MODERN OBSTETRICS MODERN OBSTETRICS COMES TO VANDERBILT:COMES TO VANDERBILT:

A PERSONAL HISTORICAL A PERSONAL HISTORICAL PERSPECTIVEPERSPECTIVE

Frank H. Boehm, M.D.Frank H. Boehm, M.D.

Birth of Modern ObstetricsBirth of Modern Obstetrics

The process leading to significant The process leading to significant improvement in the care and outcome improvement in the care and outcome of pregnant women and their babies of pregnant women and their babies had its birth in the late 1960s and had its birth in the late 1960s and became fully developed in the 1970s.became fully developed in the 1970s.

Maternal Mortality in 1930Maternal Mortality in 1930

670 deaths per 100,000 live births670 deaths per 100,000 live births

Maternal Mortality in 1982Maternal Mortality in 1982

7.5 deaths per 100,000 live births7.5 deaths per 100,000 live births

Perinatal MortalityPerinatal Mortality

19401940 60/1,00060/1,000

19651965 41/1,00041/1,000

20042004 7/1,000 7/1,000

Infant MortalityInfant Mortality

19401940 47/1,00047/1,000

19971997 8/1,000 8/1,000

Electronic Fetal MonitoringElectronic Fetal Monitoring

1972 – Purchase of 5 EF monitors and a 1972 – Purchase of 5 EF monitors and a blood gas analyzer at cost of $50Kblood gas analyzer at cost of $50K

L & D renamed Fetal Intensive Care UnitL & D renamed Fetal Intensive Care Unit

All patients in labor underwent EFM with All patients in labor underwent EFM with scalp pH sampling PRNscalp pH sampling PRN

Monitor conference, Mondays at 4 pm beganMonitor conference, Mondays at 4 pm began

Southern Med JSouthern Med J1974; 67:1145.1974; 67:1145.

Contemp Ob/GynContemp Ob/Gyn1977;9: 571977;9: 57

VANDERBILT OBVANDERBILT OB19721972

60 deliveries per month60 deliveries per month

Most low-risk patientsMost low-risk patients

AMA - 1971AMA - 1971

Adopted a position supporting the Adopted a position supporting the regionalization of perinatal care. In regionalization of perinatal care. In 1972, ACOG/AAP developed guidelines 1972, ACOG/AAP developed guidelines on how to evolve regionalization.on how to evolve regionalization.

Ideally, it was recommended that Ideally, it was recommended that whenever possible, pregnant mothers whenever possible, pregnant mothers should be transferred before delivery, should be transferred before delivery, so as to provide the unborn child with so as to provide the unborn child with the best incubator (the mother's uterus) the best incubator (the mother's uterus) during transfer. during transfer.

Perinatal Regionalization involved the Perinatal Regionalization involved the transfer of high-risk newborns from smaller transfer of high-risk newborns from smaller hospitals to larger, better-equipped and hospitals to larger, better-equipped and staffed neonatal intensive care units for their staffed neonatal intensive care units for their care following delivery. It also involved the care following delivery. It also involved the transfer of high-risk pregnant women to transfer of high-risk pregnant women to tertiary hospitals, like Vanderbilt, prior to tertiary hospitals, like Vanderbilt, prior to delivery, so they could receive the most delivery, so they could receive the most sophisticated and advanced treatments sophisticated and advanced treatments available. available.

It was determined that delivery in a It was determined that delivery in a hospital appropriately staffed and hospital appropriately staffed and equipped for all problems that might equipped for all problems that might arise would result in better outcomes. arise would result in better outcomes.

Regionalization of perinatal health care Regionalization of perinatal health care required the organization of a region, required the organization of a region, (in our case, middle Tennessee), in (in our case, middle Tennessee), in which there were defined levels of which there were defined levels of perinatal care consisting of at least one perinatal care consisting of at least one tertiary care (Level 3) hospital, whose tertiary care (Level 3) hospital, whose primary concerns were education, primary concerns were education, consultation, transportation and a high consultation, transportation and a high level of care. level of care.

