Brownsyne Tucker Edmonds1, Teresa A Savage2, Robert E Kimura3, Sarah J Kilpatrick4, Miriam Kuppermann5, William Grobman6, Karen Kavanaugh7. 1. a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA. 2. b Department of Women, Children & Family Health Science , University of Illinois at Chicago , Chicago , IL , USA. 3. c Department of Pediatrics , Rush University Medical Center , Chicago , IL , USA. 4. d Department of Obstetrics and Gynecology , Cedars-Sinai Medical Center , Los Angeles , CA , USA. 5. e Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA. 6. f Obstetrics and Gynecology-Maternal Fetal Medicine , Northwestern University Medical School , Chicago , IL , USA. 7. g Wayne State University College of Nursing and the Children's Hospital of Michigan , Detroit , MI , USA.
Abstract
OBJECTIVE: To examine prospective parents' perceptions of management options and outcomes in the context of threatened periviable delivery, and the values they apply in making antenatal decisions during this period. STUDY DESIGN: Qualitative analysis of 46 antenatal interviews conducted at three tertiary-care hospitals with 54 prospective parents (40 pregnant women, 14 partners) who had received counseling for threatened periviable delivery (40 cases). RESULTS: Participants most often recalled being involved in resuscitation, cerclage, and delivery mode decisions. Over half (63.0%) desired a shared decision-making role. Most (85.2%) recalled hearing about morbidity and mortality, with many reiterating terms like "brain damage", "disability", and "handicap". The potential for disability influenced decision making to variable degrees. In describing what mattered most, participant spoke of giving their child a "fighting chance"; others voiced concerns about "best interest", a "healthy baby", "pain and suffering", and religious faith. CONCLUSIONS: Our findings underscore the importance of presenting clear information on disability and eliciting the factors that parents deem most important in making decisions about periviable birth.
OBJECTIVE: To examine prospective parents' perceptions of management options and outcomes in the context of threatened periviable delivery, and the values they apply in making antenatal decisions during this period. STUDY DESIGN: Qualitative analysis of 46 antenatal interviews conducted at three tertiary-care hospitals with 54 prospective parents (40 pregnant women, 14 partners) who had received counseling for threatened periviable delivery (40 cases). RESULTS:Participants most often recalled being involved in resuscitation, cerclage, and delivery mode decisions. Over half (63.0%) desired a shared decision-making role. Most (85.2%) recalled hearing about morbidity and mortality, with many reiterating terms like "brain damage", "disability", and "handicap". The potential for disability influenced decision making to variable degrees. In describing what mattered most, participant spoke of giving their child a "fighting chance"; others voiced concerns about "best interest", a "healthy baby", "pain and suffering", and religious faith. CONCLUSIONS: Our findings underscore the importance of presenting clear information on disability and eliciting the factors that parents deem most important in making decisions about periviable birth.
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