Navigating birth plans: illuminating neonatal provider perspectives in prenatally diagnosed complex fetal anomalies

BACKGROUND/OBJECTIVES: Birth plans include preferences for neonatal care in prenatally diagnosed complex medical conditions. This study aimed to determine how neonatal providers interpret birth plans for those with prenatally diagnosed life-limiting conditions. SUBJECTS/METHODS: This single-site study of neonatal attendings, fellows, advance practice providers, and pediatricians assessed provider actions to prompts associated with potential limitations of care identified in birth plans via three case scenarios developed by palliative care and neonatal providers, with expert review. Data analysis included descriptive statistics and Chi-square or Fisher's exact test, to assess associations between responses and demographics. RESULTS: Seventy-five providers completed the survey (54% response rate). We identified high degree of variability in responses, including high-risk interventions. Previous palliative care training had little impact on interpretation of birth plans. CONCLUSION: High degrees of variability in birth plan interpretation supports their utility to guide discussion with families, rather than a step-by-step guide for care.