A clinical team at Saint Joseph Health System Mishawaka Medical Center is improving the chances of a successful outcome for northern Indiana women with high-risk deliveries, and for their babies. Maternal Fetal Transport team members accompany these expectant mothers during their ambulance rides from outlying hospitals to Mishawaka Medical Center, monitoring mother and baby and providing care.
Since the team began in January 2017, it has participated in the mobile medical care of about two dozen women.
The transport team can be dispatched to pick up patients from lower-acuity facilities within about a 45-mile radius of the medical center, including facilities in northcentral Indiana and southwest Michigan.
A group, including members of the Maternal Fetal Transport team at Saint Joseph Health System Mishawaka Medical Center, prepares for an ambulance to depart to pick up a mother at a partnering hospital. From left are Pam Dziadosz, Susan Schmidt, Michelle Rodman, Tyler Rhoades and Laurie Shapiro.
The medical center provides Level III obstetric services, which require it to be equipped to provide critical care services that smaller hospitals cannot offer. Hospitals with that classification must provide comprehensive management of severe maternal and fetal complications, have a delivery room for patients in need of acute medical care and a neonatal intensive care unit.
There are two Level IV facilities in Indiana — that is the highest level of maternal child care — but those facilities are in Indianapolis, which is about 140 miles south of Mishawaka.
Amy Murray, administrative director of maternal child services for Mishawaka Medical Center, said complications warranting the activation of the transport team can include preterm labor, preterm rupture of membranes, preeclampsia, infection and respiratory distress.
When the need arises to transport a woman with a high-risk pregnancy, Tri-County Ambulance Service dispatches an ambulance to Mishawaka Medical Center, and two of the four members of the Maternal Fetal Transport team climb aboard for the ride to pick up the patient. If an ambulance is not close to Mishawaka Medical Center, the travel team consisting of a nurse and a respiratory therapist ride to the partner hospital in a "chaser car" and meet the ambulance there.
The Maternal Fetal Transport team's maternal fetal medicine physician and a laborist, which is a physician whose sole practice focus is managing the patient in labor, particularly in an obstetrical emergency, take over the patient's care upon her arrival at the medical center.
Murray said the hospital can field a transport team around-the-clock and team members are trained and equipped to respond to "every emergency eventuality," including unexpected delivery.
The team's average response time has been just under an hour. "When you consider that most of the hospitals we work with are 45 minutes to an hour away, that is impressive," said Murray.
Ambulances are staged throughout the region, so they can quickly travel to any of the partner hospitals.
All the nurses available to staff the travel team are trained in advanced cardiac life support, with an obstetric focus; they are certified in inpatient obstetric and fetal monitoring; and they are specially trained in emergency care of newborns, said Murray. So far, no babies have been born in transit. If a delivery is imminent, it is safer for the expectant mother to remain at the community hospital where she is being treated, she said.
Murray said Indiana has one of the highest infant mortality rates in the U.S., and the Indiana State Department of Health has made it a priority to reduce infant mortality, including through maternal and neonatal transport improvements.
"It's all about good outcomes for our most vulnerable patients," Murray said of the transport service.
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