Story Time – My job

I have been a nurse, now, for over twenty-five years. Doesn’t always seem that long. Some days, it seems longer. Just like the twelve-hour night shifts that I work.

For those who do not know the specifics of my career, I am a neonatal nurse. I work in Newborn Intensive Care. I have periodically jumped ship and tried my hand at other aspects of nursing – adults, pediatrics, case management, transport – but I seem to always return to the babies.

Within all of nursing, I think my specialty is unique in the sense that, no matter the circumstance, we will do everything humanly, and medically possible to save the lives of some of the tiniest, sickest babies ever to enter this cold, cruel world. Yes, we talk to parents about quality of life and, sometimes, respectfully and gently suggest that doing nothing may be what is better for the baby. But in the majority of the cases, we do everything because it is what parents want. Our patients have no say in the matter. We do our best to advocate for them, but do not always get to do what is best for them.

Parents don’t always understand what it is they are asking of us, or what it is they are sentencing their precious infant to, possibly for a very long time to come.

At times, I see articles posted across the internet about the whole abortion debate. Just the other night, I read something about a group of Obama supporters trying to accuse anyone against late-term abortions to be sexist, or “anti-woman.” Crazy, right? The current line in the sand is that there is a ban on abortions after twenty weeks gestation. One question the article posed was, if you are a woman against late-term abortions, can you be “anti-woman”??

When I was younger, even though I have always leaned conservatively in my ideologies, I was more liberal-minded about abortion. I felt that it should be legal if only to prevent the back-alley coat-hanger-induced variety of abortion that would endanger many a [young] woman’s life. That didn’t mean that I, personally, would choose to have an abortion, myself. Like most folks on the right, I tend to think in terms of, if you don’t like something don’t do it/read it/buy it/use it/etcetera. We shouldn’t need more laws about it.

Should a woman be permitted to use abortion as her primary method of contraception? Well, it’s epically stupid, but shouldn’t it be her choice?

I used to think so. Kind of still do. Mostly, since it’s not something I need to consider, personally, I quite frankly don’t care about it as a political issue all that much.

What I care about more is actually the flip side to this coin. The increasing number of women using some form of infertility treatment in order to have a baby, or four or five, or eight. The more you have, the harder it is to carry the infants to term. The earlier they are born, the harder it is to save them. I blame the fertility specialists for this. I’d also blame “Big Pharma”, but that would take me three more days of writing to sort out my thoughts. I’ll stick to hating on fertility docs for now. They indiscriminately implant far more eggs than a human would release naturally, perhaps discuss selective reduction once the embryos decide to survive (though most parents can’t bring themselves to do that), and then expect that the family simply accept that, if the infants are born early, the neonatal teams will take care of them. Once a baby is born, whatever the gestation, the OB is done with it. His (or her) focus is back on the mom and, other than performing the occasional circumcision on a baby boy, s/he has no further vested interest in the infant. Leave that to the pediatrician or neonatologist.

Technology being what it is today, babies all over the world are being “saved” at earlier and earlier gestational ages of birth. Currently, twenty-four weeks is the average accepted age of viability, though there have been documented cases of “successful” treatment of twenty-three week gestation infants. Perhaps an infant or two has even been “saved” at twenty-two weeks. People are in awe of the abilities we have in place to care for infants this small, this premature.

People should not be in awe. They should be cautious if not down right frightened.

The sad truth that most people don’t realize is, more likely than not, babies born this early suffer life-long disabilities as a result of being born too early. But the parents that have been trying for years to just get pregnant look at their newborn and only see the promise of a bright and shining future for this miracle child who has a world of opportunity ahead of them. Add multiple births into the equation, and, even though the infants might reach a “decent” gestational age, they still tend to be smaller in size, and somewhat more vulnerable to complications than their singlet peers. Remember “OctoMom”? Does any news outlet still report on the kids? No? Why do you think that is?

Babies are cute, even if they are disabled. Toddlers and older kids who have not successfully met and passed various milestones are not so cute. They make folks uncomfortable, and thus are no longer “news-worthy.” I wonder where her support network drifted off to after the first few months or so of the babies’ lives. How long before helping this woman care for her excessively large family became tedious, inconvenient, or a down-right burden to her friends, family, church, and local community? Some reports indicate that several of her children suffer from various health and behavioral issues, including autism. At least one is still in diapers at almost five years of age.

