The following is a summary of “Periviable Decision-Making in a New Era of Parentage: Ethical and Legal Considerations and Provider Perspectives on Shared Decision-making in Diverse Family Structures” published in the December 2022 issue of Pediatrics by Cheng et al.
In the context of periviable delivery (i.e., between 22 and 25 weeks of gestation), researchers sought to examine providers’ perspectives on decisional authority, conflict resolution, and different family structures with the ultimate goal of assisting practitioners in supporting, engaging, and resolving conflict with parents facing periviable delivery.
Thirty neonatologists and obstetricians participated in qualitative interviews to get their thoughts on the subject of whether and how a pregnant person’s partner should be involved in making decisions about potentially life-saving treatments, as well as how medical teams should proceed when parents disagree on a course of action. Doctors were questioned about whether their beliefs had evolved in the context of marriage, biological relationships, adoption, and surrogacy.
The four primary themes that emerged from the interviews were: providers care; involvement important; mom is the priority, and uncertainty and advice required. The themes reflected the perceptions of the providers regarding partner engagement and decision-making power. When different family configurations were discussed, distinctive themes emerged.
When there is periviable delivery and decisions are both value-laden and preference-sensitive, shared decision making is the best option. The interviews led them to believe that considering the dynamics and effects of partners’ involvement in decisions regarding possible resuscitation may lead to more fair, high-quality, shared decisions suited to the interests of pregnant women and their spouses.