From inpatient care for complex deliveries to outpatient treatment at convenient community locations, The Children’s Hospital of San Antonio offers a broad network of services for mothers and infants, improving access and coordinating treatments for patients with high-risk pregnancies.
In Texas, maternal mortality and morbidity rates have risen dramatically in recent years, with causes including hypertension, heart disease and infectious disease. At The Children’s Hospital of San Antonio, the physicians with the Center for Maternal and Fetal Care are proactively addressing this problem by providing early, consistent access to prenatal care. Such care could save both the lives of women whose pregnancies are made more dangerous by maternal health problems and their babies.
“We are an integrated inpatient and outpatient high-risk obstetrics service, ensuring coordination of care between referring physicians and pediatric and neonatal specialists,” says Peter Nielsen, MD, Obstetrician-in-Chief at The Children’s Hospital of San Antonio and Professor of Obstetrics and Gynecology and Vice Chair of the Department of Obstetrics and Gynecology at Baylor College of Medicine. “Our principal goal is to enhance safety, quality and access to care for patients with high-risk pregnancies in San Antonio and the surrounding communities.”
This is being accomplished through the growth of new clinics at The Children’s Hospital of San Antonio Professional Pavilion in downtown San Antonio and at CHRISTUS Santa Rosa – Westover Hills, and through the initiation of telemedicine services at CHRISTUS Santa Rosa Imaging Center in New Braunfels.
The Fetal Care Center Program: Breaking Down Barriers to Care
The highly trained physicians at The Children’s Hospital of San Antonio have strong backgrounds in research and leadership. While they are equipped to deal with any maternal medical concern, they also share a keen interest in the social and logistical aspects of maternal care. For instance, Dr. Nielsen says, patients may have numerous reasons for receiving inadequate or fragmented prenatal care: They may not be able to take time off work, they may not have a car to get to medical appointments, or they may need to see a specialist but feel intimidated by traffic and parking in a metropolitan area such as San Antonio.
Andrea Shields, MD, reviews her upcoming appointments.
Dr. Nielsen and his associates have responded with innovative ways to link women and care: telemedicine, transportation and, for women whose fetuses display possible anomalies — coordinated care designed specifically around mother and fetus. As the centerpiece of this fetal care service, women come to The Children’s Hospital of San Antonio for a one-day visit. They receive valet parking and are escorted to a room where they meet with all the subspecialty providers who may take part in their delivery or in their child’s neonatal care.
“For example, a patient whose fetus has a diaphragmatic hernia might meet with a pediatric cardiologist, a pediatric surgeon, a social worker, nurses and a spiritual care leader, all in the same room,” Dr. Nielsen says. “She would tour the labor and delivery area and the NICU. Her questions would be answered in one comprehensive, multidisciplinary appointment.”
Regular meetings track the progress of each patient. Based on the outcomes of a multidisciplinary appointment, specialists can coordinate a plan of care for the patient on her delivery date.
“We know that the more barriers we place in front of patients, the less likely they are to come to appointments,” Dr. Nielsen says. “We have moved more than 20 patients through the Fetal Care Center so far, and they have nothing but praise for the process.”
Expert Inpatient Medicine
Whether mother, infant or both need advanced medical treatments, The Children’s Hospital of San Antonio is fully equipped to care for them. Advanced diagnostic imaging, including comprehensive fetal ultrasound and echocardiography, is available to identify and track any abnormality, and the range of specialists and subspecialists means any condition identified can be treated with confidence.
New mother, Karissa Langston, tends to her son, who was diagnosed with gastroschisis.
“We care for women with preeclampsia, premature rupture of the membranes, diabetes and fetal conditions requiring close monitoring,” says Andrea Shields, MD, FACOG, Associate Professor of Obstetrics and Gynecology at Baylor College of Medicine and Chief of Clinical Research for the Department of Obstetrics and Gynecology at The Children’s Hospital of San Antonio. “We offer a full spectrum of inpatient services, including extracorporeal membrane oxygenation [ECMO] for those infants who may have any barriers to oxygenation.”
