Feeling of Caregivers After a Palliative Management of Extreme Premature Babies in Delivery Room.

Caregiver Feeling

Caregiver feeling, Palliative care, Delivery room, Extremely preterm birth

Introduction : The birth of a child is usually a happy event that caregivers working in delivery rooms share with families. Unfortunately, newborns sometimes need palliative care as soon as birth occurs. In France, neonates who were liveborn under 24+0 weeks amenorrhea (date of last mentrual period) or weighing less than 500 grams) usually have non resuscitation in delivery room \[Ancel 2020\]. Some of them are considered as viable (referring to World Health Organisation definition : either term ≥ 22 + 0 amenorrhea week or birth weight ≥ 500 grams), others as nonviable (term \< 22 AW and birth weight ≤500 grams). In France, legislative development over last two decades have allowed the emergence of palliative care in delivery room. In a French survey in 2016, 83% of maternities were confronted at least once a year with this situation.

In France as in other countries, published studies concerning palliative care for extremely premature babies focused on the grey zon period, but not on the nonviable preterm infants (also called late miscarriage) who have signs of life at birth. Only a fairly recent French book of 735 pages exclusively dedicated to the palliative approach in perinatal medicine, reports in a single chapter the existence of palliative care in extremely non-viable premature newborns. There is a paucity of articles about the actual experience of caregivers confronted to palliative care of extremely preterm babies, viable or non viable, primarily studies in the so-called gray literature. Thus, a midwifery graduation thesis describes the experience of midwives in a French university hospital following the care of babies born alive between 18 and 24 weeks old . Two recent reviews explore the notion of resilience of caregivers who have been involved in perinatal palliative care . A nursing graduation dissertation explores the emotions of caregivers faced with perinatal bereavement . Primary objective: the primary objective of this both qualitative and quantitative monocentric study is to explore the feelings of caregivers (doctors, midwifes, nurse's aids, pediatric nurses) within 2 months of a palliative situation for an extremely preterm baby in a delivery room, viable or not, and not eligible for resuscitation. Secondary objective: the secondary objective of the study is to quantify the impact of this stressful event: * Within the first month (acute stress). * 2 months after the event (post-traumatic stress). Expected impact of the study: * These care situations are not described in the scientific literature and little described in the so-called grey literature: this study aims to make them readable. * The caregiver's feelings and the mechanisms that underlie them may differ, depending on the type of profession and links within a team: this study aims to better characterize and understand them. * As a result, the investigators hope this study will identify avenues for work and action to better support caregivers and prevent work-related burnout.

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