One day short of 33 weeks, Sarah Laury went into labor. Well, she was pretty sure. Nothing about her pregnancy had gone as planned, so when she told her nurse during a routine growth scan that she thought her water may have broken that morning, it was just the latest in a series of surprises. Not only had Laury and her husband, T.J., found out they were expecting triplets, but she had also developed anemia and preeclampsia and needed to deliver Theophilus (Theo), Magdalene (Maggie), and Zoe even earlier than expected.
Luckily, she was already in the right spot — Pennsylvania Hospital. Not only does PAH deliver more than 5,000 babies every year, but staff across the Women’s Division have picked up a few tips and tech tricks to take some of the guesswork out of maternal health care. For Sarah and the newest members of the Laury family, many of these came together to create a wonderful experience.
Making a Change of Plans Feel Special
In an effort to create a more memorable experience for moms undergoing Caesarean sections, PAH began initiating immediate skin-to-skin contact in the OR. In many hospitals, C-sections differ from vaginal births in that mothers and babies are often separated. However, because skin-to-skin has been shown to strengthen bonding, stimulate milk production more quickly, and release hormones that relieve stress and stabilize the baby’s temperature, breathing rate, heart rate, and blood sugar, PAH has adopted the practice as standard protocol.
“Our plans for a calm, scheduled C-section suddenly went out the window when I went into labor. I needed to take steroids to help develop their lungs because they were so early, but their heart rates kept dropping,” Laury said. “It was crazy, but when they came out — 1:45 a.m. on April 3 — they started crying immediately. We’d prepared for the worst, but T.J. got to cut their cords, and when they brought them over to me…. It was just a really special time.”
Earlier this year, PAH also introduced clear drapes to allow patients to witness the birth and feel less like a surgery patient and more like a new mom. The response has been overwhelmingly positive, but of course, squeamish patients like Laury who’d rather not watch the process can opt for the drape’s blue backing to be left intact.
“Our goal has been developing a more ‘family-friendly’ process for C-sections. A lot of the C-sections we perform are unscheduled, and we wanted identify ways to make patients feel comfortable and like they were able to have as close to their planned birth as possible,” said Ruth Dileo, MSN, RN, RNC-OB, nurse manager of the Labor and Delivery unit. “Not only do these practices elevate our value, but they serve as yet another way that we keep patients at the center of our care.”
Simplifying Milk Management for All
For premature babies like the Laury triplets who need to spend time in the Intensive Care Nursery (ICN) before going home, keeping a full inventory of breast milk and manually labeling and tracking each bottle proved a strenuous ordeal for moms and nurses alike. In 2017, the Hospital of the University of Pennsylvania (HUP)’s ICN partnered with Penn graduate student Vidur Bhatnagar to pilot a new milk management system, Keriton. Bhatnagar’s prototype was awarded second place at the 2016 PennApps competition, and with the enthusiastic backing of Penn Medicine and Wharton, it successfully streamlined a complicated process.
Keriton, which made its PAH debut in February 2019, is an integrated system that operates on a HIPAA-compliant server. Moms log pumping times and amounts on their side of the app, and the data automatically syncs on PAH’s end, allowing nutrition techs to track the bottle inventory without needing to double or triple check details with bedside nurses.
"When you have so many different expiration dates and types of milk and fortifiers, it's nice to have all the information and recipes already set up in the app. It really offers peace of mind to both our milk room staff and our moms,” said Stephanie Hollister, BSN, RN, assistant nurse manager of the ICN. “Keriton isn’t just a feeding safety platform — it allows us to generate lactation analytics, identify potential issues early, and provide moms with the support they need to make the process less overwhelming during a stressful time.”
For many moms, the best feature is the messaging platform. Not only can they discuss their lactation needs, but they can also receive baby pictures from the ICN nurses, which has been shown to increase milk production. “We live an hour away, so the app gives us a way to easily communicate with the nurses,” Laury said. “We knew the triplets would need to go to the ICN, but I was so worried about missing out on pictures. I was even going to bring them a disposable camera! Getting photos has been really great, and even when they come home, it’ll still be very helpful to have something that reminds me to pump and tracks my progress since I’m going to be a little busy….”
Monitoring Mom’s Blood Pressure Remotely
Though she never experienced hypertension prior to her pregnancy, as a first-time mom carrying multiple babies, Laury checked a few of the boxes that increased her risk for preeclampsia, or high blood pressure beginning around the twentieth week of pregnancy. Preeclampsia is the leading cause of maternal illness and death in the United States, and it contributes to about 15 percent of premature births. While Laury’s care team was able to manage her blood pressure and safely deliver the triplets early, complications can still arise postpartum.
Heart Safe Motherhood is an award-winning remote, text-based blood pressure monitoring program that was developed as part of the Penn Medicine Innovation Accelerator Program and adopted by PAH last summer. Twice a day for seven to 10 days, patients receive text messages reminding them to check their blood pressure and reply with their numbers. An automated system is set up to identify red flags and will notify a physician if a patient’s blood pressure is too high. Because it balances convenience with patient safety and has reduced readmissions, Heart Safe Motherhood has become the standard of care.
“We give each patient a cuff and a pamphlet to take home with them, and before they’re discharged, a nurse teaches them how to take their blood pressure. This empowers them to take a direct role in their health, and they go home feeling safe,” said Aida Schumacher, MSN, RN, CNL, a clinical nurse education specialist. “Our goal is to reduce maternal morbidity and mortality and to set these moms up for success. Monitoring them at home, rather than having them return after a week or second-guess symptoms, allows them to settle into their new lives safely and confidently.”