Collaborative decision-making for extreme premature delivery.

A multidisciplinary workshop with parent/consumer involvement was held to determine a consensus in the difficult arena of perinatal care of women and babies at the borderlines of viability. Interactive forums produced consensus statements following an extensive consultation process. A grey zone between 23(0) and 25(6) weeks of gestation was identified and agreed upon. In this grey zone, while there was an increasing obligation to treat, it was acceptable not to initiate intensive care following appropriate counselling with parents. Important areas identified before birth, were continuing communication between the perinatal team and parents, a review of choice with continued counselling, decision support and empathy. The process must be transparent, open and honest, using the most relevant up to date outcome data in a collaborative framework.