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Issue 22013

Cocoon of Care: Maternal-Fetal Medicine

Mom Christie Husband nuzzles 9-month-old Brooke, who was born with a single kidney.

Sandra Bretting and Angela J. Hudson

Photos by C.J. Martin

The moment pediatric nurse Christie Husband learned her unborn baby had a birth defect, her mind started flailing. Husband was 32 weeks pregnant when her obstetrician discovered her baby had only one kidney.

This was Husband’s second pregnancy, and up until that moment, it had been enjoyable and relatively uneventful.

“By 32 weeks, I’d totally bonded with my baby,” Husband said. “I could feel her moving and flipping around in there, and I had been so excited thinking she was a happy, healthy baby.”

Jolted by the unexpected, Husband thought of some of the patients for whom she’d cared. She knew about the increased risks of urinary tract and kidney infections, and she was terribly anxious about her baby’s health and future.

“I knew just enough to be dangerous,” Husband said. “But in that moment I wasn’t a nurse — I was a mom. I was just trying to get my footing and figure out what to do next.”

What gave Husband peace and reassurance was the network of care and expertise that sprang up around her. Todd Ivey, M.D., her obstetrician at Texas Children’s Pavilion for Women, immediately engaged specialists at Texas Children’s Maternal-Fetal Medicine Clinic in The Woodlands to carefully monitor Husband’s pregnancy.

Caring for Complex Pregnancies

Maternal-fetal medicine (MFM) is an obstetric specialty focused on the management of high-risk pregnancies. MFM specialists have three years of additional specialized training aimed at improving outcomes in pregnancies in which the mother has underlying health conditions that place her in danger, or in which conditions exist that could threaten fetal survival.

According to the March of Dimes, one in about 700 babies (less than 1 percent) is born with unilateral renal agenesis — having one kidney instead of two. Husband was concerned that other urinary tract defects may cause problems for the one kidney, but her doctors assured her most babies with this condition grow and develop normally.

Physicians at Texas Children’s six maternal-fetal clinics treat everything from gestational diabetes to hypertension, heart disease and other illnesses. The clinics also offer screening services — such as ultrasound and 3-D imaging — as well as genetics and nutritional counseling.

“Maternal-fetal medicine doctors receive additional training and exposure to managing pregnancies complicated by complex chronic medical illness, acute intensive care conditions and congenital abnormalities,” said Texas Children’s Obstetrician-in-Chief Michael A. Belfort, M.D. “They become experienced in the use of sophisticated ultrasound, learn fetal intervention techniques, and perform prenatal diagnoses and genetic screening during fellowships. This training and certification allows us to better manage very high-risk pregnancies and to improve outcomes for mothers and babies.”

MFM is a growing specialty. According to the Society for Maternal-Fetal Medicine, the need for high-risk maternal-fetal care has never been greater. More than 500,000 babies are born too early in this country every year, which means one in eight births involves a premature delivery.

Physicians at Texas Children’s six maternal-fetal clinics treat everything from gestational diabetes to hypertension, heart disease and other illnesses. The clinics also offer screening services — such as ultrasound and 3-D imaging — as well as genetics and nutritional counseling.

“Our MFM clinics give community-based obstetricians access to our experts, which can lead to earlier diagnoses and clinical interventions for mothers and babies,” said Cris Daskevich, senior vice president at Texas Children’s Pavilion for Women. “Texas Children’s and Baylor College of Medicine MFM specialists had more than 43,000 patient visits this past year at our community hospital partner sites across greater Houston and in the Pavilion for Women.”

The Right Care in the Right Place

While the first Texas Children’s MFM center opened in 2008, the concept really took hold when Belfort joined the team in 2011. At that time, Texas Children’s employed five maternal-fetal specialists.

“It felt like there was a hole in our offerings,” Belfort said. “Our doctors had always served as consultants, but by adding additional community-based clinics and an MFM practice at the Pavilion for Women, in which our MFM physicians took on the complete outpatient and inpatient care of patients when necessary, we gained the ability to oversee a patient’s care more comprehensively.”

Today there are 22 maternal-fetal medicine specialists at Texas Children’s — the largest such group of MFM physicians in the nation — and they work at six locations strategically placed throughout the greater Houston area to serve mothers with high-risk pregnancies and their infants.

“It’s a matter of offering the right care in the right place,” said Christine Keating, director of business development for community initiatives at Texas Children’s Pavilion for Women. “We are providing care closer to home for our patients. When we first opened in The Woodlands, we offered neonatology services to the community, but now we’re able to provide more comprehensive care for mothers, fetuses and newborns.”

In fact, the demand for high-risk obstetric care in The Woodlands was so great that the clinic outgrew its space within three years.

“It grew from a 1,900-square-foot clinic to one with almost 4,000 square feet of space,” Keating said. “Now we offer more services than ever before.”

In addition to The Woodlands, maternal-fetal clinics also are located in northwest Houston, west Houston, Sugar Land and the Texas Medical Center. The MFM clinics are near community partner hospitals so obstetricians can follow their patients with the help and expertise of MFM specialists.

The cocoon of care that brought the Husband family so much comfort during those last few uncertain weeks remained.

“Everyone knows the health care environment is changing,” Belfort said. “Health care has become so expensive that it just makes sense to keep mothers and their babies in their communities whenever it’s possible. By doing this, we decrease the hardship for the family and keep mothers closer to their homes and their families for support.”

Although other hospitals in this country offer similar services, Belfort said few have the resources behind them like Texas Children’s has assembled.

“Specialized services such as the critical care unit, the Fetal Center, the Placenta Percreta Program and the Maternal Mental Health Program at the Pavilion for Women offer the highest level of comprehensive care for women and babies anywhere on the planet,” he said. “Texas Children’s specifically brought these programs to Houston because we have all of the resources the doctors need, and all of the services our families have been asking for.”

Cocoon of Care

Christie Husband and her husband Robert welcomed baby Brooke on January 31 at Texas Children’s Pavilion for Women. Texas Children’s Hospital ultrasound and renal services, just next door, immediately came to assess Brooke and confirm the prenatal diagnosis.

Christie and Robert Husband, with daughters Brooke and Brennley, were grateful to have seamless, comprehensive care close by when the unexpected happened during Christie’s pregnancy.

Christie and Robert Husband, with daughters Brooke and Brennley, were grateful to have seamless, comprehensive care close by when the unexpected happened during Christie’s pregnancy.

Brooke did not require additional assistance or hospital stay, and both baby and mom went home within a couple days. But the cocoon of care that brought the Husband family so much comfort during those last few uncertain weeks remained. Brooke’s pediatrician at Texas Children’s Pediatrics The Woodlands continues to monitor her, and she sees a renal specialist at Texas Children’s Hospital.

“I can’t say enough about how amazing it was to deliver at an institution that had so many resources for our new baby right there. And then to be able to go back to our community and have a primary doctor who had immediate access to all our information and those same resources,” Husband said. “During my pregnancy, my delivery and afterward, everything between my doctor, MFM specialists, the pediatric specialists and Brooke’s pediatrician was just seamless. They created a pathway and a plan for me and my baby to make sure I knew what to do and where to go from here.”