In May 2021, Eisenhower Health opened its Family Birth Center, with 14 labor delivery, recovery, and postpartum rooms, two operating rooms for C-sections, four triage rooms, seven postpartum rooms, and eight private level II newborn intensive care rooms. Along with an exceptional team of clinicians and staff, Eisenhower has focused on providing state-of-the-art technologies and security. Healthy Living gathered Thomas Kelly, MD, UC San Diego Health, Paul Mikel, MD, Jamie Tannenbaum, MD, and Veronica Williams, MSN, PHN, RN, MBA, Director, Maternity Services, Eisenhower Family Birth Center, to discuss the development of the new program and the services women can expect when delivering at Eisenhower. The discussion was moderated by Justin Thomas, MD, Board Certified in Pulmonary Disease, Internal Medicine and Critical Care Medicine.
Dr. Thomas: What is the vision and mission of Eisenhower’s new Family Birth Center?
Veronica Williams: Our overriding mission is to provide high quality care in a family-centered atmosphere. It is aligned with Eisenhower’s, to help our parents and babies achieve optimal outcomes, and support women to have empowering birth experiences by delivering evidence-based care and a welcoming atmosphere. This is characterized by the cultural humility and diversity of our care providers. Our practices reflect our values of excellence, compassion, community and social justice.
Dr. Thomas: What are some of the advantages and benefits of working in a brand new facility with cutting edge technology?
Dr. Tannenbaum: For me, the most unique opportunity was starting a Maternal Infant program from scratch and shaping the culture of the program together.
Veronica Williams: I have to agree with Dr. Tannenbaum. An experience and opportunity such as this... and whether you’re a physician or a nurse, it’s something that doesn't come around but once in your whole career.
Dr. Kelly: I have to tell you from personal experience that the folks that I’ve worked with at Eisenhower have been the best people I’ve ever been able to work with in a clinical situation, not only their attitudes toward quality of care, but also their interpersonal relationships are unparalleled.
Dr. Mikel: This truly was a once-in-a-lifetime opportunity that I feel very blessed to have because not only were we able to build a program from the ground up, but we were also able to actually build an amazing team of people that has morphed into a family. It’s one of the things that allows us to deliver family-centered care.
Dr. Thomas: What is unique about family-centered care for a birth center?
Veronica Williams: I think it defines the relationship of health care by placing an emphasis on the collaboration between the people, whether it be staff, our physicians, the patients, or their spouses or partners. It’s an entire family that we are caring for. As we know, families are different for everybody, so to be able to tailor the care for the individual family, I think it’s very important. They all come with their biases, beliefs, and what they envision delivery should be. Sometimes things don’t go the way they are planned, as we know, and having a child is much like that. Babies make up their own rules, and when you prepare for that, delivery is much nicer.
Dr. Tannenbaum: I think it is also the concept of having the family as part of the health care team, so that decisions are discussed together and agreed upon. This allows families greater control regarding the care of their infant.
Veronica Williams: It gives them a sense of control when they’re the most vulnerable, so that’s really important.
Dr. Thomas: What’s the difference between a freestanding birthing facility and a birth center at a hospital?
Veronica Williams: A birth facility, typically, is a center that is backed by midwives. They offer women with low-risk pregnancies an alternative to labor in various scenarios. At Eisenhower, we have the specialty of our board certified physicians. We have a workflow for every high-risk type of delivery. We have to be prepared for the reality that every low risk can turn into a high-risk scenario.
Dr. Mikel: You never know when a low risk becomes a high risk and they can happen in an instant. It has happened in an instant on our unit. The delivery of a baby is about the safety of the baby and mother, and we have worked hard to combine the comfort and the family-centered feeling of an outpatient birth center with the safety and quality of a hospital.
Dr. Thomas: How many babies have been delivered at Eisenhower so far?
Veronica Williams: To date, we have more than 500 deliveries .*
Dr. Thomas: I’d like each of you to share a little bit about your background and specialty for our readers, please.
Dr. Tannenbaum: I’m a Neonatologist, which is a pediatric specialist that takes care of critically ill newborns and premature babies. I am originally from New York and I did my medical school training in Philadelphia. I then moved to California and did my residency training in the Bay area [Northern California], where I’ve practiced as a Neonatologist for the last 26 years.
Dr. Thomas: What attracted you to Eisenhower and what are maybe some of the opportunities that you envisioned for yourself?
Dr. Tannenbaum: The biggest driver for me was the unique opportunity to start a Neonatal program. I never dreamed that would be an option; nobody that I knew in practice or trained with ever had that opportunity, so when the opportunity arose, there was no way to say no. In addition, to work for a health system like Eisenhower with their reputation as a center of excellence was also incredibly appealing.