“There are very few maternal-fetal care specialists in the city who can provide continuity of care from the outpatient to the inpatient experience,” Dr. Shields continues. “We are all credentialed and privileged to evaluate and manage patients from an inpatient perspective. If a referring provider sends a woman to us, we can work hand-in-hand with that provider to admit the patient to the hospital and follow her as an inpatient as much as the referring provider needs us to. We serve as a safety net, answering questions and providing recommendations for any major decision, and enabling seamless transitions between the outpatient and inpatient settings.”
Furthermore, both Drs. Nielsen and Shields have admitting privileges at CHRISTUS Santa Rosa, allowing patients access to more comprehensive medical care when needed.
The Children’s Hospital of San Antonio’s excellent obstetric hospitalists ensure every delivery, however unexpected, is followed with expert care and compassion. Brook Thomson, MD, Division Director of the Obstetrics Hospitalist Program at The Children’s Hospital of San Antonio, says his team’s key roles are patient safety and care coordination. Additionally, obstetric hospitalists attend patients who come from outlying communities and those who do not have obstetricians.
Karissa visits her primary care physician for a prenatal checkup.
This work takes dedication. Currently, four obstetric hospitalists work 24-hour shifts, ensuring continuous coverage.
“All my obstetric hospitalists are highly experienced,” Dr. Thomson says. “They have all been board-certified for a minimum of eight years. They have seen everything the field has to throw at them. They are a good resource for rare events.”
The physical atmosphere, meanwhile, is relaxing and comfortable for patients and families. Sixteen new labor and delivery suites, still under construction, will double as postpartum rooms. These family-sized, comfortable suites will accommodate even high-risk deliveries, Dr. Thomson says. About 30 new aftercare-only suites are also being created.
“Surgically and from the medical side, they will have all the capabilities I need to care for high-risk patients,” he says.
Today, physicians advise patients to plan for a healthy pregnancy well in advance of the event. The Children’s Hospital of San Antonio offers preconception and genetic counseling services. A referral to these providers will ensure patients and their family medicine or OB-GYN physicians will have expert partnership from the very beginning of a pregnancy.
“Our Director of Perinatal Genetic Counseling Services, Dana Knutzen, is fully affiliated with Baylor College of Medicine,” Dr. Shields says. “She has a wealth of knowledge about genetic conditions in pregnancy and the newborn period up into the pediatric population. She has been running the Fetal Care Center since its inception.”
Telemedicine extends The Children’s Hospital of San Antonio’s reach, bringing care to patients in outlying areas. The initial telemedicine location, in New Braunfels, allows maternal-fetal specialists at The Children’s Hospital of San Antonio to view real-time imaging performed in a remote location, Dr. Thomson says.
“Physicians can talk to the sonographer to make sure images are captured correctly,” he says. “They can also speak with the patient face-to-face over the telemedicine link, counsel them and answer questions.”
Patients in areas without access to high-quality care have typically been the very populations who need that care the most, Dr. Thomson continues.
“For those patients, telemedicine will be a great extender,” he says. “We will be able to care for them in the community as long as possible, while arranging the correct time for them to be brought to a higher-risk center in those situations when it would not be safe to deliver at a small community hospital.”
In Bexar and Comal counties, where maternal mortality has been an intractable issue, telemedicine may prove to be a lifesaver. Just as important as reaching patients where they are, patients need to be brought to centers for high-risk pregnancies when needed. That journey should happen before delivery if possible, Dr. Nielsen says.
“When infants will need surgery immediately after birth, transporting the mother for delivery here is much safer and less costly than using neonatal transport services after birth,” he says. “We collaborate with organizations offering rotary and fixed-wing air transport services, as well as ambulance services. We have a range of transportation options for patients anywhere in South and West Texas. We’ve brought women in from as far away as El Paso.”
And The Children’s Hospital of San Antonio continues to spread its wings. Discussions are active with several municipalities and hospitals about bringing telemedicine services to their areas, Dr. Nielsen says. With access as its goal, the Center for Maternal and Fetal Care is ready to fly.
To learn more, visit chofsa.org/cmfc.