Innovate Women & Infants: Issue 4, Winter 2012

Winter 2012 TM

WOMEN & INFANTS

/ COVER STORY /

Baby-Friendly Hospital Initiative Underway / F E AT U R E /

Maternal Fetal Transport Service Launched

Biospecimen Bank Supports Research / Centering Pregnancy Program Garners National Attention / Fistula Center Opens in Niger, Africa i n t h is is su e

WINTER 2012

CONTENTS

RESEARCH

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6

12 FEATURE

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Barnes-Jewish Hospital consistently is listed on the Honor Roll of America’s Best Hospitals by U.S. News & World Report. This marks the 20th consecutive year on the list of the nation’s elite hospitals.

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IOSPECIMEN BANK PROVIDES B INFRASTRUCTURE FOR RESEARCH The Women and Infant’s Health Specimen Consortium at Washington University School of Medicine assists researchers by offering a collection of high-quality data and biospecimens from pregnant women and their infants.

Education + Research

NEWS

BECOMING BABY FRIENDLY Barnes-Jewish Hospital has been selected to participate in Best Fed Beginnings, a first-of-its-kind national effort to significantly improve breast-feeding rates in states where rates are lowest.

Ranked #10 in the Nation for Gynecology

Timing of Antibiotics Reduces Post C-Section Infections Giving antibiotics before cesarean section surgery rather than just after the newborn’s umbilical cord is clamped cuts the infection rate at the surgical site in half, according to researchers at Washington University School of Medicine and Barnes-Jewish Hospital.

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FISTULA CENTER OPENS IN NIGER, AFRICA For Lewis Wall, MD, a dream has come true. aternal Fetal Transport M Service Launched A new, comprehensive service is designed to provide patients with safe, specialized maternal fetal transport and to offer referring providers and hospitals easy activation through the service’s call center.

b a rne s - j ewi s h h o s p it a l a n d w a s h in g t o n u ni v er s it y p h y s i c i a n s

BA R N E S - Jewi s h H o s p it a l ,

a nonprofit academic institution, is the largest hospital in Missouri and is consistently ranked among the Honor Roll of America’s best hospitals

by U.S. News & World Report. The adult teaching hospital of Washington University School of Medicine, Barnes-Jewish was the first adult hospital in Missouri to be certified as a Magnet hospital for its nursing excellence.

Barnes-Jewish Hospital is a member of BJC HealthCare, one of the largest nonprofit health care organizations in the United States.

Barnes-Jewish Hospital, in conjunction with St. Louis Children’s Hospital, is a fully participating Level III Perinatal Center within the Southern Illinois Perinatal Network (SIPN), as designated by the Illinois Department of Public Health (IDPH). As a Level III Perinatal Center within the network, Barnes-Jewish Hospital helps optimize perinatal outcomes and promote the use of best evidence-based expertise and resources to provide excellent patient- and family-centered perinatal care.

W a s h in g t o n u ni v er s it y p h y s i c i a n s

are the medical staff of Barnes-Jewish Hospital and the Siteman Cancer Center.

Innovate Women & Infants is published quarterly by Barnes-Jewish Hospital.

Editors: Carol Scott, MBA, RN; Jessica Garrett, BSN, RN Managing editor: Anne Makeever Physician editor: George Macones, MD, MSCE, medical director, Women and Infants Services Contributing writers: Jessica Garrett, BSN, RN; Michele Landeau; Jamie Rose; Julia Strait; Diane Duke Williams Address Changes: Innovate Women & Infants circulation Mailstop 90-75-585, One Barnes-Jewish Plaza St. Louis, MO 63108

a l e t t e r f r o m C AROL S C OTT

Dear Reader, Best practice tells us that immediate, post-birth skin-to-skin contact between mom and newborn improves physical and emotional health outcomes for both. One has only to experience, once, the radiant joy a mother exudes and the calm of a newly born infant on his mother’s chest to sense that when scientific evidence and the patient’s desires are perfectly interwoven, seemingly magical moments in childbirth and newborn care ensue. Our aim in Women and Infants Services at Barnes-Jewish Hospital is to sustain a culture of patient-centered care, where these moments are the norm. Recently, we have launched two transformative initiatives, Best Fed Beginnings and the Maternal Fetal Transport program, both of which work to combine best practices and patient-centered care.

