Caring for High-Risk Expectant Moms

On Valentine’s Day 2017, Ebony Boyd (pictured above with Dr. Kirsten Lawrence Cleary), six months pregnant and dressed in a celebratory pink blouse, picked up two dozen red, white, and pink doughnuts decorated with heart sprinkles on her way to work. She had felt mild stomach pain that morning but chalked it up to “contracting and stretching muscles.” Soon into her workday, however, the pain intensified.

“It was out of control,” Ebony recalls. “I was bowled over, holding my stomach.”

A friend rushed Ebony to nearby NewYork-Presbyterian Lower Manhattan Hospital, where tests showed there was no fetal heartbeat. While grappling with the devastating news that she had lost her baby as a result of a placental abruption, a condition in which the placenta separates from the uterus, Ebony began hemorrhaging, a potentially life-threatening event. She was also experiencing preeclampsia, or dangerously high blood pressure, another serious condition that can lead to seizure or stroke.

Physicians performed an emergency cesarean section and administered blood transfusions. But several days later, when she was due to go home, her care team saw that she had developed yet another potentially life-threatening complication — a pulmonary embolism, or blood clot in her lung. Ebony remained at the hospital for five more days.

“I felt like a part of me was ripped out completely,” she says of her loss. She and her boyfriend had already chosen a name for their expectant baby boy: Bryce Alexander.

Now, 15 months later, Ebony, 36, is pregnant again. This time, she is one of the first patients of the Mothers Center, a new space at NewYork-Presbyterian Morgan Stanley Children’s Hospital that provides comprehensive, multidisciplinary care all in the same location — before, during, and after a high-risk pregnancy.

Announced in time for Mother’s Day 2018, the Mothers Center comes at a time when the high rate of maternal deaths and “near misses” in the United States has become a major public health concern.

Dr. Mary D’Alton, the visionary behind the groundbreaking new Mothers Center, says she hopes it will be the first of many such centers nationwide.

“The Mothers Center is the first of its kind in the country to provide multidisciplinary care for a pregnant woman with complicated medical or surgical conditions, all in one space,” says Dr. D’Alton, chair of the Department of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center. “We are excited to introduce a model of maternal care that we hope will reduce the high rates of maternal mortality and morbidity we see in New York and across the country.”

The Mothers Center will enable patients with acute or chronic medical and surgical complications to see their specialists all in the same location, where these experts will consult and collaborate with another.

“When mom is sick or has a medical or surgical condition, it adds much more anxiety to travel to different locations for her care,” says Dr. D’Alton. “We would like to take out the anxiety and difficulty of having women visit multiple offices in our institution and have our specialists come to them.”

At the Mothers Center, patients will meet with their maternal fetal medicine (MFM) experts, who provide obstetric care, as well as subspecialists from a variety of disciplines, such as cardiology, neurology, surgery, and endocrinology. In addition to her MFM specialist, Ebony, for example, will no longer go to her hematologist’s office; he will come to the Mothers Center. She will also see her anesthesia team at the center, and, like all Mothers Center patients, she’ll be offered on-site mental health services because of the emotional stress that women with high-risk pregnancies face. Care coordinators will streamline and schedule Ebony’s appointments, and she’ll be able to see her subspecialists in a single visit. Patients will have access to healthcare experts throughout NewYork-Presbyterian/Columbia University Irving Medical Center.

“When you have a whole lot of complications with your pregnancy, bouncing around from office to office becomes a lot,” says Ebony. Then, the longer you’re pregnant, you’re tired and you don’t want to travel all over New York City going to four or five different doctors. It’s wonderful if you have one central location where you’re taken care of and where you know that all of your doctors are talking to each other.”

The Mothers Center is equipped to help women with a wide range of serious complications and risk factors, such as lung and heart transplants, hypertension, seizure disorders, and placenta accreta, a condition that increases the risk of premature birth and life-threatening blood loss after delivery. The highest proportion of the Mothers Center’s patients have cardiac conditions.

