Provider attitudes about gaining consent for perinatal autopsy

Objective: To examine the attitudes of neonatologists, obstetricians, midwi ves, and neonatal nurses toward perinatal autopsy and survey physicians abo ut whom they perceive influence women's decisions on autopsy consent. Methods: A postal survey that incorporated a questionnaire of eight fictiti ous case scenarios and combined three factors (confidence of antemortem dia gnosis, intention to have future pregnancy, and parental attitude toward au topsy) in various permutations was sent to various Australian physicians an d nurses (all consultant neonatologists working in neonatal intensive care units and a sample of consultant obstetricians, midwives, and neonatal nurs es in level III maternity hospitals). Respondents were asked to rate how li kely they were to seek consent for or suggest autopsies on a seven-point Li kert scale (1 = certainly will not, 7 = certainly will). Interactions betwe en factors and respondents were measured by analysis of variance, and diffe rences were compared using Mann-Whitney U, chi (2),and generalized estimati ng equation tests. Results: The overall response rate was 70% (neonatologists 57%, obstetricia ns 62%, midwives 77%, and neonatal nurses 75%). Neonatologists (median scor e 7, interquartile range 7, 7) were more likely to ask for autopsies than n eonatal nurses (5; 2, 6) (P <.001), as were obstetricians (7; 7, 7) compare d 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 auto psies. Midwives and nurses are influenced by the three factors studied, whi ch might negatively influence the consent rate for perinatal autopsies. Int ervention strategies aimed at changing nurses' attitudes should be consider ed. (Obstet Gynecol 2001;97:994-8. (C) 2001 by The American College of Obst etricians and Gynecologists.).