Antenatal parental counselling by healthcare providers is recommended
to inform parents and assist with decision-making before the birth of a
child with anticipated poor prognosis. In the setting of a low-income
country, like Mongolia, attitudes of healthcare providers towards
resuscitation of high-risk newborns are unknown. The purpose of this
study was to examine the attitudes of healthcare providers regarding
ethical decisions pertaining to non-initiation and withdrawal of
neonatal resuscitation in Mongolia. A questionnaire on attitudes
towards decision-making for non-initiation and withdrawal of neonatal
resuscitation was administered to 113 healthcare providers attending
neonatal resuscitation training courses in 2009 in Ulaanbaatar, the
capital and the largest city of Mongolia where ~40% of deliveries in
the country occur. The questionnaire was developed in English and
translated into Mongolian and included multiple choices and free-text
responses. Participation was voluntary, and anonymity of the
participants was strictly maintained. In total, 113 sets of
questionnaire were completed by Mongolian healthcare providers,
including neonatologists, paediatricians, neonatal and obstetrical
nurses, and midwives, with 100% response rate. Ninety-six percent of
respondents were women, with 73% of participants from Ulaanbaatar and
27% (all midwives) from the countryside. The majority (96%) of
healthcare providers stated they attempt pre-delivery counselling to
discuss potential poor outcomes when mothers present with preterm
labour. However, most (90%) healthcare providers stated they feel
uncomfortable discussing not initiating or withdrawing neonatal
resuscitation for a baby born alive with little chance of survival.
Religious beliefs and concerns about long-term pain for the baby were
the most common reasons for not initiating neonatal resuscitation or
withdrawing care for a baby born too premature or with congenital
birth-defects. Most Mongolian healthcare providers provide antenatal
counselling to parents regarding neonatal resuscitation. Additional
research is needed to determine if the above-said difficulty with
counselling stems from deficiencies in communication training and
whether these same counselling-related issues exist in other countries.
Future educational efforts in teaching neonatal resuscitation in
Mongolia should incorporate culturally-sensitive training on antenatal
counselling