Although we have always supported breast-feeding, the Best Fed Beginnings program, a nationwide initiative, will expand and improve our services, allowing us to provide comprehensive, multidisciplinary support to parents who transition quickly and easily into breast-feeding, as well as to those who may struggle with the process. To that end, we are moving toward achieving Baby-Friendly accreditation, fully renovating the way we educate clinicians and patients to help new mothers achieve breast-feeding success in the critical time immediately following childbirth and to sustain that success to meet each family’s specific needs.

Our team also is working to enhance the care we provide to high-acuity pregnant women, even before arrival at the medical center. In collaboration with St. Louis Children’s Hospital and Washington University Physicians, we have created a Maternal Fetal Transport program, designed to get a pregnant woman in need of immediate and specialized attention to the medical center as quickly and safely as possible. The transport team includes a maternal nurse specialist to attend to the mother, a neonatal nurse specialist to see to the needs of the infant and an EMT. This new initiative ensures that a pregnant woman at a community facility can be safely transported to our campus via air or ground service to receive immediate medical care provided by our highly trained team.

I hope you will use this issue of Innovate Women & Infants as a way to learn more about these two new programs and the other ways in which we provide excellent care to our patients while carrying out our role as a leader in maternal, fetal and newborn care.

With sincere regards,

Carol Scott, MBA, RN Director, Women and Infant Services Barnes-Jewish Hospital

Want to send a message to Carol Scott? Have questions or comments?

Email innovate@bjc.org.

If you no longer wish to receive Innovate Women & Infants or received multiple copies, please send an email to WomenandInfants@bjc.org. To send a letter to the editor, including any suggestions for outreach education improvement or magazine content, please send an email to WomenandInfants@bjc.org.

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BECOMING BABY FRIENDLY W ritten b y A n n e M a k e e v e r Photography by Jay Fram

Barnes-Jewish Hospital has been selected to participate in Best Fed Beginnings, a first-of-its-kind national effort to significantly improve breast-feeding rates in states where rates are lowest. During the next 18 months, Barnes-Jewish, along with 89 other selected hospitals, will work to earn a Baby-Friendly Hospital designation from Baby-Friendly USA, the accrediting body for the initiative in the United States.

In order to achieve that status, each hospital must verify it has comprehensively implemented the American Academy of Pediatrics-endorsed Ten Steps to Successful Breastfeeding program, as established in the World Health Organization/UNICEF Baby-Friendly Hospital Initiative. The National Initiative for Children’s Healthcare Quality, with support from the Centers for Disease Control and Prevention and Baby-Friendly USA, is leading the Best Fed Beginnings effort to help improve maternity care by increasing the number of U.S. hospitals participating in the Baby-Friendly Initiative.

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“The hospitals chosen to participate in Best Fed Beginnings are now on the leading edge of maternity care in the United States and will serve as models for change for other hospitals throughout the country,” says Trish MacEnroe, executive director of Baby-Friendly USA. Although breast-feeding is one of the most effective preventive health measures for infants and mothers, half of the babies born in the United States are given formula within the first week after birth; by nine months only 31 percent of babies are breast-fed. Best Fed Beginnings seeks to reverse this trend by dramatically increasing the number of U.S. hospitals implementing a proven model for maternity services that better supports a new mother’s choice to breast-feed.

Participating hospitals will use quality improvement methods that follow the Breakthrough Series approach pioneered by the Institute for Healthcare Improvement. Teams will work with each other and with national breast-feeding and qualityimprovement experts through in-person learning sessions and subsequent action periods. Regional collaboratives will be established to help participating teams better connect to each other and to local resources.

“This is a fantastic opportunity to improve our Women and Infants Services to better support breast-feeding in the St. Louis community,” says Carol Scott, RN, director of Women and Infants Services at Barnes-Jewish. “We recognize that for women who plan to breast-feed, the hospital experience strongly influences a mother’s ability to start and continue breast-feeding.

We are committed to implementing

Ten Steps to Breast-feeding Success* 1. Maintain a written breastfeeding policy that is routinely communicated to all health care staff

Barnes-Jewish Hospital, in partnership with Best Fed Beginnings, will be a designated Baby-Friendly USA Hospital

by September 2014.