Level 1 care hospitals (small rural Level 1 care hospitals (small rural hospitals throughout the 39 counties of hospitals throughout the 39 counties of middle Tennessee), described care middle Tennessee), described care given to normal obstetric patients and given to normal obstetric patients and normal newbornsnormal newborns

Level 2 care described care given for Level 2 care described care given for somewhat more complicated somewhat more complicated pregnancies and newborn illnesses pregnancies and newborn illnesses (Murfreesboro, Clarksville, Columbia, (Murfreesboro, Clarksville, Columbia, Cookeville Hospitals). Cookeville Hospitals).

Being a tertiary care facility, Vanderbilt Being a tertiary care facility, Vanderbilt University Hospital was able to provide University Hospital was able to provide the Level 3 care required for the most the Level 3 care required for the most complicated and sick pregnant patients complicated and sick pregnant patients and their newborns. and their newborns.

Important aspects of the regionalization Important aspects of the regionalization process was the prevention of process was the prevention of expensive duplication of health care expensive duplication of health care services and staff as well as to provide services and staff as well as to provide the most sophisticated and the most sophisticated and technologically advanced care by technologically advanced care by highly trained health care providers. highly trained health care providers.

The task for Vanderbilt was to convince The task for Vanderbilt was to convince doctors and administrators in small doctors and administrators in small rural hospitals throughout surrounding rural hospitals throughout surrounding counties of Nashville, to send to counties of Nashville, to send to Vanderbilt Hospital their sick Vanderbilt Hospital their sick newborns, as well as their complicated newborns, as well as their complicated pregnancies, so that improved pregnancies, so that improved outcomes could materializeoutcomes could materialize

Initial telephone calls to practicing Initial telephone calls to practicing Obstetricians in some of the hospitals Obstetricians in some of the hospitals around Nashville to explain the benefits around Nashville to explain the benefits of Perinatal Regionalization were not of Perinatal Regionalization were not productive.productive.

I soon realized that convincing I soon realized that convincing physicians to transfer care of their physicians to transfer care of their patients (and income) to Vanderbilt patients (and income) to Vanderbilt Hospital would take a face-to-face Hospital would take a face-to-face encounter in their office, as well as a encounter in their office, as well as a visit to the administrator of the hospital visit to the administrator of the hospital who would also be affected by a loss of who would also be affected by a loss of patient care dollars. patient care dollars.

With that in mind, I paid a visit to Dr. With that in mind, I paid a visit to Dr. Eugene Fowinkle, the then Tennessee Eugene Fowinkle, the then Tennessee State Commissioner of Health, to ask for State Commissioner of Health, to ask for his support. I explained the importance his support. I explained the importance of Perinatal Regionalization and how of Perinatal Regionalization and how this process would not only save lives, this process would not only save lives, but would also save considerable but would also save considerable duplication of equipment and personnel duplication of equipment and personnel in hospitals throughout the state. in hospitals throughout the state.

Dr. Fowinkle did not hesitate. He Dr. Fowinkle did not hesitate. He instructed me to write a proposal instructed me to write a proposal outlining the costs and said he would outlining the costs and said he would do what he could. do what he could.

Three months later, the State of Three months later, the State of Tennessee awarded Vanderbilt's Ob/Gyn Tennessee awarded Vanderbilt's Ob/Gyn Department $20,000 a year for two years Department $20,000 a year for two years thus allowing me to travel to each thus allowing me to travel to each hospital in middle Tennessee in hopes hospital in middle Tennessee in hopes of convincing doctors to send their high of convincing doctors to send their high risk pregnant patients to Vanderbilt risk pregnant patients to Vanderbilt rather than trying to care for them in rather than trying to care for them in their local community hospitals. their local community hospitals.

Convincing doctors to accept Perinatal Convincing doctors to accept Perinatal Regionalization once I arrived in their Regionalization once I arrived in their picturesque cities, however, was not as picturesque cities, however, was not as pretty. pretty.

