Periviable births: communication and counseling before delivery

The potential delivery of an extremely premature infant presents a clinical situation that raises a complex combination of medical, social, ethical, religious, and economic issues. It is a unique medical encounter such that it is not all about "curing" the patient. Rather, it is an encounter where counseling is assisting families in deciding between life and death underscoring the stressful nature for both patients and providers. As with any other condition, health care providers are responsible for discussing all potential options and outcomes for families presented with the threat of an extremely premature infant. These decisions include but are not limited to place and mode of delivery, resuscitation decisions, and palliative management. Given the urgency of the situation, the emotionally charged nature of the decision, and the relative unpredictability prior to presentation, this particular situation poses unique challenges for all involved and mandates the need to have carefully constructed guidelines and processes for care and counseling that meet the needs of all involved.