P0543 - Hospice Home Birth

Background:
Perinatal palliative care (PPC) consultation plays an integral role in the care of parents expecting a newborn with life-limiting illness by creating an open dialogue regarding goals of care, delivery of care, and management of distressing symptoms after birth. PPC consultation also facilitates referral to home hospice. The role of PPC consultation or home hospice in the setting of planned home birth for infants with a life-limiting illness has not been described in palliative care literature.

Case Description:
Antenatal PPC consult was requested for parents expecting a son with hypoplastic left heart syndrome. Palliative surgery was not within their goals of care. The family sought guidance on developing a comfort care plan. The mother previously delivered a healthy son at a community hospital and desired a similar experience for this delivery. As parents and providers worried the community hospital may not be able to adequately address neonatal symptom management, the option of a home birth was explored. PPC team collaborated with home hospice to provide newborn care beginning at delivery. Contingency planning was necessary due to risk of maternal complications requiring hospitalization and the potential logistics of a community hospital agreeing to a hospice care plan in such an emergency. Home birth allowed this family to deliver at home with a midwife while supported by hospice for neonatal end-of-life care, maximizing their time and attention to their newborn son before his death.

Conclusions:
Hospice care in the setting of a home birth offers unique challenges to midwives responsible for the well-being of mothers and infants. It requires significant collaboration with community hospice organizations to ensure optimal symptom management and end-of-life care is available immediately after delivery.