I said earlier that my specialty is “unique.” One aspect of it that makes it so is that, regardless of the parents’ financial status, including whether they have insurance and of what type, all hospitals see to it that premature and severely ill newborns are set up on assistance plans to ensure they (the hospital) get paid. NICUs are big revenue generators for hospitals that made the investment to have them. Not all NICUs are in the confines of an established children’s hospital. Many hospitals that cater mostly to adults, but that have maternity departments have Special Care Nurseries or Newborn Intensive Care Units. A NICU in a Midwest Children’s Hospital can charge around $6000 PER DAY just for the bed and nursing care of the infant. Doctor fees, specialist consults, surgeries, therapies, and medications are all expenses incurred above and beyond that daily charge. Consider that a term infant is born at or after 37 weeks (36 weeks in some cases). Any infant born earlier is likely to stay in the hospital until its original due date. So an infant born at 30 weeks gestation may stay in the hospital for six to ten weeks. A twenty-four week infant will stay around fourteen weeks or more, depending on complications. Most singlet premature infants will wipe out an insurance policy’s maximum pay-out of around a million dollars.

Now, what do you think it cost for OctoMom’s eight premature infants’ hospital stay? She was already on welfare when some idiot fertility doctor agreed to implant her with all those embryos, so let’s not bother talking about who paid the bill for their hospitalization.

I’m not sure how OctoMom was able to finagle having all those kids via fertility treatment, since it’s expensive and, even if she had insurance, it’s not covered by any that I’m aware of. Still, every year thousands and thousands of women pay large sums out of pocket to become mothers of multiples.

I’m not saying that this miracle of modern medicine should not be available to those who can afford it. I, myself, benefited from some fertility medications in order to become pregnant for my two sons. My “plumbing” issues were easily corrected with a single round of two different pills that did not cost me very much and, each time, I was blessed with one baby, not multiples.

But, should there be a line that fertility doctors no longer be allowed to cross? I tried to look up information on naturally-occurring multiple births and found only that the vast majority of multiples consists of twins, with a few triplets, and rarely any more than that. Humans were not designed to bear more than two or three infants at a time. So why are doctors implanting eight eggs in a woman, or even five or four? I understand that there is a possibility that some, perhaps none of the embryos will “take”. Some that do implant successfully may spontaneously abort for any number of reasons, reducing the number of embryos that will survive to delivery at some viable gestational age. I get that, the more embryos implanted, the better chance of having at least one baby born.

But what about when all the implanted embryos survive?

I firmly believe that fertility specialists should implant no more than two embryos at a time since twins have a much better chance of remaining in utero nearly to term, and thus are born healthier than infants born extremely premature. I’m sure some moms (maybe even some dads) would heartily disagree with me. Some may say that, due to finances, or other nefarious reasons, they will only ever have this one opportunity to attempt fertility treatments, so it’s imperative that all fertilized embryos be implanted to ensure at least one survives.

But what happens when a family uses all their savings just to have the treatment, then give birth to, let’s say four babies. Regardless of whether these infants end up completely “normal” at the end of their hospital stay, how does the family expect to pay for all the things four newborns need? Car seats, high chairs, bouncy seats, playpens, formula (if mom doesn’t/can’t breastfeed) – DIAPERS! If they didn’t already have a van or some other type of vehicle capable of carrying six or more people, now they will likely need to get one. Can they afford to? Not surprisingly, these families tend to turn towards others – their family, friends, church, community, government – to help supply them with the things they will need to care for all these babies. Sometimes, communities (and others) step up and help, but more often than not, families end up on some form of government assistance.

In my opinion (and, yes, I know what opinions are like), choosing to bring multiples conceived through artificial means into the world is one of the most selfish acts a woman (and her partner) can make. Sometimes, these couples already have one or more singlet children that they conceived without any assistance. Suddenly, that child is saddled with multiple needy siblings that will dominate attention-getting simply by design – babies need more of everything from their care-givers than older children do. But to a toddler who used to be the sole recipient of all his parents’ attention and affection, it is a traumatic event to suddenly have to share that attention and affection with several more contenders. Add in any special needs one or more of the new siblings may have, and there will be very little time and energy left over for quality time spent with big brother.

