A friend of mine would pose that question whenever we had discussions about preemies and gestational age. She didn’t say it quite that bluntly, but did clearly state that James could have been 23 weeks and 3 or 4 days when he was born. In fact, she thinks it is likely he was 23 weeks and some number of days, and seems to take offense when I get on my soap box about preemies born as early as James being able to survive. She doesn’t realize that her argument is making my point for me.
Gestational age is not an exact science. Many factors contribute to determining a baby’s gestational age and pinpointing mom’s due date. Doctors look at the first day of your last menstrual cycle initially. Then, measurements are taken during ultrasounds and compared to typical growth patterns. Early ultrasounds are especially accurate. As baby gets bigger, growth patterns aren’t quite as predictable and there’s more room for error. Even with these early, “extremely accurate” measurements, the margin of error at best is +/- 5 to 7 days. When you look at the big picture of a full term pregnancy, that’s pretty good. When you look at a hospital policy that states only babies born at 23 weeks and later will be offered life saving measures, that’s not nearly good enough.
In my case, when I went for my initial OBGYN appointment I knew the dates for my last menstrual cycle. My doctor used that information to predict my due date of November 30th. James had many ultrasounds very early on and throughout my pregnancy due to complications. His growth pattern and measurements followed along as predicted for the most part. At the end of June, when I was around 18 weeks, my doctor told me not to expect to deliver November 30th. They weren’t officially changing my due date yet. They did expect that it would be later in the first week of December before James would arrive, indicating he may be a few days younger gestationally than she originally thought.
Several issues exist when trying to predict gestational age. One of the most common is that many women do not track their menstrual cycles closely. Many know approximate dates, but not exact dates, and some have no idea when the first day of their last cycle was. In addition to that, some women have little to no prenatal care, and some women choose not to have ultrasounds. All of that works against making accurate predictions of gestational age.
Unless determining gestational age is an exact science, how can you use that as a basis for making a life or death decision? How is it possible for a hospital to have an arbitrary cut-off of 23 weeks gestation when there is, minimally, a margin of error of +/- 5 to 7 days in determining gestational age? My 22-weeker could, developmentally, be a 23-weeker, but because the gestational age isn’t accurate, when I go into active labor at 22 weeks he will only receive comfort care until he passes. In many hospitals, no assessment is done to determine the accuracy of gestational age after the baby is delivered. If the baby doesn’t meet their arbitrary cut-off date, the baby dies.
I’m not arguing that all 22-weekers have life-saving measures attempted. I know James has done exceptionally well when most don’t. Take a look at the statistics (22 weeks, 440 grams) and you will see just how exceptional James is. Even at 23 weeks and his birth weight he’s far from the norm. What I am asking, is that babies at 22 weeks gestation at least enter the discussion for life-saving measures. Talk to families about possibilities, assess the baby after delivery. They may or may not actually be 23 weeks. Either way, they may actually do pretty awesome!