Perinatal palliative care guidelines by ACOG

Recommendations and Conclusions

The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:

• Perinatal palliative care refers to a coordinated care strategy that comprises options for obstetric and newborn care that include a focus on maximizing the quality of life and comfort for newborns with a variety of conditions considered to be life-limiting in early infancy. For the purposes of this document, the term “life-limiting” includes lethal fetal conditions as well as others for which there is little or no prospect of long-term ex utero survival without severe morbidity or extremely poor quality of life, and for which there is no cure.


• With a dual focus on ameliorating suffering and honouring patient values, perinatal palliative care can be provided concurrently with life-prolonging treatment. The focus of this document, however, involves the provision of exclusively palliative care without intent to prolong life in the context of a life-limiting condition, otherwise known as perinatal palliative comfort care.


• Perinatal palliative comfort care is one of several options along a spectrum of care, which includes pregnancy termination (abortion) and full neonatal resuscitation and treatment, that should be presented to pregnant patients faced with pregnancies complicated by life-limiting fetal conditions.


• Although specific offerings may vary between institutions, some care components are generally advisable across perinatal palliative comfort care programs: a formal prenatal consultation; development of a birth plan; access to other neonatal and pediatric specialties, as needed; and support and care during the prenatal, birth, and postnatal periods, including bereavement counseling.


• The birth plan is an individualized proposal for delivery and neonatal care and a critical prenatal component of perinatal palliative comfort care.


• The perinatal palliative care team should prepare families for the possibility that there may be differences of opinion between family members before and after the delivery of the infant, and that there may be differences between parents and the neonatal care providers about appropriate postnatal therapies, especially if the postnatal diagnosis and prognosis differ substantially from antenatal predictions.