Micro premies: Care and costs

[Irishy]

I swear to whatever deity you please, nobody here would be that stupid? There again.

I know I know... Just panicky moment there. Phew

[OkToBeTakei]

I know I know... Just panicky moment there. Phew

:lol: I have those. i think it may be our innate Celticness Irishy. That and a huge dose of just about 80% of our everyday chat is irony.

[Irishy]

:lol: I have those. i think it may be our innate Celticness Irishy. That and a huge dose of just about 80% of our everyday chat is irony.

Totally. Was worried briefly that it might not translate.

[J'ean Skirt]

That's why I tried to qualify my statement, and for the record I certainly don't think you're "broken" for not feeling the desire or need for children. I didn't want children for most of my 20's, I still don't understand why someone would want children when they are themselves quite young, but it's their choice, not mine, so there is no need for me to be an asshole about it. Also, I get why some child free folks are pissy, having people tell you that you are selfish or will change your mind has got to be annoying. There is just a certain subset of child free who seem to think there decision to not have kids makes them more special and enlightened, and feel the need to explain their superiority at great length.

20's. 30's. Now into my 40's. :)

Even when I was a teen ager, though, I kept looking at all of the things I wanted to do with my life and thinking "how am I going to do all of this AND have kids?" It just seemed undoable to me.

[valsa]

I think it makes sense, in the case of both micropreemies and the elderly, to have a frank discussion about the fact that our ability to keep people alive with technology often outpaces our ability to give them a good quality of life when they survive, as well as whether the money spent to cover the cost of extraordinary measures in a few cases would be better allocated towards preventive care for many more people (though, as pointed out here, in some cases one dovetails into the other (ie- preventive care for poor women would likely decrease the rate of premature birth))

However, I think we can have a reasonable discussion about allocation of scarce resources without craziness like not being able to care for a child until they're one year old.

[Turtle]

I think it makes sense, in the case of both micropreemies and the elderly, to have a frank discussion about the fact that our ability to keep people alive with technology often outpaces our ability to give them a good quality of life when they survive, as well as whether the money spent to cover the cost of extraordinary measures in a few cases would be better allocated towards preventive care for many more people (though, as pointed out here, in some cases one dovetails into the other (ie- preventive care for poor women would likely decrease the rate of premature birth))

However, I think we can have a reasonable discussion about allocation of scarce resources without craziness like not being able to care for a child until they're one year old.

I agree. Especially seeing how moms of premies don't all agree, so there is clearly not one right way to view the problem. Medical/bioethics is fascinating and constantly developing as technology changes. We need to be able to have a rational conversation without the crazies.

If someone doesn't care about their kid until they're one, I would hope they seek professional help.

[Sobeknofret]

Totally. Was worried briefly that it might not translate.

My Irish great grandmother told me one time with a straight face that she kept her seven kids in the barn when they were children, so I totally understood the humor there, no worries. :D

[lilith]

I agree. Especially seeing how moms of premies don't all agree, so there is clearly not one right way to view the problem. Medical/bioethics is fascinating and constantly developing as technology changes. We need to be able to have a rational conversation without the crazies.

If someone doesn't care about their kid until they're one, I would hope they seek professional help.

I totally agree with Valsa.

I do think not caring about a kid til it's one, while an exaggerated statement, is an expression of what a lot of non parents ( especially non mothers) feel.

I used to get really frustrated with my ex husband cause he didn't seem to bond with our babies when they were young. Then, when they were about a year old, and started toddling about and interacting a lot more, his relationship with them suddenly grew. He loved them before that, but in a more abstract sense.

I loved them and bonded with them from the start, but I was attatchment parenting them. That didn't really leave much interaction for Dad.

I think many people who haven't bonded with an infant dnt understand the process and the death of feeling it involves, and it's not something that can be easily explained - from the outside caring for an infant looks like a very thankless task.

That said, most people take it on faith that parents do love and attach to their babies.

[Sobeknofret]

I think it makes sense, in the case of both micropreemies and the elderly, to have a frank discussion about the fact that our ability to keep people alive with technology often outpaces our ability to give them a good quality of life when they survive, as well as whether the money spent to cover the cost of extraordinary measures in a few cases would be better allocated towards preventive care for many more people (though, as pointed out here, in some cases one dovetails into the other (ie- preventive care for poor women would likely decrease the rate of premature birth))

However, I think we can have a reasonable discussion about allocation of scarce resources without craziness like not being able to care for a child until they're one year old.

