Facilitating home birth in perinatal palliative care: A case report

Facilitating home birth in perinatal palliative care: A case report

Bertaud S; Kirven R; Kirven T; Harrop E; Crudgington A; Wilkinson D

Palliative Medicine

2024

Collaboration; Decision Making; Decision Making Clinical; Family -- Education; Female; Home Childbirth; Hospice Care; Hypoplastic Left Heart Syndrome -- Diagnosis; Infant Newborn; Life Experiences; Multidisciplinary Care Team; Palliative Care -- In Infancy and Childhood; Patient Care Plans; Perinatal Care; Perinatal Death; Pregnancy; Pregnancy Complications; Prenatal Diagnosis; Professional-Family Relations; Spouses; Support Psychosocial

Abstract Background: Perinatal palliative care can offer compassionate support to families following diagnosis of a life-limiting illness, to enable them to make valued choices and the most of the time that they have with their newborn. However, home birth is usually only offered in low-risk pregnancies. Case: A couple who received an antenatal diagnosis of hypoplastic left heart syndrome and who had made a plan to provide palliative care to their baby after birth requested the option of a home birth. Possible courses of action: Recommend birth at hospital or explore the possibility of a home birth with perinatal palliative care support. Formulation of a plan: Multidisciplinary discussion and collaboration enabled a plan for home birth to be made which anticipated potential complications. Outcome: The baby was born at home and died on day 5 of life receiving outreach nursing, paediatric and palliative care support and buccal and oral opioids for symptom management. We include reflections from the family on the importance of this experience. Lessons: We provide a list of potential criteria for considering home birth in the setting of perinatal palliative care. View: Facilitating a home birth in the setting of perinatal palliative care is an option that can be hugely valued by families, but this service may be practically difficult to deliver in many contexts. Further research is needed to understand the preferences of women and families receiving perinatal palliative care.

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