Paper
Sunday, November 4, 2007
359
A New Paradigm for Prenatal Education on Prematurity
Anita J. Catlin, DNSc, FNP, FAAN, Nursing, Sonoma State University, Rohnert Park, CA, USA and Christine Elaine Armigo, RN, BSN, MSN-Cand, NICU, Alta Bates Summit Medical Center, Berkeley, CA, CA, USA.
The concept of advance directives is well-known in the care of adults as a mechanism for choosing, in advance, the extent of medical interventions desired in clinical situations, particularly life-extending interventions such as ventilatory support and drugs to maintain cardiopulmonary status. Infants born extremely prematurely often require life-supporting measures; parents or guardians have reported feeling inadequately prepared for making decisions about such measures. A literature analysis was conducted to review all major sources of prenatal education in English speaking countries. No sources were found that included an educational component that taught women about the length of gestation needed for healthy viability, survivorship, and outcome without major impairment. Presently, women who go into preterm labor are asked to make immediate decisions during times of crisis without any formal educational base for this decision-making. A paradigm shift regarding the manner in which women are educated regarding pregnancy and fetal viability is indicated. A prenatal advance directive, explaining the woman’s wishes should she go into preterm labor, is suggested. A program of education which adds this educational component to prenatal care is being piloted in a high-risk obstetrics hospital, with data collection from providers and patients on acceptance of this component and its influence upon their decision-making.