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Major renovation set for hospital’s maternity ward

Photo: Megan McFall, director of women’s healthcare at both the hospital and at the Partners clinic with Liz Bruner, President at Indian River Medical Center Foundation.

At least 20,000 babies born at Indian River Medical Center have one shared experience: they first opened their eyes to the same surroundings – a maternity ward unchanged for more than two decades.

Now that setting is about to change, as one of the most sentimental spaces in the hospital, which became part of Cleveland Clinic Florida in January, gets ready for an extensive $12.25-million renovation.

Hospital District trustee Allen Jones delivered the good news last week that the capital campaign for maternity ward improvements is being launched.

He also announced that infant and maternal health in the county is getting better, crediting the improvement to Partners in Women’s Health – a Hospital District-subsidized, Cleveland Clinic-run OB-GYN practice providing maternal care for three-fourths of births in the county.

Partners doctors, nurses and soon-to-be-added midwives provide prenatal and postpartum care to women regardless of their ability to pay.

Jones, for whom maternal and infant health has been a pet project since 2015, proudly reeled off the latest data from 2018 at last week’s Hospital District meeting:

The county’s maternal mortality rate was zero; the neonatal mortality rate was zero; and the infant mortality rate was one-fourth the statewide rate. Adequate prenatal care as measured by a nationally recognized index was 81.1 percent in this county, compared to 70 percent for Florida as a whole.

“When you think about that and where we were just a few years ago, this is an incredible achievement on the part of doctors, nurses and staff that make the Partners program what it is,” Jones said.

The maternity ward re-do, the first in 22 years, will reduce the size of the nursery while enlarging patient rooms by 50 percent. That’s because nowadays babies stay mostly with their mothers, the majority of whom deliver their babies in the same room they recover in.

Space is also needed for new sleep sofas, added so that a friend or family member can stay overnight with the mom. Those fold-out sofas were part of a $500,000 spend this fall on maternity and neonatal furniture and equipment.

“Before this change took place, the new baby would go to the nursery after delivery,” said Megan McFall, director of women’s healthcare at both the hospital and at the Partners clinic. “Now that the baby stays with the mom; the only time they go to the nursery is when they’re having some kind of complication. There, they get one-on-one care and a pediatric hospitalist.”

The new way of thinking began to take hold at Indian River about 10 years ago, said McFall, who says providers now think in terms of the “mother-baby couplet.” They also encourage having a family member or friend stay in the mom’s room, including for new-mom education.

“Family-centered care is a new generation of care,” said McFall.

In addition to making rooms more spacious, the renovation will upgrade plumbing, medical gas systems and wiring, including improved IT hardware in anticipation of the installation of new medical records software in the near future.

“It’s not a facelift, it’s a complete re-do,” said Rick VanLith, vice president of strategy and business development at the hospital. “For the small rooms being enlarged, we’ll take it down to the studs, so there’ll be new bathrooms that are handicapped accessible."

Upgrades will include enlarging shower stalls, which McFall joked are challenging in their current state: “Try lathering your hair in there with a postpartum belly. It’s quite interesting,” she said.

The renovation, which has no start date as yet, will be more extensive than last year’s $1.2 million renovation of 96 patient rooms, similar to the renovation four years ago of patient rooms used in conjunction with the Scully-Welsh Cancer Center. That renovation also turned three rooms into two, creating space for guests to stay with cancer patients.

The renovated maternity ward will leave space for future needs as well. “The construction anticipates expansion for the population to grow or the acuity to change,” VanLith said, adding that the hospital currently delivers about 1,100 babies a year.

Having successfully wrapped up a $10.5 million stroke center campaign that topped its goal by $400,000, Liz Bruner, Cleveland Clinic Indian River Foundation president, said the maternity ward capital campaign will be the first to target younger donors, in particular, those thinking of starting a family or having more children.

“For the past 10 or 15 years, the foundation has facilitated a lot of incredible philanthropic gifts. All of them have been focused on life-threatening emergency issues that our population fears the most: heart care, stroke care, cancer care,” Bruner said. “Now that we have all those wonderful things, we’re stepping back and seeing what else needs our attention. It’s really exciting to do this.”

The renovation will include creating offices for Healthy Start Coalition, a hospital- and home visit-based program for new mothers run through the state’s Department of Health. Healthy Start has been “embedded” in the Partners clinic, as Jones put it, since 2015, when Jones helped launch a quality initiative to reduce infant mortality.

When the Partners clinic began in 1993, Indian River County’s rate of infant deaths in the first year of life was 12 for every 1,000 live births. In 2018, it was down to 1.5 deaths per 1,000 births, far below the state average last year of 6 per 1,000 births.

The zero maternal mortality rate last year compares to 17 per 100,000 statewide. That zero rate has held steady here for 14 years, according to McFall.

Indian River County’s neonatal mortality rate of zero last year is down from the county’s rate averaged over the previous three years of 3.7 deaths per 1,000 live births. In Florida, the 2018 rate was 4.1 per 1,000 births. Neonatal mortality refers to the death of an infant within 28 days of birth.

Despite the improvements, McFall says there is “laser focus” imposed by the new leadership of  Cleveland Clinic Florida on promoting breastfeeding and reducing C-sections, episiotomies and transfers to other hospitals.

Two weeks ago, McFall added another concentration: maternal opioid addiction, after she attended the Florida Perinatal Quality Collaborative kick-off of a new initiative to combat the problem, seen as a significant contributor to maternal mortality.

Economics play into the challenges of keeping women and infants healthy as well.  Nearly half the births in Florida – and 47.7 percent in Indian River County – are to women struggling enough financially to qualify for Medicaid. But Medicaid reimbursements to the doctors who care for them are notoriously low, particularly for maternity care, Jones pointed out.

“Often hospitals are trying to get away from this cost of delivering babies if they can,” Jones said. “Cleveland Clinic is doing the opposite, I think probably in part because taxpayers are supportive of this Partners program, but certainly mostly because Cleveland Clinic believes it’s in the best interest of the community to have healthy babies and healthy mothers.”