2. Train all health care staff in the skills necessary to implement this policy

evidence-based care through the Baby-Friendly designation process.

This will ensure that mothers delivering in our hospital who intend to breast-feed are fully supported.”

3. Inform all pregnant women delivering at Barnes-Jewish Hospital about the benefits and management of breast-feeding

In 2011, 64.2 percent of new mothers in Missouri report attempting to breast-feed, compared to 70.6 percent of Illinois mothers, according to the Centers for Disease Control and Prevention’s Breast-Feeding Report Card. At Barnes-Jewish, the breast-feeding rate is approximately 49 percent. Breast-feeding rates in impoverished communities and among the African-American population traditionally are low. Barnes-Jewish delivers approximately 3,500 infants a year. Of that number, 64 percent are African-American and about 70 percent are insured through Medicaid.

4. Help mothers initiate breast-feeding within one hour of delivery 5. Demonstrate to mothers how to breast-feed and how to maintain lactation, even if they are separated from their infant 6. Give infants no food or drink other than breast milk, unless medically indicated 7. Practice rooming in— allowing mothers and infants to remain together 24 hours a day

Research has shown that breast-feeding has multiple health benefits for both infants and mothers. For infants, it decreases the incidence and severity of many infectious diseases, reduces infant mortality and optimally supports neurodevelopment. It also decreases infants’ risk of becoming obese later in childhood. For mothers, breast-feeding decreases the risks of breast and ovarian cancers, diabetes, rheumatoid arthritis and cardiovascular disease.

8. Encourage unrestricted breast-feeding 9. Give no pacifiers or artificial nipples to breast-feeding infants 10. Foster the establishment of breast-feeding support groups and refer mothers to them upon discharge from the hospital or clinic * Steps devised by Baby-Friendly USA, with the World Health Organization and the

To learn more about the Best Fed Beginnings

United Nations Children’s Fund

initiative, including a list of the 90 participating hospitals, visit bjhne.ws/da.

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What’s the best way to ask families whether they want to breast-feed or bottle feed?

Best fed beginnings

FAQ

An open-ended question—“What do you know about breast-feeding?— allows mothers and their partners to discuss what they know and provides an opportunity for correcting misinformation.

What is Best Fed Beginnings and what is it trying to accomplish?

It is a federal program, supported by the Centers for Disease Control and Prevention and National Institutes for Children’s Health Quality, to help 90 hospitals across the United States implement the steps necessary to achieve Baby-Friendly USA designation.

Barnes-Jewish Hospital will become a Baby-Friendly USA institution by

staff members, patients and families,

and family-centered care, is there room

and the community about this new focus

for those who choose to bottle feed?

in care. Teaching tools and up-to-date

All families will receive the same high

educational materials will become part

level of culturally sensitive, focused,

of the standard work we do to support

supportive care. As a Baby-Friendly

infant feeding.

hospital, we will ensure that all families

////////////////////////////////////////

receive comprehensive information on the benefits of breast-feeding and the risks of formula feeding, documenting each step and choice in the medical record. We will help every parent provide skin-to-skin newborn care, teaching

methods while encouraging parent-

Is the program designed to change a

newborn bonding.

mother’s mind about breast-feeding?

////////////////////////////////////////

undecided are supported in exclusive breast-feeding during the hospital stay.

And it’s never too late to ensure that a mother and her family have the most accurate information about breastfeeding so that they are educated and fully informed when making crucial infant feeding decisions.

How do we honor cultural differences and still promote what is best for

breast-feed and those who are

Beginnings steering team will develop

In a hospital that is focused on patient-

////////////////////////////////////////

that those who already intend to

Over the next 22 months, the Best Fed the processes and tools needed to teach

correct, formula-specific preparation

Not necessarily. The goal is to ensure

help educate women and families?

////////////////////////////////////////

those who choose to formula feed the

September 2014.

What teaching tools are available to

breast-feeding mothers and infants?

With help from the Barnes-Jewish Center for Diversity and Cultural Competence, we will strive to ensure that all patients giving birth at Barnes-Jewish and their families receive complete, evidence-based infant feeding information. Once a family has made an informed decision, we will

What is being done to educate mothers and families before they arrive at the hospital?

