A qualitative study of predelivery counselling for extreme prematurity

How parents should be counselled before the delivery of an extremely preterm (EP) neonate remains hotly debated. The Canadian Paediatric Society uses 22 weeks’ gestational age (GA) as the lower limit of viability because below that GA, there is almost universal mortality (1). Prognosis for EP neonates born at 23 weeks and greater is widely variable (1,2). While experts recommend that explicit consent be obtained from parents regarding whether to resuscitate, research shows that it may often not be known or sought (1,3,4). Predelivery counselling primarily occurs when the mother presents in preterm labour (3,4). The emergent nature of this clinical scenario may preclude fully informed consent; as a result, many resuscitation decisions are made at delivery by physicians solely based on GA and birth weight (3,5). In one study, parental preference was unknown in 31% of cases (3). When predelivery counselling does occur, challenges persist. Keenan et al (6) found that mothers believed they had no choice 60% of the time, whereas counsellors believed they had given mothers choice 57.6% of the time. Yee and Sauve (7) showed that while most parents believed that antenatal consultation had been helpful, 12% believed it did not relieve their worry. Parents also reported inconsistently receiving information about disability. These studies support the need for greater understanding of the counselling process. We conducted the present qualitative study to ascertain how we can improve predelivery counselling. Our aim was to gain insight on current practices from those most affected by the decisions made in the delivery room – the parents of these EP neonates.