This is a rhetorical analysis I wrote on the debate about treating very premature babies. I read several pieces of writing on both sides of this issue and analyzed how people are publicly talking about the topic.
The debate over whether or not to resuscitate and treat babies who are born extremely prematurely is simultaneously emotional and scientific. There are countless stories of miracle babies whose lives were saved by a mistake in determining gestational age or a doctor who took a chance on them, or of babies whose parents thought it was better to let them peacefully die. There are also many studies conducted on babies who were almost or barely viable that are devoid of emotion and concerned only with statistics. Each of these stories or studies approaches this issue differently and is directed toward a different audience.
The blog 22w6d is written by a mother, Alison Epps, about her experience having a son who was born at 22 weeks and 6 days into her pregnancy. The post “Dear NICU Doctor” includes a letter Epps wrote to various medical directors of neonatal intensive care units (NICUs). She asks them to reconsider policies of not treating babies born at less than 23 weeks gestation, recounting the story of her own son, who was only resuscitated and treated at birth because doctors mistakenly thought he was born at exactly 23 weeks. She feels strongly that 22-week babies should be given a chance at life. Her purpose in writing this letter was perhaps also to make people think more about the issues of prematurity or lead the public to question hospitals’ policies about treatment, which they might have never thought about before. Judging by the comments on her post, her audience is largely other parents of premature children who seem to agree with her opinion. A blog is a fitting genre for the purpose of Epps’s writing. She has a very personal story and she wants to express her own views in a way that would not work for, say, a newspaper article or an academic journal.
An opposing opinion on this issue is given by Alexia Pearce, a mother written about in an article in the British newspaper The Guardian titled ‘Nathan was born at 23 weeks. If I’d known then what I do now, I’d have wanted him to die in my arms.’ The article appears to be written to make the public more aware of the issue of prematurity through this one mother’s story. This article probably attracted a wider audience than just those interested in prematurity because of the rather surprising and sensational title. The Guardian used a dramatic quote as their title to entice readers to join the conversation about this very delicate subject. Pearce’s son Nathan was born at 23 weeks gestation and at three years old has multiple severe disabilities, including “chronic lung disease, cerebral palsy and global developmental delay” (McVeigh 2011). Pearce wishes that she had let her son die at birth rather than making him endure multiple medical procedures and months in the hospital. She wishes more people would realize the devastating effects that extreme prematurity can have on those who survive it.
The essay “When Is It Right to Let Your Unborn Baby Die?,” published by the online magazine Slate, offers another parent’s story about facing the possibility of a premature birth. The author, Eugenie Samuel Reich, had very low levels of amniotic fluid at 22 weeks pregnant, and her baby had intrauterine growth restriction, or IUGR, which caused them to weigh much less than usual for their gestational age. According to doctors, the baby wouldn’t last much longer in utero before dying. Reich had to decide whether to stay pregnant and risk a stillbirth, or deliver her baby very early to try to save their life. Reich doesn’t provide a clear stance in this essay on whether she believes extremely premature infants should be treated. She seems to believe that, at least in the specific situation she went through in which the only alternative to a premature birth is a stillbirth, the pregnant person or parents of the unborn baby should decide the minimum gestational age or weight at which they think their baby should receive treatment instead of being allowed to die. Reich seems to advocate for individual decisions and not judging the viability of each baby by the same criteria. The likely audience of this essay is similar to those of the previous sources, namely people who have some connection to or interest in prematurity or pregnancy.
The New York Times article “Premature Babies May Survive at 22 Weeks if Treated, Study Finds” explains the results of a study in The New England Journal of Medicine. Like the Guardian article, the purpose of this Times article seemed to be informing their readership, in this case about a new study in the field of neonatology. The study showed that babies born at 22 weeks gestation have a small, but non-zero, chance of surviving with no major health issues, and also found that different NICUs had different protocols for how (or whether or not) to treat babies born so prematurely. Some hospitals do not treat 22-week old babies at all, some give intense treatment to most 22-week-olds, and most are in between those extremes. The newspaper does not itself give an opinion on whether such premature babies should be treated, only offering the information that some, but not most, babies born at 22 weeks, survive fairly healthily, leaving the reader to form their own opinion.
