too long though-the Liberals really only put out the welcome mat for religion when they want to use them like a door mat....

Because, in the end their can only be one moral authority-the few Liberal Elites at the Pinnacle of the Common....

madawaskan said...

Ever wonder why Liberals almost always are arrogant...?

madawaskan said...

If air conditioning weren't nearly universal in many parts of the United States we'd probably have much higher death rates in heat waves.

Well A) it is, and B) French families went to cooler climbs on vacance-which by the way is mandated and lasts about three/four weeks(?) leaving the oldsters behind.

Frumson Wooters said...

ironrailsironweights said...

How life works:

1. We grow old.
2. Our bodies deteriorate.
3. We die.

Nothing in the world is ever going to change that, no matter how enormous the nation-bankrupting amounts we spend on health care.

Agreed. To avoid bankrupting the country we should get rid of MRI machines, CAT scanners, heart surgery, appendectomies, xray machines, penicillin.... Heck, let's close the sewage treatment facilities and water treatment plants. Sure, they add to life span, but they cost money.

peter hoh said...

Alex responded to the US/UK infant mortality stats with:

Ah statistics without context. What is infant mortality among African Americans vs the rest of the population I wonder?

I'll cede the issue that comparing infant mortality rates is problematic, but I'd like to know how Alex comes to conclude that somehow African Americans should be excluded from determining the actual infant mortality rate in the United States.

Smilin' Jack said...

— answer "No we don't," to a woman in labor who begs "You have got to help."

That sounds pretty callous. Obama's Death Squads will be much more diplomatic. At least at first.

Joe said...

frican Americans should be excluded from determining the actual infant mortality rate in the United States.

You miss the point. When comparing mortality rates in place like Iceland or Sweden to the US or Japan you are, to an extent, comparing apples and oranges.

More importantly, if we take blacks out of the life expectancy equation and discover that the rest of Americans are doing pretty damn well, then we need to understand what it going on with blacks and address that specifically (I think there's a huge genetic component, so we are limited in what we can do.)

Here in Utah and other places in the mid and mountain west with measurable American Indian populations, we can point to the criminally awful IHS as part of the problem (and general poverty, alcoholism and genetics as another part.)

Roger J. said...

DTL: stay away from epidemiology if you arent an epidemiologist--you just expose your ignorance. Will be more than happy to recommend some epi text books to you if you like--thats what I do for a living. And for life expectancy, nothing more involved than simple arithmatic. All you need for data is an accurate census that identifies age cohorts.

Others have correctly pointed out that only the US uses the WHO definition of live birth (any movement or gasp for air)--and apropos this topic, almost any foetus who is around 24 weeks will exhibit those traits.

Laura: I work with the MSCHD health department--yes we have one of the highest IM rates in the country--but the biggest correlate to IM is education level of the mother--and memphis school systems are a disaster area

madawaskan said...

And I steal this from Jonah Goldberg because Friedman is the ultimate weenie-on last week's Sunday ABC News show he was decrying how everyone is a reporter now...and that people go around saying- "I read it on the internet!".

As if the media has been responsible-

"I read it in a Maureen Dowd column in the NYT!".

I think he would have really hated Ben Franklin and his self- publishing pamphlets-

Freedom of speech for Freidman and not for thee!

Here is the quote Jonah Goldberg va cherche from that Liberal Elitsest-it's a beaut-


One-party autocracy certainly has its drawbacks. But when it is led by a reasonably enlightened group of people, as China is today, it can also have great advantages. That one party can just impose the politically difficult but critically important policies needed to move a society forward in the 21st century.
- Thomas Friedman

Synova said...

madawaskan... that sort of thing is expected for people who write speculative fiction, and heaven help us if we over-hear a mystery writer planning her murders.

As a serious suggestion, though, yikes!

miller said...

Shorter Tom Friedman:

"If we could just limit the news to the NYT, then we'd have it easy."

MadisonMan said...

Like crime statistics, health statistics when comparing different countries aren't as comparable as they first seem.

