April 20, 2020

COVID-19 has affected much of what we do here at Texas Children’s but there are still areas of our system where things are almost, well, normal. One of those areas is the Labor and Delivery Unit at the Pavilion for Women where new babies are born every day and families celebrate some of the best moments of their lives.

“No one is canceling having a baby,” said Lynda Tyer-Viola, vice president of nursing at the Pavilion for Women. “The deliveries are still coming and we are going the extra mile to help our patients make joyful, lifelong memories despite what’s going on outside the walls of their hospital rooms.”

These efforts combined with precautions and protocols established to minimize any potential exposure to COVID-19 are helping ease the anxiety of expectant mothers who are having babies during this historic and unprecedented time.

To protect patients and families from the potential spread of COVID-19, members of the Labor and Delivery team are wearing masks in patient-facing settings, screening patients and visitors for symptoms of the disease, and limiting the number of visitors who come into the unit to see their loved one. Other than that, things are pretty much business as usual.

“All of the changes we have made have been embraced by both patients and families, and staff, Tyer-Viola said. “Everyone has been extremely supportive and seems to understand that we are doing what is best for everyone involved.”

Kristin Thorp, assistant clinical director of nursing at the Pavilion for Women, agreed and said she is extremely proud of her team for being so adaptive during this event and for always keeping their attention and focus on what matters most – our patients.

“Team members have exhibited a lot of grace and have been extremely nimble during this entire process,” Thorp said. “They have really stepped up to care for our patients and themselves during this unique time in history.”

Natalia Angulo Hinkson, a new mom and a Texas Children’s employee, delivered her first child, Isabel Iris, on March 27 at the Pavilion for Women. Prior to the outbreak of COVID-19, Hinkson said she had talked to several colleagues and friends about what to expect from the experience and had made plans accordingly.

Post-delivery, she said outside of the precautions made to protect her and her daughter, and a few tweaks in her own plans to align with those measures, everything went like she hoped it would. Her husband was able to be in the delivery room with her when Isabel was born, her doctor was there to deliver the 6 pound 6 ounce bundle of joy, and her labor and delivery nurses and support staff were cool, calm, reassuring, warm and friendly.

The biggest change Hinkson said she had to make and accept was that her extended family was not able to be at the hospital during delivery. She said she had planned for them to be in the lounge and for her mom to come into the delivery room if there were complications. Fortunately, there were not, and her family is standing by to meet Isabel when it’s safe for all parties involved.

“There were things that were different and not possible, but it felt like everything my friends had told me about,” Hinkson said. “Any apprehension I had went away once I was at the hospital under the team’s care. They were extremely professional, prepared and attentive to making my experience the best it could be during what is obviously a very unusual time.”

Tyer-Viola said her team and the hospital as a whole have weathered many storms and that we’ve always ended up stronger and better than before.

“This pandemic will be no different,” she said. “We are resilient and we are dedicated wholeheartedly to our mission of caring for children and women.”

Texas Children’s Public Relations and Social Media teams are looking to share stories such as these on social media. If you delivered your baby at the Pavilion for Women during the COVID-19 pandemic, we’d love to hear your story to potentially be featured on the Pavilion for Women’s Facebook page. Please contact vxjavor@texaschildrens.org with your story.

November 25, 2019

When Jennifer Bryan showed up at the hospital to deliver her second child, she was in a considerable amount of pain, more than she had experienced with her first child, but not enough to request an epidural.

Desperate for relief, Jennifer asked for nitrous oxide, more commonly known as “laughing gas.” Being a labor and delivery nurse at the Pavilion for Women, she knew the hospital had just started offering the gas as a pain reliever for labor pain and was curious if it worked.

To her pleasant surprise, it did! About five minutes after inhaling the mixture of nitrous and oxygen through a face mask, Jennifer stopped feeling the pain of her contractions.

“It gave me some breathing room to decide whether to get an epidural or try to have natural child birth,” Jennifer said. “I would definitely do it again and am happy to be able to offer it to our patients.”

The Pavilion for Women started offering nitrous oxide for labor pain in October. The gas is administered via mask about 30 seconds before a contraction begins and is continuously breathed in until the contraction ends. Starting before a contraction begins helps the gas reach its full effect as the contraction reaches its peak.

No extra monitoring is required and there are no known effects on the baby. Nitrous oxide is the only pain relief method for labor that is cleared from the body through the lungs. As soon as a patient pulls the mask off, the effects of nitrous oxide quickly diminish.

“It’s fast acting and it’s fast to wear off,” said Kristin Thorp, assistant clinical director of nursing for the inpatient portion of the Women’s Assessment Center. “It’s a viable option for pain relief and women love it. It’s the No. 1 requested method of pain relief for labor pain.”

Since offering the new pain relief option several women have received it and many soon-to-be moms have inquired about it. Labor and delivery clinicians believe both of those numbers will continue to rise.

“All of my patients have responded positively when they’ve heard we are offering nitrous oxide for labor pain,” said Dr. Jennifer Bump, assistant director of Quality and Patient Safety for Obstetrics at Texas Children’s Pavilion for Women. “I think it’s an excellent option for our patients who want short-term relief and am happy to have the opportunity to offer it.”

