When expecting mothers in high-risk pregnancies are faced with
fears and frustrations, 35 nurses are waiting to listen
Pregnant moms carry a precious cargo, and to ensure moms-to-be carry their babies to full term, a group of nurses is going back to the days of house calls … literally.
In the late 1980s, a doctor named Donald Dyson headed a study that looked at babies born prematurely, their health, their mortality statistics and how these statistics could be improved. His extensive research found that the more a mother at risk for giving birth early was monitored, the better her chances were of carrying her baby to full term.
The study led to the creation of Kaiser Permanente’s Regional Perinatal Service Center, which is celebrating its 15th year in operation this year. The center employs 35 registered nurses and several dietitians, all who spend their days calling pregnant mothers. The center, based in Cupertino, serves all of Northern California.
“The center monitors at-risk moms for pre-term labor,” said Jenny Ching, the nurse manager at the center. “The study Dr. Dyson did essentially said these mothers needed surveillance. They needed a program to educate them and to provide answers to their questions. So, that’s what we did. Instead of these women having to go in and see a doctor, a nurse calls them every day, every week or semi-monthly, depending on the individual. We’re also available for them to call us with questions 24 hours a day, seven days a week.”
There are many kinds of at-risk pregnancy, but most involve a mother with high blood pressure, diabetes or a mother who has had pre-term births previously. A pre-term birth is a delivery after less than 37 weeks of pregnancy, said Ching, who has worked at the center since its inception in 1991.
“The program was extremely helpful – I don’t know what I would have done if it didn’t exist,” said Madeline Dasalla-DiSanto, a Morgan Hill resident who used the service when she was diagnosed with gestational diabetes about six months into her pregnancy with her first child. “(My nurse) called me once a week, and she would talk to me about my diet and check on my blood sugar levels. She also talked to me about her experiences, which made me feel more comfortable talking to her about my concerns. It was wonderful.”
Lily Tran was the nurse working with Dasalla-DiSanto through the last three months of her pregnancy. She, along with all the other nurses at the center, cares for about 25 patients a day via telephone. Dasalla-DiSanto credits Tran’s weekly phone calls as one of the main reasons she was able to carry her pregnancy to full term.
“One of the reasons this program is so wonderful, I think, is because it allows the mothers to stay at home,” said Tran, also a Morgan Hill resident. “A lot of people don’t like having to stay in a hospital. It’s harder to sleep with all the activity, family has to come see you during certain hours and it’s just hard to be comfortable. This way, these women don’t have to be in a hospital. They can be at home and surrounded by their family, and much more comfortable. At the same time, they are getting the same care they would get in the hospital, they just get it over the phone.”
The nurses at the center get the medical history of each patient they care for. Based on that history and their current health issues, the nurses implement a care plan for each individual.
“It’s very rewarding to be able to empower these women to be able to care for themselves,” said Tran, who won a Nurse Excellence award from Kaiser Permanente for her work at the center. “We educate these women and give them the tools to take care of themselves and of their baby. We also give them a lot of support and encouragement. Pregnant women are emotional, and managing diabetes when you’re pregnant is very different from managing diabetes normally, so it’s a very frustrating thing. Sometimes, all these women need is for someone to listen to their frustrations.”
Those frustrations are something Tran can personally relate to. She is a mother and a diabetic, so she has dealt firsthand with many issues the mothers she’s caring for are dealing with.
“It’s a very scary thing to have high blood pressure or diabetes and be pregnant and go through all the changes that come with being pregnant,” she said. “But we tell these women that we can manage their problems and they can have healthy babies. For example, having diabetes can mean you have your baby early, but you still have a large baby. A lot of people think, ‘Oh, I have a large baby, so it must be healthy.’ But most times, these large babies are not healthy. Their lungs and kidneys may not be developed, but if you stay on top of the diabetes, the baby will be fine.”
Statistics show the center’s work is making a difference. Nationwide, about 12 percent of births are pre-term. About 11 percent are pre-term in the state of California. For patients in Northern California using the center’s services, the statistics are less than eight percent, Ching said.
“You know, I’m a neuro clinical psych doctor at Santa Clara Valley (Medical Center), but even though I’m a doctor, the information I received from the center was so helpful,” Dasalla-DiSanto said. “I would absolutely recommend the center to other at-risk moms. There was so much I didn’t know, and Lily kept me on track. I’m surprised that not very many organizations have this kind of program.”
The Regional Perinatal Service Center, which is only available to Kaiser Permanente members, is the only program of its kind in California. Ching and Tran both speculated about why other medical groups hadn’t implemented similar programs.
“When we started the program it was very controversial,” Ching said. “We started with a very small group of patients, but we found that it worked, and now we have more than 900 patients. I think it’s still a controversial idea, despite all the success we’ve had.”
Tran said she believed the expense of getting a program like the perinatal center off the ground was probably daunting to many medical organizations, but she also believed that the red tape involved could hinder other similar centers.
“You have to have support from everyone to get something like this started,” Tran said. “You’ve got to do extensive research, and then you have to get everyone to agree to start the program. You need the doctors and staff, you need the administration, you need the nurses and the patients, you need everyone to work together. We were lucky at Kaiser. All the facilities in Northern California agreed to work on this, and we had the research. It’s really wonderful that we can provide this service to our patients.”
