Increasing survival of extremely premature babies again raises questions about upper abortion limits

The increasing survival of extremely premature babies is again raising serious questions about the 24 week upper limit for social abortion.

On 6 March, Inside Out on BBC One in the East Midlands related how new treatments – including some trialled in Nottingham and Leicester – are helping to limit disabilities and boost life expectancy in premature babies weighing as little as one pound (450g).

Last week, under the headline ‘extremely premature baby saved by groundbreaking NHS surgical team’, the Guardian reported on the astounding case of Abiageal Peters who last year became the youngest baby ever to survive major abdominal surgery.

Abiageal was born three months premature in October 2016 at St Peter’s hospital, Chertsey after a gestation of only 23 weeks.

Her parents were warned at her birth that she had very little chance of surviving a severe gut condition known as perforated necrotising enterocolitis.

But thanks to the surgical team led by consultant Zahid Mukhta, Abiageal made an extraordinary recovery. ‘Any patient that comes into our system gets the best we can do for them’, Mukhta said.
Yesterday, the Sunday Times (£) reported that survival rates for babies born at 23 weeks’ gestation are now so high that up to 70% are being saved at some hospitals:

At University College London Hospitals, one of Britain’s leading trusts, the figures show that in the past five years, 22 out of 30 babies born after 23 weeks in the womb survived, according to new figures obtained under Freedom of Information laws.

At Leeds Teaching Hospitals NHS Trust, 16 out of 25 babies born at 23 weeks between 2011 and 2016 survived, and at East Kent Hospitals University NHS Foundation Trust, 9 of the 18 babies born at 23 weeks between 2012 and 2016 survived.

These figures are strongly at odds with those from the last national study, Epicure 2, which looked at babies born in 2006, and found survival of babies at 23 weeks of just 19%.

The best survival rates, not surprisingly, come from centres with expert levels of neonatal intensive care, but lower survivals elsewhere are nonetheless something of a self-fulfilling prophecy.

Although there has been no comparable national study since Epicure 2 to assess how survival rates are improving, many units are still being guided in their treatment decisions by these antiquated figures.

Lower survival of premature babies in some parts of the country is not surprising when, backed by the RCOG and BMA,  neonatal units apply blanket rulings on resuscitation based on a simplistic assessment of gestational age – which is often inaccurate – and fail to treat each baby as an individual in her or his own right.

This means effectively that that some babies that could be saved are dying from neglect.

There is an excellent article on this in the CMF journal Triple Helix by Professor John Wyatt which makes these points in greater detail.

These latest figures from centres of excellence demonstrate dramatically what can be achieved with a proactive approach and skilled staff and they highlight an unacceptable postcode lottery of care.

Every extremely pre-term baby deserves the chance to be considered for treatment and, even if curative treatment is not possible, to be given the best possible palliative care.

If there is a realistic chance that a particular baby can survive without overwhelming and catastrophic injury, then surely as a wealthy country we owe it to each child to give them a chance of life.

In this situation it is best to start ‘provisional intensive care’, giving the baby the initial benefit of the doubt, and taking each day as it comes.

But these latest figures will also fuel calls for the Abortion Act upper limit for able-bodied babies of 24 weeks to be revised (abortion is of course currently legal up until full term (40 weeks) for disabled babies, a situation which Lord Shinkwin is currently attempting to change with his abortion (disability equality) bill).

It is utterly incongruous that on the one hand we are aborting babies at a gestation when others are surviving with good neonatal care. Abortion at this gestation is tantamount to infanticide.

When this issue was last debated in Parliament, in 2008, MPs voted by a narrow margin not to lower the upper limit from 24 weeks to either 20 or 22 weeks. I argued back then (and again here) that it was time for change.

But since this time survival rates have improved yet further and the composition of Parliament has also changed. At the last vote Labour government MPs were informally whipped to vote against any lowering of limits.

Were the issue to be revisited now there’s a good chance of a very different result.

A lowering of the upper abortion limit to 20 weeks would save more than 3,000 babies a year.

That may be a small start when we consider that there are around 200,000 abortions a year in Britain. However, for those 3,000 it would represent every difference in the world.

Ultimately each society will be judged on the basis of how it treats its weakest members. Neonatal centres of excellence in Britain are already demonstrating how worthwhile it is to make sacrifices for these most vulnerable of human beings.

Nearly two thirds of the public and more than three-quarters of women support a reduction in the 24-week upper age limit.

76% of the public think that aborting a baby at six months is cruel. Furthermore, a 2007 poll by Marie Stopes International found that two thirds of GPs wanted a reduction from 24 weeks (more similar figures here).

It’s time now for Parliament again to ask serious questions about late abortion.