Sarah Smith, RN, BSN, CLC, (at left, in the purple shirt) and Heather Weiler, RN, (in the colorful skirt) began their nursing careers in their 40s after working in other fields. Smith was an elementary and preschool teacher, sold real estate and worked in institutional development. Weiler held positions in physicians’ offices and worked as a medical claims processor. Both were working moms and both experienced the loss of a young child: Smith, a twin son after a difficult pregnancy; Weiler, the sudden, tragic death of a young nephew.

Now, both women work as fetal care nurse coordinators in the Fetal Care Center, a collaboration by Barnes-Jewish Hospital, Washington University Physicians and St. Louis Children’s Hospital. Their backgrounds give them an understanding of life’s unpredictable nature, of its joys and sorrows. And they inform the passion each has for helping moms whose unborn babies are diagnosed with health problems.

What was your nursing experience before joining the Fetal Care Center?

Smith: I worked on the antepartum floor at Barnes-Jewish Hospital. I took care of moms who needed to be hospitalized for lengthy periods of time during pregnancy, as well as moms who experienced the loss of their babies, either before birth or shortly after.

Weiler: Since becoming a nurse, I’ve always worked as a high-risk obstetric nurse in labor and delivery at Barnes-Jewish Hospital and other hospitals.

Why were you interested in becoming a fetal care nurse coordinator?

Smith: The loss of my twin son Nicholas was life-changing for me and my family. It was what motivated me to pursue a career in nursing. I first learned about the Fetal Care Center while attending Goldfarb School of Nursing at Barnes-Jewish College. I already had an interest in obstetric-gynecology care, but I was really drawn to fetal care because my baby spent time in the NICU [newborn intensive care unit]. But before that happened, I served for more than 10 years as a parent volunteer in another NICU in St. Louis. When the coordinator position became available, I applied because I thought it would allow me to use my nursing background and my experiences during pregnancy and postpartum.

Weiler: I was happy working in the labor and delivery unit; then I was asked to serve as circulating nurse on one of Dr. Bebbington’s surgeries. [Michael Bebbington, MD, is a Washington University maternal-fetal medicine specialist at the Women & Infants Center and the director of the Fetal Care Center.] I thoroughly enjoyed the experience and was fascinated by what could be done to help a fetus prior to birth. When a second coordinator position opened up, I applied.

What are your responsibilities?

Weiler: The simple answer is that we serve as advocates for families and their unborn babies, but that includes a lot of detailed planning and coordination to ensure all of their needs are met. It begins when a mom is referred to the Fetal Care Center by her physician after an ultrasound reveals problems with the fetus. We gather all of the information and test results Dr. Bebbington will need for a consultation with the patient. Our goal is to meet with the mom within a week of her referral. Either Sarah or I are involved at all consultation appointments and follow-up visits. Once a plan is in place for the remainder of the patient’s care, we begin coordinating what is needed.

Smith: Our goal is to make sure families are in the best place possible to manage a baby that has the potential for medical complications. We arrange follow-up ultrasounds and clinic visits. If families need help with transportation or lodging, or there are other obstacles in the way of receiving care, we connect them to our social worker. We schedule appointments with the pediatric subspecialists at St. Louis Children’s Hospital who will be involved in the baby’s care, including specialists in newborn medicine, cardiology, surgery, neurosurgery and urology. We are present at all appointments so we can clarify anything that might be confusing to families; the information they receive can be complicated. And we take patients on tours of labor and delivery rooms, and arrange for tours of the NICU and cardiac intensive care unit.

Weiler: If a fetus requires surgery or other intervention, we make arrangements for the surgical team and ensure all equipment they will need is available.

Smith: And if the mom wants us there, we are in the delivery room …

Weiler: We can be a supportive, familiar presence in the room …

OUR GOAL IS TO MAKE SURE FAMILIES ARE IN THE BEST PLACE POSSIBLE TO MANAGE A BABY THAT HAS THE POTENTIAL FOR MEDICAL COMPLICATIONS.

Smith: And then we follow up with families after their babies are born. Throughout the whole process, we are the constants in these families’ lives. We help them get through what may be the most challenging and frightening experience of their lives.

This sounds like a complex job. How many patients do you care for at one time?

Smith: On average, we care for about 80 patients on a regular basis. Many of them are from Missouri and Illinois, but we also care for patients from Kansas, Iowa, Minnesota, Arkansas, Indiana and Kentucky, for example. To help provide the best care, we divide our responsibilities: Heather primarily works with fetal-surgery patients, while I concentrate on fetuses diagnosed with cardiac problems or other abnormalities.

Weiler: But we both get to know all patients because it’s important that both of us are prepared to take calls and answer questions.

What do you like best about your job?

Weiler: It has been a revelation to discover what we can do surgically for fetuses, and I have learned so much from Dr. Bebbington during the consultations he has with families. I’m always learning, and the job is never boring.

THEY MAY NEED US TO LISTEN, TO HUG THEM, TO LET THEM SCREAM — WHATEVER HELPS THEM GET THROUGH A STRESSFUL TIME..

Smith: It’s also gratifying to work with the pediatric subspecialists, who really are among the best in their fields. I can always say with confidence to our patients that any specialized care their babies may need is available right here. But I think Heather would agree with me that the very best part of our job is having moms visit us with their babies. We almost become members of their families during the time they are with us. Seeing their babies grow and develop is a delight.

Then what is the most difficult part of your job?

Smith: The losses, of course. There’s no denying there is sadness involved with this job, and the most challenging is when babies die unexpectedly. Those are the times when you sit with the families, cry with them and offer emotional support.

What qualities do you have that make you good at this job?

Smith: Being compassionate and accepting of the ways people make this journey, because it is different for everyone. The job requires listening and taking cues from families, knowing when they need you and when they would rather be alone. Sometimes it’s recognizing their needs before they are aware of them.

Weiler: I think our personal experiences are invaluable. They help us understand what families may be feeling. They may need us to listen, to hug them, to let them scream — whatever helps them get through a stressful time. It’s also being open to fully sharing in the joy that so many of our patients’ experience. Fortunately, there are a lot of happy outcomes to celebrate.