A Unique Care Model for Pregnancies Complicated by a Fetal Anomaly: A Review of the First 5 Years

Abstract

Purpose for the Program Advances in the field of prenatal ultrasonography have allowed for the identification of neonates with anomalies that will require intervention at birth. This allows health care providers and families the ability to devise delivery plans to optimize neonatal outcomes. A unit was envisioned that eliminated the need for a mother and her critically ill newborn to be in separate facilities to receive the necessary medical attention and promote the establishment of the maternal-infant bond. In 2008, the Garbose Family special delivery unit (SDU) at The Children's Hospital of Philadelphia was opened. This unit enabled mothers carrying fetuses with anomalies to receive prenatal care and give birth in the same facility where their neonates would receive immediate postnatal care. This innovative program review highlights the advantages and challenges identified in the first 5 years of operation. Proposed Change Patients are referred to the SDU for outpatient evaluation and fetal therapy and receive seamless outpatient and inpatient obstetric services. The belief was that this model of care would normalize the pregnancy and birth experience for women and their families. A dedicated staff of advanced practice and registered nurses from multiple specialties collaborate on a daily basis to coordinate the care of these families. Women also have access to a multitude of ancillary and psychosocial services. Implementation, Outcomes, and Evaluation To keep abreast of unit operations, processes, and patient needs, monthly multidisciplinary meetings are scheduled. With rapidly increasing patient referrals and volume, this structure facilitates ongoing, open communication. Each discipline, including nursing, is grounded in evidence-based practice. In this forum, conflicts, ideas, and gaps in services are addressed. For example, it was identified that our patients and their families needed additional behavioral health support to cope with the birth of a child with an anomaly. Resources were then allocated to hire a full-time psychologist for the unit. Implications for Nursing Practice This care model as well as the knowledge and expertise we have gained during the past 5 years can serve as an example for other centers that provide care to women with pregnancies complicated by fetal anomalies. Nurses are at the forefront for the development and dissemination of maternal and neonatal care guidelines for this population. Nurses are central in providing holistic care and preventing the disruption of the maternal-infant bonding process. Advances in the field of prenatal ultrasonography have allowed for the identification of neonates with anomalies that will require intervention at birth. This allows health care providers and families the ability to devise delivery plans to optimize neonatal outcomes. A unit was envisioned that eliminated the need for a mother and her critically ill newborn to be in separate facilities to receive the necessary medical attention and promote the establishment of the maternal-infant bond. In 2008, the Garbose Family special delivery unit (SDU) at The Children's Hospital of Philadelphia was opened. This unit enabled mothers carrying fetuses with anomalies to receive prenatal care and give birth in the same facility where their neonates would receive immediate postnatal care. This innovative program review highlights the advantages and challenges identified in the first 5 years of operation. Patients are referred to the SDU for outpatient evaluation and fetal therapy and receive seamless outpatient and inpatient obstetric services. The belief was that this model of care would normalize the pregnancy and birth experience for women and their families. A dedicated staff of advanced practice and registered nurses from multiple specialties collaborate on a daily basis to coordinate the care of these families. Women also have access to a multitude of ancillary and psychosocial services. To keep abreast of unit operations, processes, and patient needs, monthly multidisciplinary meetings are scheduled. With rapidly increasing patient referrals and volume, this structure facilitates ongoing, open communication. Each discipline, including nursing, is grounded in evidence-based practice. In this forum, conflicts, ideas, and gaps in services are addressed. For example, it was identified that our patients and their families needed additional behavioral health support to cope with the birth of a child with an anomaly. Resources were then allocated to hire a full-time psychologist for the unit. This care model as well as the knowledge and expertise we have gained during the past 5 years can serve as an example for other centers that provide care to women with pregnancies complicated by fetal anomalies. Nurses are at the forefront for the development and dissemination of maternal and neonatal care guidelines for this population. Nurses are central in providing holistic care and preventing the disruption of the maternal-infant bonding process.