Two years ago when Mary Donovan found out she was pregnant, she never considered going anywhere but Jackson Memorial Hospital to have her baby.
Sure, the accommodations at the sprawling campus near downtown Miami don’t offer the ambience of the hotel-like rooms at some hospitals. But she thought Jackson offered something better: specialists and one of the best neonatology units in the country.
At 41, Donovan was among the growing number of women falling into the category of high-risk pregnancy. As more women have babies later in life, more have multiple births and more suffer from obesity, the number of pregnancies considered high risk has ticked up. In 2007, the number of preterm babies born before 37 weeks reached one in every eight, higher than any year between 1981 and 2002, according to the Centers for Disease Control and Prevention.
And that has driven up the need for hospitals like Jackson where “we created multiple layers of specialists and sub-specialists who can take care of things in the blink of an eye,” said Dr. Salih Yasin, vice chair of obstetrics and gynecology and director of obstetrics and patient safety for the Women’s Hospital Center at Jackson Memorial Hospital.
For Donovan, a radiology nurse at Miami Children’s Hospital, getting pregnant capped a harrowing few years. In 2007, she was still single but determined to have a baby. Then came a big surprise.
“My goal in 2007 was, all I wanted was to be a mom. People said, ‘But you’re still single,’ and I said ‘I don’t care. I’ll get in vitro if I have to.’ Then I got my diagnosis [of thyroid cancer] and they said you can’t get pregnant for a year after treatment. I thought, ‘oh my God, that’s like getting a hysterectomy.’ ”
The cancer diagnosis prompted Donovan, a Buddhist who lives in Fort Lauderdale, to do some soul searching. She decided it was time to start meeting more people and living life a little larger, so she joined a social network. Exactly one year after her treatment, she met a man, who became her partner. One year later, she was pregnant.
For Donovan, age and cancer were not her only concerns. She also suffered from migraines and had learned during treatment that she had a gene mutation that made her prone to miscarriage. While she had never had a miscarriage, her obstetrician at Jackson, Dr. Rabah Laoun, wanted her on blood thinners. So for the next nine months, Donovan gave herself daily injections and made frequent visits to her doctor.
Last year, U.S. News ranked Holtz Children’s Hospital at Jackson Memorial No. 25 in the nation among pediatric hospitals. The hospital overall ranked No. 1 when the field narrowed to hospitals in South Florida.
Despite the growing number of high-risk pregnancies, the news is not all bad if you look closely at what drives it: older women now able to have children and successful fertility treatments. Both can produce more twins and other multiples.
“When I came to Miami in 1984, national data told us women having babies after 35 was around nine to 11 percent. Nowadays, it’s 27 to 30 percent,” Yasin said.
Advances in medicine have also enabled doctors to diagnose problems earlier, he explained.
“People are more alert, more aware at an earlier stage. It gives the impression that there is more risk in pregnancy,” he said.
Still, the number of maternal deaths has ticked up. The CDC reported that in 2003, the number of maternal deaths, while still very rare and down significantly from the turn of the century when the rate was 850 for every 100,000 live births, rose to 12 for every 100,000. In 2004, it again rose to 13. It was the first time the number had passed 10 since 1977.
While researchers attribute some of that to how deaths are calculated, it could also be tied to the high number of C-sections. In 2011, Florida had one of the highest C-section rates in the nation at 36.8 percent of all births, according to a report by ratings company HealthGrades. The national average was 34 percent.
Yasin said scar tissue from C-sections, along with more infections, were causing more bleeding problems because placentas are not properly implanting.
“The placenta has an invasive nature. It will invade through tissues,” he explained.
Normally, a placenta will separate across a thin line of loose tissue attached to the uterus. “The uterus contracts and everybody’s happy thereafter,” he said.
But when it implants on scar tissue, it does not separate easily and can even invade other organs. Recently Yasin cared for a pregnant mother who was 43. She had had multiple C-sections and the placenta had implanted on the scar, gone through the uterus and into the bladder. Her doctor in Palm Beach County, a University of Miami graduate, called Yasin to take the case.
“She came to us and stayed for five weeks,” he said. “We gave her 10 liters of blood to cope with the blood loss. If this would have occurred in a small hospital, she would have died.”
In the past half-dozen years, he said, the hospital would get these cases every two or three years. Now it gets 10 a year or more.
In addition to bleeding issues, Yasin said the hospital has handled more serious cases, including a baby whose heart was outside its body, and pregnant transplant patients. One mother who had a liver transplant at Jackson as a child returned to give birth to her two sons, because medicine she takes to prevent the liver rejection made her pregnancies incredibly risky.
“A simple infection you get in pregnancy, like a urine infection, can kill her,” he said. “We were able to carry her through two pregnancies. We had two healthy babies, her liver is working well and she is happy.”
Unlike smaller hospitals, he said, Jackson staffs the unit with physicians round-the-clock. Altogether, the hospital has 30 obstetrics faculty members, 36 residents and more than 350 nurses, he said.
In recent years, financial problems have caused Jackson Health System to lose nearly $419 million and caused a bitter battle between the health system and the University of Miami, which supplies 90 percent of Jackson Memorial’s doctors. But Yasin argued having a bad business model has not made Jackson a bad hospital.
“When things fail anywhere else, they come to Jackson. We really feel this is a mission we do because we provide the highest level of care. This is not a luxury. Everybody should have the best medical care they need,” he said.
The day before her daughter was born, Donovan was visiting her doctor across the street from Jackson when the baby’s heart rate started fluctuating during an ultrasound.
“He said go to the hospital right away because she’s waving the red flag,” she said.
Nurses started her on medicine to induce labor that evening. At 11:42 a.m., Cailinh Madison Bui was born.
“If you’re a normal delivery, a community hospital is fine,” she said. “But if you’re high risk, you don’t want to be anywhere else.”