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  • Letter to the Editor
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Reply to Govande et al. Prenatal counseling beyond the threshold of viability

Journal of Perinatology volume 33, page 823 (2013)Cite this article

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The article by Govande et al.1 regarding prenatal counseling beyond the threshold of viability makes an essential distinction between two populations delivering at 23 to 33 weeks—patients in spontaneous preterm labor, and patients in induced preterm labor—so we were disappointed that their data on maternal knowledge of possible morbidities were not broken down by patient population.

The authors correctly observe that ‘no decisions are necessary’ for those in spontaneous preterm labor, therefore ‘it may not be necessary’ to counsel them about potential long-term problems before birth. We agree, and would take it a step further: beyond the point where non-resuscitation is no longer an acceptable standard of care we believe that it is insensitive, and arguably immoral, to bludgeon a family with morbidity and mortality data that ultimately cannot be avoided. Therefore, we would find it reassuring if Govande et al.’s data showed that women in spontaneous labor interviewed after receiving antenatal counseling ‘in the precious time interval’ before preterm delivery had a declining knowledge of possible long-term morbidities with increasing gestational age. As the authors point out, ‘this information can be provided during the neonatal intensive care unit stay after the initial shock of preterm birth is over.’

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References

  1. Govande VP, Brasel KJ, Das UG, Koop JI, Lagatta J, Basir MA . Prenatal counseling beyond the threshold of viability. J Perinatol 2012; 33: 358–362.

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  2. Boss RD, Hutton N, Sulpar LJ, West AM, Donohue PK . Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns. Pediatrics 2008; 122: 583–589.

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  3. Payot A, Gendron S, Lefebvre F, Doucet H . Deciding to resuscitate extremely premature babies: how do parents and neonatologists engage in the decision? Soc Sci Med 2007; 64: 1487–1500.

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Authors and Affiliations

  1. Pediatrics, Walter Reed National Military Medical Center/Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    T A Stokes & K Watson

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  1. T A Stokes
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  2. K Watson
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Correspondence to T A Stokes.

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Stokes, T., Watson, K. Reply to Govande et al. Prenatal counseling beyond the threshold of viability. J Perinatol 33, 823 (2013). https://doi.org/10.1038/jp.2013.97

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