Expertise and empathy guide Tiffany Tonismae, MD, UofL Health’s maternal-fetal medicine and high-risk obstetrician
“There’s only two of us, but we have nurses, medical assistants, general OB/GYNs, and 24 residents that are all working as a team to provide care for not just Louisville, but the state of Kentucky and southern Indiana,” says Tonismae, who is also an assistant professor in the Department of Obstetrics, Gynecology and Women’s Health with the University of Louisville School of Medicine.
Tonismae grew up in South Carolina and was inspired by a local physician at an early age to pursue a medical career. She earned a bachelor’s bachelor’s degree from Wofford College, then attended the University of South Carolina School of Medicine. She did her internship and residency in obstetrics and gynecology at Virginia Tech Carilion; then she completed a maternal-fetal medicine fellowship at Indiana University School of Medicine.
Tonismae continued her career at Johns Hopkins All Children’s Hospital in Saint Petersburg, Florida, for four years. Over time, she came to realize that she missed the teaching component of her work and looked for other opportunities. With some friends and family in Louisville, she found UofL Health to be a logical fit.
“I just fell in love with the setup and structure,” she says. “I spend a lot of time with students, with residents, teaching every single day, but I also still get a moment to have some private time with patients. It’s the best of both worlds.”
Empathy and Understanding
Due to the extremely serious nature of the care Tonismae provides, patients have many questions along with fears and anxieties. Tonismae says patients usually are referred to her because there is something abnormal on the ultrasound, something wrong with the fetus, or the mother has a medical condition that creates higher risk. She also does preconception visits with women who are at a high risk for complications and want to optimize their health before they get pregnant.
“There’s a lot of anxiety when people come to see me because there’s usually something going on,” says Tonismae. “My first step is to try to make people feel comfortable. I always start with making sure they know why they are there to see me. I want to make sure that what their OB is concerned about is the same thing they are concerned about.”
Sharing duties with Miller, Tonismae is on call every other week, covering the hospital consults and doing the rounds in the morning, followed by any scheduled deliveries or procedures. The afternoons are usually spent in the clinic.
Tonismae performs cesarean sections, cervical cerclages, high-risk deliveries, breech babiesdeliveries, and hysterectomies. Her patients present with a wide range of potentially serious issues, including hypertension, history of transplants, history of trauma such as gunshot wounds during pregnancy, thyroid disorders, advanced maternal age, and obesity.
Mental health has also become a more prevalent factor in high-risk pregnancies. Accordingly, Tonismae sees patients with anxiety, bipolar disorder, depression, and PTSD.
“We are finally getting the message out there that it’s OK to not be OK, but you have to be willing to talk about it and seek help for it,” says Tonismae.
Diagnostic Technologies Are Life-Changing
Along with increased mental health awareness, other advancements in maternal healthcare include the use of technology such as ultrasound and MRI. Tonismae says that, when ultrasounds are limited, an MRI can reveal vital information, such as specific anatomy of the brain and how the placenta interacts with the uterine wall. Another significant advancement is genetic testing.
“Thirty years ago, the only option to get answers beforehand was to do an invasive procedure that put you at risk of losing the pregnancy,” says Tonismae. “Now I can send the mom to get some blood drawn and I can give her some pretty good specifics about her risk of having abnormalities with the pregnancy. That has made people a lot more comfortable and has made genetic screening more available for every patient in pregnancy.”
While helpful, the results of these screenings aren’t always good. The conversations aren’t always easy. The decisions can be even harder, particularly in the modern political climate.
“When I first started here, we had a patient whose blood screening tests showed an abnormality in the baby’s chromosomes,” says Tonismae. “An ultrasound showed multiple abnormalities. She had an invasive screening test to prove what we suspected. Because of that test we were able to get consults from other subspecialists before she delivered. We were able to talk about delivery in a way where she would get closure because, unfortunately, this baby was not going to survive. A lot of our conversations were geared toward what were her goals for delivery and what she wanted it to look like for her child.”
Tonismae continues, “One of the things she said to me was, ‘I want to be able to hold my child while my child is still living and I want to do everything I can to make my child comfortable.’ We were able to have specialists available at delivery and have everything scheduled. She had other children at home, so we were able get pictures, get mementos, record baby’s heartbeat, get her pictures for her family to have afterwards. If we didn’t know all of this beforehand, that baby probably would have been swiftly swept away to the NICU and mom may not have had a chance to really see the baby before the baby passed.”
Silver Linings
Even on the hardest of days, Tonismae tries to help her patients find a silver lining.
“When it’s bad news, the patient’s first emotions are always fear, anger, and sadness,” says Tonismae. “When you see them come back, you watch those emotions evolve. They are not afraid, because they have a better understanding. They may still be sad, but they are happy with the plan. They may still be angry, but a lot of them have turned that anger around into helping other people in their same situation. My favorite thing is when somebody comes in, gets bad news, and when I see them postpartum, they tell me that they joined a support group and they shared their story. They helped somebody else in their same situation. That’s what is going to make it a better world. We are not just here for ourselves. We are here for everybody who comes after us.”