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  • Letter to the Editor
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Reply to Stokes and Watson

Journal of Perinatology volume 33, pages 823–824 (2013)Cite this article

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We appreciate the dialog initiated by Stokes and Watson1 in response to the publication regarding prenatal counseling beyond the threshold of viability.2 The need to counsel parents of risks and issues surrounding premature birth at >25 weeks gestation is being increasingly recognized. Recently, this journal published a supplemental issue entitled ‘Multidisciplinary Guidelines for the Care of Late Preterm Infants (LPI).’ In this publication the steering committee for the National Perinatal Association recommended that medical professionals ‘communicate risks of late preterm birth (prior to delivery, if possible), explaining that immature organ systems and brain of LPI may lead to complications….’3 In a study of counseling practices regarding premature infants in hospitals across the United States, Mehrotra et al.4 found that all 337 hospitals in the study routinely offered counseling to parents expecting birth up to 33 weeks gestation. However, there is not much information or discussion in the literature regarding the content or timing of this important parent–physician communication. With this publication we were hoping to generate similar dialog and more research in this area.

Stokes and Watson1 suggest that the study design could have been improved if the study populations were classified into those delivering spontaneously and those delivering after a medical intervention, hypothesizing that parents in the medical intervention group have received more detailed neonatal outcome information. We could have collected mode of delivery information for the study pregnancies. However, their hypothesis is based on the assumption that most counselors know to tailor the level of outcome detail depending on the reason for preterm delivery (spontaneous labor or medical intervention). In our experience, currently counseling for pregnancy at >25 weeks is usually provided by trainee counselors; even experienced counselors are often unsure how much learning and motor impairment data should be shared with parents expecting, for example, a 32-week premature infant. This is why we advocate for guidelines regarding counseling at >25 weeks gestation, of course, after a healthy dialog.

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References

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Authors and Affiliations

  1. Scott and White Healthcare, Temple, TX, USA

    V P Govande

  2. Children’s Corporate Center, Medical College of Wisconsin, Milwaukee, WI, USA

    J Lagatta & M A Basir

Authors
  1. V P Govande
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  2. J Lagatta
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  3. M A Basir
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Correspondence to M A Basir.

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Govande, V., Lagatta, J. & Basir, M. Reply to Stokes and Watson. J Perinatol 33, 823–824 (2013). https://doi.org/10.1038/jp.2013.98

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