The article “In Premature infants born at borderline viability, do days matter?” published by the Journal of Paediatrics and Child Health on April 28, 2016, describes a study, the purpose of which was to test the hypothesis that “there would be a difference in survival within weeks” (Schindler et al. 349-350). Usually, gestational age is only counted in weeks, and the decision to resuscitate and treat an infant is based on the week they were born, with the exact number of days not being taken into account. The study found that there was a significant difference in the survival rates of babies born later in each week and earlier in the next week. There was also a difference, although not significant, between the survival rates of babies born earlier and later in the same week. Babies had a slightly higher chance of survival if they were born later in the week (for example at 23 weeks and 4, 5, or 6 days) than earlier that week (at exactly 23 weeks or 23 weeks and 1, 2, or 3 days). Even though this difference was not significant, the authors write that “there are potentially clinically important differences in survival within gestational age weeks” (Schindler et al. 349-350). The authors think that if days, not just weeks, make a difference for a baby’s chance of survival, that should be taken into account. It is important to note that this article is a scholarly essay, and therefore is aimed at a different audience than the other sources mentioned above, which generally have audiences of anyone who reads or subscribes to that magazine, blog, or newspaper, with parents of premature children perhaps being more interested. The intended audience of this essay is the scientific and medical community, more specifically neonatologists and those who study neonatology. This audience makes a scholarly article in an academic journal the only fitting genre for this piece.
The blog post and the Guardian article both give personal stories of premature births. They appeal to their audience with emotional pleas to consider their opinion, either that very premature babies should be allowed a chance at life, or that it’s okay to not give them that chance. The Slate essay also has a personal story from the author, but doesn’t appear to be strongly on one side or the other of this debate. The study in the Journal of Paediatrics and Child Health and the New York Times article recounting another study both consider extreme prematurity from an outside, objective, perspective. Although the Times article does mention individual children, neither it nor the study in the Journal try to use the story of one baby to convince readers of their opinion. In fact, they avoid giving an opinion and merely give information. The different opinions, or lack thereof, of these pieces informed the authors’ purpose in writing them. The writers either tried to convince their audience of their beliefs or to give their audience new information. And the differences in the purpose of the pieces impacted their genre. A blog or a magazine is the right place for personal stories meant to change people’s minds, whereas articles or essays only intending to inform readers belong in a newspaper or a journal. Each piece of writing had a reason for being written in a certain genre, which in turns affects how it’s received by its audience.
Works Cited
Belluck, Pam. “Premature Babies May Survive at 22 Weeks If Treated, Study Finds.” The New York Times, The New York Times, 6 May 2015, www.nytimes.com/2015/05/07/health/premature-babies-22-weeks-viability-study.html?_r=0.
Epps, Alison. “Dear NICU Doctor.” 22w6d, 7 May 2015, 22w6d.com/2015/05/07/dear-nicu-doctor/.
McVeigh, Tracy. “’Nathan Was Born at 23 Weeks. If I’d Known Then What I Do Now, I’d Have Wanted Him to Die in My Arms’.” The Guardian, 19 Mar. 2011, www.theguardian.com/society/2011/mar/20/nathan-born-premature-life-death.
Reich, Eugenie Samuel. “When Is It Right To Let Your Unborn Baby Die?” Slate, 5 Nov. 2012, slate.com/human-interest/2012/11/preterm-delivery-or-risk-a-stillbirth-when-is-it-right-to-let-your-unborn-baby-die.html.
Schindler, Tim, et al. “In Premature Infants Born at Borderline Viability, Do Days Matter?” Journal of Paediatrics and Child Health, vol. 52, no. 3, 2016, pp. 349–350.