Dr. Mikel: I’ve been in obstetrics now for 28 years. I was born and raised in Southern California and was educated in Southern California, but ultimately moved to Phoenix, where I practiced for the last 30 years. When my twins were born seven weeks early, the care of their mother was actually suboptimal and she went through significant complications that were completely avoidable, ultimately resulting in her being in an ICU for several days and having a prolonged hospitalization, partly because the hospital didn’t have the equipment needed to intubate her emergently and partly because her fluids were not managed correctly. She became so fluid overloaded that her heart became enlarged and began functioning poorly. Ultimately, she ended up with a great deal of fluid on her lungs.
That changed me as an obstetrician and opened my eyes to the need for quality and safety in obstetrics. I’ve spent the last 20 years really focused wherever I was on trying to implement changes that would improve maternal health and improve outcomes. I came to Eisenhower through OB Hospitalist™ Group (OBHG), the nation's largest hospitalist organization. They offered me the chance to become a Laborist here. Once I accepted that, I was offered the role of Medical Director of the department. It has been awe-inspiring to be a part of this team and build relationships with these people.
Dr. Kelly: I went to the University of Nevada and subsequently trained in San Diego for residency and fellowship and now I’m the Division Chief of Maternal Fetal Medicine at UC San Diego Health. I have a colleague, Dr. Steve Plaxe, who is an oncologist and director of Eisenhower Lucy Curci Cancer Center. He spoke extremely highly of his experience building the affiliation between Eisenhower and UC San Diego Health in cancer and I have to say I would completely agree that the support from the hospital system has been nothing less than outstanding. I’m really thrilled to be a part of this.
Dr. Thomas: Veronica, can you tell us a little bit about yourself and your role as the Director of the Eisenhower Family Birth Center?
Veronica Williams: I’ve been a nurse for 27 years. I’ve been a nurse in Med-Surg, ICU, and I have worked in fertility as well and of course, maternity. When the opportunity came up for this amazing once-in-a-lifetime experience to build a service and team, I just couldn’t pass it up.
Dr. Thomas: What personnel make up Eisenhower Family Birth Center?
Dr. Tannenbaum: On the neonatal side, we have Pediatric Hospitalists that attend every delivery and also cover the NICU at night. In addition, the Pediatric Hospitalists are available to see pediatric patients in the emergency department as well as admit pediatric patients to the hospital. For sick babies, there are Neonatologists like me who care for the patients in the NICU. On the maternal side, we have OB Laborists, like Dr. Mikel, who are in the hospital 24/7 taking care of mothers in labor along with OB anesthesiologists who manage pain during the labor and delivery process.
Veronica Williams: We have Maternal Fetal Medicine through our affiliation with UC San Diego Health which is how we came to work with Dr. Kelly.
Dr. Kelly: Eisenhower spared no expense in getting the equipment and recruitment they needed to put in a good perinatal program.
Dr. Mikel: One of the ways that this is a game changer for the valley and for Eisenhower is that pregnant women came into the emergency department before this, even when there wasn’t a Family Birth Center. These women had to be transported to another facility and that delayed the care that they would get, which really can change outcomes. Allowing the patient to be seen quickly via a trained specialist in pregnancy is, again, one of the many ways this is a game changer for Eisenhower.
Dr. Thomas: What is the scope of practice at Eisenhower Family Birth Center?
Veronica Williams: With our Level II NICU, we’re licensed to care for 32 weeks gestation, 1,500 grams. Any infant younger than that or under that weight would have to be transferred to a higher level of care. We also have labor, delivery and recovery that can be completed all in one room — called LDRP rooms. We have postpartum rooms, four triage rooms, and two surgical suites which are beautiful and spacious. As far as equipment, everything in those rooms is high-tech with everything we would need for a high-risk mom. Our NICU has eight private rooms, which no other area hospital has. We have a wonderful nurse practitioner in NICU who has nearly 30 years of experience. She’s our manager and she’s amazing.
Dr. Thomas: There are special beds for laboring, correct?
Veronica Williams: The beds themselves break into various forms, allowing the mother to change the labor position so they can be comfortable. We can use birthing balls which allows the mother to move around freely instead of just lying in bed in one position.
Dr. Mikel: The beds are also ergonomically designed to help the nurses. Breaking apart the old, traditional beds for a delivery was very challenging on the back of the nurse who had to do that work. These beds are intelligently designed, not only for the patients, but for the staff.
Veronica Williams: Yes. We also have wireless telemetry fetal monitoring, which came in very handy with our COVID patients because we didn’t have to be in the room, adjusting their wires. We can have the monitor outside the room and continue to monitor the patient. For those patients that come in who don’t want to be tethered to the monitor, these can be very handy. They can walk around the room, continuing with their labor progress. It’s nice to be able to keep track and make sure that the baby is doing well during the process.
Dr. Thomas: What about security for the mom and baby?
