When external factors limit care options for complex fetal and neonatal diagnoses

Each year in the United States, many individuals receive a complex fetal or neonatal diagnosis. Amidst grief and processing, they are faced with making difficult and multifaceted medical decisions for the pregnancy and, at times, neonatal care. Care options often include abortion, fetal interventions, palliative and hospice care, and invasive neonatal interventions. These incredibly personal resolutions about the most appropriate care path are often based on multiple influences beyond the medical information and prognosis. External factors (geography, finances, provider bias, institutional policies, and legislation) may limit the availability of certain care options patients would prefer. This article explores how each of these external factors may limit the choices of abortion, fetal interventions, palliative and hospice care, and invasive neonatal interventions for patients facing a complex fetal or neonatal diagnosis. Further, it discusses the implications of restricted options and suggests strategies to continue to provide complete, comprehensive counseling and care.