When a woman is facing a high-risk pregnancy, Floating Hospital for Children and Tufts Medical Center have in place a remarkably collaborative system of caring for both mother and baby. In fact, of the nearly 1,200 births at Tufts Medical Center each year, about 40 percent are high-risk, often premature deliveries – a significantly higher percentage of complex births than at any other Boston hospital, and testament to the expertise that resides here.
High-risk pregnancies are managed by Tufts Medical Center’s renowned nine-member Maternal-Fetal Medicine (MFM) Division, headed by Sabrina D. Craigo, MD.
“We have a truly multidisciplinary approach to caring for mother, baby and the family,” she says. Key collaborators are the neonatologists in the Division of Newborn Medicine at Floating Hospital for Children.
“Our working relationship with MFM starts relatively early in high-risk pregnancies,” says Jonathan Davis, MD, Chief of Newborn Medicine Division, explaining that MFM brings in a neonatologist to consult whenever a potential problem is identified, even during outpatient care.
“MFM recognizes that we can have significant input as to how such factors as developmental abnormalities, medications during pregnancy or premature delivery will influence the newborn,” he notes. “We talk to parents early on, counsel them, and give them outcome data that’s helpful for making important decisions. Then we work with MFM to coordinate care, including treatment and the timing of delivery.”
“This interaction and communication allow seamless care to be given during pregnancy,” Davis adds.
“And it’s an approach that optimizes outcomes for this patient population,” says Craigo.
When a high-risk delivery requires hospitalization at Tufts Medical Center, both MFM and newborn medicine specialists are on hand.
“We arrange for the pregnant woman to be seen by a member of Floating’s newborn medicine team soon after admission, and the neonatologist explains to parents what to expect if the baby is delivered at that gestational age,” Craigo says.
“Then our two services stay in contact by phone and pager,” she continues. “If maternal status changes, if there’s concern for the fetus, or if the mother labors and can’t stop, Newborn Medicine is notified and present at delivery to immediately take care of the newborn. Both MFM and Neonatology are in-house 24/7,” she adds, noting that this around-the-clock coverage is unique among Boston hospitals.
“Whenever possible, however, we try to keep mother and baby in the community,” Craigo says. This effort is enhanced by the presence of Tufts Medical Center’s MFM satellite offices and nurseries staffed by Floating neonatologists at community hospitals including Lawrence General Hospital, Lowell General Hospital and MetroWest Medical Center.”
“When there’s a complication requiring higher-level neonatal intensive care, we can quickly arrange for a transfer to Boston,” she notes, referring to Floating’s award-winning, 45-bed Level III NICU.
“If a premature birth occurs in the community and the baby requires transport to Floating for NICU care, we also transport the mother here, so they can be together,” says Davis. “That’s unique to Floating and Tufts Medical Center.”
“And as the baby gets stronger and needs less intensive care, we bring them back to the Level II nursery in the community with our neonatologists managing them,” he adds.
“This approach requires and ensures a closed loop of communication among all caregivers – the perinatologist, the referring obstetrician, neonatologists and maternal-fetal specialists in Boston and at the community hospital, and pediatricians in the community,” Craigo says. “It’s a collaborative approach that is tremendously beneficial to the family, and it has a positive impact on outcomes.”