One Day From Viability, Parents Let Their Baby Make the Choice

At 23 weeks and four days pregnant, Kelly Benham was told there was nothing left to stop labor. Her baby would arrive in 24 to 48 hours.

A doctor came to her hospital room, uncomfortable but direct. He assumed she and her husband, Tom French, would want everything done to save the baby, and then he explained what that would mean.

He put the chance the baby would die no matter what was done at about 53 percent, and the chance she would be fine at about 20 percent. The rest meant a bad outcome, life on a ventilator, a massive bleed in the brain that could impair her thinking, speech, or movement, or blindness or deafness.

This was the choice parents face in the gray zone just before viability, the point, around 24 weeks, when a baby can survive outside the womb with intensive care. The doctor said they should decide before birth, because meeting the newborn would make it, in his words, "really hard to say no."

Kelly spent the night listening to the heartbeat on the monitor, steady and close, while she and Tom cried and talked. She wondered if she was being selfish, if she had pushed nature too far to get pregnant, and if saving the baby would cost their house, their marriage, and any chance of another child. She said she came pretty close to saying no, to letting nature take its course.

The next day, they asked for another meeting. Diane Loiselle, a neonatal nurse practitioner with 30 years in intensive care, walked in and refused to talk in numbers. She said it was different for each baby, and then she reframed the whole decision.

It was not yes or no, all at once, right now. Loiselle told them, "If the baby came out crying and active, then we should do everything." Kelly recalled the other possibility as "Blue and limp," with severe bleeding in the brain. If that happened, they could stop, withdraw support, and, as Kelly recalled Loiselle putting it, "you can hold your baby until it dies." In effect, the newborn herself would show them whether to go on, and they could follow her lead.

Hours later, Kelly went into labor. She was rushed to an operating room for an emergency cesarean. The birth came at 23 weeks and six days, one day shy of 24 weeks. Kelly never saw her daughter's face, only a shape rushing past in an incubator. As Benham put it, "a little dark smear in a hat."