Baby-Friendly USA-designated hospitals have systems in place to ensure breast-feeding education happens in the prenatal period. We will offer tools to providers and support staff that they can use throughout prenatal care to help promote breast-feeding. ////////////////////////////////////////

What additional efforts are being made to improve prehospital decision-making and postdischarge education and support?

In addition to collaborating with our prenatal providers and support staff, we will develop relationships with community organizations and organize a Barnes-Jewish Hospital support group.

provide full support while they learn to feed and nurture their infant.

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W ritten b y J ULIA S t r a i t

Timing of Antibiotics Reduces Post C-Section Infections Giving antibiotics before cesarean section surgery rather than just after the newborn’s umbilical cord is clamped cuts the infection rate at the surgical site in half.

“We followed more than 8,000 women

policy to administering antibiotics

over an eight-year period, and our

before C-section surgery in January 2004.

findings support giving antibiotics just

The American College of Obstetricians

before a cesarean section to prevent

and Gynecologists recommended the

infections,” says David Warren, MD,

same change in practice in 2011.

Washington University infectious

In 2003, the year before the policy

disease specialist at Barnes-Jewish

changed, the infection rate at

Hospital. “Until recently, standard practice in the U.S. was to give antibiotics David Warren, MD

when the baby was delivered, after the

trend in the infection rate began after

The previous practice of waiting to

In 2003,

In 2010 after

the policy switch, the rate was about two infections per 100 cesarean deliveries.

On average, researchers calculated about five times fewer infections per 100 surgeries due to changing the timing of the antibiotics.

between nine or 10 infections per 100 cesarean deliveries. A downward

umbilical cord was clamped.”

the year before the policy changed, the infection rate at BarnesJewish Hospital fluctuated between 9 or 10 infections per 100 cesarean deliveries.

Barnes-Jewish Hospital fluctuated

the policy switch, and by 2010, the

give antibiotics until after the surgical

rate was about two infections per

delivery of the baby evolved out of

100 cesarean sections. On average,

concern that these drugs might hide

researchers calculated about five times

signs of blood infection in the newborn.

fewer infections per 100 surgeries due

But other recent studies have shown

to changing the timing of the antibiotics.

that giving antibiotics in the hour before surgery both reduced the risk of

Over the entire eight-year period, researchers observed 303 infections

infection in the mother and had no

following 8,668 cesarean deliveries.

effect on the health of the infant.

Investigators also pointed out that

“It was always a theoretical concern that

infection rates were cut almost in half

giving antibiotics might somehow mask sepsis in the neonate,” says Warren. “But there have been several recent studies

after the policy change despite the fact that there were significant increases over the course of the study in the

showing that this was not an issue.”

number of patients who were overweight

In this study, the researchers tracked

or obese. Having a higher body mass

C-section deliveries and associated

index is associated with increased risk

surgical site infections at Barnes-Jewish

of infection following surgery.

Hospital between January 2003 and

The study is available online and

December 2010. Based on reduced

appears in the August 2012 issue of

infection rates following other types

Obstetrics & Gynecology.

of surgeries, the hospital changed its

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W ritten b y MI C HELE LANDEAU and j a m i e r o s e

BIOSPECIMEN BANK

Provides Infrastructure for Research Created in 2008, the Women and Infant’s Health Specimen Consortium (WIHSC) at Washington University School of Medicine assists researchers by offering a collection of high-quality data and biospecimens from pregnant women and their infants.

T

he brainchild of Washington University scientist Ann Gronowski, PhD, WIHSC grew out of her research interests in the biochemical markers of pregnancy.

Because Gronowski’s lab studied the markers of preterm delivery, fetal lung maturity and ectopic pregnancy, she saw the need for specimens that were obtained before the onset of symptoms.

As a result, and unlike other repositories, WIHSC collects specimens and patient medical data longitudinally, from preconception throughout gestation from the mother and after delivery from the infant. These motherinfant sets of data are recorded, stored and made available to investigators.

“Because WIHSC specimens are collected from women prior to pregnancy, we can make associations between preconception health and lifestyle, and subsequent outcomes during pregnancy and postpartum,” says Emily Jungheim, MD, assistant professor of obstetrics and gynecology and women’s reproductive health research scholar in the Division of Reproductive Endocrinology and Infertility at Washington University.