Fundamental to the center is the close collaboration of the patient’s medical team. The 5,300-square-foot outpatient center is home to four exam rooms, three consultation rooms, and meeting spaces where specialists will gather regularly to discuss a patient’s care plan.

“The center is a phenomenal example of patient-centered care because it brings specialists to the patients while also enhancing their ability to collaborate in patient care,” says Dr. Leslie Moroz, the director of the Mothers Center and assistant professor of maternal fetal medicine and critical care at Columbia University Vagelos College of Physicians and Surgeons. “It is a space for providers to act as a team and be seen as a team by their patients.”

The Mothers Center builds on a similar initiative with the same name at NewYork-Presbyterian/Columbia University Irving Medical Center that coordinates multidisciplinary care for women with high-risk pregnancies. But subspecialists did not have one space where they could see patients and collaborate on care until now.

After giving birth, women will have the option of having their postpartum visit virtually through telemedicine that the Mothers Center will provide. And they will be connected to specialists for ongoing care they may need after the birth of their baby or further down the road. For example, the preeclampsia, or high blood pressure, that Ebony experienced during her first pregnancy puts her at increased risk in the future for heart disease and stroke.

The Mothers Center team also will conduct research on future health risks related to pregnancy complications.

The Mothers Center is co-located with and modeled after the Carmen and John Thain Center for Prenatal Pediatrics, an outpatient center that takes the same multidisciplinary approach to fetal complications. The Mothers Center, in turn, focuses on the mother’s health. Dr. D’Alton led the opening of both centers. The Mothers Center’s construction was made possible by a generous gift from Carmen and John Thain.

“At our own center for prenatal pediatrics, we have seen the benefits of multidisciplinary care for families that have a baby with a birth defect or abnormality,” Dr. D’Alton says, noting that there are now about 20 such fetal centers across the country. “But I didn’t see a similar program for mothers. We felt there has been so much work focused on prenatal complications but there has not been much focus on the mothers — and we felt it was time to create something innovative for mothers.”

The Mothers Center comes at a time when the U.S. maternal death rate is higher than the rates of almost all wealthy countries and many poorer countries, as well. The rate of severe complications around childbirth has steadily increased in recent years and affects more than 50,000 women every year, according to the U.S. Centers for Disease Control and Prevention. An estimated half of maternal deaths in the U.S. are preventable.

Ebony had experienced three of the leading causes of preventable maternal deaths in the U.S. — hemorrhage, hypertension, and blood clots. So when she learned in November that she was pregnant again, she admits to being concerned.

“We were nervous and thinking, what if it happens again?” Ebony says.

Ebony went to a different medical team, this time at ColumbiaDoctors Riverdale, which referred her right away to a high-risk pregnancy expert at NewYork-Presbyterian/Columbia. Based on her history, Ebony has a 40 percent risk of experiencing preeclampsia again, according to research.  So in addition to seeing her OB-GYN frequently, Ebony takes daily baby aspirin, looks for danger signs like headaches, vision changes, and swelling, and has bought a blood pressure machine, which she uses daily. Because of the pulmonary embolism she experienced during her previous pregnancy, she takes a blood thinner. So far, Ebony has been healthy.

Now, nearly seven months pregnant, Ebony and her boyfriend, Lonnie Darden, are getting into the spirit of welcoming their baby. They found an apartment in the Bronx and moved in together. In April, they held a gender reveal party, where they learned the sex of their child with their assembled families and friends. With blue and pink eggs — all but one hard boiled — each person smashed one on his or her forehead. When it came to Lonnie’s turn, he smashed a pink one, and as egg streamed down his face, guests screamed and laughed and the couple hugged.

“I feel much more relaxed, much more relieved,” Ebony says. “I feel safe. I feel very secure in the care that I’m getting. We can finally start to relax and enjoy this pregnancy.”

This article was published in May 2018.  In July, Ebony gave birth to a healthy girl, Janiyah S’Mori.

Learn more about women’s health.