RPD310 - Birth Plans: Illuminating Neonatal Provider Perspectives in Prenatally Diagnosed Complex Fetal Anomalies

Key Message : This single-site survey of neonatal providers explored how birth plans for infants with life-limiting conditions are interpreted. Responses to case scenarios revealed wide variability in clinical decision-making, regardless of palliative care training. Findings underscore birth plans’ value as tools to prompt communication with families rather than prescriptive care directives.

Abstract:

Background: Originally designed for expectant mothers to share their labor and delivery preferences, birth plans have since expanded to share preferences regarding neonatal interventions for infants with prenatally diagnosed complex medical conditions (1). While intended to better align the neonatal course with parent/family wishes, how neonatal providers interpret birth plans remains largely unknown (1, 2, 3).

Objective: To determine how neonatal providers interpret birth plans for infants with prenatally diagnosed life-limiting conditions.

Methods: This is a single-site survey study describing how neonatal attendings, fellows, advanced practice providers, and pediatricians interpret birth plans. Content interviews with neonatal palliative care providers informed development of three case scenarios. Associated multiple choice questions querying provider clinical decisions were guided by principles of neonatal comfort care (4). Questions about provider perceptions of the effectiveness of birth plans from a previously published survey were included. Data analysis included descriptive statistics and Chi-square or Fisher’s exact test, as appropriate, to assess associations between responses and provider demographics.

Results: Seventy-five providers completed the survey (54% response rate). There was a high degree of variability in proposed clinical actions, including high risk interventions like positive-pressure ventilation, intubation, and chest compressions. Previous palliative care exposure (e.g., workshops, electives) had little impact on interpretation of birth plans. Forty-six participants (61%) felt birth plans contained sufficient information regarding desired interventions during delivery, but only 28 (37%) felt the same about the neonatal course. Twelve (16%) believed the plans adequately addressed care if the infant survived to discharge.

Conclusion: While birth plans may provide direction to providers regarding desired perinatal interventions for patients with prenatally diagnosed life-limiting conditions, we identified high variability in birth plan interpretation. These findings support birth plan utility to guide discussion with families about their wishes, rather than being used as a step-by-step guide for care.

References: (1) Cortezzo DE, Ellis K, Schlegel A. Perinatal Palliative Care Birth Planning as Advance Care Planning. Front Pediatr. 2020 Sep 8;8:556. doi: 10.3389/fped.2020.00556. PMID: 33014940; PMCID: PMC7505922.

(2) Afshar Y, Mei J, Fahey J, Gregory KD. Birth Plans and Childbirth Education: What Are Provider Attitudes, Beliefs, and Practices? J Perinat Educ. 2019 Jan 1;28(1):10-18. doi: 10.1891/1058-1243.28.1.10. PMID: 31086471; PMCID: PMC6491153.

(3) Mohaghegh Z, Javadnoori M, Najafian M, Montazeri S, Abedi P, Leyli EK, et. al. Implementation of birth plans integrated into childbirth preparation classes for vaginal birth: a qualitative study of women, their husbands and clinicians' perspectives in Iran. BMC Pregnancy Childbirth. 2022 Dec 27;22(1):969. doi: 10.1186/s12884-022-05305-7. PMID: 36575405; PMCID: PMC9792921.
(4) McCarthy FT, Kenis A, Parravicini E. Perinatal palliative care: focus on comfort. Front Pediatr. 2023 Sep 26;11:1258285. doi: 10.3389/fped.2023.1258285. PMID: 37822320; PMCID: PMC10562587.