#Background
The outcomes and experience of preterm birth vary significantly for each whānau, but there is likely to be significant uncertainty and anxiety for all when it is anticipated due to preterm labour, preterm prelabour rupture of membranes (PPROM), threatened preterm labour, or planned birth for the wellbeing of the māmā/person and/or pēpi. Appropriate, skilled and culturally supported counselling in advance of preterm birth will improve understanding and help to reduce anxiety.
#Recommendations and Practice
Good Practice
Antenatal counselling for wāhine/people and whānau when preterm birth is anticipated or planned
- All wāhine/people, their whānau and chosen support people should be offered and provided counselling by experienced obstetric and neonatal/paediatric care providers in advance of preterm birth.
- The level of seniority of the care providers should be dependent on the gestational age of expected birth and availability of appropriate staff.
- Wherever possible, the LMC should be involved in antenatal counselling.
- Interpreter services and cultural support should be available and offered to all wāhine/people and whānau to support the counselling kōrero.
- Virtual technology should be considered and used as required (e.g. to include LMC after in utero transfer, to include whānau members unable to be present and for consultation in advance of a planned in utero transfer).
- Decisions for care should be reached through a shared decision-making process.
- Information discussed should include likelihood/timing of birth, interventions that may impact on outcome, place of birth, mode of birth, monitoring and care in labour, chance of survival, neonatal care and length of stay, neonatal morbidity and longer-term outcomes.
- Information should be based on local (where care will be provided) and Aotearoa specific data and be gestational age specific.
- Wāhine/people and whānau should be provided with verbal and written information and this should include the use of visual decision aids which include Aotearoa specific data and other resources such as virtual tours of local (where care will be provided) Neonatal Intensive Care Units.
- After counselling, a plan of care should be developed and documented.
- Wāhine/people and whānau may benefit from connection to other parents and whānau. They should be referred to local and Aotearoa specific resources.
- Counselling should include consideration of the psychosocial, cultural and spiritual needs of each wahine/person and their whānau.
- All obstetric and neonatal/paediatric care providers should receive training in preterm birth counselling kōrero.
The Carosika Whānau Information on antenatal counselling may be used to support conversations with wāhine/people and whānau.
PDF
Guideline Recommendations
Antenatal counselling for wāhine/people and whānau when preterm birth is anticipated or planned at extreme preterm gestation (23+0 to 24+6 weeks)
- Counselling prior to birth at the limits of survival should be undertaken by an obstetric or maternal fetal medicine specialist and specialist neonatologist.
- Decisions for care should be reached through a shared decision-making process using guidance and resources from the New Zealand Consensus Statement on the care of mother and baby(ies) at periviable gestations.2
More detailed recommendations are provided in Birth at the limits of survival.
#Auditable Standards
To be developed.