Working hand in hand

Maternal fetal medicine and neonatology provide seamless care for high-risk moms and babies

Today, Simon Dolan is a happy, healthy 21-month-old boy. But before he was born, a serious congenital defect gave him a slim chance of survival. His mother, Teri, is grateful for the seamless, compassionate care she and Simon received, which started during her high-risk pregnancy and carried through postdelivery.

Today, Simon Dolan is a happy, healthy 21-month-old boy. But before he was born, a serious congenital defect gave him a slim chance of survival. His mother, Teri, is grateful for the seamless, compassionate care she and Simon received, which started during her high-risk pregnancy and carried through postdelivery.

Teri Dolan and her husband were anxiously awaiting the birth of their fourth child. Like her previous pregnancies, everything seemed to be progressing normally. Then one night, at just 29 weeks pregnant, Dolan’s water broke. She and her family rushed to University Hospitals MacDonald Women’s Hospital.

Dolan was diagnosed with preterm premature rupture of membranes, which required inpatient bed rest to delay labor. But an ultrasound performed at UH MacDonald Women’s Hospital after she was admitted found something even more upsetting. The baby had a congenital diaphragmatic hernia (CDH).

“It means that a portion of the diaphragm is missing,” says Method Duchon, MD, Maternal Fetal Medicine Specialist at UH MacDonald Women’s Hospital, who helped care for Dolan. “This is often a devastating diagnosis in which the child does not survive.”

With CDH, because the diaphragm is either underformed or absent, other organs can creep into the chest, crowding the heart and lungs. This often leads to underdeveloped lungs and life-threatening breathing difficulties. As a result, Dolan’s baby had a 50 to 60 percent chance of survival.

“I was a mess,” recalls Dolan. “All I could do was wait for the baby.”

Seamless coordination of care

While doctors were trying to postpone labor as long as possible to give the baby’s lungs time to mature, the staff at UH Rainbow Babies & Children’s Hospital was preparing the couple for after the birth. Eileen Stork, MD, an expert in the care of newborns with CDH, met with Dolan and her family to help them better understand what to expect once their son was born. Pediatric surgeons also met with Dolan and her family to talk about evaluation and surgery. This teamwork and an individualized approach to care improves outcome for newborns and minimizes patient concern.

With one of the nation’s highest infant survival rates, the Quentin & Elisabeth Alexander Level IV Neonatal Intensive Care Unit (NICU) at UH Rainbow Babies & Children’s Hospital – ranked No. 2 in the nation in neonatology by U.S. News & World Report – is located just steps away from UH MacDonald Women’s Hospital’s Maternal Fetal Medicine Unit. Unavailable at other facilities in the region, this close proximity ensures the best outcomes by allowing the two areas to closely collaborate while keeping mother and baby together.

“Our mission is to make a complicated pregnancy as simple as we can for parents. We strive to provide seamless care from before conception through delivery,” says Honor Wolfe, MD, Chief of the Division of Maternal Fetal Medicine at UH MacDonald Women’s Hospital. Dr. Wolfe says all cases, however common or rare, benefit from teamwork between the hospitals. The end goal, she says, is to provide the best care possible to mothers and their babies.

A baby boy

After about a month of bed rest, Dolan went into labor. Simon Dolan was delivered on December 4, 2011, more than a month early. He was immediately intubated and rushed to the NICU.

“I met Simon for the first time when I put my hand in the incubator,” Dolan says. “I was able to change his tiny diaper that day, and considering the circumstances, that was so wonderful!”

Day and night, the NICU nurses, doctors and respiratory specialists cared for Simon as Dolan and her husband watched and waited for him to improve.

“Everyone in the NICU was so knowledgeable and compassionate. Someone was always available to answer my questions even if it was the hundredth time I asked. They were always consistent, and that gave me comfort,” says Dolan.

Road to recovery

Nine days after Simon was born, he was strong enough to undergo surgery to repair the hernia. Thankfully, the operation went well. But his condition was still critical and he remained on life support to breathe.

“I was so emotional,” recalls Dolan. “I really appreciated that the NICU had private rooms so we could navigate through this difficult time without being on display.”

Although doctors estimated Simon might be in the hospital between six and 10 months, he made tremendous progress and was back at home after six weeks.

A miracle

Today Simon is nearly two years old and is a happy, healthy little boy. “He is my independent, spunky child,” Dolan says.

Although Simon’s health issues are largely behind them, Dolan still remembers the care she received and is empathetic to others going through the stress and heartache of having a baby with medical problems.

“As a parent, you are responsible to care for your baby’s every need. Although it is not easy, you need to trust someone to take over that role for a little while,” says Dolan. “The NICU is that place where every need – physical and emotional – is met. They are truly amazing.”

High-risk pregnancy care: Close to home

Visit UHhospitals.org/MFM for a list of locations where you can find services such as targeted fetal ultrasound, genetic counseling and first and second trimester screenings for chromosome abnormalities and malformations.

Method Duchon

METHOD DUCHON, MD
Maternal Fetal Medicine Specialist, UH MacDonald Women’s Hospital
Clinical Assistant Professor, Case Western Reserve University School of Medicine

Honor Wolfe

HONOR WOLFE, MD
Division Chief, Maternal Fetal Medicine, UH MacDonald Women’s Hospital
Professor, Case Western Reserve University School of Medicine

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