Women can use nitrous oxide as an alternative to other pain management options, or they can use it for the reason Jennifer did, as a way to buy time while deciding to have natural child birth, have an epidural or have intravenous narcotics. Nitrous oxide cannot be used with intravenous narcotics. It also cannot be used by women who:

  • Cannot hold their own facemask
  • Have received a dose of narcotics in the past two hours
  • Have pernicious anemia or a B12 deficiency and are taking B12 supplements
  • Have one of a very few other rare medical conditions

Other situations in which nitrous oxide can be used and will be offered at the Pavilion for Women include external versions, IV starts, placement of cervical ripening balloons, manual removal of placenta and lacerations repair.

October 15, 2019

The Pavilion for Women recently held a two-day conference focused on obstetric critical care. With increasing focus on maternal morbidity and mortality the need to expand and elevate the care provided by physicians and nurses is paramount. This unique conference affords the opportunity to participate in skill simulation and expert presentations. Additionally, CMEs and CNEs were awarded upon receiving a successful pass rate of the post-test administered.

Attended by more than 100 people across Texas, and 12 midwives visiting the Pavilion for Women from Hong Kong, the conference covered physiologic changes during pregnancy, specific obstetric medical conditions and appropriate treatment; maternal cardiovascular resuscitation and airway management of critically ill pregnant patients; as well as appropriate steps in fetal assessment, delivery, and neonatal management.

The conference was held October 4 and 5, and was formatted as a series of presentations and skill stations to provide knowledge and guidance for decision-making, and limited practice in some clinical procedures and scenarios. Positively received by attendees, the conference enables the Pavilion for Women as a Level IV Maternal Care Designated facility to determine what educational needs exist across the state and provide additional education to help improve quality outcomes for women.

June 10, 2019

Texas Children’s Pavilion for Women has been designated a level IV maternal care facility, the highest level of care available. The designation was finalized late last week and followed a rigorous site visit conducted by the EMS/Trauma Systems Office of the Texas Department of State Health Services. A level IV maternal care facility provides comprehensive care for pregnant and postpartum patients, from those with low-risk conditions up to and including the most complex medical, surgical and/or obstetrical conditions that present a high-risk of maternal morbidity or mortality.

“This designation certifies that we offer the highest level of care for the most complex obstetric patients,” said Dr. Christina Davidson, a maternal-fetal medicine specialist and chief quality officer at Texas Children’s Pavilion for Women. “It speaks to the expertise of our clinical teams and the processes we have in place to ensure high-quality care and the positive outcomes we strive for.”

With the overall goal of reducing infant and maternal morbidity and mortality in the United States, the designation comes as the result of legislation passed in 2013 requiring Texas to establish and implement neonatal and maternal level of care designations by March 1, 2018. The intent of the legislation is to ensure both neonatal intensive care units (NICUs) and maternal care facilities have the resources and expertise to provide high-quality, specialized patient care that leads to the best outcomes for mothers and babies.

Texas is one of the first states requiring maternal care facilities undergo a site visit to verify the level of care provided to patients meets the Maternal Levels of Care classifications as defined in the Texas Administrative Code. Completing the designation process is a requirement to receive Medicaid reimbursement for obstetrical care by August 31, 2020.

“This designation is the fruit of the work we perform daily. It is recognition by the Department of State Health Services of Texas Children’s commitment and investment to maternal health,” said Dr. Nan Ybarra, director of nursing for inpatient services at Texas Children’s Pavilion for Women. “With over 6,200 deliveries annually, we are committed to serving women in our community and partnering with community hospitals to strengthen their maternal care processes and programs – our singular goal is to improve outcomes for pregnant women across Texas and beyond.”

Texas Children’s announced in January it opened one of the nation’s few intensive care units dedicated solely to obstetrical critical care. It is the only four-bed maternal ICU in the country staffed 24/7 by both pulmonary critical care and maternal-fetal care teams embedded in a hospital’s labor and delivery unit. This maternal ICU offers a specialized, private space for high-risk expectant and postpartum mothers with conditions such as sepsis, peripartum bleeding, placenta accreta, maternal heart disease and other serious conditions.

The hospital also has a nationally known placenta accreta spectrum program, where a team of experts provide comprehensive, multidisciplinary care for women with this potentially life-threatening pregnancy complication that occurs in approximately 1 in 1,000 to 2,000 pregnancies.

Additionally, in 2017, Texas Children’s obstetrics service partnered with the hospital’s Kangaroo Crew to create the Maternal Transport Service, further bolstering its reputation as a primary referral site for patients with high-risk pregnancies. The team, consisting of a Kangaroo Crew nurse, labor and delivery nurse, respiratory therapist, and EMT, can provide specialty care to mothers while enroute to the Pavilion for Women, helping the hospital’s community partners transport their sickest patients for the most optimal outcomes for mothers and babies.