Nor are meteorological statistics. Your comment would have been far more sound had you not commented on the 2003 heatwave.

How far above normal were the temperatures in France, and how long did they persist? That is the metric that should be used when discussing heat waves.

madawaskan said...

I'm sure you guys get why that comment fits-here.

Look at the tags.

MadisonMan -

Liberals expect miracles when it comes to unusual weather-from the US military particularly-please France couldn't handle a heat wave. Give me a break.

tsunamis of biblical proportion, and historic disasters of record breaking magnitudes back to back btw-de rein.ey?

The US military should be able to turn warships on a dime and be able to get across the world in a day and enter a disaster zone as if it was never there.

madawaskan said...

I'm off obviously your sympathies only lie in one direction.

wv;mices

Pogo said...

State health socialism is all about making a promise of security in exchange for some of your freedom.

Problem is, it's a pig in a poke.

What's in the bag, mister?
DEM: Well, it changes from year to year, depending on how much money's left in the till, who's in charge, who's important (and who's not), and who squawks the loudest.
AVG JOE: How much freedom will it cost me?
DEM: Oh, only a little. At first, anyway.
With each year, a little more is required. Just a little.


AVG JOE: What happens when you control everything we eat and where we live and the jobs we do and what kind of leisure we can have?
DEM: Well, that's the trick, isn't it?

Stephen said...

No we don't? Probably not the best bedside manner. But consider (this is from the first article Ann linked to...)

More than 80,000 babies are born prematurely in Britain every year, and of those some 40,000 need to be treated in intensive care.

The NHS spends an estimated £1 billion a year on their care.
But while survival rates for those born after 24 weeks in the womb have risen significantly, the rates for those born earlier have barely changed, despite advances in medicine and technology.
Medical experts say babies born before 23 weeks are simply too under-developed to survive, and that to use aggressive treatment methods would only prolong their suffering, or inflict pain.

...Studies show that only 1 per cent of babies born before 23 weeks survive, and many suffer serious disabilities.


Yep. Those evil doctors don't want to poke at a dying 22 week old and stick it in an incubator so it can suffer and die slowly. How insensitive. See they follow the guidelines, which are "not meant to be a 'set of instructions'" because they "regard them as the best available advice on the treatment of premature babies." Not because the government told them to. Ask yourself how much pain you would be willing to inflict on a tiny little newborn knowing that for all that suffering, there's only a 1% chance of survival.

miller said...

You know, you're right. How unfair to stick newborns if they have only a slim chance to survive.

Better just to put them out on the stony mountains.

Because it's about fairness. And free healthcare!

Stephen said...

I didn't say anything about fairness, or free healthcare.

The point is that there is a reason doctors might not want to use agressive treatment at high cost when 99% of the time all you've done is make the infant's short life worse.

Joe said...

My first son was born prematurely at almost 21 weeks of development. The doctor explained that at that time, no baby had ever survived younger than 24 weeks. The problem was that the cilia don't finish maturing sufficiently until 22-23 weeks. He said that they could try heroic measures and the implications of that or they could make our baby as comfortable as possible. My wife and I chose the latter. Our son lived for an hour and a half.

This wasn't an easy decision, but it was made with an excellent doctor giving us advice. (I can't praise those doctors and nurses enough. They were truly fabulous.)

A year later, a 23 week old infant became the youngest survivor. To my knowledge, it hasn't gone much below that in the two decades since.

The important point is that in both these cases, the decision was made between parents and doctors. The government wasn't involved.

Stephen said...
This comment has been removed by the author.
Scott M said...

How is this in any way different to the question faced by the US since Roe? A baby, even full term, can still be killed on the whim of the mother as long as it's not cleared the birth canal and taken a breath.

What if it were 10 minutes before 22 weeks? What about an hour? How the hell do they know exactly how far along she was anyway??? I've been through four pregnancies with my wife and from personal experience I know it's just a very good guess.

If health care is a fundamental human right, as those on the left seem to claim, then when does it start? At what age, prenatal or post, does an individual's rights start?

Damned nagging question...

