Perceptions of Options for Mode of Delivery in Periviable Decision-Making

Abstract

This study sought to qualitatively evaluate women’s perspectives on shared decision-making for mode of delivery (MOD) in the setting of periviable delivery (22-25 weeks), including their understanding of alternatives, risks/benefits, and provider recommendations. Interviews were conducted with women hospitalized for a threatened periviable delivery. We explored decision-making prompts related to MOD. Participants were also prompted to discuss their understanding of MOD risks/benefits and provider recommendations. Interviews were coded and analyzed using NVivo 12. Two-thirds of participants explicitly acknowledged having the option of cesarean section (CS) or vaginal delivery (VD). Maternal comorbidities limited some to one option. Many expressed a particular MOD preference, but most ultimately wanted “whatever’s best for baby.” Conceptually, MOD preference and decision-making were distinct, but typically aligned. However, occasionally, women recognized a MOD choice, but did not perceive the decision to be theirs, and vice versa. Likewise, consent was a separate concept, as some gave consent but did not feel they made a/the MOD decision. Understanding of MOD risks was mostly limited to bleeding, infection or fetal harm. Nine participants did not discuss any risks/benefits. Most women did not describe classical cesarean or risk to future pregnancies as risks. Patients felt that physicians recommended CS for fetal distress and to avoid risk of VD, though both CS and VD were equally recommended overall. Findings revealed a need for providers to clarify options and decision-making roles; review risks more comprehensively; refine recommendations; and create shared MOD plans in periviable counseling to aid women in informed, shared MOD decision-making.