Local doctors resented Vanderbilt Local doctors resented Vanderbilt Hospital for the way some of its staff had Hospital for the way some of its staff had treated them whenever they attempted to treated them whenever they attempted to call for a consult or when they sent a call for a consult or when they sent a critically ill patient to Vanderbilt for critically ill patient to Vanderbilt for special care. Many referring doctors special care. Many referring doctors explained how physicians at Vanderbilt explained how physicians at Vanderbilt were often condescending or arrogant were often condescending or arrogant when asked their advice. when asked their advice.

I was told that when these local doctors I was told that when these local doctors did refer patients to Vanderbilt, their did refer patients to Vanderbilt, their patient were lost to follow up. No one at patient were lost to follow up. No one at Vanderbilt, it seemed, made an attempt Vanderbilt, it seemed, made an attempt to inform referring physicians as to to inform referring physicians as to what had happened to their patients. what had happened to their patients.

To add insult to injury, I was told of To add insult to injury, I was told of patients having returned home patients having returned home following treatment at Vanderbilt, following treatment at Vanderbilt, telling their local doctors of telling their local doctors of disparaging comments made by disparaging comments made by Vanderbilt staff about the care they had Vanderbilt staff about the care they had received prior to transfer. received prior to transfer.

It was with this in mind that we began It was with this in mind that we began to stress to the many doctors and to stress to the many doctors and nurses in the department of Ob/Gyn at nurses in the department of Ob/Gyn at Vanderbilt, the importance of our Vanderbilt, the importance of our relationships with referring doctors relationships with referring doctors throughout middle Tennessee. throughout middle Tennessee.

Insisting on direct Vanderbilt attending Insisting on direct Vanderbilt attending physician to referring physician physician to referring physician consultation, we were able to gain consultation, we were able to gain control of our communication with control of our communication with physicians in middle Tennessee and physicians in middle Tennessee and slowly began to change opinions of our slowly began to change opinions of our referral base of doctors. referral base of doctors.

Putting into place a system that emphasized Putting into place a system that emphasized rapid verbal and written communication to rapid verbal and written communication to keep referring doctors updated on their keep referring doctors updated on their patients after transport to Vanderbilt, as well patients after transport to Vanderbilt, as well as making certain that none of our staff made as making certain that none of our staff made negative comments concerning care patients negative comments concerning care patients had received prior to transfer, was helpful in had received prior to transfer, was helpful in beginning a process whereby doctors began beginning a process whereby doctors began feeling comfortable referring their feeling comfortable referring their complicated pregnant patients to Vanderbilt complicated pregnant patients to Vanderbilt Hospital for specialized care. Hospital for specialized care.

Unfortunately, not everyone was Unfortunately, not everyone was pleased with our attempts to pleased with our attempts to regionalize the care of pregnant regionalize the care of pregnant patients. patients.

Slowly and steadily, however, the Slowly and steadily, however, the number of high-risk obstetric patient number of high-risk obstetric patient referral for in-patient care began referral for in-patient care began coming to Vanderbilt Medical Center coming to Vanderbilt Medical Center with numbers reaching as high as 700 with numbers reaching as high as 700 each year. each year.

As early as 1981, Vanderbilt was able to As early as 1981, Vanderbilt was able to report that survival of very small report that survival of very small infants born at Vanderbilt Medical infants born at Vanderbilt Medical Center had doubled during the years Center had doubled during the years 1975 and 19801975 and 1980

Perinatal mortality (babies dying Perinatal mortality (babies dying around the time of birth) in Tennessee, around the time of birth) in Tennessee, which was 31.2 babies per 1000 births which was 31.2 babies per 1000 births in 1970, steadily declined to 15.8 by in 1970, steadily declined to 15.8 by 1983. 1983.

Maternal mortality (mothers dying Maternal mortality (mothers dying because of pregnancy complications) because of pregnancy complications) also declined during this time, from 2.9 also declined during this time, from 2.9 pregnant patients per 10,000 pregnant patients per 10,000 pregnancies to 1.3. pregnancies to 1.3.

