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Comparing obstetricians’ and neonatologists’ approaches to periviable counseling

Journal of Perinatology volume 35, pages 344–348 (2015)Cite this article

Subjects

Abstract

Objective:

To compare the management options, risks and thematic content that obstetricians and neonatologists discuss in periviable counseling.

Study Design:

Sixteen obstetricians and 15 neonatologists counseled simulated patients portraying a pregnant woman with ruptured membranes at 23 weeks of gestation. Transcripts from video-recorded encounters were qualitatively and quantitatively analyzed for informational content and decision-making themes.

Result:

Obstetricians more frequently discussed antibiotics (P=0.005), maternal risks (<0.001) and cesarean risks (<0.005). Neonatologists more frequently discussed neonatal complications (P=0.044), resuscitation (P=0.015) and palliative options (P=0.023). Obstetricians and neonatologists often deferred questions about steroid administration to the other specialty. Both specialties organized decision making around medical information, survival, quality of life, time and support. Neonatologists also introduced themes of values, comfort or suffering, and uncertainty.

Conclusion:

Obstetricians and neonatologists provided complementary counseling content to patients, yet neither specialty took ownership of steroid discussions. Joint counseling and/or family meetings may minimize observed redundancy and inconsistencies in counseling.

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Acknowledgements

This publication was made possible in part by Grant Number KL2 TR000163 (A Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award, and the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA

    B Tucker Edmonds, F McKenzie & J E Panoch

  2. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    A E Barnato

  3. Mary Margaret Walther Center for Research and Education in Palliative Care, IU Simon Cancer Center, Indianapolis, IN, USA

    R M Frankel

Authors
  1. B Tucker Edmonds
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  2. F McKenzie
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  3. J E Panoch
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  4. A E Barnato
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Correspondence to B Tucker Edmonds.

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Tucker Edmonds, B., McKenzie, F., Panoch, J. et al. Comparing obstetricians’ and neonatologists’ approaches to periviable counseling. J Perinatol 35, 344–348 (2015). https://doi.org/10.1038/jp.2014.213

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