Quiz 2: Providing palliative care in the antenatal period

Please choose the one, most correct answer to each question or statement.

When should parents be informed that their unborn baby has been diagnosed with a congenital disorder?
- The sooner they are told the bad news the better
- They should only be told towards the end of the pregnancy
- They should not be informed until after the delivery
- Only when they ask to be told
How should bad news be broken to the parents?
- Just give the facts so as not to upset the parents
- In a sensitive and caring manner using language the parents will understand
- Each parent should be told the news at different times
- Give them complicated explanations of all the medical details
Instead of using a broad label such as ‘incompatible with life’ rather use the following:
- A lethal malformation or fatal condition
- A lethal or fatal prognosis
- A baby has no chance of survival
- A life-limiting condition or congenital disorder
What are the correct steps to follow when breaking the bad news?
- Create a safe environment, share the information, respond appropriately by providing support and explaining the follow-up process
- Share the information first and then inform the parents what they need to do
- Give the news over the phone and then ask them to come for counselling
- Wait for the doctor to first break the news to the parents then ask them to come back for counselling at a later stage
Once a diagnosis of a life-limiting illness is made what is the best option for the parents?
- To terminate the pregnancy immediately
- To put the baby up for adoption once it is delivered
- To wait and see if the diagnosis is correct after the baby is born
- To be counselled by a team of healthcare professionals who will give them a few options to consider before making an informed decision
If a diagnosis of a life-limiting condition is made and the parents choose to continue the pregnancy they should be given:
- The choice of comfort care or full life-sustaining interventions once the baby is delivered
- Instructions to follow the doctor’s orders as he would know what the best option would be
- Advice to consider a home birth to avoid contact with parents who are having a normal baby
- No choice in what should happen to their baby once it is born
If a decision is made to terminate the pregnancy when would the procedure need to be performed?
- Immediately so that the parents can move on with their lives
- Unless there is a medical emergency, the family should be given a period to grieve the loss and plan tasks such as notifying other family and friends
- As soon as there is a bed available in the hospital
- Once they have been seen by the spiritual counsellor
When should a mother be referred to the perinatal palliative care team after diagnosis of a life-limiting condition?
- As close to the due delivery date as possible
- After delivery
- At any point from viability
- When the obstetrician decides
A mother who chooses to continue a pregnancy with a life-limiting diagnosis will most likely:
- Experience anticipatory grief
- Experience regret and guilt
- Experience rejection from family and friends
- Experience rejection from the healthcare team
If the mother has decided to continue with the pregnancy, what should the prenatal care focus on?
- The clinical care of the mother
- The clinical care of the unborn baby
- Facilitating attachment, creating memories and assisting the family to cope with possible anticipatory grief
- Monitoring of the pregnancy on a weekly basis
Quality of life must be assessed from the:
- The baby’s perspective
- The mother’s perspective
- The parent’s perspective
- The healthcare team’s perspective
Holistic perinatal palliative care planning includes:
- Telling the family that they may have regrets for not terminating the pregnancy
- The healthcare team making decisions as to what is in the best interest of the mother
- Prenatal planning for the delivery only
- Finding out about both the family’s wishes and hopes, and their cultural, spiritual and religious beliefs
Parents who have chosen to continue with the pregnancy after a diagnosis of a life-limiting fetal condition should be:
- Told to come back when labour starts
- Told that they are making a mistake continuing with the pregnancy
- Be offered an opportunity to meet the healthcare team to facilitate planning for the foreseeable future
- Referred to a psychologist and birth doula
Advance care planning is:
- A once-off discussion on what should happen when the baby is born
- Not a once-off conversation but rather a series of discussions between the healthcare team and parents
- A discussion that is started if the baby dies in utero
- A plan put in place once the baby has been delivered
Goals of care are established by the parents and take what into consideration?
- Comfort focused medical interventions only
- Full life-sustaining interventions
- The parents’ wishes for themselves and their baby
- The healthcare teams’ decisions
What is a birth plan?
- A plan that is put in place if the baby has died and needs to be delivered immediately
- A document that is written by the doctor on the care he wants provided for the mother at the birth
- A plan for the delivery
An advance care plan for the newborn baby:
- Is the same as the birth plan
- Is a documented plan telling the parents what the doctors want to happen after the delivery
- Is only used if the baby needs to be resuscitated at birth
- Details the management of the baby’s postnatal care, pain and symptom control and end-of-life care
What is parallel planning?
- Parallel planning is a way for planning for several possible outcomes or scenarios
- Planning that is put in place after the delivery only
- Planning by the doctor who will be at the delivery
- Planning for either a vaginal delivery or Caesarian section
If there is an unexpected early death of the baby before delivery it is preferable:
- To do a Caesarian section immediately
- To induce labour immediately
- To wait for a few days to see if she goes into labour naturally
- For the mother to give birth vaginally after having discussions with the doctor that this will be the safest option
How can you plan to provide support once a stillborn baby is delivered?
- Allow the parents and siblings to spend time saying goodbye and to make memories with their baby
- Take the baby away in order that they don’t see it
- Allow only the mother to spend time with her baby
- Tell the parents that their baby at least did not suffer