A High-Risk Pregnancy: Emergency Delivery While Snowbound

"You've got to bring your own weather," reflects pediatric otolaryngologist Stephen Early, MD, looking back on his years of experience at UVA. Driving two hours to Winchester, VA, on a snowy February night, Early hoped to deliver better weather to a mother in labor after a high-risk pregnancy.

"It was snowing outside, but I thought we could do something good for the child."

Second Opinion for a High-Risk Pregnancy

After a smooth first trimester of pregnancy, Carrie Rush received news that her baby would have micrognathia, a jaw abnormality. After receiving a grim prognosis from other hospitals, Carrie contacted UVA for a second opinion.

At UVA, the OB-GYN physicians contacted pediatric otolaryngology. They spoke with Early about a procedure that could alleviate airway obstruction during birth and greatly increase the chance of survival: the EXIT procedure.

During the EXIT procedure, the baby is partially delivered, with the umbilical cord attached, while doctors intubate and reestablish the baby's airways. EXIT procedures require a large, coordinated staff on-hand:

• An OB-GYN team
• A pediatric otolaryngology team
• A neonatology team

They also need a labor and delivery suite that's equipped for all these teams.

A Dark and Snowy Night

With two weeks left before the procedure, the EXIT team was preparing for a trial run. That same night, Rush went into labor in Winchester, VA, two hours north of UVA. And the snow was falling outside.

That's when Early got the call.

It was too late to transport Carrie down to UVA Health. "It was snowy and icy," Early says. "The roads were a mess. The helicopter couldn't fly. And so, the neonatal response team was dispatched (to Winchester)."

"I sat there and thought about this for a second," he continues, "and it didn't make sense for me to be here in Charlottesville and have that mother with a high-risk pregnancy present to an outside hospital that did not have the team assembled for an EXIT procedure."

He continues, "So I decided that the right thing to do was to get in my car, go up there, and see what I could do to help them."

A Team Partner Steps In

But he couldn't leave without covering his shift. That next morning, another child with micrognathia was scheduled for a similar procedure. Early received a call from his partner, otolaryngologist Will Brand, MD, who was on vacation at the time. Having caught wind of the situation, Brand gladly stepped in to cover that morning's operation.

"He's the real hero in this story," says Early. He added that Brand's morning became even busier when a second emergent intubation procedure arrived from the NICU.

As Early was driving up north, he got on the phone with the physicians in Winchester. He arranged for the necessary staff and equipment to intubate the baby on delivery. Although the original EXIT team would not be present, they discussed and prepared for all possible situations.

As the weather worsened, Early arranged for emergency privileges with the hospital, so there wouldn't be a second to lose.