Am J Obstet GynecolAm J Obstet Gynecol1979; 134: 4841979; 134: 484

J Tenn Med AssocJ Tenn Med Assoc1979;72:8291979;72:829

Most doctors and nurses needed an on-Most doctors and nurses needed an on-going educational process that would going educational process that would involve on-site education on a regular involve on-site education on a regular basis. We needed a team of educators basis. We needed a team of educators who would travel to hospitals around who would travel to hospitals around Nashville to provide education on the Nashville to provide education on the use and interpretation of fetal use and interpretation of fetal monitoring. monitoring.

Our department turned to the March of Our department turned to the March of Dimes and requested money to hire a Dimes and requested money to hire a nurse specialist who would be able to nurse specialist who would be able to spend her days traveling throughout spend her days traveling throughout middle Tennessee in order to teach middle Tennessee in order to teach nurses the art and science of fetal nurses the art and science of fetal monitoring. monitoring.

JOGN NursingJOGN Nursing1981; 141:4511981; 141:451

J Gynecol Obstet NursingJ Gynecol Obstet Nursing1978;7 :291978;7 :29

J Tenn Med AssocJ Tenn Med Assoc1977;70:3261977;70:326

We also requested enough money to We also requested enough money to purchase Xerox telecopiers for each purchase Xerox telecopiers for each hospital as well as one for our labor hospital as well as one for our labor and delivery suite and my home, and delivery suite and my home, thereby allowing physicians to transmit thereby allowing physicians to transmit strips of their patient's fetal heart rate strips of their patient's fetal heart rate tracings for rapid consultation tracings for rapid consultation

Obstet GynecolObstet Gynecol1973; 42:4751973; 42:475

Obstet GynecolObstet Gynecol1979; 53:5201979; 53:520

We also began receiving an even larger We also began receiving an even larger number of outpatient referrals to the number of outpatient referrals to the Vanderbilt Clinics. Patients were being Vanderbilt Clinics. Patients were being sent to our clinics for consultations on sent to our clinics for consultations on how to manage their complicated how to manage their complicated pregnancies. Patients requesting genetic pregnancies. Patients requesting genetic counseling and testing increased rapidly counseling and testing increased rapidly as was our need for ultrasound as was our need for ultrasound examinations of pregnant women. examinations of pregnant women.

Establishment of theEstablishment of the

Diabetes MellitusDiabetes Mellitus

Antepartum ClinicAntepartum Clinic

19761976

South Med JSouth Med J1978;71:371978;71:37

J PerinatologyJ Perinatology1985; Vol. V; 11985; Vol. V; 1

During this time there did not seem to During this time there did not seem to be anyone in our Vanderbilt Radiology be anyone in our Vanderbilt Radiology Department who was interested in the Department who was interested in the new and very exciting technology of new and very exciting technology of ultrasonography. ultrasonography.

We needed someone at Vanderbilt to We needed someone at Vanderbilt to step forward and help bring this step forward and help bring this technology to the bedside. technology to the bedside.

That someone did appear. It was, That someone did appear. It was, however, not a faculty member, but however, not a faculty member, but rather a very junior resident, Dr. Arthur rather a very junior resident, Dr. Arthur Fleischer who came to my office one Fleischer who came to my office one day to tell me that he understood the day to tell me that he understood the capabilities and possibilities of capabilities and possibilities of ultrasound. ultrasound.

