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A High-Risk Pregnancy: Emergency Delivery While Snowbound

Dr. Stephen Early tells story of mother's high-risk delivery

"You've got to bring your own weather," reflects pediatric otolaryngologist Stephen Early, MD, looking back on his years of experience at UVA. Driving two hours to Winchester, VA, on a snowy February night, Early hoped to deliver better weather to a mother in labor after a high-risk pregnancy.

"It was snowing outside, but I thought we could do something good for the child."

Second Opinion for a High-Risk Pregnancy

After a smooth first trimester of pregnancy, Carrie Rush received news that her baby would have micrognathia, a jaw abnormality. After receiving a grim prognosis from other hospitals, Carrie contacted UVA for a second opinion.

At UVA, the OB-GYN physicians contacted pediatric otolaryngology. They spoke with Early about a procedure that could alleviate airway obstruction during birth and greatly increase the chance of survival: the EXIT procedure.

During the EXIT procedure, the baby is partially delivered, with the umbilical cord attached, while doctors intubate and reestablish the baby's airways. EXIT procedures require a large, coordinated staff on-hand:

They also need a labor and delivery suite that's equipped for all these teams.

A Dark and Snowy Night

With two weeks left before the procedure, the EXIT team was preparing for a trial run. That same night, Rush went into labor in Winchester, VA, two hours north of UVA. And the snow was falling outside.

That's when Early got the call.

It was too late to transport Carrie down to UVA. "It was snowy and icy," Early says. "The roads were a mess. The helicopter couldn't fly. And so, the neonatal response team was dispatched (to Winchester)."

"I sat there and thought about this for a second," he continues, "and it didn't make sense for me to be here in Charlottesville and have that mother with a high-risk pregnancy present to an outside hospital that did not have the team assembled for an EXIT procedure."

He continues, "So I decided that the right thing to do was to get in my car, go up there, and see what I could do to help them."

A Team Partner Steps In

But he couldn't leave without covering his shift. That next morning, another child with micrognathia was scheduled for a similar procedure. Early received a call from his partner, otolaryngologist Will Brand, MD, who was on vacation at the time. Having caught wind of the situation, Brand gladly stepped in to cover that morning's operation.

"He's the real hero in this story," says Early. He added that Brand's morning became even busier when a second emergent intubation procedure arrived from the NICU.

As Early was driving up north, he got on the phone with the physicians in Winchester. He arranged for the necessary staff and equipment to intubate the baby on delivery. Although the original EXIT team would not be present, they discussed and prepared for all possible situations.

As the weather worsened, Early arranged for emergency privileges with the hospital, so there wouldn't be a second to lose.

Expert Care for High-Risk Pregnancies

If you have a high-risk pregnancy or undergo complications during pregnancy, UVA's neonatal intensive care unit provides a staff of experts that you can trust.

From High-Risk Pregnancy to Successful Delivery

When Early arrived, the staff was ready to roll. Together, they were able to successfully intubate the baby during delivery.

"The relief I felt at that moment, I can't even explain it," says Rush.

UVA's NETS (Newborn Emergency Transport Service) team was on-hand to transport the baby back to UVA's NICU, keeping the airways open along the way.

When asked what distinguishes UVA in his experience, Early reflects.

"There is compassion and caring in the healthcare providers, from the PCT's up to the faculty, to the administration. Everybody has one goal in mind, and that's to provide excellent, compassionate care to patients... We always do our best to bring the best care to the patients."

See their story here.

View Transcript

STEPHEN EARLY, MD: There are a lot of heroes in this hospital. The mother had a child that was identified as having micrognathia, which is associated with severe airway obstruction at birth.

SANTINA ZANELLI, MD: Between the MFM physician, the ENT doctors, and us we sort of decided for her, the safest route for delivery would be an EXIT procedure.

STEPHEN EARLY, MD: An EXIT procedure is a really strong team effort. This team was planned to be assembled, I think it was for March 1st, to perform the EXIT procedure. However, she went into labor two weeks early and she presented to Winchester Hospital. It was truly a dark and stormy night.

SANTINA ZANELLI, MD: I was on that day and I heard about this, and I was very worried about her baby because I knew her care would be very difficult without subspecialty support.

CARRIE RUSH: I was just about to get my epidural and get things rolling, and they're like, well, hold on. We're on the phone with UVA.

STEPHEN EARLY, MD: Too late to try to transport the child down to UVA. It was snowy and icy. The roads were a mess. The helicopter couldn't fly. I decided that probably the right thing to do was to get in my car and go up there and see what I could do to help them.

CARRIE RUSH: The relief that I felt in that moment. I can't even explain it.

SANTINA ZANELLI, MD: We sent newborn our transport team to Winchester to assist with the delivery.

LAURA WATSON, RN, C-NPT, EMT: It was decided that I would be in the delivery room, right beside Dr. Early, with the plan to manage an airway so that I could then manage the patient along with my two other team members back to UVA, which is about a two-hour drive.

STEPHEN EARLY, MD: Ultimately, we were able to get the child intubated after the child had been delivered. We clamped the cord and the child was born at that moment. This kind of thing happens every day at UVA. We always, I think, do our best to bring the best care to the patients.

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