"It feels like you have to choose one or the other": a qualitative analysis of obstetrician focus groups on periviability counseling

Abstract

Objectives: The objective of this study was to gain knowledge and ascertain challenges about periviability counseling among obstetricians to inform curricular development.

Methods: Focus groups were utilized. A series of open-ended questions was posed to each group of obstetricians; responses were audio recorded and transcribed. Transcriptions were analyzed by two coders using thematic analysis.

Results: Four focus groups were convened. Prominent themes included: (1) Obstetrician knowledge about neonatal outcomes is limited, (2) Periviability counseling is both time intensive and time-challenged, (3) Patient processing of information relies on the content, delivery and patient readiness, and (4) Obstetrician bias is toward advocating for maternal safety, which may run counter to parental instinct to "do everything." The last theme was specifically focused on the role of cesarean delivery.

Conclusions: Curricula focused on improving obstetrician periviability counseling should focus on neonatal outcomes, the role of cesarean delivery, and utilization of shared decision-making.

Keywords: curricular development; focus groups; obstetricians; periviability.