RadiolRadiol1981; 141: 1631981; 141: 163

Am J Obstet GynecolAm J Obstet Gynecol1981; 141:1531981; 141:153

J Tenn Med AssocJ Tenn Med Assoc1976;67:331976;67:33

Obstet GynecolObstet Gynecol1986; 67: 5661986; 67: 566

Am J Obstet GynecolAm J Obstet Gynecol1989;160:5861989;160:586

Obstet Gynecol Obstet Gynecol 1989; 74:3381989; 74:338

This desire to deliver a baby in a home like This desire to deliver a baby in a home like atmosphere was becoming quite popular in atmosphere was becoming quite popular in many cities around the country. To keep up many cities around the country. To keep up with this growing demand our obstetric staff with this growing demand our obstetric staff requested the hospital administration to requested the hospital administration to open birthing rooms (also called labor, open birthing rooms (also called labor, delivery and recovery rooms (LDR)) on our delivery and recovery rooms (LDR)) on our newly constructed labor and delivery floor in newly constructed labor and delivery floor in the new 11 floor Hospital, which was the new 11 floor Hospital, which was scheduled to open in the fall of 1980. scheduled to open in the fall of 1980.

Despite what seemed a reasonable Despite what seemed a reasonable request, opposition surfaced. Members request, opposition surfaced. Members of the anesthesia department were of the anesthesia department were expressing concern that LDR rooms expressing concern that LDR rooms might impose an increased risk for might impose an increased risk for laboring patients. laboring patients.

Anesthesiologists, providing pain relief for Anesthesiologists, providing pain relief for our laboring patients stated that any patient our laboring patients stated that any patient placed in one of the newly built LDR rooms placed in one of the newly built LDR rooms should not have epidural anesthesia nor be should not have epidural anesthesia nor be given oxytocin during labor and should not given oxytocin during labor and should not be allowed to have the father of the baby be allowed to have the father of the baby attend the delivery without undergoing an attend the delivery without undergoing an educational process and signing an educational process and signing an agreement to abide by a number of rules of agreement to abide by a number of rules of behavior. behavior.

Fortunately, over time, with the help of print Fortunately, over time, with the help of print and electronic media, as well as continued and electronic media, as well as continued pressure from patients, consumer groups pressure from patients, consumer groups and practicing obstetricians, Obstetric and practicing obstetricians, Obstetric Anesthesiologists were convinced that the Anesthesiologists were convinced that the LDR process was a safe and rewarding LDR process was a safe and rewarding experience and all of the once placed experience and all of the once placed restrictions on patients wanting a birthing restrictions on patients wanting a birthing room experience were lifted. room experience were lifted.

Perinatol NeonatolPerinatol Neonatol1986; 10: 25.1986; 10: 25.

Abortions at VanderbiltAbortions at Vanderbilt

Roe v Wade 1973Roe v Wade 1973

Planned Parenthood 1973 (Sept.)Planned Parenthood 1973 (Sept.)

Director Dr. Angus CrookDirector Dr. Angus Crook

Gestational Age Limits 1980Gestational Age Limits 1980

Only Indicated Cases 1980Only Indicated Cases 1980

19781978

Creation of Maternal Fetal Medicine Creation of Maternal Fetal Medicine DivisionDivision

Co-Directors:Co-Directors:

Al Killam, M.D and Frank Boehm, M.D.Al Killam, M.D and Frank Boehm, M.D.

Fellows TrainedFellows Trained

Jeffrey M. Barrett, MDJeffrey M. Barrett, MD 7/1/80-6/30/827/1/80-6/30/82James E. Brown, MDJames E. Brown, MD 1/1/84-12/31/861/1/84-12/31/86Salvatore Lombardi MDSalvatore Lombardi MD 7/1/86-6/30/887/1/86-6/30/88Periclis Roussis, MDPericlis Roussis, MD 7/1/88-6/3-/907/1/88-6/3-/90Richard Rosemond, MDRichard Rosemond, MD 7/1/90-6/30/927/1/90-6/30/92Cornelia Graves, MDCornelia Graves, MD 7/1/91-6/30/937/1/91-6/30/93Eric Dellinger, MDEric Dellinger, MD 7/1/92-6/30/947/1/92-6/30/94Thomas Wheeler, MDThomas Wheeler, MD 7/1/93-6/30/957/1/93-6/30/95David Fox, MDDavid Fox, MD 7/1/94-6/30/967/1/94-6/30/96Tracy Papa, DOTracy Papa, DO 7/1/95-6/30/977/1/95-6/30/97Audrey Kang, MDAudrey Kang, MD 7/1/96-6/30/987/1/96-6/30/98

Another significant obstacle to Another significant obstacle to advancing the concept of modern advancing the concept of modern obstetrics was our inability to care for obstetrics was our inability to care for obstetric patients in our labor and obstetric patients in our labor and delivery rooms who were critically ill. delivery rooms who were critically ill.

