BY CONNIE MITCHELL PHOTOS BY GARA DYSON & GREGG GOLDMAN
Jeannie Kelly, MD, MS, and Roxane Rampersad, MD, recently sat down to talk with me about the Maternal-Fetal & Newborn Transport Services, a fleet of aircraft and ambulances prepared to transport pregnant women and newborns in need of specialized care.
A service of the Women & Infants Center, a collaboration by Barnes-Jewish Hospital, Washington University Physicians and St. Louis Children’s Hospital, the service transported more than 353 high-risk pregnant women and 367 newborns within the first 10 months of 2020 alone. Kelly is medical director of the service; Rampersad is its outreach director. Both women are Washington University maternal-fetal medicine specialists at Barnes-Jewish Hospital.
We want to keep healthy moms and babies in their own communities, but when that’s not possible, we’re here and available.
Among the many vehicles available to rush patients to Barnes-Jewish Hospital for emergency care, six intensive-care ambulances, two twin-engine helicopters and a fixed-wing aircraft stand ready. Each is equipped and staffed to deliver patients from locations across the Midwest to the maternal-fetal care specialists they need.
Tell us about the Maternal-Fetal & Newborn Transport Services. When did the service start and why? Who does it help?
Kelly: The transport service has been around since the mid 1990s, and the purpose is essentially to provide a streamlined way to get infants and pregnant women who need higher levels of care from other health care facilities to Barnes-Jewish Hospital. Our typical patient is a woman who is having pregnancy complications. She could be experiencing pre-term labor or have preeclampsia, or maybe her water broke early. In these instances, among others, her situation requires that she be evaluated or admitted at a place like Barnes-Jewish, where we can support her medical needs and those of her baby, especially if circumstances necessitate an early delivery.
JEANNIE KELLY, MD, MS, (LEFT) AND ROXANE RAMPERSAD, MD (RIGHT)
We also may transport postpartum women, either because they’re sick and require higher levels of care or because they were delivered elsewhere and need specialized medical treatment.
How does the transport service work?
Rampersad: We have relationships with 60 to 70 hospitals across the region. Typically, they contact the service when they have a patient who’s been assessed and needs a higher level of care than they can provide. The referring physician calls our transport line and is immediately connected to our obstetrical transport nurse and to a maternal-fetal medicine specialist.
Once we accept the request for transport over the phone—which we virtually always do—the team, including a specialized obstetrical nurse, travels in the transport vehicle to the patient. We use the most appropriate mode of transport at the time, considering distance and weather conditions. We like to get our patients here as quickly as possible. During transport, the nurse is in contact with the maternal-fetal medicine team while assessing the patient’s heart rate and giving medication and fluids as needed. Once the vehicle arrives at the hospital, we move the patient to our labor and delivery unit.
Kelly: We do ensure that patients are stabilized before they get on a helicopter or in an ambulance. So the referring hospital may give medications prior to transport and will assess the speed of the labor. We always try to get moms here before delivery, but sometimes we find that the fetus is in a lot of distress or that labor has progressed to a point where it’s not safe to transport. In those situations, we may send out a neonatology team to provide care and support.
Once the patient arrives at Barnes-Jewish Hospital, what happens?
Rampersad: In general, we greet the mom as soon as she arrives with a team assembled to meet her specific needs. Because the obstetrical nurse keeps us updated during the transport, we know what to expect and who needs to be there to meet the patient. In obstetrics, things can turn on a dime, so we’re always ready to mobilize, even if that means transporting the patient directly into an operating room with up to 25 team members on hand.
What makes the Maternal-Fetal & Newborn Transport Services unique?
Kelly: We’re a safety net, not just for St. Louis and the surrounding area but for the entire Midwest. The relationships we have with our referring facilities and providers are extremely important to us. And we’re always looking for ways that we can improve and strengthen the relationships we have across the region. That’s part of our job as a major academic tertiary care center. We want to keep healthy moms and babies in their own communities, but when that’s not possible, we’re here and available.
Rampersad: In recent years, we’ve seen a lot of smaller, rural hospitals closing or struggling, so it’s harder for some women with complex pregnancies to get the care they need in their hometowns. And some of the women we care for come from areas that don’t have obstetrical care. It’s simply not available in large swaths of the Midwest. So the doctors and patients in these areas know that if they need specialty care, we can provide it.
Kelly: This service is something our whole maternal-fetal team is involved in and supports. It’s one of the most advanced transport services of its kind in the nation, and data show better outcomes for women who have access to a service like this.