It’s the latest in an ever-growing line of parenting conversations that have become a lightning rod for discussion on social media: Expecting moms have been sharing “living will” videos on TikTok, expressing their wishes for either saving themselves or their babies if something were to go wrong during childbirth. And while their concerns are valid and completely understandable (especially in the aftermath of Roe v. Wade being overturned last year), is this something that expecting parents need to do?
In a post-Roe world, the constitutional right to a safe abortion is dwindling for patients in states across the country. Several states — including Alabama, Arkansas, Idaho, Kentucky, and more — have already passed restrictive abortion bans, while states like Arizona, Florida, and Georgia allow abortions with serious caveats that effectively make them illegal for many patients who might need them.
Maternal healthcare has always been fraught in the U.S., given that we’re the country with the highest maternal mortality rate in the developed world. And that’s without mentioning the fact that the mortality rate only increases among our most vulnerable populations, including Black and Indigenous patients.
But generally speaking, the chances of doctors needing to choose between a mom and a baby’s life during delivery are “very, very low,” as Kim Langdon, MD, an OB-GYN with Medzino, tells Scary Mommy, with board-certified family medicine physician Dr. Laura Purdy, MD, adding that “occasionally complex emergency, dangerous, critical situations occur, and doctors may have to make very difficult decisions.”
What is a living will, anyway?
According to Purdy, a living will is a written legal document that details your preferences for medical care if you are unable to make decisions for yourself. Doctors and caregivers typically use them if you become terminally ill, seriously injured, in a coma, are in the late stages of dementia, or are nearing the end of your life.
While we typically think of these scenarios as happening to the elderly, the unfortunate truth is that life or death or end-of-life situations can happen at any age, so Purdy thinks sitting down with a lawyer and your partner/spouse or close loved one is a “fantastic idea,” especially if you already have kids or are about to have them — more on this in a sec. It’s an unpleasant thought (especially for people in their twenties or thirties who are otherwise healthy), but you’ll surely have peace of mind knowing that your affairs are in order and your beneficiaries are taken care of in the event of your death.
Do you need a living will before birth?
Langdon reiterates, “It’s a low risk that the mother will die or become comatose in labor or during Cesarean section.” The risk is even lower that doctors will be forced to choose between your life and your baby’s. Langdon notes that extraordinarily serious birth complications typically only occur in pregnant patients with major health concerns, like congestive heart failure.
This is where a living will would come into play. “On the very rare chance that something does happen during childbirth, it is clear what the wishes are,” says Purdy. “It also allows you to appoint a medical power of attorney, who is the person that can make medical decisions on your behalf if something happens and decisions need to be made.”
In these cases, health experts told CNN that doctors will typically recommend delivery to save the mother’s life, with Dr. Elizabeth Langen, a maternal-fetal medicine physician at the University of Michigan Von Voigtlander Women’s Hospital, noting that the chances of the baby’s survival are low before the fetus is viable (under 24 weeks).
The overturning of Roe could present a situation where doctors will attempt to prioritize the baby’s life even if they’re not considered viable for fear of legal ramifications. Still, generally, doctors will do everything in their power to save both mom and baby, as Rochester, New York-based OB-GYN Dr. Franziska Haydanek told CNN.
“We do everything in our efforts to save both,” she said. “I can’t think of a time where the medical team has had to make a decision about who to save in a viable laboring patient. It’s just not a real scenario in modern medicine — just one we are seeing played out on TV.”
While the scenario does feel like something that might play out on Grey’s Anatomy, both doctors reiterated that hospitals have ample resources, including obstetrics and neonatal intensive care unit teams, to meet the needs of both mom and baby.
“We’re usually doing our best to take care of both the mom and the baby. And there’s very rarely a circumstance where we will do something to harm the mom in order to have the benefit of the baby,” added Langen.
“If mom’s health is deteriorating, ultimately, she’s not going to be able to support baby’s well-being,” she added. “And so generally, what we encourage folks to do is really support mom’s health, because that’s in the best interest of both mother and baby.”
“It’s always a good idea to have your wishes recorded in writing,” says Langdon. “When you are admitted for delivery, your birth care team will offer you the opportunity to do so.” But like many TikTok trends out there, Haydanek acknowledges that the living will trend is little more than “horribly anxiety-inducing,” telling CNN, “Before getting in a fight with your partner about who they choose to save, know that there isn’t a situation where we will ask them that.”