What we needed was the ability to provide What we needed was the ability to provide this same type of medical intensive care to this same type of medical intensive care to our pregnant patients on labor and delivery our pregnant patients on labor and delivery where highly trained obstetric doctors and where highly trained obstetric doctors and nurses could continuously provide nurses could continuously provide simultaneous modern obstetric technology simultaneous modern obstetric technology with the technology of medical intensive care with the technology of medical intensive care usually provided in surgical and medical usually provided in surgical and medical intensive care units in other parts of the intensive care units in other parts of the hospital. hospital.

With this in mind, I asked one of our first year With this in mind, I asked one of our first year Maternal Fetal Medicine fellows, Dr. Connie Maternal Fetal Medicine fellows, Dr. Connie Graves if she would be interested in learning Graves if she would be interested in learning the art and science of medical and surgical the art and science of medical and surgical intensive care and help us set up an intensive care and help us set up an intensive care unit for critically ill obstetric intensive care unit for critically ill obstetric patients on the labor and delivery floor. After patients on the labor and delivery floor. After an enthusiastic yes, Dr. Graves began a three an enthusiastic yes, Dr. Graves began a three month rotation in Vanderbilt's surgical month rotation in Vanderbilt's surgical intensive care unit, under the supervision of intensive care unit, under the supervision of its Director, Dr. John Morris. its Director, Dr. John Morris.

What was also needed, however were What was also needed, however were obstetric nurses who had interest and obstetric nurses who had interest and skill to also care of these extremely skill to also care of these extremely complicated patients. One of our complicated patients. One of our nurses, Nan Troiano, had an interest in nurses, Nan Troiano, had an interest in this type of intensive care and began this type of intensive care and began the task of selecting a group of the task of selecting a group of obstetric nurses for intensive care obstetric nurses for intensive care training. training.

Ms Troiano, along with Dr. Graves, Ms Troiano, along with Dr. Graves, trained nurses as well as Ob/Gyn trained nurses as well as Ob/Gyn residents on how to properly take care residents on how to properly take care of pregnant women requiring intensive of pregnant women requiring intensive care monitoring and treatment.care monitoring and treatment.

Thus began one of the country’s first Thus began one of the country’s first Obstetric Intensive Care Units Obstetric Intensive Care Units providing care for critically ill pregnant providing care for critically ill pregnant women on a labor and delivery floor. women on a labor and delivery floor.

Dr. Connie Graves and Nan Troiano Dr. Connie Graves and Nan Troiano became Directors of our Obstetric became Directors of our Obstetric Intensive Care Unit and began taking Intensive Care Unit and began taking care of approximately 50 patients a care of approximately 50 patients a year.year.

Critical Care Obstetrics. Dildy GA, Critical Care Obstetrics. Dildy GA, ed. 4ed. 4thth Ed. 2004; Blackwell; Malden. Ed. 2004; Blackwell; Malden.

Numerous other exciting programs Numerous other exciting programs began to surface at Vanderbilt Hospital began to surface at Vanderbilt Hospital as a result of the introduction of as a result of the introduction of modern obstetrics. In 1982, the modern obstetrics. In 1982, the Department of Obstetrics and Department of Obstetrics and Gynecology received a grant to Gynecology received a grant to participate in a multicenter preterm participate in a multicenter preterm birth prevention project. birth prevention project.

Certain unborn babies become severely Certain unborn babies become severely anemic because of Rh disease and may anemic because of Rh disease and may die as a result. Previous attempts to die as a result. Previous attempts to transfuse these fetuses using x-ray transfuse these fetuses using x-ray equipment were difficult and frequently equipment were difficult and frequently unsuccessful. unsuccessful.

