A Unique Care Model For Pregnancies Complicated By a Fetal Anomaly: A Review Of The First 5 Years
Title: A Unique Care Model For Pregnancies Complicated By a Fetal Anomaly: A Review Of The First 5 Years
- 1. Identify the challenges and opportunities for integrating a multidisciplinary team in a pediatric facility for the pregnant woman diagnosed with a fetal anomaly.
- 2. Recognize the need for continuing ongoing assessment of resources, institutional support, model of care, communication, and integration of disciplines as the program expands in volume and services.
- 3. Describe how nursing care of different levels and specialties, are central in maintaining holistic care throughout the program, preserving the maternal infant bond postnatally.
Advances in the field of prenatal ultrasound has allowed for the identification of neonates with anomalies that will require intervention at birth. This allows providers and families the ability to devise a delivery plan to optimize neonatal outcome. A unit was envisioned that eliminated the need for a mother and her critically ill baby 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 opened. This unit enabled mothers carrying fetuses with anomalies to receive prenatal care and deliver in the same facility where their neonates receive immediate postnatal care. This innovative program review will highlight the advantages and challenges identified in the first five years of operation.
Proposed change:
Patients are referred to the SDU for outpatient evaluation and fetal therapy. Women now receive seamless outpatient and inpatient obstetrical services. The belief was that this model of care would normalize the pregnancy and birth experience for women and their families. There is a dedicated staff of advanced practice and registered nurses from multiple specialties who 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 over the last five years can serve as an example for other centers providing care to women with pregnancies complicated by fetal anomalies. Nursing is 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.
Keywords: fetal anomalies, maternal-infant bonding, Special Delivery Unit