Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-27T16:12:32.187Z Has data issue: false hasContentIssue false

14 - Decision-making in the delivery room

from Section 2 - Ethical issues at the beginning of life: perinatology and neonatology

Published online by Cambridge University Press:  07 October 2011

By
Mark R. Mercurio
Edited by
Douglas S. Diekema ,
Mark R. Mercurio  and
Mary B. Adam
Douglas S. Diekema
Affiliation:
Seattle Children's Research Institute
Mark R. Mercurio
Affiliation:
Yale University School of Medicine
Mary B. Adam
Affiliation:
Department of Pediatrics, University of Arizona School of Medicine, Tucson
Get access

Summary

Case narrative

A 26-year-old woman is admitted to the Labor and Delivery Unit in early labor. She is at 23 weeks’ gestation (based on last menstrual period and second trimester ultrasound) with a singleton female fetus, and the pregnancy has been unremarkable until today. The estimated fetal weight is 580 grams, and there are no apparent anomalies on the ultrasound done today. The perinatologist believes that the patient will deliver today, and requests that the neonatology team meet with the patient and her husband to discuss the prognosis and the management plan for the baby. Since choices surrounding care of the newborn might also influence obstetrical decisions, the meeting is requested immediately.

Summary of ethical issues

Decisions regarding newborn resuscitation are often made under great time pressure, either due to imminent delivery, thus limiting the time for discussion with the parents beforehand, or because specific actions may be required immediately after delivery if the child is to have a chance at survival. For this reason, it is essential to have considered the possible scenarios that may arise when the child is born and, as much as possible, to have worked through the ethical questions beforehand. There will be very little, if any, opportunity for ethical analysis or in-depth discussion at the time of delivery.

Type
Chapter
Information
Clinical Ethics in Pediatrics
A Case-Based Textbook
 , pp. 77 - 82
Publisher: Cambridge University Press
Print publication year: 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Batton, D.G. 2009 Clinical report: antenatal counseling regarding resuscitation at an extremely low gestational agePediatrics 124 422Google Scholar
Beauchamp, T.L.Childress, J.F. 2001 Principles of Biomedical EthicsNew YorkOxford University Press
Committee on Bioethics, American Academy of Pediatrics 1994 Guidelines on foregoing life-sustaining medical treatmentPediatrics 93 532Google Scholar
D’Angio, C.T.Mercurio, M.R. 2008 Evidence-based ethics in the “gray zone” of neonatal viability: promises and limitationsPediatric Health 2 777Google Scholar
Hack, M.Taylor, H.G.Drotar, D. 2005 Poor predictive validity of the Bayley scales of infant development for cognitive function of extremely low birth weight children at school agePediatrics 116 333Google Scholar
Janvier, A.Leblanc, I.Barrington, K.J. 2008 The best-interest standard is not applied for neonatal resuscitation decisionsPediatrics 121 963Google Scholar
Kattwinkel, J.Perlman, J.M.Aziz, K. 2010 Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular carePediatrics 126 e1400Google Scholar
Meadow, W. 2007 Babies between a rock and a hard place – neonatologists vs parents at the edge of infant viabilityActa Paediatrica 96 153Google Scholar
Mercurio, M.R. 2005 Physicians’ refusal to resuscitate at borderline gestational ageJournal of Perinatology 25 685Google Scholar
Mercurio, M.R. 2009 The ethics of newborn resuscitationSeminars in Perinatology 33 354Google Scholar
NICHD Neonatal Research Network (NRN) 2010 www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/epbo_case.cfm
Stoll, B.J.Hansen, N.I.Bell, E.F. 2010 Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research NetworkPediatrics 126 443Google Scholar
Tyson, J.E.Parikh, N.A.Langer, J. 2008 Intensive care for extreme prematurity – moving beyond gestational ageNew England Journal of Medicine 358 1672Google Scholar
Byrne, S.Szyld, E.Kattwinkel, J. 2008 The ethics of delivery-room resuscitationSeminars in Fetal and Neonatal Medicine 13 440Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×