In 1986, Vanderbilt doctors were able to In 1986, Vanderbilt doctors were able to directly transfuse a fetus while still in directly transfuse a fetus while still in its mother's uterus. Real time its mother's uterus. Real time ultrasound technology allowed doctors ultrasound technology allowed doctors to direct a needle into the unborn's to direct a needle into the unborn's umbilical cord and directly transfuse umbilical cord and directly transfuse blood into the anemic child with blood into the anemic child with considerable success.considerable success.

In January 1987, a Hendersonville, In January 1987, a Hendersonville, Tennessee woman, Darlene Hawkins, Tennessee woman, Darlene Hawkins, gave birth at Vanderbilt Medical Center gave birth at Vanderbilt Medical Center to the first quintuplets ever born in to the first quintuplets ever born in Tennessee Tennessee

The delivery came 24 weeks into the The delivery came 24 weeks into the pregnancy with the babies weighing pregnancy with the babies weighing about 1 1/3 pounds each. about 1 1/3 pounds each.

Tragically, only the first born, Stephen, Tragically, only the first born, Stephen, survived, yet the event catapulted survived, yet the event catapulted Vanderbilt's Obstetric and Newborn Vanderbilt's Obstetric and Newborn services to a national audience. services to a national audience.

We have kept in touch with the Hawkins We have kept in touch with the Hawkins family and, 16 years after his birth, family and, 16 years after his birth, Vanderbilt's labor and delivery staff Vanderbilt's labor and delivery staff gave Stephen a birthday party at the gave Stephen a birthday party at the hospital. Today he is a healthy and hospital. Today he is a healthy and delightful young man. delightful young man.

The introduction of a new method for The introduction of a new method for early prenatal testing called CVS early prenatal testing called CVS (chorionic villi sampling) made (chorionic villi sampling) made Vanderbilt a pioneer in the field of early Vanderbilt a pioneer in the field of early prenatal testing. prenatal testing.

We were unwilling, however, to perform We were unwilling, however, to perform CVS on pregnant patients without first CVS on pregnant patients without first gaining experience. gaining experience.

We therefore, requested that Planned We therefore, requested that Planned Parenthood of Nashville allow us to Parenthood of Nashville allow us to perform this procedure on women who perform this procedure on women who were to undergo an abortion. Fifty were to undergo an abortion. Fifty patients at Planned Parenthood patients at Planned Parenthood accepted a monetary gift allowing us accepted a monetary gift allowing us the opportunity to perform and perfect the opportunity to perform and perfect this new and innovative procedure. this new and innovative procedure.

In 1987 our Obstetric Division began In 1987 our Obstetric Division began offering CVS to pregnant patientsoffering CVS to pregnant patients

Am J Obstet GynecolAm J Obstet Gynecol1993;168:17661993;168:1766

Since those early days, patients have Since those early days, patients have come to Vanderbilt Medical Center from come to Vanderbilt Medical Center from all parts of Tennessee and surrounding all parts of Tennessee and surrounding states and we have performed over states and we have performed over 3,000 CVS procedures.3,000 CVS procedures.

In 1987, the Vanderbilt Perinatal Parent In 1987, the Vanderbilt Perinatal Parent Education Program began formal Education Program began formal classes to help children understand classes to help children understand pregnancy so they could be prepared pregnancy so they could be prepared to witness the birth of a sibling. Many to witness the birth of a sibling. Many parents told us that watching siblings parents told us that watching siblings being born would be a learning being born would be a learning experience for their children and would experience for their children and would enhance the feeling of being a part of enhance the feeling of being a part of an important family and life cycle event. an important family and life cycle event.

