Supporting bereaved parents: practical steps in providing compassionate perinatal and neonatal end-of-life care e A North American perspective * Constance Williams a , David Munson b , John Zupancic c , Haresh Kirpalani b,d, * a Division of Neonatology, Hospital for Sick Children, University of Toronto, Canada b Division of Neonatology, Children’s Hospital of Philadelphia, 2nd Floor, Main, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA c Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts, United States d Department of Epidemiology and Biostatistics, McMaster University, Canada KEYWORDS Perinatal bereavement; End-of-life care; Neonatal intensive care; Ethics; Parental involvement Summary Providing compassionate bereavement support challenges care-givers in perinatal medicine. A practical and consistent approach tailored to individual families may increase the care-giver’s ability to relieve parental grief. This approach includes: (1) clear and consistent communication compassionately delivered; (2) shared decision-making; (3) physical and emotional support; and (4) follow-up medical, psychological and social care. Challenges to providing comprehensive end-of-life care include care-giver comfort, consistency of care, cultural and legal barriers, and lack of adequate training. ª 2008 Elsevier Ltd. All rights reserved. Introduction Care-givers face major challenges in providing effective and compassionate care at times of perinatal or neonatal death. These include determining what is in the best interest of both the mother and fetus or newborn, balanc- ing risks and benefits of treatments, and supporting parents’ grief. The cause, timing and events surrounding the delivery and death of their fetus or newborn modify parents’ grief. 1 Current grief models emphasize the benefit in parents building and preserving a relationship with the child. 2 In the busy, technological world of the resuscitation room and the neonatal intensive care unit (NICU), fostering this parenteinfant relationship requires care-giver sensitivity and special skills. We are not aware of randomized con- trolled trial (RCT) interventions on perinatal bereavement. We aim in this review to provide a practical perspective on supporting bereaved parents through a perinatal or neona- tal death. * This work was supported by a research grant from Physicians’ Services Incorporated Foundation, Ontario, Canada; awarded to C. Williams and H. Kirpalani. * Corresponding author. Division of Neonatology, Children’s Hos- pital of Philadelphia, 2nd Floor, Main, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA. Tel.: þ1 215 590 3051; fax: þ1 215 590 3031. E-mail address: kirpalanih@email.chop.edu (H. Kirpalani). 1744-165X/$ - see front matter ª 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.siny.2008.03.005 available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/siny Seminars in Fetal & Neonatal Medicine (2008) 13, 335e340