Parents' Wishes Sway Docs' Choices on Preterm Deliveries

Study found practice, counseling in very early gestation differed greatly among obstetricians

By Mary Elizabeth Dallas

Friday, March 2, 2012

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FRIDAY, March 2 (HealthDay News) -- When making decisions or counseling families on how to manage very premature deliveries, obstetricians are strongly influenced by parents' wishes, especially when the parents want everything done to save their baby's life, a new study finds.

Almost 50 percent of babies born between 22 weeks and 26 weeks gestation (also known as a "periviable" delivery) do not survive, University of Pennsylvania researchers explained. About half of the babies who do survive will have moderate to severe neurologic disability.

The researchers asked 21 obstetricians at academic medical centers in Philadelphia to describe how they would typically deal with a periviable delivery, the factors that influence their decisions and challenges they face in counseling their patients.

The study, published in the March issue of the American Journal of Obstetrics and Gynecology, found that since there often is no formal policy on how to manage very early deliveries, obstetricians' decisions can vary significantly -- even among doctors working at the same hospital.

"While most participants said their first consideration was balancing maternal and child well-being, and the need to weigh the questionable benefits of Cesarean delivery for neonatal survival against the known risks of maternal morbidity, many described a 'do-everything default,'" study author Dr. Brownsyne Tucker Edmonds said in a journal news release.

That "default" means "interventions to prolong the pregnancy [are] universally pursued unless patients actively opted out," said Tucker Edmonds, an assistant professor of obstetrics and gynecology at Indiana University who completed the research during a University of Pennsylvania fellowship.

Although some obstetricians felt it was their job only to offer information and not sway patients' decisions, others felt it was necessary to provide guidance since the complexity and emotionality of these situations may render patients incapable of making sound decisions regarding the care of their babies.

These differences among obstetricians, the researchers said, make it more difficult to manage patients' expectations. Study participants said their greatest challenge was talking to patients about the uncertainty of the situation and its effects on the baby, particularly when parents had less education or faced a language barrier.

SOURCE: American Journal of Obstetrics and Gynecology, news release, Feb. 28, 2012

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