Angie Daniell counted silently as the seconds passed with agonizing slowness after her baby was born in an operating room at Akron Children’s Hospital.
One one thousand, two one thousand …
Toward the end of a seemingly typical pregnancy, an ultrasound revealed her son had a cyst nearly the size of his head growing on his neck.
Until he was born, there was no way to know for sure whether the noncancerous mass of lymph nodes and fluid would crowd his airway and keep him from breathing.
Doctors had warned her and her husband, Andrew, that if their baby wasn’t getting enough oxygen within three minutes after birth, surgery could be needed to prevent brain damage or death.
When the baby was born, a medical team rushed him to another nearby operating room for evaluation and, if needed, emergency care.
All his mother could do was wait as the seconds crawled by.
… Three one thousand, four one thousand …
For decades, Akron Children’s Hospital has delivered care to newborns with complex medical problems who are transferred there shortly after birth. But when he arrived via a cesarean section in May, Ashton Daniell became the first planned on-site delivery at the pediatric hospital.
Ashton’s birth followed two years of preparations by Children’s to begin offering deliveries in special life-or-death cases when babies are expected to need immediate medical intervention after birth.
“The thing that drove this is what’s in the best interest of the baby and mom,” said William Considine, the hospital’s president and chief executive. “There are those cases where it makes sense for the mom to do the delivery in a place like Children’s, where we have all the specialists and services available for the baby.”
Children’s plans to have a dedicated high-risk delivery suite as part of a six-floor addition being built on the main campus in downtown Akron.
Until the construction is complete in the summer of 2015, select deliveries will take place in the hospital’s existing ORs on an as-needed basis in cooperation with Akron General Medical Center and Summa Akron City Hospital, said Lisa Aurilio, vice president of patient services and chief nursing officer for Children’s.
“We’re committed to evaluating those cases where the baby needs immediate intervention and prepared to perform additional deliveries in those situations here at Children’s,” she said.
Because baby Ashton originally was supposed to be born at Akron General, labor and delivery nurses from that hospital were asked to assist with his delivery.
Considine said his organization also has had discussions with Summa and Akron General about whether it makes sense to combine all labor and delivery services in Akron.
However, Summa Senior Vice President and Chief Nursing Officer Lanie Ward and an Akron General spokesman confirmed in separate emails that those talks have ended without any deal being reached.
Children’s already works closely with Akron’s two birthing hospitals and runs the special-care nurses at the facilities. Newborns requiring more intensive care are transported to the pediatric hospital’s neonatal intensive care unit.
Children’s also employs maternal-fetal medicine specialists who deliver babies at City and Akron General.
100 babies expected
Only a small percentage of the high-risk babies born in Akron are expected to be delivered at Children’s. Initially, the pediatric hospital anticipates delivering about 100 babies annually, Considine said.
Last year, City had 2,917 births and Akron General had 3,249.
“Only a very small number of our birth mothers are transferred outside the area for childbirth because their infant will require immediate pediatric surgery,” Sue Sorboro, Summa’s vice president of Women’s Health Services, said in an email. “Although this situation is rare, we are very receptive to a local solution that would help keep these mothers and high-risk infants close to home.”
Ashton’s parents thought their second child might be born four hours from their Bath Township home at Cincinnati Children’s Hospital Medical Center.
During a routine ultrasound by Angie’s obstetrician 34 weeks into her pregnancy in April, the doctor noticed the baby’s head measurements were larger than normal and referred her to the Fetal Treatment Center at Akron Children’s for evaluation.
At first, the couple weren’t concerned. Their 2-year-old son, Anderson, also had larger-than-average head measurements in utero but was healthy at birth.
Concern about breathing
But during an appointment at Akron Children’s with Dr. Melissa Mancuso, the maternal-fetal medicine specialist found an 8-centimeter mass on the baby’s neck.
“Immediately, I was concerned about airway compromise at delivery,” Mancuso said. “As soon as I saw her and found the neck mass, I started pulling the forces together to get this delivery accomplished at Children’s.”
After more testing, Mancuso referred the couple for a consultation and possibly delivery at Cincinnati Children’s.
But the Daniells wanted their baby to be born close to home, near their support network of family and friends, particularly their church family at Grace Church in Bath.
After talking with the experts at Cincinnati, Mancuso determined the delivery could happen in Akron.
The team at Cincinnati agreed a resuscitation team was needed at the birth in case the baby’s airway was blocked but didn’t think he was a candidate for a rare surgery performed there before the umbilical cord is cut.
“Home was just the right answer,” his father said. “It was just a huge relief to us.”
Assembly of experts
In the days leading up to Ashton’s birth, Mancuso spent hours on the phone with a neonatologist, general surgeon, ear-nose-and-throat specialist, anesthesiologist and respiratory therapists to plan for his arrival.
His delivery was scheduled a few weeks before his due date to reduce the risk of labor starting without the team of specialists assembled.
The doctors developed a step-by-step plan to quickly evaluate the baby and open his airway if needed. If he couldn’t be intubated because of the mass, surgeons would be standing by to try to drain the cyst or create an artificial airway within minutes.
“Every second is crucial,” Mancuso said.
On the morning of May 10, eight physicians, two certified nurse anesthetists, 16 nurses and several respiratory therapists assembled for Ashton’s arrival.
The staff wore badges with a colored sticker to represent their duties — red if they were caring for mom and yellow if they were tending to baby.
“It was kind of frightening, but the fact that they had this whole thing worked out was reassuring,” Ashton’s mom said.
C-section goes well
Surrounded by the specialized team, Mancuso and fellow maternal-fetal medicine specialist Dr. Stephen Crane performed a routine C-section that went exactly as planned, without complications.
In the seconds that followed, Ashton’s parents heard a gurgled cry before their 8-pound, 10-ounce baby was whisked away for evaluation and possible surgery by ear-nose-and-throat specialist Dr. Marc Nelson and the hospital’s chairman of surgery, Dr. John Crow.
The noise was a good sign.
If he could cry, their son was breathing and getting at least some oxygen on his own.
As the seconds passed, the couple waited for an update.
“That was sheer horror, those couple minutes,” his father recalled.
Within a few minutes, a nurse returned with an update.
“He’s OK,” she told them.
Despite the mass, Ashton was breathing on his own, without the need for assistance or emergency surgery.
Ashton’s mother was able to visit him in the neonatal intensive-care unit (NICU) briefly before she was transported by hospital ambulance to Akron General for her recovery.
Ashton spent eight days in the NICU until he was released to go home, where he continued to get bigger and stronger. He’s scheduled to return to Children’s this week for surgery to remove the mass.
“We definitely feel that God had a hand in this,” his father said. “He put the right people around us to help us out.”
Cheryl Powell can be reached at 330-996-3902 or firstname.lastname@example.org. Follow Powell on Twitter at twitter.com/abjcherylpowell.