No guarantees

When I become a parent, I realized how tenuous life is. I find myself imagining all sorts of terrible situations that might befall my children—quite outlandish things that come unbidden to my mind when I’m drifting off to sleep or daydreaming. Accidents, kidnappings, incurable diseases, that sort of thing. In these scenes, I’m always one step or one shout too late. These waking nightmares became particularly intense after Dio was born, to the point that I had a hard time sleeping for a while because I kept worrying that someone was going to kidnap my children. My logical mind knew it was a bit silly, but my primitive brain--the part that controls instinctual responses and emits adrenalin--was on high alert. 

In real life, my children have never met with disaster. We’ve had our share of scrapes and falls, of course. And some really scary near misses—like the time a few weeks ago when Zari was riding her trike and I was walking behind her, pushing Dio in the jogging stroller. We came to an intersection. Instead of stopping and waiting for me, as she always had done in the past, she pedaled even faster. Right into the path of an oncoming semi truck.

Of course this story turned out happily. The truck driver saw her and stopped. A friend who was walking with me ran into the street and snatched Zari back onto the sidewalk. Another woman across the street had been watching and was running towards Zari as well, yelling at the oncoming traffic to stop. Afterwards, my mind replayed the incident, and I couldn’t stop thinking what if the truck hadn’t seen her? What if my friend hadn’t been there with me? What if what if what if?

This afternoon Zari and Dio were playing inside a tent on the living room floor. I was on the couch, reading a book. Dinner was made and we were waiting for Eric to come home from playing ultimate Frisbee. The sounds of play—talking, giggling, babbling, minor squabbling—suddenly stopped. Dio began screaming. Not the usual “you took my toy away!” scream, but a piercing shriek of pain. I opened the tent flap and saw blood all over Dio's face, shirt, and hands. Zari had been cutting paper inside the tent, so I knew that the scissors were somehow involved. Zari shrunk away from me and wouldn’t make eye contact. I had to quickly figure out a) where the blood was coming from and b) what had happened.

I looked at his face first. No active bleeding, no scissors in the eye or mouth or anything awful like that. Okay. Hands next: I saw blood flowing from his index finger. The tip of his finger had been cut off. Now, that sounds worse than it really was. More specifically—a piece of skin the diameter of a lentil was missing at the tip. I told Zari to run get a towel, but she wouldn’t move.

So I ran Dio into the bathroom and rinsed the cut off. He was shrieking and writhing, so we soon had blood all over both of us. I held a washcloth around his finger and opened the first-aid kit. I tried a band-aid first, but it soaked through and was dripping blood in just a few seconds. So I opened up a gauze eye patch, put it around his finger, and wrapped it snugly with medical tape. This was more complicated than it sounds, because he would not hold still. I ended up pinning him on the ground between my legs while I bandaged him up.

He needed lots of snuggles and nursing the rest of the evening. I put a new bandage on right before bedtime, since his old one had slipped loose. I hope the new one stays on all night. The bleeding is still fairly brisk when there’s no bandage applying pressure to the cut.

I never could get a straight story from Zari about how exactly his finger had made it into her scissors. She wouldn’t make eye contact with me for a long time. My guess is that it was an accident.

Even though I was only about three feet away, it still wasn’t enough to prevent the accident. Sure, I could never keep a pair of scissors in the house…but Zari has been using scissors quite competently for a long time. She enjoys doing “activities”—cutting paper and fabric, gluing on pompoms and glitter and googly eyes, tracing patterns, and using her stamp sets. (After today’s incident, though, I did explain that she can only use her children’s scissors, rather than my “adult scissors.” More for Dio’s sake than her own, since he’s started to imitate whatever she does.)

Part of being a parent is realizing that you cannot be there every moment. You cannot anticipate every eventuality. You cannot guarantee that your children will be safe and unharmed, or even that they will be alive the next day. That sounds a bit morose, but it’s a reality that hits me especially hard during pregnancy. I have to live with the knowledge that my baby might not survive. Although there's a very good likelihood that my pregnancy will continue to term and that the baby will be born alive and healthy, it's never 100% certain. I'm still working to find the right balance between hoping and planning for life and accepting the possibility of mortality. Or even just plain-Jane things like getting the tip of your finger cut off by your older sister.

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Home burial

In the middle of my parent's garage, under a pile of junk (to my mother) or potentially useful things that need to be organized (to my father) sits a handmade wooden coffin.

