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Mode of delivery in the context of periviable birth: informed deference and shared decision-making

Abstract

Objective

To qualitatively evaluate women’s perspectives on shared decision-making for periviable (22–25 weeks’ gestational age) mode of delivery (MOD).

Study Design

Interviews were conducted at two Midwestern academic hospitals with 30 women hospitalized for threatened periviable delivery between September 2016 and January 2018. Prior to delivery (T1) and at 3-months postpartum (T2), MOD-related decision-making was explored using prompts. Interviews were coded and analyzed using NVivo 12.

Result

The majority of women perceived the MOD options as cesarean section or vaginal delivery. Most ultimately preferred “whatever’s best for baby.” Understanding of MOD risks was limited, and physicians recommended each option equally. Sixteen participants perceived themselves as decision-makers at T1, while at T2, only nine participants identified themselves as such.

Conclusion

Informed deference is introduced as a novel concept in the setting of periviable MOD decision-making, whereby the mother defers decisional authority to the provider, the baby, a higher power, or the circumstance itself.

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Data availability

The dataset generated and analyzed in the current study is available from the corresponding author on reasonable request.

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Funding

This study was funded by the NIH as a R21 Exploratory/Developmental Research Grant (HD089032-01).

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Contributions

BTE and KK contributed to the study concept, design, analysis, and writing of this manuscript. KK served as an advisor to BTE. SMJ, LMB, SMH, and TL contributed to the recruitment, data management, analysis, and writing of the manuscript. JP contributed to analysis and writing.

Corresponding author

Correspondence to Brownsyne Tucker Edmonds.

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The authors declare no competing interests.

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Bode, L.M., Jager, S.M., Panoch, J. et al. Mode of delivery in the context of periviable birth: informed deference and shared decision-making. J Perinatol 43, 23–28 (2023). https://doi.org/10.1038/s41372-022-01537-9

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