I agree almost completely. The problem with micropreemies can be that the outcomes can be almost totally up in the air, with some exceptions obviously. I spent three years with my son in therapy of one sort or another 4x a week, sometimes two or more sessions a day. We also endured another hospitalization and trips to a feeding specialist out of state several times. IOW, we worked like dogs to get our son the appropriate therapies and are still advocating for him. Other than what looks like a very mild case of ADD, he's a normal 9 year old boy. I strongly suspect Josie Duggar will not have anywhere near as successful an outcome as my son did because her parents won't even acknowledge she has delays. So much of the outcome for mircopreemies depends on getting appropriate therapy and assistance for them. Some states excel in getting care for these kids, some don't, and others have parents who for one reason or another can't or won't get the help that they and their kids desperately need.

[treemom]

I think it makes sense, in the case of both micropreemies and the elderly, to have a frank discussion about the fact that our ability to keep people alive with technology often outpaces our ability to give them a good quality of life when they survive, as well as whether the money spent to cover the cost of extraordinary measures in a few cases would be better allocated towards preventive care for many more people (though, as pointed out here, in some cases one dovetails into the other (ie- preventive care for poor women would likely decrease the rate of premature birth))

However, I think we can have a reasonable discussion about allocation of scarce resources without craziness like not being able to care for a child until they're one year old.

I think it was more the OMG TAX DOLLARS for me.

[adayinthelife]

What struck me the most was, if they had decided not to intervene after her birth or that all the interventions were causing Juniper unnecessary pain or would lead to a poor quality of life, they would not have the relatively healthy little girl they have now. The outcome is such an unknown I can see why anyone would do anything it took to save their baby. The weight of all the decisions that must be made with micro-preemies is amazing to me. I don't know how I would deal with that. Hats off to all the Mom's who have been through it.

[August]

What sorts of delays does Josie have?

[treemom]

What struck me the most was, if they had decided not to intervene after her birth or that all the interventions were causing Juniper unnecessary pain or would lead to a poor quality of life, they would not have the relatively healthy little girl they have now. The outcome is such an unknown I can see why anyone would do anything it took to save their baby. The weight of all the decisions that must be made with micro-preemies is amazing to me. I don't know how I would deal with that. Hats off to all the Mom's who have been through it.

That is why I don't understand someone objecting to the tax dollars.

NICU babies often cost less in health care, even micro preemies than a toddler that develops ALL. but hopefully we would back treating that.

But I admit, I just still think it should be down to the docs and the parents.

[rhianna]

I apologize for my poor wording. While I do not understand on a visceral level the connection parents have with their kids, I do understand on an intellectual level that parents love their kids more than anything in the world and place a high premium on reproducing and raising children.

I stand behind everything else I say, including the "OMG tax dollars" part of it. While people can do whatever they want (within the limits of the law) with their private money, tax dollars are public funds and so should be allocated towards where they can do the most good. I'm NOT saying that the NICU isn't one of those places (in fact I retracted my earlier statement when I learned how small a percentage of our total health dollars go towards NICUs); however, there is room for debate about some of what goes on in NICUs.

[treemom]

I apologize for my poor wording. While I do not understand on a visceral level the connection parents have with their kids, I do understand on an intellectual level that parents love their kids more than anything in the world and place a high premium on reproducing and raising children.

I stand behind everything else I say, including the "OMG tax dollars" part of it. While people can do whatever they want (within the limits of the law) with their private money, tax dollars are public funds and so should be allocated towards where they can do the most good. I'm NOT saying that the NICU isn't one of those places (in fact I retracted my earlier statement when I learned how small a percentage of our total health dollars go towards NICUs); however, there is room for debate about some of what goes on in NICUs.

I think there is some debate about the efficacy of everything. But I also really hate the "tax dollars" phrase. Always...not just now. I hate it about everything.

[RosyDaisy]

To be honest, I don't know how a I feel about intensive intervention for micro-preemies. I guess it's on a case by case basis.

[Witsec7]

To be honest, I don't know how a I feel about intensive intervention for micro-preemies. I guess it's on a case by case basis.

If there are government funds available who decides? Do the parents have the ultimate choice about fully paid for interventions?

[Miggy]

What sorts of delays does Josie have?

According to Michelle & Jim Bob, none.

[MLizabeth]

And in breaking fundy/preemie news:

inashoe.com/2013/01/please-pray-for-my-baby-nephew/

Take one (non-micro) preemie. Think about the time you spent in the NICU with said baby. Remember that the doctors told you that all preemie are immunocompromised and have weaker lungs than their full-term compatriots. Remember that the doctor told you to limit your preemie's contact with other people, particularly children, and that your preemie was susceptible to a dangerous disease called RSV that is everywhere during the winter months. Go through a scary bout of pneumonia with your baby that illustrates how easily and seriously sick your baby can get. With all that information, decide to go party with the Coghlan clan, including their many young children and guests.

Result, baby gets dangerously sick with RSV that he got "somewhere along the line."

All of the above isn't even snark, it is just anger that people would be so careless with a child they love, and fear for that poor baby.

