Knowing NICU Level Designations Saved My Baby’s Life—Here’s What You Need To Know If You're Pregnant
A decision on which hospital a mother goes to may mean the difference between a miracle and a tragedy.
The Wall Street Journal published an article earlier this month with the damaging headline: “Doctors Can Now Save Very Premature Babies. Most Hospitals Don’t Try.”
The headline implies that hospitals can but won’t save micropreemie babies, which is a dangerous and reckless thing to suggest. Hospitals are, in fact, the only option to save a micropreemie’s life if a mother finds herself in the living nightmare of laboring months before her due date. A micropreemie is a baby born before 26 weeks gestation.
The Wall Street Journal’s article was ultimately about the current “gray area” of NICU technology capabilities for babies born at 22-23 weeks. This actually is a valuable topic worth discussing but is layered in so much nuance that distilling the right choice for anyone down to a single article is irresponsible.
What expecting mothers need to know is there are hospitals that are specifically equipped to handle micropreemies. These hospitals with Level IV NICUs won’t shy away from the challenges and risks this situation brings. But it’s the responsibility of the moms-to-be to take note of exactly where those hospitals with advanced NICUs are in case the need unfortunately arises.
My son was born at 24 weeks and is now a healthy and wonderful 2 year old, thanks in part to us driving an hour to the nearest hospital with a Level IV NICU when my water broke at 23 weeks in 2022. No hospital in my local area had a NICU at the time. Now, only one local hospital has a Level I NICU, which still wouldn’t have been able to give him a chance at living life.
The sad reality is if a mom in need goes to a hospital that is ill-equipped to help, it can be the case that the baby is delivered at that hospital, and then the best option is to transfer the baby to a hospital that has the ability to care for them. Transferring such a vulnerable and fragile baby (whether by ambulance or helicopter) is fraught with severe risks and is far from ideal.
Be Prepared: Know Your NICU Levels
According to the CDC, 1 in 10 births in the U.S. were born prematurely in 2022, meaning they were born before 37 weeks gestation. Understanding NICU level designations can mean the difference between life and death for your baby.
Definitions for the NICU levels are summarized from Children’s Hospital Colorado.
LEVEL I – A Level I NICU designation means the hospital is able to care for healthy preterm babies born between 35 and 37 weeks gestation. More specifically, they can take care of “babies whose health is stable, meaning that they can breathe on their own, feed and maintain their body temperature.”
LEVEL II – A Level II designation indicates a hospital is equipped to handle babies born at 32 weeks gestation or later, with moderate medical issues and “are expected to recover fairly quickly.”
LEVEL III – A Level III NICU can provide “critical care” for babies born before 32 weeks gestation (generally speaking, they can care for babies born as early as 28 weeks). They are equipped to provide lifesaving care (ventilators, surgeries) and house babies for extended periods of time.
LEVEL IV – A Level IV NICU is what a mom of a micropreemie should look for. These facilities have all the technology of a Level III and also “employ more experienced staff with 24/7 access to medical and surgical specialists who care only for children.”
The Consequences of a Lack of Trust in the Medical System
It’s a devastating reality that many women of childbearing age don’t trust hospitals to take care of their newborn baby and opt for other settings (birthing center, home birth) because of the lack of trust they have in the medical system.
I suppose what’s more devastating is that these feelings are warranted because hospitals have managed to take away so much of the beauty of a birthing experience in the name of “quality medical care.”
Hospitals have life-saving equipment, so much technology that could be wielded to support mothers and babies in extraordinary ways, but providers often focus on statistics and vital signs rather than the comfort and dreams of the mother.
The Wall Street Journal's misleading headline was trying to take that existing division and distrust and twist the knife to make moms feel even more skeptical of hospitals' intentions with them. What a damaging thing to do to vulnerable mothers and babies.
The article focuses on the worst reality of the system: that some moms may find themselves in this situation at the wrong hospital that can’t help them, or worse, that a mom has made it to a hospital that can help her and her baby but the medical staff discourages the mom from pursuing lifesaving care for her micropreemie.
Regardless of whether you have a medical team that is trying to sway you one way, when you’ve found yourself at a Level IV NICU, facing an emergency delivery (like me), you get to have the final say. You can demand they do everything they can, and they will.
For anyone interested in following a real-time example of a heroic woman who stepped up and demanded they save her son, who was delivered at 22 weeks in an emergency C-section, I highly encourage you to follow Leah Darrow on Instagram. Her journey has been nothing short of inspiring to watch from afar.
Closing Thoughts
We have to hold space for the beautiful, picturesque labor and delivery while also being honest with ourselves that it may not be our reality as mothers. Which means empowering ourselves with necessary knowledge if things take a turn.
I pray for any mom or mom-to-be reading this that they don’t find themselves in a situation where they need a NICU, but if so, that this knowledge saves their baby's life.
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