When a mother receives a diagnosis of a life-limiting fetal condition, it is essential to allow for maternal decision-making in anticipation of perinatal loss. This chapter presents care plan strategies for perinatal health providers. It provides information about milk donation as part of perinatal palliative care birth planning with women and families anticipating the loss of their child prior to or shortly after birth. The chapter first discusses the importance of prenatal counseling regarding breastfeeding and milk donation options for families choosing palliative care at birth. It then explains the screening processes required for a mother to become a donor to a milk bank through the Human Milk Banking Association of North America (HMBANA). The chapter helps the reader to identify principles of lactation support for bereaved women through an exemplar from the Children’s Hospital of Philadelphia. It explores the concept of milk donation as part of the grieving process.

Parent–child attachments often begin early in pregnancy and, therefore, if a wanted pregnancy or infant well-being is threatened, feelings of intense worry, anxiety, and emotional suffering follow. Given the long-term psychological aftermath for women who experience a pregnancy affected by a life-limiting fetal condition (LLFC), it is helpful for healthcare providers (HCPs) to understand the factors that women consider when deciding to continue their pregnancy. This chapter reports themes of decision-making rationale of parents with pregnancy affected by an LLFC when asked, “What shaped your decision to continue the pregnancy?” and provides clinical implications for HCPs. It examines the decision-making rationale of parents who opt to continue a pregnancy affected by an LLFC. The chapter then delineates clinical implications for providers wishing to use palliative care principles to support families who face a life-limiting fetal or neonatal condition.

Extremely preterm neonates account for a large proportion of infant deaths in the United States. These patients commonly face life-threatening complications related to multi-organ immaturity. Survivors may have complex special health needs and neurological impairment. Understanding the complex sociocultural preferences inherent to a highly emotional and stressful care setting can be invaluable in partnership with families to align treatment plans with goals of care. The mortality risk and serious morbidities facing extremely preterm neonates are discuss. A summarization is given of the role of prenatal consultation in the setting of anticipated periviable delivery and key aspects of subsequent decision-making. The chapter then considers parental psychosocial challenges and complications inherent to the course of having a critically ill preterm neonate in the neonatal intensive care unit. Finally, it formulates strategies in pharmacologic and nonpharmacologic analgesia, sedation, and symptom management specific to the unique pharmacokinetics of the preterm neonate, including at end of life.

Counseling and planning involve protecting the patient from intensive care interventions and focusing on parental caregiving and memory making or, alternatively, focusing on a trial of intensive care. Fetal palliative care teams are generally consulted when the underlying disease or syndrome has a high risk of death in the perinatal period. Many of these diseases and syndromes may have clinical aspects where surgical intervention may be considered. This chapter explores three general scenarios where surgical intervention may be an option and how these three scenarios may influence the team’s approach. It explores what is known about ethics in the culture of surgery and how this may influence interprofessional communication. The chapter also explores how clinicians can frame and communicate surgical interventions within the context of perinatal palliative care and discusses how to incorporate surgeons into the decision-making process for patients with a high probability of perinatal death.

Abnormal uterine bleeding (AUB) is one of the most common patient concerns in the adolescent population. AUB is defined by menstrual bleeding that occurs outside of the normal range and can include irregular bleeding patterns; prolonged or short bleeding episodes; and heavy or light bleeding. In order to determine abnormal bleeding amounts and/or patterns, it is important to understand the normal parameters for a menstrual cycle in this age group. Nurses and healthcare providers must collect as much information as possible about the menstrual bleeding to help determine the appropriate plan of care.

Ovarian cysts are often evaluated according to the patient's age. In the antenatal period, placental hormones and fetal hormones may stimulate the ovary. Ovarian cysts are not common in the prepubertal female because of low gonadotropin and sex hormone levels. Some functional cysts will activate hormones and result in a prepubertal child presenting with vaginal bleeding or premature breast development. Nonfunctional ovarian cysts also occur in children and may not resolve without intervention. Functional cysts in the pubertal females are often a result of anovulation, with persistence of the remaining follicle and persistence of the corpus luteum.

Combined oral contraceptives contain two hormones, estrogen and progestin. The combined options come in the form of a pill, vaginal ring, or transdermal skin patch. These options are approximately 91% effective as contraception with typical use. The combined hormonal effects prevent pregnancy by inhibiting ovulation, thickening cervical mucus, and thinning the endometrial lining. The progestin-only birth control pills, sometimes known as the “mini-pill”, contain only one progestin hormone called norethindrone. Birth control pills can be initiated at any time when pregnancy can reasonably be excluded.

The etonogestrel implant is a single-rod progestin-only contraceptive method. The implant is a small 4 cm × 2 mm semi-rigid plastic rod containing 68 mg of the progestin etonogestrel and is radiopaque. The hormone is slowly released over 3 years but recent studies suggest the implant can be used up to 5 years. Fewer than one in 100 women become pregnant while using the implant. The contraceptive implant is a highly effective, reversible long-term option for patients in need of contraception. Patients will likely experience menstrual irregularities while having the implant, so effective counseling is important prior to insertion is important.

The etonogestrel implant is a single-rod progestin-only contraceptive method. The implant is a small 4 cm × 2 mm semi-rigid plastic rod containing 68 mg of the progestin etonogestrel and is radiopaque. The hormone is slowly released over 3 years but recent studies suggest the implant can be used up to 5 years. Fewer than one in 100 women become pregnant while using the implant. The contraceptive implant is a highly effective, reversible long-term option for patients in need of contraception. Patients will likely experience menstrual irregularities while having the implant, so effective counseling is important prior to insertion is important.

Vaginal intercourse is considered to be unprotected anytime a male's penis enters a female's vagina without the use of a condom. Patients often call the gynecology office with concerns regarding unprotected intercourse or regarding concerns for a broken condom during intercourse. When a patient reports that they had unprotected intercourse, the nurse should assess whether the patient is using another form of contraception. If the patient is using a form of hormonal contraception, or has a copper intrauterine device in place, the nurse addresses methods of contraception in order to determine if emergency contraception is needed.