Jungheim is investigating the influence of lifestyle and diet on reproductive health in women undergoing fertility treatments. Her hope is that specimens collected through WIHSC will reveal lifestyle modifications that

Percent Enrollment by Location

18% Women’s Health Clinic

50%

R eproductive Endocrinology and Infertility Clinic

20% Center for Advanced Medicine

12% Labor and Delivery

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may improve outcomes for previously infertile women.

Data and specimens collected by WIHSC are available to all researchers.

The consortium currently operates under the direction of Gronowski, Kelle Moley, MD, and Marwan Shinawi, MD, Washington University physicians at Barnes-Jewish Hospital. Moley, says Gronowski, was instrumental in the founding of the consortium. From the beginning, Gronowski and Moley were committed to establishing a large bank of specimens collected from all stages of pregnancy.

In fact, the two women’s complementary skill sets played a significant role in the foundation of WIHSC and its ongoing success. Thanks to her practice in obstetrics and gynecology, Moley had connections to physicians in those fields and understood what was needed to achieve patient enrollment. Gronowski’s research in the field of pathology gave her particular insight into the collection and storage of specimens.

With funding from the Institute of Clinical and Translational Science and the Children’s Discovery Group, Moley and Gronowski were able to begin collecting

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WIHSC ACHIEVEMENTS, 2010-2012 Accomplishments

2010-2011

2011-2012

Increased number of patient sources; added infants to the database

1,033 mothers from 4 sites 52 infants

1,868 mothers from 4 sites 8 males 438 infants

>4,000 samples: added amniotic fluid, urine, newborn heel stick, cord blood and miscarried tissue

>15,000 samples: 12 types of specimens, including discarded oocytes, granulosa cells and semen

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Increased number of engaged departments

Pediatrics, Microbiology, Obstetrics and Gynecology, Pathology, Internal Medicine, Developmental Biology

Added Anesthesia, School of Social Work

Increased WIHSC staff

1 research study coordinator 3 research assistants 1 data manager

2 research patient coordinators 5 research assistants 1 data manager

Resulting publications and grants

1 manuscript, 3 abstracts, 1 grant

2 manuscripts, 8 abstracts, 3 grants (and 2 pending)

WIHSC is unusual in its ability to offer researchers access to its biospecimen bank without requiring specimen deposits to replace ones that are retrieved. Because it collects and processes new samples daily, the repository’s reserves are never depleted.

the departments of anesthesiology, social work, molecular microbiology, developmental biology and internal medicine, and the Washington University Brown School of Social Work. The consortium has supported research in a wide variety of women’s health issues, including infertility, pre-eclampsia, recurrent pregnancy loss and preterm delivery, as well as gynecologic pathologies such as endometriosis and sexually transmitted infections.

Increased number of samples and expanded types of samples Number of studies

specimens from a small population of patients seen by the Reproductive Endocrinology and Infertility Clinic at Washington University. Specimen recruitment then expanded to include the Center for Advanced Medicine, Women’s Health Clinic and Labor and Delivery. Samples are now collected at preconception and throughout each trimester of pregnancy during a patient’s medical appointments; infant and delivery specimens are collected through the Labor and Delivery department.

“WIHSC is everything we had hoped and more,” says Moley. “As a result of its infrastructure and the services we offer, researchers from within the Washington University community have come to us for help in designing their studies. We are extremely pleased that we have facilitated so many projects in women and infant health.”

The staff of the consortium not only obtains patient consent and collects, processes and stores specimens, it also assists researchers in selecting and obtaining previously banked specimens based on a comprehensive database of outcomes data.

Since its inception, WIHSC has significantly changed the landscape of translational research in women and infant health at Washington University, providing resources to the departments of pathology, pediatrics, and obstetrics and gynecology, and supporting research in areas not historically connected with reproduction, including www . B a rne s Jewi s h . o r g

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All studies using WIHSC data must be approved by the Washington University Institutional Review Board. Those who wish to use WIHSC data must have the objective of studying clinically important women and infant health issues related to maternal-fetal medicine, pregnancy or pediatric diseases.

For more information about WIHSC, visit wrhr.wustl.edu/WIHSC.

