Illustrative quotes regarding the need for increased support in decision-making
| Theme and participant group | Quote |
|---|---|
| Obstetrician counselling | |
| Obstetricians | “To 34 and 6 [weeks’ gestation], I generally recommend steroids if I think that the patient is at high risk of delivering within 7 days.” — OB 7 “It’s in those cases [at 34 + 0 to 34 + 6 weeks’ gestation] that I would typically speak to MFM — just a phone call and ask their opinion. And I get varying opinions. It’s not consistent.” — OB 8 After 35 [weeks’ gestation], I wouldn’t necessarily even bring it up — unless the patient perhaps asked about it. […] After 36 weeks, I wouldn’t even bring it up.” — OB 6 [For 35 + 0 to 35 + 6 weeks’ gestation] “That’s my grey zone.” — OB 4 |
| Pediatricians | “I think it’s variable.” — Peds 8 “I certainly do not think there’s any consensus amongst them, so it’s very operator dependent, from what my experience is in coming and meeting these parents.” — Peds 6 |
| Balance of harms and benefits | |
| Pregnant participants | “The things that are mentioned seem very small and … relatively insignificant in comparison to the risk of a respiratory problem.” — Pr 17 “The neurodevelopment … that the baby’s brain is still developing, and those neural paths and everything is still developing … those would be the kind of risks that I’d be most concerned about.” — Pr 5 “I’m not sure. I really need some help to understand, long-term, which one is, which problem is worse, which one is harder treat … I’m unable to determine, you know, assign a greater weight to either problem.” — Pr 14 |
| Obstetricians | “Our Canadian organization and a lot of people in the world feel that the benefits outweigh the risks.” — OB 5 “I don’t think that there is a clear, obvious thing, where I say, ‘This is really bad, and this is the worse outcome you should be worried about.’ I think that the biggest risk is something that only the patient and her or his support network can understand, right?” — OB 7 |
| Pediatricians | “If this was a child that was otherwise going to have a totally normal respiratory course, we gave the antenatal corticosteroid just because that’s what we now do … they end up needing a nursery stay for hypoglycemia. That seems like morbidity, to me, in a child that otherwise … may not have happened for.” — Peds 1 |
| Utility of decision support tool | |
| Pregnant participants | “I could go away, read it, talk it over with my husband … cover enough of the considerations that I wouldn’t feel like I need to go down the rabbit hole of going through the Internet, finding information that I may or may not trust.” — Pr 2 |
| Obstetricians | “What would be really helpful is something more geared towards physicians about how to understand the risks and benefits … that would be really helpful for me in order to have a conversation where I felt a bit more confident in being able to make a recommendation or being able to present all the data … if somebody wanted something to read about or to think about, then you could give it to them. They could read it on their own with their partner, with their family, and then come back to you with other questions … There may be two opportunities. One is a way to provide the information to clinicians.” — OB 7 |
| Pediatricians | “We kind of take for granted that, for us, the routine, the mundane, is all new to them, and it’s always anxiety-inducing. We know what happens when we’re anxious. Things get shut down. Information isn’t fully processed, but the tools sometimes, it’s something concrete that they reference back to.” — Peds 8 |
Note: MFM = maternal–fetal medicine, OB = obstetricians, Peds = pediatricians, Pr = pregnant.