Maria Katalina Chavez Martinez, a mother of two from Tipton, has dealt with doctors and hospitals for years. But this trip to Valley Children’s Hospital to meet with Dr. Cindy Tai is different. It is months from her April due date, but Martinez and Ramon Sanchez know their third child has a medical problem that will need care as soon as the child is born.
The hospital’s Maternal Fetal Medicine program uses genetic testing to determine high-risk pregnancies. The testing on Martinez has revealed that the child’s intestines are on the outside, a condition that occurs in about one of every 2,500 births.
Having advance information can make a major difference when hours, minutes or even seconds are crucial. It allows a medical team to work with the parents before and after the birth. Tai, a pediatric surgeon, began working with Martinez and Sanchez months ago.
3%-5% of births will have some sort of medical issue.
In the past, doctors could not identify a potential problem until the baby was born. That meant having to scramble to get a team in place to take care of the newborn. And, if the baby was born at a hospital a long distance from Valley Children’s in Madera County, it would mean a delay in giving the medical attention needed.
“Instead of waiting for the baby to be born, they wanted to provide a service where we could identify a problem and streamline the care that happens,” says Dr. David McLean, medical director of Maternal Fetal Center/Perinatology. “It also helps the parents transition. You can imagine the worst case is for a parent to think they are going to have a healthy baby and there’s a major problem identified and the baby gets immediately shipped off to another institution.”
This process is possible because of technological advancements. Equipment used to collect images of the fetus has improved so much it is now possible to identify problems as small as a cleft palate.
Once a problem is detected, a plan is put in place to make sure the child gets the best medical attention before and after birth, including the trips to the hospital the parents make before the birth. The Maternal Fetal Center has seen about 20,000 moms since 2010, including 4,240 patients in 2016.
Tai spends more than an hour talking to Martinez and Sanchez about what is going to happen when their child is born. The emphasis of this talk is on how the team will respond. But Tai also talks to the parents about all the risks to make sure they are as well informed as possible.
It’s impossible today to identify all the medical problems a newborn could have, but most major problems can be identified. McLean has been working in medicine for 30 years and says the advancements in technology have made this “a whole new world.”
“Right now we can identify 80%-90% of children who are going to need early neonatal intervention,” McLean says.
That is important because 3%-5% of births will have some sort of medical issue.
For the Martinez-Sanchez baby, Tai will handle the surgery on the abnormality. Although she does surgery on patients as old as teenagers, she says getting to meet her patient before the birth is “very special.”
Meeting with the doctor is only part of the process.
Parents are given a tour of the neonatal center to show them where the baby will stay.
Evangelina Arenas and Steven Martinez are also expecting their child in April. Doctors have found their baby has a congenital heart defect that will require immediate attention.
Their trip to Valley Children’s months before the birth is to get a look at all the facilities, from hospital rooms to the waiting area. Jennifer Norgaard, a clinical neonatal specialist, gives the couple a tour.
The plan is for their child, Noah, to be born at Saint Agnes Medical Center in Fresno. Although Valley Children’s Hospital specializes in medical care for children, there are no births at the facility. Arenas is assured she will get to see Noah before he is taken to Valley Children’s.
At this point, there is no exact time as to when heart surgery would be done.
“Noah will tell us when he needs surgery,” Norgaard says.
The team wants to get the problem corrected, but it also wants the patient to be as strong as possible before the procedure.
The parents are told there are 88 beds in the neonatal unit, which means visitation is limited. If there is a large family, children younger than 12 – who aren’t allowed in the unit – or family and friends from far away can now use one of the hospital’s 25 NicView bedside webcams that give families access remotely through a computer, laptop, mobile phone or tablet. The camera transmits a live streaming image of the baby through a secure, closed system.
Both Martinez and Arenas were scared when they first heard their unborn child was going to need surgery. But the chance to talk with doctors and nurses has helped to calm their concerns.
“I am so glad they have a plan in place,” Arenas says.
Darsy Caballero of Madera went through the same process twice for her children, Sharlene, 6, and Rivaldo, 3. They were diagnosed with having their intestines outside the body. With Sharlene, the initial diagnosis was spina bifida, but after Caballero became part of the Maternal Fetal program she learned that the problem was with the child’s intestines.
She found the program beneficial because she knew exactly what was going to happen once her children were born: “Having Valley Children’s Hospital there taking care of my kids, I could not ask for a better hospital than them.”
How to help
Make a donation to Kids Day at www.valleychildrens.org/kidsday.