​​Q: What is the overriding philosophy behind the perinatal care program? 
A: When prenatal testing reveals a baby may be born with a life-threatening or chronic condition, the family is faced with overwhelming uncertainty and grief. Our perinatal team walks with these families on their journey through pregnancy, birth, and death, honoring the baby as well as the baby's family.  It is a compassionate and supportive way of caring for the pregnant mother, the baby, and the entire family with dignity and love.

Q: What are the roles of the team and how does the team interface with the expectant mother's obstetrician?
A: Our perinatal care team collaborates with the obstetrician and/or midwife to formulate a care plan. The perinatal care team helps families identify community resources and support groups while navigating the health care system and maximizing social service support.  

Q: What members comprise the perinatal hospice care team?
A: The Consulting Pediatric Medical Director or Team Physician provides guidance to the team on pain and symptom management, ethical dilemmas and decision making.  A Nurse Practitioner supervises the team, providing consultation and clinical care.  A Nursing Assistant provides personal care for the baby, and the Spiritual Care Coordinator offers support and guidance in the family's search for meaning, connection, spiritual strength and peace. The Pediatric Nurse visits the baby and provides instruction to the family on ways to simplify feeding, medication and other issues.  A Social Worker assists in choices during pregnancy and after the birth, and identifies legal and financial resources for the family.  Other core members of the team include Expressive Therapists, who use art and music to help families express their feelings, a Massotherapist who uses touch and massage to comfort the baby and a Pediatric Bereavement Coordinator to guide parents, siblings and other family members through feelings associated with grief and loss. Trained volunteers provide supportive visits as well as respite for the family.

Q: What else does the perinatal team do for families?
A:  There are many ways in which we support families. These include creating a plan to determine the family's preferences at birth, addressing emotional needs, including those of siblings and grandparents, coordinating hospitalization and discharge of the baby, assisting in creating keepsakes and help with final arrangements, memorial services and goodbyes, as needed.

Q: Does Hospice of the Western Reserve offer any additional services to these families?
A: Yes, the baby may stay at one of our two in-patient care centers – David Simpson Hospice House on Cleveland's east side, or Ames Family Hospice House in Westlake. Trained volunteers offer respite care, providing the caregiver with a much-needed break or time to participate in normal family activities.  We also provide on-call support 24/7 and medications and medical supplies are delivered to the family's home.

Q:  How is perinatal hospice care financed?
A: Hospice of the Western is a nonprofit organization providing services regardless of an individual's ability to pay.  Hospice and palliative care services are covered by many private health insurance plans as well as Medicare and Medicaid.  We also rely on memorial gifts, grants, private donations and community support. 

Q: How are referrals made?
A: A referral to our perinatal care program can be made by anyone, including a family member, friend or health care professional by calling 216.916.5520.  A member of the team will return the call the same day.

About Mary Kay Tyler:- In this issue, Clinical Connections interviews Mary Kay Tyler, RN, CNP, CHPPN, Director of Pediatrics and Clinical Support Teams, about perinatal care. A certified nurse practitioner, Tyler has been practicing in pediatric palliative care for 10 years. Prior to joining Hospice of the Western Reserve, she was employed 10 years as a nurse practitioner in pediatric oncology, specializing in brain tumors. Tyler is a certified Pediatric End-of-Life Nursing Education Consortium (ELNEC) instructor. She has presented on the local, state, and national levels on a variety of pediatric palliative care topics.