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FISTULA CENTER Opens in Niger, Africa For Lewis Wall, MD, a dream has come true

The road in Niger, Africa, leading to the fistula center in Danja

W ritten b y DIANE DUKE W ILLIAMS

F

or almost 20 years, Lewis Wall, MD, worked doggedly to build a hospital in one of the world’s poorest countries to treat women with a devastating childbirth injury. His dream became reality in February 2012, when a 42-bed hospital opened in Niger, Africa. The facility is dedicated to repairing fistulas, wounds inflicted by prolonged labor, which leave women—and often girls—steadily leaking urine and sometimes feces.

“It was wonderful to be there that day,” says Wall, a Washington University obstetrician and gynecologist at Barnes-Jewish Hospital. “This hospital may seem small by American standards, but it will make a large difference in the lives of so many African women who have suffered needlessly for too long.”

For most of his career, Wall’s passion has been to end the scourge of fistulas in Africa. He first saw the miserable lives of women with this injury when

he worked as an anthropologist in West Africa in his mid 20s.

Medical care to repair fistulas is widely available in developed countries.

But in Africa, many women don’t have access to medical care during childbirth or afterward, should injuries occur.

Fistulas occur in women of all ages but are more common among those who marry young and whose narrow pelvis makes them susceptible to childbirth trauma. Many women with a fistula are divorced by their husbands, cast out by their families and must eke out a meager living with no marketable skills. Often, they live humiliating, desolate lives on the edge of their village, with only rags to catch their waste.

“When these girls get a fistula, life is basically over for them,” says Wall, who enrolled in medical school at age 27 because he decided the

world needed more doctors than anthropologists. “They become social pariahs. With an inexpensive surgical repair, we are able to give them back their life and dignity. It’s astonishing.”

In 1995, after visiting a large fistula hospital in Ethiopia, Wall envisioned opening a similar hospital in West Africa, where fistulas are prevalent.

He founded the nonprofit Worldwide Fistula Fund to raise money to construct hospitals to repair fistulas.

The fund has helped support and build a number of fistula centers in Africa.

It also has provided money to train local doctors to perform the surgical procedure and to help raise awareness of the problem.

In Africa, girls often marry as young as age 12. Many cannot deliver babies safely because their birth canal is not fully developed. These young women may labor for five or six days only to deliver a stillborn baby. The treatment

Lewis Wall, MD (center), addresses the crowd at the grand opening of the Danja Fistula Center in Niger, Africa.

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for obstructed labor is a cesarean section, but this care is not available in many parts of Africa. As a result, women often develop a fistula.

In Niger, among the scattered grasslands on the edge of the Saharan desert, people grow millet and raise sheep, cattle and goats. The majority of people live on less than $1 a day.

There are very few personal or private resources for medical clinics or hospitals.

Getting the Danja Fistula Center built in Niger was much harder than Wall anticipated. “I thought I was fairly realistic because I had lived in West Africa for two years,” he says. “But we had to contend with unexpected obstacles—bureaucratic hassles, insects, a lack of communication and supplies, and people who thought their own interests would be threatened.”

He also had to raise about $1 million.

Large contributions from the Trio Foundation of St. Louis, South African musician Dave Matthews and an executive at Merrill Lynch helped the Worldwide Fistula Fund reach its goal.

The fund also received many small personal donations, including $35 from a potluck hosted by a group of elderly women in New York.

“This was not my individual achievement; it was from the efforts of thousands of people,” he says.

Mark Manary, MD, a Washington University pediatrician at BarnesJewish Hospital, understands some of the obstacles Wall faced in getting the hospital built. Manary has spent more than 15 years treating malnourished children in Africa. He started a nonprofit organization, Project Peanut Butter, that each year produces between 1,000 to 1,250 tons of a peanut-butter mixture used in Africa to treat children with malnutrition.

EACH YEAR, ABOUT 1,000 WOMEN WILL HAVE FISTULA SURGERY AT THE CENTER.

“Wall’s work removes a huge burden, a permanent scar, from the lives of thousands of African women,” Manary says. “I admire his commitment and persistence.”

Each year, about 1,000 women will have fistula surgery in the hospital, which is affiliated with an existing leprosy hospital run by a Christian missionary organization. Some will travel hundreds of miles in trucks and buses to get there.

Aside from repairing fistulas, the hospital will oversee outreach efforts to promote maternal health and reduce childbirth deaths. It also will educate women about microfinance, business and empowerment.

