After 26 hours of labor, Elizabeth Fink and her husband, Kevin, found themselves prepping for a cesarean section for the delivery of their first baby. Elizabeth’s labor had stalled, and together with their obstetrician, the couple decided a C-section was the best plan.
At about 7:30 p.m. on Aug. 4, Layne Michael arrived in the Family Birthplace at Sentara RMH Medical Center. Immediately, Elizabeth knew her new baby was struggling.
“I could hear his cry, and I knew it wasn’t a normal cry,” recalls Elizabeth, 28, of Singers Glen. “After my husband cut the cord, a nurse put an oxygen mask on the baby. He was having trouble breathing. Before I could even see him, Layne was taken to the neonatal unit to find out what was wrong.”
Fortunately for baby Layne and his parents, a Sentara RMH neonatologist was on hand and ready to jump into action. Medical experts in providing the most up-to-date care for newborns, neonatologists specialize in treating the littlest, sickest, most vulnerable new babies. They also assist with providing care for healthy newborns, when needed.
Specialized Care for Newborns
In August 2020, four neonatologists officially joined the staff of the Sentara RMH Family Birthplace, which delivers about 1,800 babies a year, according to Sabrina Shiflett, BSN, RN, NE-BC, director of patient care services at Sentara RMH. The arrival of these specialists was part of a long-term Sentara RMH goal to offer expanded services for parents and their babies.
For many years, hospital-based pediatricians at Sentara RMH known as pediatric hospitalists have been treating healthy newborns and those with minor medical issues, as well as providing 24/7 care for hospitalized children of all ages.
The addition of neonatologists to the medical staff brings a whole new level of care, says Ann Heerens, MD, interim medical director for Sentara Neonatology Specialists. Sentara RMH partnered with Pediatrix Medical Group, the nation's leading provider of maternal-fetal, newborn and pediatric subspecialty services, to provide neonatology services locally. Their expertise and training provide them the skills to care for newborns in high-risk situations.
“Neonatologists become involved whenever a baby is sick—for example, when a baby is having trouble breathing,” Dr. Heerens explains. “We also work with obstetricians (OBs) to counsel women who have a high-risk premature baby or a baby who is expected to be sick at birth with a known congenital problem.”
Sentara RMH neonatologists coordinate with parents and OBs to create a plan to deliver these higher-risk babies safely. They also help hospitals plan for deliveries involving multiple births.
Helping More Newborns and Families
Sentara RMH currently offers Level 2 neonatal care, an intermediate level of care indicating that the hospital can treat babies with minor health concerns. When the neonatologists came on staff last August, the hospital became eligible to apply for status as a Level 3 neonatal intensive care unit (NICU).
Previously, premature babies and newborns with breathing problems, genetic abnormalities or other complications were either referred prior to birth to another hospital, or were transferred after birth to another hospital with a higher level of care. In either case, this kind of disruption can result in additional stress for families.
“After a mom delivers, she and her partner need time to bond with their baby and time to recover,” Shiflett says. “If a baby is born or transferred to a hospital to receive a higher level of care, the parents may have to travel an hour or more to see their new baby—which can create many challenges and stressors for families.”
Besides being apart from their babies, new parents having to leave town to see their baby may be separated from their support system. They may have to arrange care for other siblings, keep up with day-to-day household demands while traveling, and cover the expense and hassle of lodging and meals. Some new parents also may need help with transportation, Shiflett explains.
“This all can be taxing and exhausting for new moms, dads and the entire family,” she adds.
Baby Layne and his parents were one of the first families to benefit from the addition of neonatologists at Sentara RMH. In fact, Layne was born just three days after the new specialists came on board. Without the intervention of a neonatologist, Layne likely would have been transferred to another hospital, explains Terri Horst, clinical manager of the Family Birthplace. Instead, a Sentara RMH neonatologist performed a needle aspiration to remove air from baby Layne’s chest cavity to expand his lung and help him breathe.
“My family greatly benefited by being able to stay together,” says Elizabeth, who also experienced complications and developed a fever after her C-section, resulting in a six-day stay at Sentara RMH. “My husband was very instrumental in my recovery. If he had left to follow the baby to another hospital, I wouldn’t have had anyone with me during my recovery.”
Higher-Level Nursery Care
As part of its long-term maternity care plans, Sentara RMH started the process to become a Level 3 NICU by filing a certificate of public need (COPN) with the state in late 2019 (see sidebar).
“Currently, as a Level 2 facility, we can keep babies born at 32-34 weeks, depending on their respiratory status, and babies who need to stay extra hospital days but do not require a subspecialist, such as a cardiologist or pulmonologist,” explains Dr. Heerens.
By expanding to a Level 3 NICU, the Family Birthplace team will be able to keep babies born as early as 28 weeks, babies who require a ventilator and babies who need longer-term hospital stays.
The hospital hired Dr. Heerens to develop a neonatal program at Sentara RMH. She served as interim medical director of the program until Jordan Leonard, MD, joined the medical staff in February 2021.
Even with a Level 3 NICU, babies who need subspecialty care or surgery would need to be transferred to a hospital with an even higher level of care, Dr. Heerens notes.
Making Room for More Babies
Developing a plan for advanced nursery care also requires support from other areas of the hospital, Shiflett adds. With that in mind, she has been coordinating plans with Sentara RMH departments such as Respiratory Therapy, Imaging Services, Pharmacy, Physical Therapy, Laboratory, Occupational Therapy, and Heart and Vascular, as well as hospital dietitians. All these departments will provide care to newborns in the NICU.
In addition, Shiflett has been gathering information and advice from the three other Sentara Healthcare NICUs at Sentara Princess Anne, Sentara Northern Virginia Medical Center and Sentara Norfolk General Hospital.
If Sentara RMH is granted the COPN, it would take 6-12 months for the hospital to offer Level 3 NICU services, Shiflett says. In preparation for these advancements, the hospital has been working with an architectural firm to reconfigure and renovate the nursery, which must be completed before the Level 3 NICU can open.
“Our Family Birthplace team is highly skilled and experienced, going above and beyond for our patients every day,” Shiflett says. “They are a very strong, compassionate and extremely dedicated healthcare team. By offering a higher level of neonatal care as close to home as possible, in the near future we hope to be able to help more babies and families in our community.”
Sentara RMH Family Birthplace at a Glance:
•2 operating rooms
•5 labor-and-delivery triage rooms
•6 intermediate-care nursery beds (this could expand to 11 beds under Level 3 NICU care)
•10 labor-and-delivery rooms
•20 mother-and-baby rooms for after delivery
What is a Certificate of Public Need?
In Virginia, when a hospital wants to offer a major new service, it must show that the community needs the service and that it will be economically viable. To do this, the hospital files a certificate of public need (COPN) with the Virginia Department of Public Health, which regulates the COPN application program.
In 2019, Sentara RMH began the process to increase its newborn nursery care from Level 2 intermediate neonatal care to Level 3 specialty neonatal care.
The application required hundreds of pages of documentation, statements from key stakeholders, documentation of community support, design and floor plans, lists of equipment needs, plans for additional staffing, and financial information, says Sabrina Shiflett, director of patient care services at Sentara RMH, who has helped spearhead the request.
The next step in the process is a public hearing to collect testimony from community members about the need for a neonatal intensive care unit. After the hearing takes place, all documentation will be submitted to the state, and a decision will be made either to grant or deny Sentara RMH’s COPN request.
In 2020, Sentara RMH transferred 60 high-risk pregnant moms to other hospitals to deliver. The hospital also transferred 53 babies born at Sentara RMH who needed specialty care.