Who decides? Exploring decisional dynamics for periviable resuscitation among diverse family structures.

Objective: To investigate conflict resolution and decisional authority among diverse family structures in periviable resuscitation decision-making.

Methods: We recruited 60 parent dyads, including 30 with prior periviable delivery experience and 30 first-time expecting dyads between 22 and 26 weeks gestation. Our diverse sample included heterosexual and same-sex partnerships, married and unmarried partners. Virtual interviews explored decision-making, engagement, and conflict resolution.

Results: Four themes emerged: "Mom is the priority," highlighting maternal decisional authority; "partner involvement is crucial," emphasizing engagement; "parents prioritize who will be caring for the child," indicating caregiver considerations; and "parents want empathy and support," underscoring emotional needs.

Conclusions: Findings reveal maternal priority in decision-making, the importance of partner involvement, and a challenges with lacking inclusive legal and ethical guidance for non-heteronormative families. The study highlights the need for shared decision-making that considers family structures, legal aspects, and emotional complexities to enhance inclusive, informed decision-making processes for parents facing periviable delivery.