Veronica Williams: Our infant security system is called Hugs®, which works great. A band is put on the baby right after delivery. Also, if you do not have access as an employee, or temporary approved access as a visitor, the elevator will not stop on our floor. No one can come on the unit unless they have access. An alarm will sound if someone pulls at the door for a certain amount of time. It’s been quite the collaboration to ensure infant safety.
Dr. Kelly: I’ve worked in three different medical systems as a consultant here at UC San Diego Health and this is the most secure mother-baby unit that I’ve ever seen. You can’t enter without being badged in — it’s incredible.
Dr. Tannenbaum: And the NICU has an additional level of security.
Dr. Thomas: That’s impressive. And I understand family members can see the baby from home, is that right?
Dr. Tannenbaum: Yes. Actually, this is relatively new technology within the last five or so years, but it has especially made an impact during COVID. At the bedside in the NICU, there is a device that allows the family to watch their baby live via webcam. The parents sign onto a particular website with a specific code. The device we use at Eisenhower is called NICVIEW and allows for live streaming of the infant so parents can see their babies when they are unable to visit the NICU. It has been a real gift for families, and parents can share the link with extended family, like grandparents who can’t visit during COVID. Since the mothers are usually discharged home before their babies in the NICU, this allows them to go home and take care of their other children, but still check in and see their baby.
Dr. Thomas: I have three kids. I have one that was born during medical school, one during residency and then one born during fellowship training. I imagine if that camera were available to me, I would have not gotten anything done. I would have been watching the babies constantly. On another note, tell me about support for our new mothers.
Dr. Mikel: Our labor team goes into every patient room each day to meet the patients who are in labor. We introduce ourselves and we let them know that we’re here to collaborate with their physicians and we’re here in case there’s an emergency. The time to meet a patient who’s having an emergency isn’t when they have it, it’s before. We explain our role on the unit, we offer them the chance to ask us any questions and we tell them, "We hope we don’t see you again." But, we make sure that we do that every single day.
Dr. Tannenbaum: We do something similar if there’s any concern about the baby. We’ll introduce ourselves to the family in advance of the delivery, and have a discussion with them about what to expect once the baby is born. Families find this very helpful.
Veronica Williams: Our nursing staff offer lactation support. They help see every single patient and are so helpful when it comes to issues with breastfeeding. They also provide follow-up once the mom goes home. A couple of days after they’re discharged, they call the mom just to make sure everything’s going well. We also provide a lactation clinic on the unit so mothers can return if they need assistance with breastfeeding. It’s important to know that a baby doesn’t come with the knowledge automatically of how to latch on. Mother and baby both have to learn from each other. Our lactation nurses are just amazing with teaching our moms about cues to look for and offering assistance if there are any issues, either with anatomy or if the baby is tongue-tied, a condition at birth that restricts the tongue’s range of motion. Our lactation experts will give the mother the best experience possible in order for them to breastfeed if that's something that they choose to do.
Dr. Tannenbaum: This is really important in the NICU as well. The NICU, just by its location, separates the baby from the mother, which complicates the process of breastfeeding. For this reason, it’s really nice to have lactation specialists working with those moms. Even if the baby is a little bit premature, they can do non-nutritive sucking and recreational breastfeeding, which really helps to stimulate milk production and also helps to teach the baby how to breastfeed. This helps give the mothers a sense of comfort and control, even though their baby is in the NICU.
Dr. Mikel: We have a donor breast milk program, which also helps those babies that need nutrition right away, but the mom’s breast milk hasn't come in. That’s, again, a wonderful option at Eisenhower.
Dr. Thomas: How important is the concept of skin-to-skin?
Veronica Williams: I think it’s really important. There are physiological needs for both mom and baby that are met when we do the skin-to-skin bonding. If there’s some irregularity in the baby’s temperature, the first thing we do is put them skin-to-skin with mom to try to bring their temperature up. Breastfeeding is a huge thing to look at as far as skin-to-skin contact and as a Family Birth Center, it’s one of our metrics that we provide skin-to-skin opportunities. Within 10 to 15 minutes after delivery, we dry off the baby and place them on mom’s skin, where they hopefully stay for about an hour or so. We can still perform nursing tasks and patient care while the mom and baby are having skin-to-skin time.
Dr. Mikel: We do everything we can to give the mom the birth experience that she planned for; we review her birth plan with her. We offer the chance to help deliver her own baby and we work hard to avoid Cesarean sections. We try hard to give parents the birth experience that they really dreamt of.
Dr. Thomas: Tell me more about the NICU and some of the features that parents might appreciate.
Veronica Williams: Normally in NICUs, you tend to see “bay” areas where everything’s open and you just have one baby after another lined up [with curtains between babies], but our NICU has eight individual rooms which provides both quiet and privacy.
Dr. Tannenbaum: Our isolettes [formerly called incubators] are multifunctional and allow easy access to babies for procedures and routine care, as well as providing a safe and comfortable atmosphere for the baby.