[SilverBeach]

(snip)

Finally, I also am in favor of reducing drastic interventions in the elderly. I work in healthcare and this is an area I am more familiar with than neonatology. We definitely need to focus more on quality of life as the optimal outcome. I also think that the decision-makers should be patients and families; however, I also think that health care providers should make it very clear how likely they think any given intervention would be to actually increase quality of life as opposed to simply prolonging it.

My mother is 86. I do not want her given spartan medical treatment, or "less drastic" medical treatment (whatever that means) just because she is elderly. And who defines quality of life? My mother has a 64 year old friend who is in the skilled nursing facility because she has multiple sclerosis and is wheelchair bound. Yet, she enjoys feeding the birds each day, getting her hair done, and her friendship with my mother. If a person is brain-dead and on life support, yes there is likely no use for prolonging death. But short of that, and unless a person expressely wishes to discontinue or curtail treatment, it should not be policy for health care providers or anyone else to judge quality of life. Besides, if we stopped spending trillions of dollars on so-called "defense", our nation would have stellar educational and health care systems to serve ALL citizens.

[RachelB]

I totally agree with Valsa.

I do think not caring about a kid til it's one, while an exaggerated statement, is an expression of what a lot of non parents ( especially non mothers) feel.

I used to get really frustrated with my ex husband cause he didn't seem to bond with our babies when they were young. Then, when they were about a year old, and started toddling about and interacting a lot more, his relationship with them suddenly grew. He loved them before that, but in a more abstract sense.

I loved them and bonded with them from the start, but I was attatchment parenting them. That didn't really leave much interaction for Dad.

I think many people who haven't bonded with an infant dnt understand the process and the death of feeling it involves, and it's not something that can be easily explained - from the outside caring for an infant looks like a very thankless task.

That said, most people take it on faith that parents do love and attach to their babies.

Yes, and yes. I've never parented-- only aunted and been friends of people with children-- and find infants completely mystifying and a little scary: they're fragile, and they're beginning a long and difficult process of learning how to communicate their needs, which involves a lot of crying. I've been told that if when you're a parent, you actually figure it out, but I understand your ex husband's position: toddlers have more communication strategies, more possibilities for interacting, and more ways of making it clear who they are. (Case in point: As a 5-year-old, my eldest nibling is a total dear-- chatty, earnest, fond of Pippi Longstocking, an excellent producer of chicken noises, and an enthusiastic if somewhat tuneless soprano. He was born early and had a pretty rough first year. When I took him off my sister-in-law's hands for a couple hours as a 6-month-old so she could get a nap, he was inconsolable the whole time. By the time I handed him back, we were both in tears. It was clear to me that his mom and dad felt deeply for him even then, but he and I didn't really understand each other for a while.)

[slickcat79]

My mother is 86. I do not want her given spartan medical treatment, or "less drastic" medical treatment (whatever that means) just because she is elderly. And who defines quality of life? My mother has a 64 year old friend who is in the skilled nursing facility because she has multiple sclerosis and is wheelchair bound. Yet, she enjoys feeding the birds each day, getting her hair done, and her friendship with my mother. If a person is brain-dead and on life support, yes there is likely no use for prolonging death. But short of that, and unless a person expressely wishes to discontinue or curtail treatment, it should not be policy for health care providers or anyone else to judge quality of life. Besides, if we stopped spending trillions of dollars on so-called "defense", our nation would have stellar educational and health care systems to serve ALL citizens.

I don't think anyone is suggesting that, even rhianna. Your mother's medical care is either her decision, or yours or a family member's. Doctors are typically not called on to judge quality of life, but they have the necessary experience to present the likely outcomes to a patient's friends or family. It would be nice if everyone made their medical and end-of-life wishes clear before they become incapacitated, but that doesn't always happen. Then the decision is left to that person's loved ones.

There is a huge gap between wheelchair-bound but otherwise healthy and brain-dead on life support; some people might not want to live through some of the conditions in that gap, myself included. If I were unable to make that choice, I hope a frank discussion of potential outcomes would lead my family or friends to the decision I would want.

[treemom]

Silver beach,

I actually read some of this different, which is when tax dollars are paying for it then it actually is a problem for someone to choose a more aggressive treatment etc.

[Eternalbluepearl]

I read the three parts to the article. I guess I'm heartless because I didn't cry and still wondered why people go through so much to have kids.

[bekkah]

I read the article. I do think she does a great job of explaining the NICU.

One thing is that not all babies leave the hospital at their due date and they end up being transferred to PICU. My sister is a nurse in a PICU and she hates it when she gets the premies. She always tells me that it is the white boys who are the least likely to make it and end up having tons of issues. My sister has literally seen everything related to premie care even if they do get released and they end up coming back because of health complications. The life is so fragile for so long in so many cases that it is hard.