The new hospital is part of a grand vision to eradicate fistulas worldwide by building fistula centers that would serve as focal points for maternity care and public-health outreach in the world’s poorest countries.

“For starters, we hope this hospital will help countless women and alleviate human suffering,” Wall says. “We also hope it will advance women’s rights and gender equality. But for now, I’m just going to enjoy this accomplishment. There still is a lot of work to do.”

To read more about the work being done to help heal women with fistulas, visit

An operating room inside the new Danja Fistula Center

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the following sites: fistulafoundation.org and worldwidefistulafund.org/.

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at a g l a n c e

Maternal Fetal Transport Service Launched

A Maternal Fetal Transport service team includes a Barnes-Jewish Hospital high-risk obstetrical nurse, a St. Louis Children’s Hospital neonate-trained nurse in the event of delivery and a Children’s Hospital paramedic.

Pregnant women requiring specialized transport have immediate access to the care they need. The new Maternal Fetal Transport service, a joint effort between Barnes-Jewish and St. Louis Children’s hospitals, offers a level of care unavailable through other regional transport programs.

The comprehensive service is designed

facilitates transfer to the hospital and

to provide patients with safe,

admission of the patient.

specialized maternal-fetal transport and to offer referring providers and hospitals easy activation through the service’s call center. When a hospital or provider calls the Maternal Fetal Transport Call Center, a member of the referral staff contacts a Maternal Fetal Transport OB medical control specialist, who will activate the transport team upon acceptance of the patient. The referral team selects the appropriate mode of transportation based on patient condition, weather and the patient’s location; the referral staff

Each dispatched transport team includes a Barnes-Jewish Hospital high-risk obstetrical nurse, a St. Louis Children’s Hospital neonate-trained nurse in the

In addition to providing specialized transport, the new service offers:  Transport response 24 hours

a day, seven days a week

 Immediate ground or air

service within 15 minutes of a referring call

event of delivery and a Children’s Hospital paramedic. Transport is provided by

 Maintained communication

with the referring provider and hospital

ground or air via one of three mobile intensive care units, the KidsFlight 1

 Direct access to Washington

and 2 helicopters and KidsFlight 3,

University maternal-fetal and pediatric specialists

a fixed-wing aircraft dedicated to transporting maternal-fetal patients and critically ill newborns and children.

For more information, visit bjhne.ws/ep.

member managing the recorded call

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To arrange transport for a patient, or to learn more about the Maternal Fetal Transport service, call 800-678-HELP (4357).

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Education + Research Education Opportunities for Perinatal Care Providers, Nurses and Allied Health Professionals for Practice Excellence is an approved

Conference: Compassionate Innovation in Fetal, Obstetric and Newborn Care

provider of continuing nursing education

February 28, 2013

by the Missouri Nurses’ Association,

Goldfarb School of Nursing

an accredited approver of the American

at Barnes-Jewish College

The Barnes-Jewish Hospital Center

Nurses’ Credentialing Center’s

Call 314-TOP-DOCS for information

Commission on Accreditation.

In the highly specialized and

Washington University is accredited

ever-evolving fields of perinatal and

by the Accreditation Council for

neonatal care, it is essential for health

Continuing Medical Education to provide continuing medical education for physicians and designates CME educational activity on an hour-per-hour basis in Category 1 credit toward the American Medical Association Physician’s Recognition Award.

care professionals to maintain current knowledge of best practice. The conference’s presenting faculty and staff, active in research and perinatal and neonatal care, will cover topics in related medical, technological and

FOR BJC HEALTHCARE EMPLOYEES AWHONN Fetal Heart Monitoring Courses R egister online at BJClearn.org Neonatal Resuscitation Program R egister online at BJClearn.org

practice advances.

Outreach Education FOR MEDICAL PROFESSIONALS Provider and Nursing Electronic

Request a needs assessment for an

Fetal Monitoring Course and

on-site, two-day AWHONN Intermediate

Competency Verification

fetal heart monitoring course taught

Request a needs assessment for an onsite, interdisciplinary, 90-minute EFM course taught by a Washington University maternal-fetal medicine expert and a Barnes-Jewish Hospital nurse educator.

