Advanced Directive for Premature Baby?

shay · Mar 6, 2002

We don't do official paperwork, but we do address the issue if we have a pre-viable or borderline delivery imminent. We also do it for patients with babies that have known birth defects that are traditionally considered 'lethal' (i.e., trisomy 13, anencephaly, etc.). We call neonatology and have them come in and talk to the parents about what to expect, chances for survival, etc.. And of course the OB/GYN talks to the family as well.

I just don't think getting 'official' documents like advanced directives is a good idea, as every time I've been involved in those deliveries (I've been in a lot of them), the parents always change their minds the moment they see the baby and plead for us to 'do everything' to sustain life. And you can't blame them...I can't imagine seeing my baby's face and then telling the doctor to let him or her die...it has to be the most horrible thing. I find that even in those instances when a baby is placed on life support contrary to what the parents said prior to delivery, all they needed was time to say goodbye to their baby and come to terms. A day or two later or even in just a couple of hours, the parents ususally agree to discontinue support if that was their original plan.

Sorry to go off on a tangent...anyhoo, no, we don't use forms, but yes, we do talk about what the parents want ahead of time.

layna · Mar 7, 2002

Hi Shay,

Thanks so much for your reply. I don't like the idea of using forms either. You are right...they always change their minds as would I in the same situation. Your point about having the time to say good-bye and come to terms is more important than some people realize. If there is not enough time for them to do this, the psychological effects are devastating.

mother/babyRN, RN · Mar 7, 2002

If someone comes in with premature labor we approach the subject gently considering the circumstances. We do have labor check and preterm labor check discharge forms which briefly go over the issue, but no other paperwork unless they are in actual pre term labor....

Angel Baby · Mar 21, 2002

We get our Neonatal Nurse Practitioners and/or Neonatologists to talk with these Moms/families. We do not use a "form" for the Mom to sign but the physician may write DNR orders.

This (like any other living patient) can be revoked with one request. The families' wishes are always respected. The docs don't push the patients towards any decision--they just lay out the options and we go with the flow.........