Antenatal counselling for parents facing an extremely preterm birth: limitations of the medical evidence
Article first published online: 4 MAY 2012
© 2012 The Author(s)/Acta Pædiatrica © 2012 Foundation Acta Pædiatrica
Volume 101, Issue 8, pages 800–804, August 2012
How to Cite
Janvier, A., Lorenz, J. M. and Lantos, J. D. (2012), Antenatal counselling for parents facing an extremely preterm birth: limitations of the medical evidence. Acta Paediatrica, 101: 800–804. doi: 10.1111/j.1651-2227.2012.02695.x
- Issue published online: 13 JUL 2012
- Article first published online: 4 MAY 2012
- Accepted manuscript online: 12 APR 2012 01:11PM EST
- Received 21 December 2011; accepted 28 March 2012.
- Extreme prematurity;
- Informed consent;
- Outcomes of high-risk infants;
- Peri-viability guidelines;
- Physician/patient/parent relationship;
- Preterm labour;
- Quality of life
When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines.
Conclusion: We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited.