Leveraging Multidisciplinary Perinatal Expertise to Deliver Healthier Babies

By Allison Gorman
Thursday, July 25, 2019

Uniting high-level prenatal and surgical care with comprehensive support services, the Perinatal Program at Penn State Health Milton S. Hershey Medical Center and Penn State Children’s Hospital has become the regional referral center for diagnosis and treatment of suspected fetal anomalies.

Since the launch of the Perinatal Program in 2012, hundreds of women in central Pennsylvania have been referred there because of a possible fetal anomaly or some other condition. The multidisciplinary team offers coordinated, tertiary-level care, complemented by counseling and other family-focused support, from early pregnancy through delivery, any necessary surgery and recovery.

Maternal-fetal medicine physician Jaimey M. Pauli, MD, who co-directs the Perinatal Program with pediatric cardiologist Thomas K. Chin, MD, says they collaborate with community providers to offer comprehensive prenatal care in these challenging cases.

“Research tells us these babies will more likely have a good outcome if the mother is cared for in a facility such as Hershey Medical Center, where we have the full spectrum of specialty and subspecialty care and a high-level NICU,” says Dr. Pauli, who is also associate professor of Maternal-Fetal Medicine in the Department of Obstetrics and Gynecology at Penn State College of Medicine and medical director of Labor and Delivery. “The mother meets with all the people who will take care of her and her baby, and we coordinate delivery at the institution where the baby will be cared for, so mom and baby won’t be separated.”

“At Hershey Medical Center, we can maximize a baby’s outcome because we have the experience and expertise to address the complete spectrum of conditions — especially with early intervention and early prenatal care.”
— Jaimey M. Pauli, MD, Perinatal Program co-director, Penn State Health Milton S. Hershey Medical Center and Penn State Children’s Hospital, Associate Professor of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at Penn State College of Medicine, and Medical Director of Labor and Delivery

Tertiary-Level Care

The Perinatal Program was built on a foundation of broad medical and surgical capabilities. Its multidisciplinary team includes obstetricians, double-board-certified Maternal-Fetal Medicine specialists and numerous fellowship-trained pediatric subspecialists: cardiologists, surgeons, cardiothoracic surgeons, neurologists, neurosurgeons, urologists, plastic surgeons, orthopedic surgeons, nephrologists and palliative care specialists.

It also includes social workers, coordinators, a clinical counselor, Maternal-Fetal Medicine nurses and a program manager, who meet weekly with Dr. Pauli to review each case. The full team, including subspecialists, meets monthly. Continual improvement in efficiency and communication as well as incorporation of a new database for tracking outcomes enable the team to tailor care to each patient.

Hershey Medical Center has a Level IV NICU, and Penn State Children’s Hospital is one of just two hospitals in Pennsylvania with a three-star rating for congenital heart surgery from The Society of Thoracic Surgeons. It is the only hospital in Pennsylvania designated a Level I Verified Children’s Surgery Center by the American College of Surgeons.

“We are a major transfer center for the region from a high-risk maternal standpoint,” Dr. Pauli says. “Not all centers can care for a sick mother — one who has a chronic disease, such as diabetes or hypertension, that predates pregnancy or who develops preeclampsia or another severe illness during pregnancy. We can take care of both mother and baby under one roof.”

Obstetrical services and the NICU are on the third and seventh floors of Hershey Medical Center, and, as the entire system is contiguous, Penn State Children’s Hospital is only an indoor walk away.

Coordinated Services

The Perinatal Program’s support for families is reflected in the wraparound services it provides from the moment a patient is referred. She is met at the hospital door by one of two Perinatal Program coordinators: Allison Irvin, BSN, RN, and Laurie Reesman, BSN, RN. Their role is to smooth a potentially overwhelming journey.

“Typically, the patient is expecting everything to be OK with her pregnancy,” Irvin says. “Suddenly, she needs multiple types of imaging and, once there’s a diagnosis, follow-up with several pediatric subspecialists. Without someone to coordinate her care and ensure communication is continuous and consistent, it’s really difficult.”

Irvin and Reesman schedule all appointments to make patients’ time at the hospital as efficient as possible. The first day includes imaging and consultation appointments and tours of the NICU, PICU and the Women’s Health Unit, with lunch provided. A coordinator attends every prenatal consultation.

“Whatever is said in these consults, we make sure that happens,” Irvin says. “Obviously babies make their own rules, but if what parents are told is what they see when their baby is born, they have less stress and anxiety.”

Family Support

Clinical psychiatric specialist Jennifer Stoner, MA, joined the team last year, becoming the region’s only clinical counselor dedicated to a perinatal program.

“We’ve researched the effect of a prenatal diagnosis on parents’ mental health,” Irvin explains. “If they learn about their baby’s condition ahead of time, we can prepare them. However, we realize it can also cause a lot of stress at a time when they are supposed to be excited about the birth of their baby.”

To address those concerns, Stoner meets with patients and families regularly until their babies are released from the NICU. In addition to counseling them in the hospital, Stoner equips them with coping skills they can use at home.

“Many of these babies have complex medical needs that may be lifelong,” Irvin says. “We know that once they’re discharged, their outcomes are heavily dependent on their parents. If we ignore parents’ mental health needs, they’re not going to be as attentive to changes in their babies that may cue some serious medical need.”

The program’s pediatric palliative care team is well-known and drives many referrals, according to Irvin.

“Our specialists are experts at helping parents make decisions about how they want the birth to look: what’s important to them, what’s important for their baby,” she says. “Additionally, we provide broad-based supportive services when the situation doesn’t necessarily require medical intervention.”

Early Referrals for Better Outcomes

With comprehensive medical and surgical capabilities and support services, the Perinatal Program offers a level of care rarely found outside select major metropolitan areas, Dr. Pauli says. That appeals to central Pennsylvanians, who do not want to travel hours for treatment, deal with big-city traffic or deliver their babies far from home.

“We can handle high-risk maternal-fetal care,” Dr. Pauli says. “If the mother goes into labor in the middle of the night, we can take care of her. But if we know about the baby’s condition during prenatal care, the parents can prepare for it and the subspecialists can make a plan for what the baby will need after birth.”

She encourages providers to refer patients for evaluation as soon as a fetal anomaly is suspected. Women whose babies will likely need surgery or NICU admission are advised to deliver at Hershey Medical Center, so deliveries can be scheduled to accommodate the baby’s needs and no time is lost transferring a sick newborn from an institution less equipped to care for it. In such a case, Dr. Pauli consults with the referring physician about temporarily assuming care before returning the patient to her primary care provider.

“We are happy to coordinate prenatal care,” she says. “We respect the patient-provider relationship.”

Poised for Growth

The Perinatal Program currently treats approximately 120 patients annually and has experienced significant growth since its founding.

Penn State Children’s Hospital is growing as well, Dr. Pauli notes. In a few years, Labor and Delivery and the NICU will move together into the expanded building. Meanwhile, the Perinatal Program is applying for institutional designation as a Perinatal Center, setting it apart as a multidisciplinary, collaborative group providing advanced care.

“We provide patients local care on the same level as or better than they could get anywhere in the state,” Dr. Pauli says.

For information, visit childrens.pennstatehealth.org/perinatal.