Would you have another preemie?

I spend a lot of time on a message board for parents of preemies.  In all honesty, I spend far too much time on this message board, but I can hardly help myself.  It’s what I usually read while I’m pumping breast milk, and I pump at least 4 hours a day.

Recently, there was a thread that posed the question, “Would you choose to have another baby if you knew that your next baby would be a preemie born at approximately the same gestation as the one you already have?”

The responses elicited by this question varied wildly, from “I would do it again in a heartbeat!” to “No way in hell would I choose to do that to another child.”  Ninety-eight mothers responded to the poll associated with the post, and responses were fairly evenly distributed:

Yes – 40%; Probably – 13%; Probably Not – 22%; No – 23%

Not surprisingly, there did seem to be a correlation between the preemie’s gestation and the likelihood that his or her parents would be willing to give birth to a sibling at the same gestation.  Statistically, the outcomes of preterm births improve drastically as one increases from 23 weeks to 28 weeks and from 28 weeks to 34 weeks.  It’s much easier to face the mortality statistics associated with a 28-weeker than those associated with a 23-weeker, and it’s much easier to face the disability statistics associated with a 34-weeker than those associated with a 28-weeker.

I was, however, a bit surprised that among mothers who responded with reasons why they would have another preemie, I gave birth to the earliest preemie.  And there were many mothers with later preemies than Peter who vehemently felt that they would not have another preemie of the same gestation.

I suppose that if I knew that I would give birth to a preemie earlier than Peter, I wouldn’t have another child.  Perhaps this is just because, for me, a preemie of 23, 24, 25, or 26 weeks gestation is a frightening unknown, a misfortune I have not experienced.  Or perhaps this is because I’ve read too many stories of preemies of these gestational ages that didn’t survive.  Or perhaps it’s because I know that it’s always a long, tough road for preemies of these gestations.  I’ve never heard and mom of a 25-weeker say, “We were lucky; our baby was a feeder-grower, and we were out of the NICU before our baby reached 36 weeks gestational age.”

One mom of a girl born after Peter but with a due date before mine wrote,

My 32-weeker is awesome, and I wouldn’t not have her.  It’s hard to explain.  I guess right now I am so worried about delays, disabilities, etc.  I think later down the road, if everything goes well with her, then my answer might change.  The NICU was just something I honestly don’t think I could ever do again.

Another mom of 32-week twins and a 35-weeker wrote,

In the past 20 months, I have had 3 preemies, and I love my children with all my heart.  But I would not want to have another preemie.  It’s just so hard to have to watch your children be so little and have to fight through everything.  Not being able to be there for them 24/7 – leaving them behind every day – is hard.  If I had a magic ball that told me I would have another preemie, I just wouldn’t want to have anymore children.  It’s too hard on my soul.

In response to the statement, “If I was told I would have another 28 weeker if I got pregnant again, I wouldn’t do it.  There’s no way I would willingly put a baby through that.  I also wouldn’t want to go through again,” a mother of a 29-weeker wrote,

My thoughts exactly, and regardless of their gestation – 24 weeks or 34 weeks – they can have serious complications, why would you risk another child’s life if you knew they would come early?  That is selfish, in my opinion.

A mother of a 30-weeker wrote,

I voted NO.  My doctor has told us that he would “hope” to get us to 32 weeks in another pregnancy.  I’m sorry; even 32-weekers can have huge problems.  It’s not good enough for me.  I feel like my husband and I could take it.  We’ve been there before.  Yes, we’re a little beat up from our journey, but we could take it.

However, I feel like it would be too hard to have my daughter go through this.  It would not just be my husband and me on the journey; it would be HER too.  For me, that’s just too much, not to mention subjecting another baby to “that” sort of journey knowingly.

For our family, I think adoption will be the way we add to our family from here on out.

After reading these responses, I was almost at the point of tears.  Am I a callous person because I would be willing to have another 27-weeker?  Is it selfish of me to want to conceive children even if they have to face the risks of being born 12 weeks premature?  Would it be cruel of me to make Peter experience the NICU for a second time, only this time as a big brother watching his tiny, fragile sibling through the plastic walls of an incubator?  Why couldn’t I just look into the possibility of adoption?

I wasn’t immediately sure what my response would be to the opening poster’s question.  But then I asked myself, If I had known everything we would have had to go through due to Peter’s prematurity before he was conceived, would I have had him? The answer is a whole-hearted, Yes!  Without a doubt! I would have gone through the whole NICU experience twice to have this beautiful little boy in my arms today.

