Recently, Ken O’Flynn TD established through a parliamentary question that 12 babies were born alive after abortion in Ireland in 2022. After this figure was reported, you might have expected a public outcry and a demand to establish what level of care is given to these tiny babies. It never materialised.
The figure of 12 babies was provided by the HSE from a National Perinatal Epidemiology Centre (NPEC) report. However, only babies weighing 500g or more, and/or with a gestation age of 24 weeks or longer, were included.
Of the 12 abortion cases born alive in 2022, nine were at 22-27 weeks and two were at 28-31 weeks.
The NPEC report states that all but one of the 12 were suffering from a major congenital anomaly. It also mentions 11 other babies delivered alive in 2022 whose weight was either less than 500g or whose gestation was less than 24 weeks. So that makes 23 babies born alive.
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From 2019 to 2022 inclusive, the report refers to 33 babies born alive after abortion, 29 after abortion for major congenital anomaly, and four for maternal complications. When you include those born alive after abortion who did not reach 500g and/or 24 weeks, there are a further 51 babies. This means 84 babies born alive in total. This is not a rare occurrence.
Even very small and premature babies, sometimes under 500g, now have a better chance of survival. The medical and scientific consensus on babies with major congenital anomalies, better described as life-limiting conditions, has shifted considerably since 2018.
The influential American Academy of Pediatrics (AAP) changed its guidance this year on babies diagnosed with trisomy 13 (Patau’s syndrome) and trisomy 18 (Edward’s syndrome), two of the most common life-limiting conditions. It was in response to medical evidence showing higher survival rates for these babies. Once assumed to be universally fatal shortly after birth, the survival rate after a year for live-born infants (not after abortion) is between 10-25 per cent for both conditions.
The AAP recognises the severe life-limiting disability accompanying T13/T18, but cautions against disability bias.
Comfort care refers to the care given to babies expected not to live long after birth, whether post-abortion or not. While stating that comfort care remains ethical, the AAP also states: “This diagnosis, however, does not justify unilaterally withholding therapies that may prolong life or facilitate hospital discharge”, unless treatment has no chance of success.
The AAP guidelines say that “T13/T18, however, appear to be prime examples of the ‘self-fulfilling prophecy’ … in which high mortality without intervention is used to justify continued non-intervention while failing to recognise that intervention alters the likelihood of mortality“. So, by not providing treatment to babies with life-limiting conditions, they are more likely to die, and those deaths are then used to justify non-treatment.
The revised AAP guidelines affirm the human right of children with severe disabilities to non-discriminatory treatment, far beyond comfort care after abortion. Yet in Ireland, the level of comfort care offered after abortion is in doubt. The 2023 three year review on abortion called for guidelines to be developed on comfort care after a live birth after abortion. The review also states that while some obstetricians carrying out abortions received “very good support” in these circumstances, others found that neonatologists would not provide comfort care to babies surviving abortion.
Qualitative research carried out in Ireland in 2020 found that half of foetal medicine specialists experienced conflict with neonatologist colleagues, leaving them “begging for help” with comfort care.
In response to questions, the HSE states that clinical teams follow established national clinical guidance and local multidisciplinary care plans, including a “Pathway for management of Fatal Fetal Anomaly and/or Life-Limiting Conditions diagnosed during pregnancy (National clinical guideline, 2020)”; and the HSE “Pathway for Perinatal Palliative Care and National Standards for Bereavement Care Following Pregnancy Loss and Perinatal Death.”
The Institute of Obstetricians and Gynaecologists (IOG) guidelines on abortion for life-limiting conditions state: “For those babies that are born with signs of life, a tentative palliative care plan will be in place.” No detail is given. There is no explicit reference to babies born alive after abortion in the national standards for bereavement care following pregnancy loss and perinatal death published by the HSE. It is advised that, in general, “comfort care measures such as skin-to-skin contact and non-nutritive sucking are employed with parental involvement as appropriate.”
Yet comfort care can encompass much more than this, including feeding as standard so the baby does not experience hunger or thirst. University of Milan neonatologist Dr Elvira Parravicini established a neonatal comfort care service at New York’s Columbia University Irving Medical Center in 2008 because, at least in the US, comfort care often meant doing nothing, just allowing the baby to die. In 2016, Parravicini gave a presentation about authentic comfort care for families who opt to continue the pregnancy. By tailoring the response to the baby’s condition, sometimes the baby goes home with his or her family.
Simon Harris promised in 2018 that babies born alive “regardless of the circumstances in which he or she came into the world” would receive all appropriate medical treatment and support. Tragically, we are nowhere near achieving this.