Email womenandinfants@bjc.org Call Women and Infants Outreach

Coordinator Jessica Garrett, BSN, RN, 314-362-7188 AWHONN Intermediate Fetal Heart Monitoring Email womenandinfants@bjc.org

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by Barnes-Jewish Hospital nurses.

Continuing education credits are available through AWHONN. Neonatal Resuscitation Program Call 314-454-2834, St. Louis

Children’s Hospital Emergency and Trauma Services Outreach Rapid Newborn Assessment Call 314-454-2834, St. Louis

Children’s Hospital Emergency and Trauma Services Outreach PALS Review/Update

Call Women and Infants Outreach

Call 314-454-2834, St. Louis

Coordinator Jessica Garrett, BSN,

Children’s Hospital Emergency and

RN, 314-362-7188

Trauma Services Outreach

b a rne s - j ewi s h h o s p it a l a n d w a s h in g t o n u ni v er s it y p h y s i c i a n s

Research Studies from Washington University School of Medicine

FOR THE COMMUNITY For information about the following

classes, including registration, call 314-TOP-DOCS Childbirth Preparation Saturdays, 9 a.m.-1 p.m.

Barnes-Jewish Hospital $35 for two attendees

Baby Care Saturdays, 1:30-4:30 p.m.

The St. Louis Neonatal Gut Microbiome Initiative Barbara Warner, MD Primary investigator

Barnes-Jewish Hospital $30 per family Helps prepare new parents and caregivers for the first few months at home with a new infant and includes

Sponsored by the Children’s Discovery Institute

infant CPR training.

In this single-session overview,

This is a twin-birth cohort study aimed

participants will learn about:

at testing the relative roles of host genotype versus early environmental

> Labor and birth, including breathing

exposures (mother, diet, etc.) on gut

and relaxation techniques, and

microbial ecology. The study will

medical and non-medical

compare how similar the microbial

pain-control techniques

community is for identical twins

> Cesarean childbirth

compared to non-identical twins in the

> Postpartum

first year of life. Recruitment will occur

The day will also include a birth video

at the Center for Advanced Medicine,

and the opportunity to tour the

Labor and Delivery, at Barnes-Jewish

Women and Infants units.

Sibling Class

Hospital and Missouri Baptist Medical

Breast-feeding

For class dates, call 314-TOP-DOCS

Center. The study aims to enroll

Barnes-Jewish Hospital

100 mothers and 25 monozygotic twin

$15 per child; multi-child

pregnancies over 34 weeks gestation.

Saturdays, 1:30-4:30 p.m.

Barnes-Jewish Hospital $30 per family

discount available

Breast-feeding is one of the most

Helps prepare children ages 3 to 8 for

effective preventive health measures for infants and mothers. This single-

the arrival of a new sister or brother.

A parent or guardian must accompany

TUPAC: Treatment of Utility of Postpartum Antibiotics in Chorioamnionitis Anthony Shanks, MD Primary investigator

session overview is designed to give new

the participant.

moms and supporting family members initiate breast-feeding, including:

Local Share Support Group: Touching Lives, Healing Hearts, Giving Hope

> Proper latch and positioning

First Wednesday of the month

trial to determine if prophylactic

7-8:30 p.m.

antibiotics are required post-cesarean

Barnes-Jewish Hospital

delivery for pregnancies with treated

the best available information needed to

> Establishing a good milk supply > Hand and pump expression > Breast milk storage > Returning to work

Multicenter trial with Washington University as the coordinating site This is a randomized, controlled clinical

Call 314-362-1788 for information

A local branch of the national Share

chorioamnionitis undergoing cesarean delivery at Barnes-Jewish Hospital are

organization, this support group is

eligible and are randomized on a 1:1 ratio

designed to help families cope with fetal and infant loss. All are welcome; registration is not required.

www . B a rne s Jewi s h . o r g

chorioamnionitis. Women with treated

to no postpartum antibiotics or postpartum antibiotics. The recruitment goal is 238 patients.

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One Barnes-Jewish Hospital Plaza Mailstop 90-75-585 St. Louis, MO 63110

Nonprofit Organization U.S. Postage

PAID Eureka, Missouri Permit No. 101

Maternal Fetal Transport 800.678.HELP (4357) • Transport services for expectant moms and babies • 24 hours a day • 7 days a week