For the record; if the link-to story was completely true, that's the sort of thing that revolutions are built on. Pure, unfiltered rage at what happened and the spinelessness of those involved.

How the hell do you look at yourself in the mirror if you were one of the docs on staff that night?

former law student said...

A baby, even full term, can still be killed on the whim of the mother as long as it's not cleared the birth canal and taken a breath.

This has never been true in the United States.

Pogo said...

Today I had an elderly patient ask me to lie on the medical record because she was afraid my writing down a certain diagnosis would get her rationed out of medical care in the coming healthcare plan.

Hope and change.

Laura(southernxyl) said...

Laura: I work with the MSCHD health department--yes we have one of the highest IM rates in the country--but the biggest correlate to IM is education level of the mother--and memphis school systems are a disaster area

It's a correlation, but I can't see it being cause-and-effect. Having decent test scores doesn't make you have a healthy pregnancy or a healthy baby.

Isn't there a strong correlation between IM and very young mothers, like ages 12-14? Is anybody looking at this?

Cedarford said...

Roger J - Nice post! We have these criterion in every country. Usually, "best medical practices, given the resources on hand". With a 37 trillion dollar unfunded mandate for medicare in the US, medical and medical insurance costs rising 100% to 180% faster than average wages in the last 20 years.........we now finally have to confront the "given the resources at hand" part of the equation.
Unless we wish to tax the young at up to 25% of their paychecks to pay for whatever treatments the dependents or their families want of whatever marginal level of gain achieved...things have to change.

We have reached the dead end of the myth of "Supply Side". The idea that you can launch a huge new healthcare benefit - free prescription drugs, free dialysis - and not pay for it but instead cut taxes and "Growth!!" will magically happen and create unlimited resources to fund anything, is over. Voodoo economics. RIP.

Roger J. said...

C4--thanks

Laura--the relationships between all the variables that lead to high IM are interrelated--young mouthers--of course--but these young mothers are school drop outs or failures. hospitals and health districts distribute literature that is not at the third grade level so it can't be read. Maternal and child health programs abound--and even if the potential recipients have coverage they don't use it.

I understand it is a cliche to blame education--but infant mortality in NOT a public health problem--it is a socioeconomic problem.

Cedarford said...

==================
Joe - "A year later, a 23 week old infant became the youngest survivor. To my knowledge, it hasn't gone much below that in the two decades since.

The important point is that in both these cases, the decision was made between parents and doctors. The government wasn't involved."

================

The point neglected is, of course, the government is already involved, any employer that is obliged by government law to pay healthcare for any full-time employee is involved, and each US taxpayer is involved.

The "Freedom!! for Freedom Lovers!!!" crowd in the healthcare debate just wants them to exist as the mindless wallets handing over whatever money is needed to fuel the "private decisions of doctors, families"

But the days of seeing America as having unlimited resources to throw at any new "need" - exploding healthcare costs, exploding size of the Fed Gov't, new entitlements for prisoners, special ed kids, goodies for teachers and welfare mommas, etc., etc. - are ending. Ending fast.

In a "Purely Private" decision between doctors, healthcare biz owners, and the sacred "family who choose"...sans "Gummint!" the conversation would go like this:

*********

Sacred family - choosing - "I don't care if our baby was born at 22 weeks. And great grandma is totally unresponsive and on medicare! We demand everything be done! Everything!"

Noble Doctors - "Well of course we have amazing new high tech that just might prolong your most probably doomed preemie by weeks, even months. A one in a million chance the baby might survive and not require assisted living. And we can put your Great Granny on machines after a stomach tube operation..and assisted care 24/7 to wipe her up, move her, and extend her vegetative life by many more months, even years..."

Sacred Family unit making 'choices': "Whatever! Just do it. Always choose Life!!"

Noble doctors: "OK, but now that evil government is out, taxpayers have said they will only pay for their own folks, and businesses have slashed healthcare down to a 300K in UN 'dollars" lifetime cap after the dollar's collapse in order to compete with China and pay off our debts..You have the freedom of choice. But you have to see the healthcare biz owners who pay us and all the other staff and all the full price drugs and equipment needed to push "amazing high tech" to the next level. You need to give them your home deed, bank account statements, 401K accounts, and your family's most recent salary.

