Comprehensive care for people with complex pregnancies

[5 min read]

In this article: 

  • At Swedish, a specialized team of 13 caregivers is dedicated to caring for patients experiencing a high-risk or complicated pregnancy. 
  • Complex pregnancy patients include those with multiples, including twins, as well as patients with chronic conditions such as diabetes or hypertension.
  • An OB or family physician may refer a patient to Swedish's maternal fetal medicine specialists.  
  • A Swedish expert explains some of the role of maternal fetal medicine specialists and what makes Swedish's program unique. 

Every pregnant person has their own unique care needs and experience. But for people who have medically complex pregnancies — patients with chronic conditions like diabetes or high blood pressure; bleeding problems; potential issues from previous deliveries; or who are carrying more than one baby (twins, triplets or more) — a specialized team care is essential to having a healthy pregnancy and the best possible birth experience.

At Swedish, a dedicated team of practitioners offer comprehensive maternal and fetal specialty care to patients who are experiencing a high risk or complicated pregnancy. The team uses the latest technology and provides diagnosis and management of fetal complications; genetic testing; maternal and fetal imaging; and more.

Katherine Eastwood, M.D., a maternal and fetal medicine (MFM) specialist [KE1] [PK2] and medical director of obstetric quality and safety for Swedish, works with a team of 13 specialists who work collaboratively with obstetrics caregivers across Swedish’s First Hill and Issaquah campuses. We spoke to her to learn more about the unique role of Swedish’s maternal and fetal medicine program.

What defines a complex pregnancy?

MFM specialists take care of many types of pregnancies, including those that aren’t necessarily abnormal, such as a person having twins or triplets. We take care of people whose water breaks early. It’s called pre-term rupture of membranes, or PPROM. When a person has a pre-term rupture of membranes, they’ll come in and stay in the hospital until they deliver. Patients with diseases and chronic conditions such as diabetes, lupus, hypertension are also considered complex as are patients who have had an organ transplant, such as a kidney or liver transplant. And with twins we most commonly care for a patient having twins who are monochorionic, which means they are sharing a placenta.

Are patients referred or do they come to your team on their own?

Some patients seek out an MFM specialist on their own, but they are often referred to us by their family medicine doctor, OBGYN, or midwife. We usually start with a consultation and review their history and pregnancy. Many patients will continue to see their family medicine doctor, OBGYN or midwife for routine OB care - they will do the delivery. These patients will often return to our office for follow up ultrasounds and consult visits. Some patients transfer their full care to our team.

Is an MFM in the delivery room if a patient has had a complex pregnancy?

If a patient has seen us for full pre-natal care we will be there for the delivery. There is always an MFM in the hospital who is available for emergencies, but mostly we are not needed for deliveries. We manage other aspects of care. We are there for patients who have conditions such as placenta accreta spectrum, or PAS. Most often it’s when the placenta is growing into the scar of a prior C-section and because of that it won’t separate normally after delivery. Sometimes it’s stuck in the muscle of the uterus and those patients are at risk for massive hemorrhage or needing a hysterectomy at the time of delivery. We’ll be there to coordinate care, in addition a gynecology/oncology specialist who provides advanced pelvic surgery expertise and an anesthesiologist able to manage potential hemorrhage. This is a case where a patient would automatically get MFM care, and we would help deliver their baby.

When should a patient discuss an MFM consult with their practitioner?

When you go for your OB visit your doctor or midwife will review your history and refer you if needed. We usually do a first consultation around 12 weeks and look at the anatomy and talk about recommendations for the pregnancy and prenatal care. We see people earlier if they have type 1 diabetes or twins. Patients with diabetes can meet with an educator and a social worker who can help with coordination to reduce the stress of things. Some patients will have their first visit with us after an ultrasound indicates an abnormality with either the baby, the placenta or the cervix.

What if someone is trying to get pregnant and is potentially a high-risk pregnancy?  

We see people who are thinking about being pregnant and may have a medical condition that will complicate the pregnancy, or who have had a complicated pregnancy in the past and they want to talk about what pregnancy may look like in the future. We are not the ones who give permission about whether to get pregnant or not. We absolutely work with the patients and make sure they have the information about that pregnancy.

What makes MFM care at Swedish unique?

We provide consultative care for the entire Puget Sound region and even into Alaska. We have a very big and very good team, including neonatal care. We have all the ancillary care you could possibly want or need within our system, including interventional radiology and intensive care units. Because of this we can take on patients with uncommon needs or who have an ongoing diagnosis, like cancer, during their pregnancy. Because our program is so comprehensive, we can care for them and support them throughout their entire pregnancy.

Learn more and find a provider

Swedish has three birth centers — First HillIssaquah and Edmonds — making it convenient for people who live or work in the Seattle, Eastside and North End areas. Swedish patients can take classes, meet other families, get help with lactation and go for new parents and well-baby checkups at The Lytle Center for Pregnancy & Newborns at our First Hill birth center. You can also get expert advice there and help with wellness. Visit our website to learn more about midwives at Swedish and how they can partner with you to create the most personalized birthing experience possible. 

If you need a gynecologistwomen's health specialist or primary care doctor, Swedish is here for you. Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Information for patients and visitors 

Additional resources

It’s time to use another name for geriatric pregnancy

Do You Know How a Midwife Can Help You?

Not just the baby blues. Swedish experts on postpartum anxiety and depression

Cutting-edge care for patients giving birth and their babies | king5.com

U.S. News & World Report names Providence Swedish among nation’s best hospitals for maternity care

This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.

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About the Author

There's a reason why more babies are born at Swedish every year than any other health system in western Washington - bringing babies into this world is our mission. The Swedish Pregnancy & Childbirth Team is committed to giving you relevant and actionable insights on how to care for yourself and your child as you navigate the trimesters of your pregnancy.

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