So, what’s my point, you ask? Perhaps I have none, other than to vent and maybe educate folks about something they may not have known much about before. Certainly, the practice of treating infertility results in “job security” for me and my fellow neonatal clinicians, so I shouldn’t really be “against” it. But I am when it involves the seemingly irrational indiscriminate application of this incredible science to produce “quantity” over “quality.” Technology continues to advance in the care and treatment of premature infants, but much of it is all still “experimental” in that there’s no way to ever predict which infants will sail through their hospital stay uneventfully or which will succumb to heartbreaking complications that perhaps result in death, or at least life-long disability. We think we can apply treatments that worked so well to save the thirty-week-gestation infant to the twenty-four-weeker with equally successful outcomes. Some places are trying to apply it to twenty-three and even twenty-two-weekers. And when just ONE report is made where a hospital was “successful” in “saving” the twenty-two-weeker, then suddenly parents think that ALL twenty-two-weekers can and should be saved.

Oftentimes, “saved” only means that the infant survived. It fails to describe in what condition he survived. People go on the internet and post on blogs about how they know someone (who knows someone) who “just had twenty-three-week twins and “they are fine.” “Fine” as in “completely normal at, say, three years of age”, or “fine” as in “alive with complications”?

The future holds even more scary notions of where science wants to take the issue of infertility. Just today I read an article from The Daily Mail (a UK publication), that talks about genetically modified babies being born. (See the full article here ). I don’t for one minute claim to understand completely the science behind the process, but I can see the writing on the wall. Those parents who want, and can afford to, will soon be able to have doctors manipulate their eggs and sperm – their DNA – to produce children with very specific traits. Maybe they want only boys, or want their baby to have blond hair and blue eyes. Babies made to order! Even scarier is that the article implies that technology is currently available to clone infants, should moral objections be overcome.

I am continually dismayed, yet not at all surprised, that more and more people feel it is always okay to do whatever they want without regard to the long-term consequences, and that it is someone else’s responsibility to see to it that they may continue along this course. Want a litter of kids in one fell swoop, but don’t want to be financially responsible for them? No problem. The fertility docs will take your money to give you the babies and the government will allow for tax dollars to pay for their care. But don’t dare criticize these families for their choices! That would be sexist, racist, elitist, whatever-ist, and just downright disrespectful! The world should rejoice in the blessed event of these multiple births as though it were “a miracle.”

Word to the wise parents who still choose to go the “multiples” route. At least have the decency to treat the doctors and nurses who care for your babies with respect. Most of us have been taking care of critically ill and premature infants longer than you have and, while you are the parent, we, in fact, do know more about what your baby needs than you do. We completely understand that your world has been rocked in a way you never imagined, and that you are completely overwhelmed. We know that it sucks to not feel like you are in control of anything and that you only want the best for your babies. We accept that you need to be included in your babies’ care and that you need opportunities to bond with them. You will not like every person on your babies’ care team, just as you do not like every person you work with, or deal with in your daily lives. That does not mean they are not qualified and capable caregivers. Certainly, legitimate concerns should be reported to the management, but, in reality, those concerns in the neonatal field are few and far between. Questioning everything the staff does typically only serves to interfere with them providing the quality of care to your infant that you are so concerned about.

One thing that irritates me is new parents’ ideas about visitation with their babies. Just because you are excited about the birth of your babies does NOT mean that it is acceptable to parade every family member and acquaintance through the NICU to ogle at them. The earlier the gestational age at delivery the LESS stimulation the infants can handle, and just conversation around the bedside is enough to put some of these babies over the edge. Again, the doctors and nurses have the experience, and it would be in your babies’ best interest for you to actually take their advice on how to interact with the babies. From sounds to temperature to lighting to touch, these infants cannot tolerate any of it in excess, and in their world, that limit is reached very quickly. If you truly want the best outcomes for your babies, please listen to the doctors and nurses and do what they say.

Lord, I could go on and on and on about various aspects of this topic, but it’s late and I’m getting disorganized in my train of thoughts. Suffice it to say, I work in a field that has outstanding rewards and devastating losses, sometimes within a single shift. It is not a field of nursing for the feint of heart.

I encourage families considering fertility treatments to not only talk with the infertility specialist and your OB/Gyn about it, but to consult with a neonatologist so that you fully understand the risks you are taking with the lives of the very beings you believe you want more than anything in your world. Everything you do has consequences in life. When your decisions affect the lives of others, you had better understand completely what it is you are choosing to do.

Choose wisely, not selfishly.


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