Healthcare biz owners - "OK family who chooses with no gov't role or death panel rationing involved: Signing over your house, 401Ks will pay for the expected neonatal hospital bills. Your bank accounts and 25% of your take-home pay will keep your Great Granny alive for 11 more months. Now that Medicare collapsed when younger people had their violent tea parties refusing the 80% with holding tax increase, and the government caved.."

Family who chooses - "And then?"

Healthcare biz owners - "Then you can't afford it anymore and your baby and granny go to whatever place you manage to rent. And of course one of you will have to quit work so you can enjoy your freedom! that much more by trying to keep them alive as private caregivers...Good luck!"

Family who chooses - "We wanted no gummint interfering with our private decisions! We will preserve life at any cost to us!"

Healthcare biz owners: "Again, good luck! Especially with only one person bringing back a paycheck for a job your own boss said is likely to go to China soon. At a minimum, her projection on your likely job income says no promotions or pay increases are possible under "Free Trade". And you know your new modified employer insurance cap will be reached anyways with the first 3 weeks of neonatal heroic care...so "Good Luck" also means we sincerely pray you and your other children don't ever get sick or injured. Let capitalism and Free Markets with no gummint protect you!! Maybe it will work out!"

Scott M said...

@fls

Correct. I should have (and meant to) type 3rd trimester. As my wife just crossed that threshold a couple of weeks ago, we're both feeling like it's full term.

Sure...she's got the constant discomfort, the little thingy moving around INSIDE HER BODY (the sci-fi geek in me shudders), mood swings, etc, etc, but just look what I have to deal with...er, um. Well I have to deal with her dealing with all of the above and more.

I will say, though, that getting out of unwanted social engagements is easier when your wife is pregnant and everyone knows it. "Sorry, can't make it. My wife is sitting in the irrational end of the pregnancy pool tonight."

Salamandyr said...

Stephen, did you miss the part of the article where they denied the woman the medicines that would have stopped the labor, at least delaying it a few more weeks until after the magic 23 week limit?

And Former Law Student, it is the damned case in this country, and it's a disgusting blight upon our honor. Very few doctors will do it that late, but one is too many, and post Casey there are no legal impediments to late term, kill it before it clears the birth canal abortions.

Laura(southernxyl) said...

infant mortality in NOT a public health problem--it is a socioeconomic problem.

I understand and agree with what you're saying, but it kind of is a public health problem.

I'd like to know if anyone has looked at who is getting the little girls pregnant - is it boys their age, or men (mama's boyfriend, the neighbor, uncle, football coach, church deacon) who ought to be in prison?

blake said...

MM says How far above normal were the temperatures in France, and how long did they persist? That is the metric that should be used when discussing heat waves.

Sure. But when discussing the robustness of an economic system in terms of its ability to survive anomalous conditions, whether or not the people could afford A/C is a matter of interest.

Europeans actually live much poorer lives than we do. They have less space, less stuff, less cash to throw around, they eat out less, etc.

A lot of people seem to be for that and that's okay. Poverty is not without its virtues. State-imposed poverty on the other hand is pretty much slavery.

Roger J. said...

laura--if I may, can I address your questions on your blog? you are asking good questions and I dont think it would contribute much to the thread here.

Laura(southernxyl) said...

Sure, Roger.

knox said...

Here's the rule:

People allowed to die in a government system were "going to die," "untreatable," or, as MM implies, maybe they wanted to die anyway.

Stephen said...

@pogo

Your elderly patient's irrational fear does not constitute proof that she will be "rationed out of her medical care" if a public option is made available. Restating people's fears does not validate them.

@Salamandyr
Yes I did. Now, I'm no expert, But think about it this way:

The mother "went into labour in October last year at 21 weeks and four days after suffering problems during her pregnancy." So if the doctors stop her labor with an injection there's still one week and three days left before getting to 23 weeks, and that's still premature.