Vanderbilt House OrganVanderbilt House Organ19891989

In 1990, doctors at Vanderbilt Medical In 1990, doctors at Vanderbilt Medical Center performed a surgical procedure Center performed a surgical procedure called a cerclage on a patient who had called a cerclage on a patient who had just delivered an extremely premature just delivered an extremely premature twin. This was the first time such an twin. This was the first time such an operation, under these circumstances, operation, under these circumstances, had been performed in the United had been performed in the United States and it saved the life of a middle States and it saved the life of a middle Tennessee newborn. Tennessee newborn.

J Reprod MedJ Reprod Med1992;37 :9861992;37 :986

In 1990, the Maternal Fetal Medicine In 1990, the Maternal Fetal Medicine Division recruited Dr. Joseph Bruner to Division recruited Dr. Joseph Bruner to Vanderbilt Medical Center in order for Vanderbilt Medical Center in order for him to develop a fetal surgery program. him to develop a fetal surgery program.

In-utero surgery of the unborn was In-utero surgery of the unborn was becoming technologically feasible and becoming technologically feasible and a number of birth defects were a number of birth defects were amenable to surgical correction while amenable to surgical correction while the fetus remained in its mother's the fetus remained in its mother's uterus.uterus.

Within seven years, Dr. Bruner and Within seven years, Dr. Bruner and Pediatric Neurosurgeon, Dr. Noel Pediatric Neurosurgeon, Dr. Noel Tulipan, performed the first in-utero Tulipan, performed the first in-utero surgical repair of fetal spina-bifida surgical repair of fetal spina-bifida

This historic event was followed by 178 This historic event was followed by 178 fetal surgical repairs of spina-bifida at fetal surgical repairs of spina-bifida at Vanderbilt Medical Center resulting in Vanderbilt Medical Center resulting in the publication of several landmark the publication of several landmark scientific publications pointing to some scientific publications pointing to some improvement in outcome for the improvement in outcome for the newborn. newborn.

JAMAJAMA1999;282:18191999;282:1819

The National Institutes of Medicine is The National Institutes of Medicine is now funding and sponsoring a now funding and sponsoring a randomized research project along with randomized research project along with two other major teaching centers, to two other major teaching centers, to ascertain the evidence based scientific ascertain the evidence based scientific value of such a procedure based on value of such a procedure based on rigid research criteria. This study is rigid research criteria. This study is now in progress. now in progress.

Centralized management of pregnant Centralized management of pregnant women infected with the human women infected with the human immunosuppressive virus (HIV) and immunosuppressive virus (HIV) and delivering 150 babies not infected with delivering 150 babies not infected with the AIDS virus during the past 6 yearsthe AIDS virus during the past 6 years

OC3 began March , 1999 at VanderbiltOC3 began March , 1999 at Vanderbilt

One of the first Certified Nurse Midwife One of the first Certified Nurse Midwife programs in the area was added to our programs in the area was added to our hospital and now delivers approximately hospital and now delivers approximately 60 babies each month at Vanderbilt. 60 babies each month at Vanderbilt.

Vanderbilt's Division of Maternal Fetal Vanderbilt's Division of Maternal Fetal Medicine began in 1975 a yearly two Medicine began in 1975 a yearly two day seminar called the High Risk day seminar called the High Risk Obstetric Conference. Obstetric Conference.

First guest speaker was Dr. Ed Hon, First guest speaker was Dr. Ed Hon, inventor of the electronic fetal monitor.inventor of the electronic fetal monitor.

It has become the longest running, as It has become the longest running, as well as the most attended, post -well as the most attended, post -graduate Obstetric course in America.graduate Obstetric course in America.

Modern obstetrics has improved the Modern obstetrics has improved the lives of countless mothers and babies lives of countless mothers and babies over the past 34 years. I am confident over the past 34 years. I am confident that in the future the staff at Vanderbilt that in the future the staff at Vanderbilt Medical Center will continue to Medical Center will continue to combine modern technology with a combine modern technology with a humane, family oriented approach to humane, family oriented approach to childbirth in an attempt to bring and childbirth in an attempt to bring and maintain excellence and safety to the maintain excellence and safety to the process of giving birth. process of giving birth.