Soins palliatifs, anticipation et incertitude en médecine périnatale

The object of perinatal medicine is the health of the fetus, then of the newborn and finally its integration into a welcoming family. When a serious malformation is diagnosed in utero, the woman can choose the medical termination of pregnancy but some prefer to continue to live the pregnancy to term, to meet the alive child and to accompany him/her in his short life “in palliative care”. Training allows teams to answer to parents' requests concerning the malformation, the course of pregnancy, the mode of delivery, the pain that would possibly affect the baby, and his/her life expectancy as well as the type of care, which he/she would require. Nevertheless, anticipation does not have authority to evacuate completely grey areas. On the contrary, uncertainty paves the way for hope, which allows the couple to live. The doctors, trained to chase away diagnostic and prognosis uncertainty, have to learn to integrate uncertainty positively in their practice. A strong link between professionals and parents is necessary during the decision-making process and later in the welcoming of the newborn. This trust allows guiding the professional plan with flexibility by protecting the possibility of adapting the initial project. When parents and professionals have been able to walk this road together and when the child has been warmly welcomed during his short life, it is likely that the mental health of the family is preserved. Everyone - family and professionals - can begin grieving process and recover to it. Some people may then think of the children to come in a serene and peaceful way.