Veronica Williams: Yes, they’re very high-tech but they’re also nice for our little preemies. As a nurse, you’re used to opening the flap of an isolette with the possibility of it falling and breaking. But these isolettes have a soft closure and are super quiet. That’s what we chose for every bassinet, every crib. It doesn’t startle the baby — which is really nice.
Dr. Thomas: And I understand there’s special lighting?
Veronica Williams: Yes, we have special lighting in the NICU rooms which helps babies with their circadian rhythm. During the day, it looks much like any light, but as the day turns to night, the lights change, which is very helpful for the baby so they’re not as confused when they go home — they’ve experienced day and night.
Dr. Thomas: That must make parents happy, too. Dr. Kelly, can you tell us a little more about perinatology?
Dr. Kelly: I’m an OB-GYN. That’s a four-year residency after medical school and then you go on to a three-year fellowship in Maternal Fetal Medicine that basically is training in high-risk obstetrics. That involves the care of mothers who have medical problems, as well as imaging for fetuses. That’s for prenatal diagnosis, looking at fetal anatomy and performing prenatal procedures like amniocentesis or chorionic villus sampling. We’re looking for abnormalities of the fetus.
I’m the Division Chief at UC San Diego Health. We have a division of 10 perinatologists. We take care of patients at UC San Diego, Eisenhower Health and elsewhere. We’re involved in primary care of obstetrical patients at UCSD, as well as consulting at these outreach sites.
Dr. Thomas: What does your experience as an educator and having that exposure to fellows and residents here at Eisenhower provide for mothers and families here?
Dr. Kelly: I think no matter what residency someone does as they begin their career as a physician, they’re going to encounter a pregnant woman, whether it’s in the emergency department or in a family medicine or internal medicine clinic. I think there is an advantage to learning about the physiologic changes of pregnancy, particularly in regard to concerns of hypertension or bleeding. I think those are very basic things that all physicians need to be aware of. Recognition of preeclampsia, recognition of abnormal bleeding and how to work that up is a really important skill set for any emergency medical physician. Those are good educational pearls that can be imparted to them.
Dr. Thomas: Dr. Mikel, are pregnant women in the higher risk group for complications of COVID-19?
Dr. Mikel: Absolutely. According to the most recent data that I’ve reviewed, pregnant women are more than twice as likely to have severe COVID-19 and more than twice as likely as the average person their age to end up hospitalized and in the ICU. We really encourage our expectant moms to get vaccinated.
Dr. Kelly: I can’t stress this enough that it’s important to make patients understand that if they get COVID-19 during pregnancy, they’re more likely to be hospitalized than non-pregnant women and their ICU admission rates are about threefold higher. Certainly things that could be avoidable are early deliveries because of complications of ventilation. There’s no data that suggests that vaccination does harm to a pregnant woman or her fetus.
Dr. Mikel: If a pregnant woman gets COVID-19, there are treatments available to her as an outpatient that can shorten the duration of her illness. Eisenhower, through its infusion center, offers monoclonal antibody treatment, and these have been approved for pregnant women. If for some reason you get COVID-19, if for some reason you weren't vaccinated and get COVID-19, there are options that can minimize your risk of having to be in the hospital.
Dr. Kelly: I agree with Dr. Mikel on this. I can’t emphasize this enough that proactive treatment — getting vaccinated — may spare them a hospitalization and the monoclonal antibodies don’t seem to affect the fetus. That should be something that should be on their radar to contact their doctor, get this done before they get horribly symptomatic.
Dr. Thomas: Yes, and the best treatment is the vaccine.
Dr. Mikel: Absolutely. We’ve also unfortunately seen an uptick in unexplained stillbirths in moms that have had COVID-19 and moms that have COVID-19. That’s a real tragedy, which could have been avoided.
Dr. Thomas: Any words of wisdom for new parents or families, specifically before and after giving birth?
Dr. Tannenbaum: What families sometimes ask is, "Where’s the manual?" While of course there isn’t one, our team of nurses provide very extensive discharge teaching to help families adapt to their new baby.
Dr. Mikel: I tell new moms to listen to only one person because too much information from too many people is confusing and it undermines their sense of well-being. That it will take three to six months until they get their sea legs as a parent and they need to listen to each other, to communicate directly with their partner, and that we’ve all been there. We’ve all been in the position of not knowing what to do and feeling like we couldn’t do anything right. We’re here not only when they’re in the hospital, but we’re here for them after they’ve gone home.
Dr. Thomas: Thank you all so much for educating us about the new Eisenhower Family Birth Center and for all you’ve done to make this such a special place for our community’s mothers and new babies.
*Number of births as of December 9, 2021.
For more information about Eisenhower Family Birth Center, visit EisenhowerHealth.org/Maternity.