VICTORIA – She is in hospital, declared brain dead but has been kept alive for the past five weeks. Robyn Benson was 22 weeks pregnant when she suffered a brain hemorrhage.
Inside of her is her unborn son and by the end of February he’ll be at or near 34 weeks gestation. Doctors have kept Robyn alive until her baby can be delivered via C-section. But the next few weeks will require around-the-clock critical care to make sure the mother’s body is still functioning and providing a safe environment for the fetus, Canadian doctors say.
“In any baby that looks like it’s being born prematurely we try to gain as much time as we can because the baby will survive much better if it can breathe and look after itself outside of the uterus but one has to weigh that against the patient (Robyn) getting sicker,” Dr. Doug Black said.
“It’s a bit of a seesaw in weighing the pros and cons,” Black said. He is doctor at The Ottawa Hospital and spokesperson for the Society of Obstetricians and Gynecologists of Canada.
Because Robyn has been declared brain dead, her body is now relying on artificial life support — she’s clinically and legally dead. At this point in time, doctors would typically have end-of-life discussions with family members and even suggest organ donation, according to Dr. Randy Wax, section chief of critical care at Oshawa, Ont.’s Lakeridge Health. He’s also hospital head for organ donation.
“Obviously, having a fetus changes the situation,” he told Global News.
Now, doctors’ priorities are to maintain Robyn’s body and organs, keep them in good function so that her baby can keep developing. What’s crucial is that Robyn’s baby has the time to achieve fetal lung maturity.
“If you think of the uterus as an incubator, most of us [doctors] think it’s better to remain inside the natural environment than it is to be delivered prematurely where other stressors are involved,” Black said.
“Even one to two weeks can make a significant difference in the outcome of the baby and avoiding complications,” Wax said.
If babies are born at the 22-week mark, they could face complications and some long nights in the neonatal ICU unit. At 34 weeks, babies generally fare better. A typical full-length pregnancy can run from 37 to 41 weeks.
But this could be touch-and-go for Robyn’s case. Our brains control critical body functions, like our blood pressure for example. Doctors are forcing these mechanisms for Robyn.
“The body isn’t meant to function for prolonged periods of time after the brain is dead,” Wax said.
If she encounters pneumonia or a lung infection, it means bad news for the baby and the duo’s doctors. If there are sudden complications or, in a worst case scenario, her heart stops beating, doctors would have little time to respond to help her baby, Wax said.
“It’s going to be a tightrope they’re going to be walking,” Black warned. Should there be any sign of Robyn’s body shutting down on her and her child, an emergency C-section would have to occur — and in a very small window of time.
Otherwise, it’s likely a C-section has been planned in the upcoming weeks. In an ideal situation, Robyn’s body will continue to safely care for the baby and under a set time, doctors, pediatricians, nurses and any other specialists can be on hand for a safe delivery.
For now, the baby is receiving all of its nutrition through the placenta. It’s also turning to its mother for oxygen and blood flow. In this case, Robyn’s body could be nourished intravenously or through a nasal gastric tube, Black said.
“It’s mind boggling the types of decisions that have to be made for this woman while she’s in a comatose state,” Black told Global News.
And what about the ethics of this case? In Texas, a pregnant brain dead woman was taken off of life support. Her husband sued the hospital looking after her because it would not remove life support as he said his wife would have wanted.
“I believe the key part of this story is that Robyn Benson’s husband, Dylan, has indicated that it would have been Robyn’s wish to continue the pregnancy and to have the child, and that Dylan is supportive and would also like his wife to be kept alive on ventilators,” Dr. Jeff Nisker, of the University of Western Ontario, told Global News.
“He wants it to be this way. I don’t see an ethical conflict at all.”
As for the rarity of this case, the Canadian doctors say that it’s quite the anomaly.
Wax says it’s doubly obscure — yes, Robyn is brain dead, but her baby made it to hospital without severe health implications and he’s still growing.
In some cases, mothers help others through the gift of organ donation.
“In this way, [Robyn] is helping her new baby by temporarily donating her organs and body to help her baby survive until it’s ready to live in the outside world,” Wax said.
“This is a unique case of organ donation from a mother to her child. It’s sort of like a last loving act of a mother,” he said.
© Shaw Media, 2014