So, how does that work? Do they have to give her multiple shots? How many? How does that effect the health of the baby? How does that effect her health? She'd also had 5 miscarrages previously. Doesn't that complicate things?

This situation is not as cut and dry as it might seem. If they had tried it your way it seems plausible that they might both have ended up dead. It does bother me that she didn't seem to have a choice in the matter, but that's only an argument against the British system, not an argument against a public plan competing with private insurance.

It would seem to me more options would be afforded in that kind of system.

Pogo said...

"Your elderly patient's irrational fear does not..."

Who said it did? I'm merely telling something that happened to me this morning that speaks volumes for how much the Democrats have screwed the reform pooch if they've lost the ones currently on a single payer program. Kinda funny, really.

"...not an argument against a public plan competing with private insurance".
Public plans do not "compete" in any normal sense of the word. Competition means creative destruction exists, but with state plans, failure is an impossibility, and losses are forever absorbed.

That is, you're completely wrong about the very basis of your beliefs here.

Laura(southernxyl) said...

So, how does that work? Do they have to give her multiple shots? How many? How does that effect the health of the baby?

Well, dying was a lead-pipe cinch to affect the health of the health of the baby in a fairly negative fashion, wouldn't you say?

How does that effect her health? She'd also had 5 miscarrages previously. Doesn't that complicate things?

It probably means that she really, really wanted this baby and may not ever get so close again to having one.

I went into labor at 36 weeks, 22 years ago. Because I carried small (didn't look in any way ready to give birth) and because they were worried about her lungs and could not treat hyaline membrane disease as they can now, I was given an injection of terbutaline followed by a prescription of terbutaline pills, to hold off having her a few more days. It gave her about a week more in the womb. She was fine when she was born, but I appreciate the doctors caring. This isn't some new exotic treatment.

Cedarford said...

On the French loss of thousands of seniors in a brutal summer heat wave. A horror story, like the flesh-eating staff infections at dirty US and UK hospitals....but...:

The French treated it as a medical misadventure. Took steps to understand what could have been done to avoid 90% of premature elderly death..mobilizing workers from other nonheathcare gov't jobs to provide fluids & electrolytes, ice compresses, water spray, installing emergency AC. Train medical staff better to recognize early signs of heat related trouble. Recognize which patients were bound to "check out soon" and the heat was just the final straw..

The French note that even factoring the heat wave deaths in as medical misadventure, their rates of such deaths were well below the abysmal American rates that spawn 95,000 -105,000 medical misadventure deaths a year. Even in that year.

former law student said...

The idea that you can launch a huge new healthcare benefit - free prescription drugs, free dialysis - and not pay for it but instead cut taxes and "Growth!!" will magically happen and create unlimited resources to fund anything, is over.

I'm not going to address the issue of increasing tax revenues by cutting taxes. I'd just like to point out that Medicare's End Stage Renal Disease Program -- for patients of any age with chronic kidney failure -- began in 1973. It is of course another patch in the quilt of government health care.

Stephen said...

@pogo
Fair enough on your first point. I agree. It is pathetic.

And I'll agree that competition is probably not the right word in it's normal sense. Perhaps I should've said "...not an argument against a public plan providing an alternative to the private insurance system."

But my point wasn't really based on competition. When fighting the public option, opponents of reform are actually limiting choice, and citing stories like this one do not address what is being proposed. Look at this flow chart. It doesn't seem to me like a public plan would crush private insurance.

The fact of the matter is that single payer is not on the table, and these stories about the British system have little to no bearing on the public option debate as it stands today.

exhelodrvr1 said...

Stephen,
Attempting to stop labor IS pretty "cut and dried". There are a number of different medications that can be used; sometimes they work, and sometimes not. We were lucky; our 28-week labor was finally stopped in the delivery room with magnesium sulfate; my wife was on bed rest for the rest of the pregnancy, but our daughter is now 23 years old and a wonderful young woman. With the two subsequent pregnancies, terbutaline was used proactively, and they both went to near full-term. So yes, attempting to stop the early labor is worth it.

exhelodrvr1 said...