Perhaps if Peter had more serious long-term complications related to his prematurity, I would not be able to say that I would have another 27-weeker.  There were no major bumps in the road during Peter’s NICU stay.  I’ve mentioned this before, but I’m going to thank my stars again, anyway:  Peter did not need a high level of respiratory assistance, he never had pneumonia or sepsis or NEC, he did not need any surgeries.  In short, I never feared for my son’s life.  Certainly, there were plenty of life-threatening complications that I could have legitimately worried about, given my son’s early arrival.  But I’m not one to worry about complications until complications actually arise.

I’ve heard many people describe preemies as sick and helpless.  I never considered Peter “sick” while he was in the NICU.  He was small and fragile, but he was as healthy as anyone expected him to be, given his early arrival.  He was growing stronger every day, even on days that he needed a little more respiratory assistance or days that he didn’t gain weight or days that he struggled with PDA or days that he was too tired to take all his milk by bottle and had to be gavage fed.  That was my mindset, and I stuck to it.  Peter was not “helpless”; he had dozens of medical professionals making sure he received the best treatment possible.  More importantly, Peter was incredibly tough and resilient.  On this point, most parents of preemies agree: their little babies are “fighters”.  Nurses agree, too: “Babies are amazing.  They can recover from just about anything.”

As a mother of a preemie, I’m a bit unusual because I don’t feel guilty about Peter’s preterm delivery.  I know I couldn’t have done anything to hold off Peter’s delivery.  There are treatments that I could have received that might have helped hold off preterm labor longer: indomethacin and magnesium sulfate instead of or in addition to Procardia; weekly 17P shots starting at 16 weeks.  But I did not know about these medications at the time, and there was no indication that I would need them until it was too late.  Yes, it was my uterus that failed Peter.  But I didn’t choose to have a Mullerian anomaly.

Therefore, I don’t feel like I forced Peter to struggle outside my womb.  I gave him a chance to grow and become a beautiful presence in the world.  Peter’s preterm birth was something that fate handed him.  And in my opinion, it’s worth risking the complications of a preterm birth in order to give a child the gift of life.

Preemies do not remember their struggles in the NICU when they grow up.  When they’re older, all they know is their current joys and struggles.  And for better or worse, every lifetime is filled with both laughter and tears.  Therefore, I disagree with mothers of preemies who say that it “is just cruel to put a baby through that knowingly.”  I stand by the often-quoted line, “Nobody said life would be easy, they just promised it would be worth it.”

And as another mother pointed out, “you never regret the children you have but you regret the ones you did not have. … Don’t make long-term decisions based on short-term problems.”

Of course, things are complicated by the fact that prematurity is not always a short-term problem.  All too frequently, it results in serious long-term consequences.  Therefore, I cannot blame the parents who decide that no, they cannot have another child knowing that it will most likely be a preemie.  Nor can I blame mothers who, having tested their own mortality during a previous pregnancy, decided that no, they will not have any more children.  They need to make sure that the children they already have grow up with a mother.

I’ve seen some of the potential long-term consequences of prematurity through my sister and her experiences.  I’ve seen Kelly struggle to walk, struggle to ride a bike, struggle to fit in with peers at school, struggle to learn math, and struggle to write legibly.  It has been hard for her, and it has been hard for my whole family.  But through her disabilities, we have grown closer, stronger, and more compassionate as a family.  If my parents could have known that Kelly would have cerebral palsy and learning disabilities before she was conceived, I would not want them to have decided to not have her.  So yes, I disagree with the mothers who reason that they would not have another preemie because it would be too difficult for their other children to deal with the consequences.

Nobody said life would be easy, they just promised it would be worth it.

I think it’s fair to say that Kelly has made me courageous.  I did not fear the wires and monitors and breathing tubes and incubators and bili lights I saw in Peter’s NICU.  I saw them in Kelly’s NICU when I was not yet 5 years old, and I learned then that this medical equipment only served to help tiny babies grow into strong children.  I do not fear developmental delays and learning disabilities the way many parents of premature babies do.  I know that if Peter has long-term health problems or delays due to his prematurity, it’s not the end of the world.  He still has unbounded potential to live a beautiful life.

I have at times struggled as a Catholic to agree with all the “respect life” teachings of the Church.  I’m not so sure that abortion should be outlawed; there are circumstances where abortion is a necessary evil to avoid greater risks and hardships.  I’m not so sure that birth control is a bad thing; it certainly seems to have helped many women and families.  However, I think that my Catholicism does shine through with this particular issue.  Yes, I would have another preemie.  Yes, I think it was worth asking Peter to struggle through his third trimester in a NICU, given that my uterus wasn’t an option any longer.  Because the gift of life is immeasurable.

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