Perinatal palliative care – how to approach antenatal counselling

There is a growing recognition that perinatal palliative care is appropriate whenever there is uncertainty about a baby's survival outcome. Many aspects of this care can, and should, be provided by existing perinatal teams, with support from community and specialist services where required. However, delivering perinatal palliative care can be practically, ethically and emotionally challenging for professionals without adequate guidance and training. In this best practice paper, we offer practical guidance for clinicians who may be involved in antenatal counselling when a baby has been diagnosed with a potentially life-limiting condition during pregnancy. We consider how to approach antenatal counselling in the context of prognostic uncertainty, how to support families in being able to treasure their pregnancy, how to remain open to all possibilities, how to develop individualised care plans for families and finally consider how to close the consultation and arrange follow-up. Drawing on the parental experience of one of our authors, we explore how to navigate the concept of hope in perinatal consultations.