How Jefferson Met Care Challenges for Expectant Hahnemann Moms

When Hahnemann University Hospital announced it was closing this summer, filling any gaps in patient care – especially for expectant mothers and their babies – became a citywide concern.
ObGyn residents with Dr. Jason Baxter
Dr. Jason Baxter talks with residents from the Department of Obstetrics and Gynecology at Thomas Jefferson University Hospital.

When the Hahnemann University Hospital closure was announced this summer, filling any gaps in patient care – especially for expectant mothers and their babies – became a citywide concern. Thanks to months of preparation and planning, Jefferson Health became the safety net for many of these patients, especially mothers to be.

“Our goal has always been to focus on the city of motherly love,” says Dr. Jason Baxter, director of Inpatient Obstetrics at Jefferson Health.

Back in early July, the Department of Obstetrics and Gynecology at Drexel University’s College of Medicine informed 819 patients that, as of July 12, Hahnemann — Drexel’s primary teaching hospital — would no longer perform non-emergency surgeries and procedures. That included childbirth. What should have been a joyous occasion for expectant moms suddenly became a bit frightening.

Because of the Hahnemann closing, Jefferson is now experiencing a nearly 50 percent uptick in the number of babies it is delivering. This translates to about 3,000 babies per year – an average of seven babies a day.  In just two weeks — and to support this surge – Jefferson worked closely with Drexel to help its obstetric providers gain the proper credentials, so they could provide care to their patients at Jefferson.

On August 15, Hahnemann patient Erica Jackson gave birth to her son, Lamazzi, at Thomas Jefferson University Hospital. “My midwife asked me if I wanted to go to Jefferson and I said yes because I heard they had a great labor and delivery department,” says Erica. “I’m really glad that I went to Jefferson. I wasn’t scared that it was my first delivery; they made me feel so calm and relaxed. I was so well taken care of – I felt like I was on vacation.”

Because of the Hahnemann closing, Jefferson is now experiencing a nearly 50 percent uptick in the number of babies it is delivering. This translates to about 3,000 babies per year – an average of seven babies a day.

Things didn’t go so simply when Lakeeta Baines – 34 weeks pregnant – was admitted to Jefferson Health’s Labor and Delivery Unit. Like Erica, Lakeeta had received her prenatal care at Drexel Medicine and her delivery was planned for Hahnemann.

In Jefferson’s Labor and Delivery triage unit, Lakeeta presented with severe shortness of breath, alarming the triage team enough that they ordered an echocardiogram. Jefferson cardiologist Dr. Yair A. Lev, also treating Lakeeta, became immediately concerned that she was suffering heart failure, possibly related to preeclampsia, a pregnancy complication characterized by high blood pressure. Preeclampsia can lead to serious, even fatal, complications for both mother and baby.

“When pregnant patients have severe preeclampsia we typically recommend delivery at 34 weeks,” says Dr. Emily Rosenthal, a maternal-fetal medicine fellow at Jefferson. “The decision was made that in addition to her treatment for heart failure, she also needed to be delivered.”

As Dr. Rosenthal explains, there was an immediate concern about Lakeeta’s heart function being very sensitive to changes in blood pressure. At one point, her blood pressure dropped to a level that would seem normal in many cases, but it was affecting how the baby was tolerating the labor. Says Dr. Rosenthal, “Unlike most cases where we are typically working to get the blood pressure down, we actually had to work to get her blood pressure up so that her baby could tolerate the labor.”

Medication was administered, Lakeeta’s blood pressure was stabilized, and the team focused on her delivery. “We really benefitted from the fact that she had had several babies before,” says Dr. Rosenthal. “She delivered the baby with about half a push.”

 

…regardless of whether we were taking care of more patients from Hahnemann or not, or whether we were busier than normal on the regular Labor and Delivery floor, this outreach would have happened, no matter what time of year or what the circumstances were.

– Dr. Barber

The unit also had had experience in the cardiac ICU with delivering expectant heart failure patients, so they were able to put a team together quickly to treat Lakeeta and to induce labor. “I think we really benefited from having done that in the last few months,” says Dr. Rosenthal.

Recent experience, coupled with a team willing to go the extra mile for patient care, ensured that Lakeeta had a safe delivery. On the night she went into labor, Dr. Baxter came in in the middle of the night, as did Dr. Rosenthal, who spent the night in the cardiac ICU – even though it was her day off.

“That may sound like it’s out of the norm,” says Dr. Cecily Barber, a resident who worked nights in Labor and Delivery for eight weeks over the summer. “But regardless of whether we were taking care of more patients from Hahnemann or not, or whether we were busier than normal on the regular Labor and Delivery floor, this outreach would have happened, no matter what time of year or what the circumstances were.”

Says Dr. Baxter, “It emphasizes our team care. What I so appreciate is all of the teams focusing on being patient centered.”

That mutual support sets Jefferson’s Labor and Delivery Unit apart and is crucial in handling the influx of Hahnemann patients. Dr. Rosenthal notes that the residents – exemplified by Dr. Barber’s work with high-risk patients during overnights throughout the summer — were one of the first groups to be impacted by the increased volume. “The residents really rose to the occasion and provided a really good support system for each other.”

Likewise, Jefferson’s six maternal-fetal medicine fellows, along with nurses on the unit, are feeling the ripple effect of the Hahnemann closing. “We’re there for each other and providing support,” says Dr. Rosenthal.  A big positive, Dr. Rosenthal adds, is the addition of Drexel’s obstetric providers. “I’ve been impressed with their positive attitudes and willingness to collaborate. We’re all willing to help each other to make Labor and Delivery a safe and happy place for our patients.”

The opening of a new obstetrics floor at Jefferson in August has helped tremendously and will go a long way toward sustaining what Dr. Baxter terms ‘the new normal.’ “With crisis comes opportunities,” he says.

And with unparalleled teamwork, this labor of love comes full circle.

 

Hear more from Drs. Baxter, Rosenthal and Barber on episode three of The Health Nexus Podcast, which dives further into how Jefferson united to care for the patients of Hahnemann University Hospital after its closure.

TAGS
, , ,
CATEGORIES
Special Reports

RELATED STORIES