According to current Canadian outcome data, fetuses with a gestational age of less than 22 completed weeks are not viable, and those with an age of 22 weeks rarely viable. Their mothers are not, therefore, candidates for cesarian section, and the newborns should be provided with compassionate care, rather than active treatment. The outcomes for infants with a gestational age of 23 to 24 completed weeks vary greatly. Careful consideration should be given to the limited benefits for the infant and potential harms of cesarian section, as well as to the expected results of resuscitation at birth. Cesarian section, when indicated, and any required neonatal treatment are recommended for infants with gestational ages of 25 and 26 completed weeks; most infants of this age will survive and most survivors will not be severely disabled. Treatment of all infants with a gestational age of 22 to 26 weeks should be tailored to the infant and family and should have fully informed parents.