My dad had never thought about home burial until his mother died of cancer. She had requested that she not be embalmed and that family members dress her body and conduct her funeral. My dad helped his siblings make her coffin--no hermetically sealed affair, but a simple wooden box to hold her remains. My grandfather was so touched by the beauty and simplicity of a home burial that he requested the same for himself. My dad is an ardent supporter of home funerals and green burials, after participating in both his parents'. He started making handmade wood coffins as a side hobby and has sold a few to friends and acquaintances. I'm not sure what the one in our garage is for, since it's been there for a few years now.

The New York Times recently published an article about home funerals and green burials: Home Burials Offer an Intimate Alternative.

Baby boomers who are handling arrangements for the first time are particularly looking for a more intimate experience. “It’s organic and informal, and it’s on our terms,” said Nancy Manahan of Minneapolis, who helped care for her sister-in-law, Diane Manahan, after she died of cancer in 2001, and was a co-author of a book, “Living Consciously, Dying Gracefully,” about the experience. “It’s not having strangers intruding into the privacy of the family. It’s not outsourcing the dying process to professionals.”

I couldn't help but notice the parallels between home burials and home births: a desire for more intimacy, for birth/death to happen on your own terms, and for the process to be one mediated by family members rather than by professionals. In fact, the article compared the upsurge in home burials to the home birth renaissance three decades ago:

Advocates say the number of home funerals, where everything from caring for the dead to the visiting hours to the building of the coffin is done at home, has soared in the last five years, putting the funerals “where home births were 30 years ago,” according to Chuck Lakin, a home funeral proponent and coffin builder in Waterville, Me.

So, if anyone needs to buy a coffin, I know of a beautiful handmade one ready to go. And my mom will thank you for decluttering her garage!

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Extreme prematurity

I've been musing about what I would do if I were to go into preterm labor. The answer is obvious if the baby were 30 weeks: go to a hospital with a good NICU. My own cutoff for an out-of-hospital birth would be around 36-37 weeks, depending on the particular situation, access to oxygen and a midwife skilled at recognizing signs of respiratory distress or other prematurity-related complications.

But what about 28 weeks? 26? 24? 22? At what point would I allow the baby to pass on peacefully, rather than attempting heroic efforts at resuscitation with a small chance of survival and high likelihood of major disabilities if the baby were to live? My own gray area is between 24-28 weeks. By time a baby hits 26 weeks gestation, survival rates are between 80-90%, and about 15% of those surviving babies will have major disabilities as a result of prematurity. I think this would be the earliest point at which I would consider intervening.

General estimates of survival for live born infants who receive neonatal intensive care in the USA in the late 1990's are:

Completed Weeks of Gestation at Birth (Using last menstrual period)	Survival
21 weeks and less	0%
22 weeks	0-10%*
23 weeks	10-40%
24 weeks	40-70%
25 weeks	50-80%
26 weeks	80-90%
27 weeks	>90%
30 weeks	>95%
34 weeks	>98%

*Most babies at 22 weeks are not resuscitated because survival without major disability is so rare.

A more accurate way of predicting survival is by birth weight, rather than gestation.

Survival Rates for Low Birth Weight Infants

Birth Weight	Survival (percent)
Pounds are approximate	Vermont Oxford Network	NICHD
501-750g (1lb 2 oz - 1 lb 11 oz)	58%	49%
751-1000g (1 lb 11 oz - 2 lb 3 oz)	85%	85%
1001-1250g (2 lb 3 oz - 2 lb 12 oz)	93%	93%
1251-1500g (2 lb 12 oz - 3 lb 5 oz)	96%	96%

Still, survival rates and even major disability rates are not the only practical or moral considerations that I would have to account for. Having a very premature baby, in my own family setting, would mean I would have to commute to a hospital with an advanced enough NICU: probably 40 minutes away and most likely an hour or more. The stresses on our family, the realities of trying to spend my time in a NICU while caring for a nursing toddler, and the emotional and financial drains that an extremely premature baby would entail are all things I'd have to carefully think about.

In addition, my own moral/religious understanding of our life on earth would influence my decisions as well. I strongly believe that life is sacred, but that it is not always appropriate to take heroic measures to prolong life. Death is something to embrace when it is the right time, since we understand it as a passage(and at times a welcome release) from one sphere of existence to another, just as our coming to earth was. It is a temporary separation, although still painful and difficult for those left behind missing their loved one. (For another LDS woman's perspective on this, read Descent's post.)

I hope I will never have to make this kind of decision. Have any of you ever been faced with such a dilemma? If not, have you thought about your own personal criteria for intervening versus letting the baby go?

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