“Dream Team” Cares for At-Risk Pregnant Women

Shirley and Corey Toby were determined to return to the “dream team” at Greenwich Hospital when they learned they were having a second child – even though other hospitals were closer to their new home in White Plains, NY.

Toby was referred to Greenwich Hospital’s Romelle Maloney, MD, by her internal medicine physician prior to her pregnancy in response to her expressed concerns about high mortality rates for Black mothers. Having access to a medical team that had expertise to manage complications should they arise was another plus.

“I wanted to do my due diligence before starting this new chapter in my life,” said Toby. She wasn’t disappointed. “Everyone at Greenwich Hospital took the time to listen to me and answer my questions.” And when Toby developed gestational diabetes, she was seamlessly referred to Yale Medicine maternal fetal medicine (MFM) physicians for specialized care.

Toby’s pregnancy went smoothly. Baby Nicolas was born on December 27, 2022, without complications. Big brother Oliver, 19 months, was waiting for him at home.

“We received the best care from everyone at Greenwich Hospital,” said Toby, 33. “The entire team was terrific, from the person checking my vitals to the person changing the sheets, to the nurses and doctors. They were the dream team for our children.”

A team approach

Dr. Maloney, of Greenwich Hospital and Northeast Medical Group, has been delivering babies for more than 30 years. Much has changed during that time, including the concept of working as a team.

“We now take a team approach,” said Dr. Maloney, a member of Toby’s “dream team.” “It’s extremely important to have subspecialists such as maternal fetal medicine doctors readily available to assist in difficult patient care. It’s become the standard of care. We have an excellent team at Greenwich Hospital that is supported by Yale New Haven Health.”

Another “dream team” member, Yale Medicine’s Kirsten Lawrence, MD, is section chief of Maternal Fetal Medicine at Greenwich Hospital, which provides specialized care for mothers and unborn babies considered at higher risk for complications. The team includes board-certified maternal fetal medicine physicians, obstetricians, ultrasonographers, neonatologists, genetic counselors and nurses, many of whom are certified in critical care.

The need for MFM physicians has grown as women delay childbearing to later in life when the risk of complications increases, explained Dr. Lawrence. Gestational diabetes and preeclampsia, a pregnancy related hypertension disorder, have been on the rise in recent years.

“We offer comprehensive consultative care for women who are planning pregnancy, pregnant, or who have a history of complications during pregnancy,” Dr. Lawrence said. “We treat patients holistically, making sure both mother and baby receive all the care they need.”

“Some women come in for a preconception consultation to assess their health as well as to identify and mitigate potential barriers to pregnancy. This way, they can come into pregnancy in the best health and shape,” said Dr. Lawrence.

A pregnancy is considered at risk due to advanced maternal age (35 years or older), multiple fetuses, recurrent preterm labor and delivery, or recurrent miscarriages. Women with diabetes, heart disease, high blood pressure, excessive weight, mental health issues, autoimmune disorders and other conditions are also at risk. MFM doctors also care for women carrying a fetus with a diagnosed heart condition or birth defect.

All maternal fetal medicine services are delivered on an outpatient basis, although some cases, as when a mother goes into preterm labor, may require a hospital stay. “We want to make sure the mother stays healthy while we give the baby time to grow and mature,” said Dr. Lawrence.

“Very rarely do we need to transfer a mother or baby to Yale New Haven Hospital because Greenwich Hospital has an excellent neonatal intensive care unit.”

Maternal fetal medicine physicians are bringing their expertise to pregnant patients across the hospital, including the Emergency Department and Intensive Care Unit. "We are forging strong relations across the hospital to provide coordinated care," said Dr. Lawrence.

Complications

As a half-marathon trainer who frequents the gym often, Toby was surprised when a blood sugar test during her first pregnancy showed she had gestational diabetes. Women who develop gestational diabetes are at higher risk of developing type 2 diabetes later in life. Babies can be larger, which can cause complications during labor and delivery.

“I thought I was going to pass the blood sugar test with flying colors,” said Toby. During her first pregnancy, she managed diabetes with dietary changes, and the condition resolved after pregnancy. Toby developed gestational diabetes again with her second pregnancy, but this time she needed insulin to manage the blood sugar levels.

During both pregnancies, Toby turned to the certified diabetes care and education specialist along with the nurse at Greenwich Hospital’s Gestational Diabetes program for guidance and support. “They were great,” said Toby. “They showed me how to shift my eating to regulate my blood glucose. I made an effort to eat more protein, vegetables and complex carbohydrates. I was also more mindful of portion control.” Toby will retake a blood sugar test three months postpartum to see if the diabetes has resolved.

Good times ahead

These days, Toby eagerly awaits returning to work as a marriage and family therapist. She also wants to start training for a half marathon. She looks forward to visiting Greenwich Hospital with Nicolas soon for a postpartum visit, and perhaps seeing some of the nurses and doctors who helped the couple expand their family.

“Our family is filled with gratitude,” said Toby.