Mother Baby Connection

Cross-specialty integration improves outcomes for high-risk pregnancies and premature babies.

Photo by Cameron Wittig

Dr. William Block has a crystal ball. A mother of twin girls gave it to him as a gift for saving the lives of her babies.

He didn’t do it alone. Neonatologist Ellen Bendel-Stenzel and their combined colleagues worked together to perform what seemed like a miracle.

Bendel-Stenzel’s contribution: the twins, born 13 weeks early and less than two pounds each, were cared for by her group and attended by her personally on neonatal intensive care unit night rotation. Block’s contribution: He performed surgery on the girls while they were fetuses in their mother’s womb.

The surgical procedure, called fetoscopic laser ablation, corrects a dangerous condition in which twins share a disproportionate amount of the blood supply. Without intervention, the condition—known as twin-to-twin transfusion syndrome—has a mortality rate of 90 percent for both babies. The surgery reduces that by half for one twin and by nearly 70 percent for the other.

But only an estimated 10 percent of women nationally who need this surgery have access to it. Here in the upper Midwest, Block and his colleagues performed their first one just five years ago. They are still the only ones doing it here. “Your next best bet is Cincinnati,” Block says.

Plus, because such fetal surgeries affect both a child and the mother and are so new, several questions arise: Who should direct them—a maternal fetal specialist whose clinical expertise is the pregnant woman or a pediatric surgeon whose expertise is the baby? And where does this surgery happen—in a children’s hospital surgical room or a conventional one?

For the Twin Cities, which claims the largest group of practicing perinatologists in the country (Minnesota Perinatal Physicians) and the largest pediatric surgery practice in the country (Pediatric Surgical Associates), these have long been two very pregnant questions.

The first was answered in March of 2008 with the creation of the Midwest Fetal Care Center, sponsored by Allina Hospitals and Clinics and Children’s Hospitals and Clinics of Minnesota, of which Block is the founding medical director. “Prior to the formation of this group, care remained isolated and fragmented. We now have one of the most advanced care systems for fetal and maternal patients offered anywhere in the country,” Block says.  

The second was answered in February with the opening of the Mother-Baby Center, the offspring of Children’s Hospitals and Clinics and Abbott Northwestern. “The Mother-Baby Center is one of only a few in the nation where mother-baby care is fully integrated,” says Bendel-Stenzel, co-director of clinical research on the Minneapolis Children’s NICU. “We don’t believe in separating moms and babies,” she says.

For good reason—keeping them together produces better outcomes for both. Mothers who use kangaroo care—skin-to-skin contact—have healthier babies and less risk of postpartum depression. Mothers who pump breast milk near their infants have increased milk production. Other factors include increased privacy, increased parental involvement in a baby’s care, noise control, improved sleep, and a decreased hospital stay. All are at work at the Mother-Baby Center. “Our outcomes for extremely preterm infants are amongst the best in the world,” Bendel-Stenzel says.

Before the Mother-Baby Center was built, a mother would have a high-risk surgical delivery at Abbott Northwestern. Then, newly birthed, high-risk babies, barely stabilized, would be whisked to Children’s Hospital’s NICU through a quarter-mile-long tunnel under the city of Minneapolis between 28th and 26th Streets. For the medical team transporting the baby, it could be a 15-minute life-or-death footrace the distance of a college racetrack. For the mother recovering more than three blocks away, it was agony. It was agony for the dad, too, who often had to choose between staying with his wife or his new baby.

Now at the Mother-Baby Center—above ground and snuggled between Children’s and Abbott Northwestern—surgical deliveries, pediatric surgeries, and neonatal intensive care happen just steps from each other. Mothers who’ve had surgical deliveries recover a hallway away from their NICU babies. Mothers spend the night with their NICU babies in private rooms.

And, says Block, “we now have a dedicated space to do operative fetoscopy procedures. We are able to do all fetal interventions that are considered effective.” Today, that’s somewhere between six and eight kinds, and others are on the horizon, such as a procedure to correct spina bifida in which the fetus is removed from a mother’s womb for surgery and then put back.

Block, Bendel-Stenzel, and their colleagues are waiting for the national study that confirms that procedure’s efficacy. If they like what they see, they’ll be among the first half-dozen medical teams in the country to perform it.

Sometimes it takes a village to deliver a child and ensure everyone goes home safe. Since 2000, Block, Bendel-Stenzel, and their colleagues have collaborated on 985 complete sets of twins and 192 complete sets of triplets, caring for them through high-risk pregnancies, dangerous births, and long, harrowing NICU nights. They continue to be prepped and ready to work under one roof.

“I always tell parents, ‘I don’t have a crystal ball,’” Block says. Bendel-Stenzel uses the crystal ball analogy, too. “It illustrates nicely the uncertainty we all have with the future in medicine.” And yet the two of them, and their teams working out of the Mother-Baby Center, seem to be holding one. And the future looks bright.

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