“It’s crucial for women, especially those experiencing a high-risk pregnancy, to be educated about the level of obstetrical care available in the facility in which they plan to deliver,” said Dr. Michael Belfort, obstetrician/gynecologist-in-chief at Texas Children’s Pavilion for Women.

The Texas Children’s Pavilion for Women garnered several top distinctions in medical care for women and babies by excelling in maternity quality measures like breastfeeding practices, minimally invasive gynecology and exceeding patient satisfaction. Learn more by visiting our 2018 virtual Annual Report.

June 3, 2019

Whenever anyone asks about Shamika Jenkins, the first observation made is about her infectious smile and enthusiastic personality.

Customer service isn’t just a specific portion of an employee’s job description, it affects a patient’s entire experience. As a clerical secretary, Jenkins comes in contact with just about every patient that checks in during her early morning shift. In the Pavilion for Women Surgery department the patient’s experience begins with her warm welcomes and persistence.

“Although it can be pretty busy, I love meeting all different kind of people,” Jenkins said. “There are times when some people may be in a bad mood, a wonderful mood, some may be lost, and others are as upbeat and cheery as I am. Regardless, it gives me joy to encounter all moods because no matter what, I’m here to make their day.”

The waiting area can be the most quiet and uneventful time during a patient’s hospital visit. Either following check in, during an appointment, or after surgery as a patient recovers, patients and their families can potentially spend hours sitting in the lobby. Jenkins has transformed her role into not just checking patients in for their appointments, but makes them feel comfortable as well.

“Shamika is always the pretty, smiling face and helpful person in the waiting room,” Nursing Manager of Pavilion for Women Perioperative Services, Aleli Cabali said. “Shamika goes above and beyond to make sure that families in the waiting room are updated while patients are in the operating room.”

Jenkins’ diligence and consistence in making sure all surgery patients are called and scheduled for their appointments helps both patients and her co-workers, and is what allows the department to continuously provide high quality care.

“I remember a time when several people from the department had to go on vacation, and Shamika called patients ahead of time and scheduled their appointment to make it easier on the rest of the team,” Cabali said. “This was a big help to the unit and is why she deserves this award.”

Jenkins says despite the constant verbal recognition that she receives, she was not expecting to get a hospital-wide award.

“To be honest I didn’t see this coming,” she said. “I just come into work, do my job, and always remember to be myself; that is probably what excites me the most about being recognized. When working at Texas Children’s you have to be ready to put your ‘A game’ on every day. We have people come from everywhere so we need to make sure we maintain that great customer service consistently, and I am more than happy to be that example.”

February 4, 2019

When Blessing Quartey was born, she was only 24 weeks old and weighed just 1.8 pounds.

To help boost her growth, Blessing’s mother, Eva Nehikare, agreed to enter her daughter into an ongoing study at Texas Children’s Pavilion for Women focused on the benefits of an exclusive human milk-based diet in extremely low-birth-weight babies. Five months later, Eva is thankful she did.

“Shortly after she got into the study, you could see her becoming more muscular and full,” Eva said. “When you look at her now, you would never know she is a preemie.”

Today, Blessing weighs 8 pounds. She is steadily gaining weight and growing, and was discharged from the hospital just before the holidays.

Dr. Amy Hair, neonatologist and director of the neonatal nutrition program at Texas Children’s Hospital, is leading the study Blessing is in and said the infant’s outcome isn’t uncommon.

“We’ve known for a while that a human milk-based diet is best for low-birth-weight babies,” Hair said, noting that Texas Children’s was the first pediatric hospital to adopt an exclusive human milk-based diet in the neonatal intensive care unit (NICU) in 2009. “Now, we have a study and outcomes to back us up.”

Hair recently published some of the study’s outcomes in the BMJ, one of the world’s oldest and most highly revered peer-reviewed medical journals.

Specifically, the study looked at the benefits of an exclusive human milk-based diet in 51 premature infants. It compared post-discharge growth, obesity and metabolic outcomes of appropriate for gestational age (AGA) premature infants versus small for gestational age (SGA) premature infants who were fed an exclusive human milk-based diet in the NICU.

The first to look at long-term post-discharge growth of this population, the study found that at 2-years-old SGA premature infants who received an exclusive human milk-based diet showed greater catch-up growth without increased obesity or elevated insulin resistance compared with AGA premature infants. These findings suggest an exclusive human milk-based diet in the NICU could lead to favorable metabolic outcomes in SGA children.

“Historically, we have overfed premature babies with either formula or cow-based fortifier, which has led to a higher risk of heart disease and metabolic problems as young adults,” Hair said. “This study proves that feeding with human milk and human milk fortifier, low-birth-weight babies grow in a healthier manner. The study also challenges the current belief that SGA babies will never catch up to their counterparts. We are seeing that they are.”

Hair said the next paper to come out about the study will focus on participants’ neurodevelopment. She added that she and her partners have seen positive results and that the families involved are extremely pleased and more than willing to participate and come in for follow-up visits.

“I am so thankful for all of the care my daughter and I received at the Pavilion for Women,” Eva said. “The opportunity for us to be a part of this was an honor.”