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Views & Reviews Review

Birth at the limit of viability

BMJ 2011; 342 doi: (Published 15 March 2011) Cite this as: BMJ 2011;342:d1681
  1. James Owen Drife, emeritus professor of obstetrics and gynaecology, Leeds
  1. J.O.Drife{at}

A documentary that considers the cost and the ethics of caring for babies born at 23 weeks’ gestation raised questions for James Owen Drife, but is it any more than voyeurism?

Preterm labour takes up lots of pages in obstetrics journals, which is always a bad sign. Despite much research for many years, there is little that obstetricians can do to stop babies being born before their time. The best we can hope for is that they are in good condition when we hand them to the neonatal team.

Paediatrics, however, has steadily improved, pushing the limit of viability as far as nature will allow—almost to 23 weeks’ gestation but not quite. At 24 weeks, with intensive care, a baby has a 50-50 chance of survival, but at 23 weeks the chance is 9%, and most of the survivors are damaged. In the Netherlands and New Zealand they don’t routinely resuscitate “23 weekers,” but in the United Kingdom these babies are likely to receive expensive, sometimes prolonged care. Still, most will die.

This point was brutally made in Adam Wishart’s absorbing documentary. He spent six months (with cameraman Chris …

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