Laura,
"Having decent test scores doesn't make you have a healthy pregnancy or a healthy baby."

No, but education level tends to be symptomatic of a number of other issues.

Stephen said...

@laura
I understand what you're saying, and you clearly know more about this than I, but I think we can both agree that 36 weeks is not 22 weeks.

You say the treatment you got postponed the labor for about a week. For Capewell's baby to reach the 36 week mark, that would presumably require almost 14 weeks of treatments.

@exhelodrvr1
I understand your feelings on this matter as well, but 28 weeks, while closer, is also not 22 weeks.

I'm not accusing either you of being disingenuous, and as I said, she should've been given a choice, but still, I think the situation is more complicated than you make it out to be. For instance the article says she had problems during her pregnancy, and those are not elaborated on, as well as the miscarrages I mentioned before. It also said next to nothing about the condition of the child, except to say that he was premature. Those things leave some room for shades of grey to creep in, no?

Laura(southernxyl) said...

@laura
I understand what you're saying, and you clearly know more about this than I, but I think we can both agree that 36 weeks is not 22 weeks.


Duh.

You say the treatment you got postponed the labor for about a week. For Capewell's baby to reach the 36 week mark, that would presumably require almost 14 weeks of treatments.

But Capewell's baby didn't have to go 14 more weeks, just one more and then he might have been far enough along to save. They couldn't even give him that chance.

Those things leave some room for shades of grey to creep in, no?

When in doubt, do you err on the side of life, or death?

Stephen said...

Like I said, she should've been given a choice. I'm not arguing that something should or shouldn't have been done.

However, because of the omissions I was talking about, I don't think the article gives us a clear picture of the situation as to the condition of both the mother and child, or what the doctor's decision making process was. (Except to site the guidelines, which are not compulsory).

All I'm saying is that we don't have enough information about what happened to make a moral judgement either way. There is room to believe the doctors were acting in the best intrest of the health of the mother. We don't have their side of the story at all.

When all the facts are in we can condemn them all we want, but at present, the phrase reasonable doubt comes to mind.

Laura(southernxyl) said...

When all the facts are in we can condemn them all we want, but at present, the phrase reasonable doubt comes to mind.

I'll give you that.

There is room to believe the doctors were acting in the best intrest of the health of the mother.

As you say, it would be nice if they had given her a choice. If the choice was, "we can do X to try to save the baby but it will kill you," that's one thing. Doubt that would have been the case. It should probably have been, "we can do X to try to save the baby; the risks to the baby are blah blah, and the risks to you are blah blah. The alternative is Y. What do you want to do?"

exhelodrvr1 said...
This comment has been removed by the author.
exhelodrvr1 said...

"There is room to believe the doctors were acting in the best intrest of the health of the mother. "

Which is more likely, that the guidelines were put in place for the health of the mother, or for the allocation of resources? And do you think that there is no pressure for the doctors to adhere to the "non-compulsory guidelines"?

MadisonMan said...

knox, you're misconstruing my words. Want to die? No. Accept the inevitability of dying with grace when you're in your mid-90s? Yes.

Stephen said...

@laura
You're right it's probably more of a risk to you, risk to the baby etc. kind of thing.

Anyway I'm glad we could reach a degree of agreement here. It's always nice to talk to a reasonable commenter. Those are in short supply on the internet these days.

You have a pleasant evening and I'll see you 'round the threads I suppose.

Stephen said...

@exhelodrvr1
I didn't say anything about what the guidelines are for, but yes they probably exist to allocate resources, among other things. And I'm sure there's pressure, but most likely both sides of the issue.

But we don't know anything about what the doctors knew, or why they chose to follow the guidelines. We just can't tell anything for sure from this article without speculating. We simply don't have all the facts.

kentuckyliz said...

The high infant mortality rate among African American women does not reflect on the health insurance situation because all pregnant women can qualify for Medicaid. No pregnant woman goes without health care.

