Start/Search | Browse by Day | Author Index

Providing palliative care in the NICU is part of a comprehensive program of perinatal palliative care available at Women and Babies Hospital in Lancaster, Pennsylvania. The case study presented exemplifies the work our nurses and perinatal palliative care team do to help individuals and families during these difficult times.

Background

Mom X was a single Caucasian female with a history of poor prenatal care and a history of drug use. She was admitted in preterm labor at 34 weeks gestation with preterm premature rupture of membranes and meconium stained amniotic fluid. Due to a breech presentation an urgent C-section was performed. Immediately after delivery Baby X  was intubated due to poor respiratory effort. Baby X weighed 2200 grams and was noted  upon delivery to have contractures of upper and lower extremities, a club foot and microcephaly. Baby X was admitted to the NICU and  placed on a ventilator for respiratory support. Baby X received IV fluids for nutrition and Fentanyl for sedation/pain. A head ultrasound showed minimal cerebral development with enlarged ventricles. The CT scan showed severe bilateral diffuse cortical thinning with enlarged lateral ventricles and extra axial spaces.

Perinatal Palliative Care Team
Mom X met with the neonatologist in the NICU to discuss the poor prognosis for survival for Baby X. Mom X was given the option of taking Baby X off the ventilator but was not ready to make that final decision. The perinatal palliative care team  made up of the neonatologist chaplain, social worker, and  several NICU and L&D nurses were consulted about Mom and Baby X. Each member provided support to this single mom who had no family or friends to turn to for help or comfort. Over the course of Baby X’s 5 day hospital stay the team was readily available. Daily discussions were held to keep Mom X up-to-date and involved in Baby X's care. Both Mom and Baby X were provided loving and supportive care by the NICU nurses and perinatal palliative care team.

Saying Good-bye
 Mom X from the beginning stated she did not want to be there or hold her baby when he died. She was assured her wishes would be respected by the staff and perinatal palliative care team and that her baby would not die alone. On day 5 of life, Baby X became increasingly acidotic, had dusky spells and was obviously struggling to breathe. Mom X feeling well informed and supported made the decision that it was time to let her baby go. Surrounded and supported by members of the perinatal palliative care team and the NICU staff Mom X stayed with her baby and held her baby until the end.  Mom X was followed up by the Perinatal Palliative Care Team with phone calls offering support to ensure her physical, emotional and spiritual well-being.