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Provider Attitudes About Gaining Consent for Perinatal Autopsy

From the Departments of Obstetrics and Gynaecology and General Practice and Psychology, University of Adelaide; and Department of Histopathology, and Division of Paediatric Medicine, Women’s and Children’s Hospital, Adelaide, Australia.

Address reprint requests to: T. Yee Khong, MD Department of Histopathology University of Adelaide Women’s and Children’s Hospital 72 King William Road 5006 North Adelaide, South Australia Australia E-mail: ykhong{at}medicine.adelaide.edu.au

Objective: To examine the attitudes of neonatologists, obstetricians, midwives, and neonatal nurses toward perinatal autopsy and survey physicians about whom they perceive influence women’s decisions on autopsy consent.

Methods: A postal survey that incorporated a questionnaire of eight fictitious case scenarios and combined three factors (confidence of antemortem diagnosis, intention to have future pregnancy, and parental attitude toward autopsy) in various permutations was sent to various Australian physicians and nurses (all consultant neonatologists working in neonatal intensive care units and a sample of consultant obstetricians, midwives, and neonatal nurses in level III maternity hospitals). Respondents were asked to rate how likely they were to seek consent for or suggest autopsies on a seven-point Likert scale (1 = certainly will not, 7 = certainly will). Interactions between factors and respondents were measured by analysis of variance, and differences were compared using Mann-Whitney U, ², and generalized estimating equation tests.

Results: The overall response rate was 70% (neonatologists 57%, obstetricians 62%, midwives 77%, and neonatal nurses 75%). Neonatologists (median score 7, interquartile range 7, 7) were more likely to ask for autopsies than neonatal nurses (5; 2, 6) (P < .001), as were obstetricians (7; 7, 7) compared with midwives (6; 3, 7) (P < .001). Physicians rated midwives and neonatal nurses as having some to substantial influence on mothers’ decisions about consent for autopsy.

Conclusion: Physicians are not averse to seeking consent for perinatal autopsies. Midwives and nurses are influenced by the three factors studied, which might negatively influence the consent rate for perinatal autopsies. Intervention strategies aimed at changing nurses’ attitudes should be considered.

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