Ginny Silva, RNC, MSN
Fetal Surgery Coordinator
Center for Labor and Birth
Only four hospital centers in the United States perform fetal surgery. As such, I am so very fortunate to be among the few fetal surgery coordinators in the nation.
BWH began performing fetal surgery four years ago, and today, the hospital completes an average of one surgery per week. Fetal surgery is defined as a direct surgical intervention to or about the fetus, but more recently, newer techniques that are better described as “fetal interventions” have been developed.
Although fetal interventions involve less invasive methods, they do require general anesthesia for the mother and specialized, technically difficult procedures performed by fetal surgeons, ultrasonographers, pediatric and obstetric anesthesiologists, and perfusionists, specialized pediatric respiratory therapists and high-risk obstetricians, who are all familiar with these techniques. Some of the most specialized techniques, such as cardiac interventions, are only being performed at BWH. All the procedures are done in conjunction with Children’s Hospital Advanced Fetal Care Center (AFCC).
I wear many hats for my role as the fetal surgery coordinator, but my ultimate goal is to keep everyone – the patient and her family, the doctors, the nurses and the social workers – all on the same page and comfortable with the care they are either receiving or providing.
For example, a patient from the Midwest was referred to the Antenatal Diagnostic Center (ADC) here at BWH when her baby was diagnosed with severe aortic stenosis with developing hypoplastic left heart at 18 weeks gestation. At 23 weeks, the patient arrived at the hospital for fetal surgery. After two initial days of fetal imaging conducted at AFCC, the patient and her husband also met the pediatric cardiologists, the fetal surgeon, the perinatologist and the ADC staff, who would be involved in the procedure. Once the fetal surgery was scheduled, I served as a guide for the patient from the beginning to the end of the process. I met the patient and her husband, conducted a tour of operating and recovery rooms, provided pre-operative education, and ensured that they had met with Anesthesia and any other necessary support services. On the day of her surgery, I set up the operating room and admitted the patient, performing pre-surgery tests and preparations. Shortly before the scheduled procedure, I participated in a debriefing meeting with the entire surgery team from both BWH and Children’s Hospital.
During the surgery, I served as the circulating nurse. Afterward, I provided post-operative care, visiting her daily to check on her progress for the two days that she remained in the hospital. The procedure was deemed technically successful, as we were able to dilate the baby’s aorta with a balloon device during the surgery. The patient and her husband returned to the Midwest, and I have since spoken to them twice over the phone. There has been some growth of the ventricle, so we are all hopeful that her baby will not require extensive post-delivery care this summer.
With this case and others, it is rejuvenating to be on the cutting edge of technology, offering women an alternative for their very sick babies before they are born. The resiliency of the families is truly amazing. Working in collaboration with Children’s Hospital is also inspiring. I meet with Children’s AFCC staff regularly to discuss upcoming patient cases as well as to go over past cases, so we can all learn from them. In addition, I collaborate with BWH’s obstetrical ambulatory staff on a weekly basis. These are the people who generally meet the patient first, so their help is critical to my job.
When I’m not coordinating fetal surgery, I also serve as a liaison for families whose babies will be receiving care at Children’s Hospital and work as a nurse researcher. Currently, I’m involved in a multi-site research project to examine nursing care of women in early labor. I am also looking at maternal perceptions of fetal surgery. All current fetal surgery-related research focuses exclusively on the effects on the baby.
The families I help treat are very special. I am blessed with the opportunity to work in such a cutting edge field, while serving in a challenging role as an advanced practice nurse. I am very vested in taking care of these families, and in doing so, advancing the role of nursing in caring for women and their families.