Automatic ball return.

Synova said...

I never quite understood the insistence on the importance of pre-natal care, at least in the very early months because I was never told to do anything different.

No caffine, no smoking, no alcohol. Take vitamins, don't diet, don't get too fat.

This isn't difficult.

I suppose that later on problems might be caught early and both my sister and my sister in law ended up on bed rest but that wasn't a result of something they weren't aware of... they *felt* like something was wrong. And gestational diabetes might be caught early with tests and stuff.

Maybe more women and young girls would go to the doctor if what they needed to go for was made more explicit.

If the problem is smoking, drugs, or alcohol it might be that women who give up those things *also* get prenatal care... an incidental correlation and not one that proves that one thing leads to the other.

Does anyone really not KNOW that they aren't supposed to smoke or drink or consume caffeine or drugs while pregnant?

Kathy said...

Stephen,

I went into labor at 30 weeks with my last pregnancy. They used drugs to stop the labor, and I took medication for the next 4 or 5 weeks (can't remember now exactly how long) and stayed on bedrest to keep labor at bay. Yes, they could have helped this woman. I have friends who have gone into labor much earlier than I did and had their labor stopped long enough for the baby to mature a bit more.

I do favor passing the cost on to the patient so that we, the patients, have to decide if the end result is worth the cost. Let us decide if we want to mortgage the house and have pancake breakfasts (fundraisers) to try to pay for it.

When government pays for it, why should they delay your labor so that you can have a premature infant who will require a lot of extra care and make their data look bad? They'd rather let the infant die and mark it off as a miscarriage, which then doesn't count against them at all.

exhelodrvr1 said...

No, Stephen, we don't have all the facts. So I'm using the information that is provided, combined with personal experience, and common sense, and going with what is the most likely explanation.

Stephen said...

@kathy
Fair enough.

@exhelodrvr1
Good old Occam's Razor huh? Guess I can't argue with that too much...

I would still say to both of you that we don't know anything about the "problems with her pregnancy" that preceded her early labor, although, I suppose that's a smaller question and I'm just parsing now. The big question is one of choice and again, I do think she should've had one. It's just unclear to me what that would've been.

@kathy
I was just listening to a good diavlog over at bloggingheads w/Glen lowry & Virginia Postrel where Virginia advocated an idea like that (passing on costs). I think it does have some merit.

Laura(southernxyl) said...

Does anyone really not KNOW that they aren't supposed to smoke or drink or consume caffeine or drugs while pregnant?

People do all kinds of things they know they aren't supposed to do. To pick just one example, there would be no STDs if everyone practiced safe sex outside monogamy.

I don't know how to fix that. Pretending the problems are due to our health care system and lack of universal health insurance will definitely not fix it.

SarcastiCarrie said...

With 5 previous miscarriages (especially a miscarriage outside the first trimester), she should have been treated as high risk from the get-go with frequent ultrasounds, blood tests, monitoring, possibly bed rest, etc (depending on the reason for her previous miscarriages). She should have been seeing a perinatalogist and a maternal-fetal medicine specialist. If this is something as simple as an incompetent cervix, then shame on NHS. If it's a more difficult chromosomal, immune, or clotting problem, we know about these things and have treatments to manage them.

Betamethasone (IM steroid injection) is normally administered to high-risk mothers (mothers at increased risk for delivering prematurely, especially those who have done so previously). Since 1994, NIH has recommended their use. They are normally used after 24 weeks and are given in shots at least 24 hours apart.

So, if they could have her on bed rest and hold off labor for a few weeks (in the hospital, if necessary) and then administer steroids for lung maturation, this story might have had a happier ending.

For her next pregnancy, I suggest she get a transfer at her job to the US and have her baby here. None of this is that uncommon here. A quick trip around the infertility blogosphere and you will see this and much more in terms of intervention for successful outcome. Even Canada, with their nationalized health care, routinely sends moms of higher order multiples (triplets) to the US for their bed rest so their babies can be cared for in our NICUs after they're born.