Cuidar da morte diante do começo da vida:cuidados paliativos em casos de incompatibilidade com a vida extrauterina a longo prazo

Abstract

Faced with the gestational prognosis of incompatibility with extrauterine life in the long term, the follow-up of the pregnancy must be planned by the family, together with a specialized multi professional team. Health professionals are tasked with providing care, while confronted with their limits in the face of the death of a baby, making their clinical management and psychological elaboration difficult. Considering that dealing with death imposes dilemmas on the perinatal field, discussions about the applicability of palliative care principles during this period have been growing in Brazil. Based on this, the aim was to analyze the perception of a multiprofessional perinatal team on palliative care in cases of diagnosis of incompatibility with long-term extrauterine life. A descriptive qualitative study was carried out in a public high-risk fetal maternity hospital in the city of Rio de Janeiro. Twelve professionals from the teams that work with lethal fetal pathologies were interviewed, considering the stages of pregnancy, childbirth and the postnatal period. The data was analyzed using thematic content analysis, according to Gomes (2016). The following categories were identified and discussed: Prenatal approach; Reception during childbirth; Postnatal care and; Health professionals facing perinatal death. The study highlighted the subjective, ethical, technical and institutional dilemmas surrounding end-of-life care due to incompatibility with long-term extrauterine life, the demand for greater dissemination of palliative guidelines and resources for professionals and patients, and the importance of institutionally including the professionals subjectivity in the context of care for imminent death and death itself.