A conversation with a neonatologist on the challenges of rural healthcare for newborns and their mothers
Dr. Haas, please tell us about your background.
[HAAS] I was born and reared in Dayton, Ohio, and began my career in medicine as part of a co-op program in high school, where I worked in a clinical laboratory. I maintained that position, while I completed a nursing program at the same hospital in 1977. Then I worked as a critical care nurse until I entered medical school at the University of Cincinnati in 1984. Upon graduation, I completed a pediatrics residency at Cincinnati Children’s followed by a neonatology fellowship there.
Are there any other healthcare providers in your family?
My ex-husband is now retired from dermatology. Our oldest daughter is in her third year of a dermatology residency at the University of Washington and will apply for a fellowship in dermatopathology. Her sister is finishing her pediatrics residency at Washington University in St. Louis and will begin a neonatology fellowship at Nationwide Children’s in July.
When and why did you choose to specialize in neonatal pediatrics?
I originally intended to pursue a psychiatry residency followed by a child psychiatry fellowship following my intern year. In the fifth month of my training, I did a rotation in neonatology and was hooked. I was very comfortable in the critical care arena, but I didn’t see myself as an organ system practitioner, as I prefer taking care of the whole patient.
When and why did you come to ARH?
I came to ARH in 2016 as a transition away from Level III-IV NICU care to a bit less acuity. A good friend lived in Southeastern Kentucky and suggested that I come to the area because there was a need for pediatricians. I began working for ARH at the Mary Breckinridge facility and provided hospitalist coverage for pediatrics and newborn care at the Hazard ARH hospital. I have provided hospitalist coverage at Middlesboro ARH, Whitesburg ARH, and Highlands ARH over the years as well.
Describe your patient population.
Training in perinatal-neonatal medicine prepares you to care for humans in their first 28 days of life with a significant focus on mothers as well, because her pregnancy is the infant’s medical history. Neonatology involves taking care of any newborn who is born prematurely, experiences birth trauma, develops an infection or otherwise becomes ill, has deformations or malformations that may impact function, or has inherited diseases or chromosomal abnormalities that can be life-limiting or cause significant morbidity. It is the only arena in medicine in which you can have a patient that weighs 500g and a patient that weighs 5000g in the same room and still call them “newborn.”
Describe your first meeting with the parents and the conversations about choosing a treatment plan.
The birth of a newborn is a huge event in any family, generally much anticipated and dreamed about. If an infant is born with a medical issue, it is often very frightening. It’s important to communicate truthfully and proportionally. By that I mean explaining the clinical situation in a clear and understandable way. I will often tell the parents, “I promise I will tell you what I know, I will not keep secrets, and I will let you know if I am ‘Doctor’ worried.” My goal is that they can trust that their baby is in good hands. Once they get beyond any medical issues, they are still going to be taking home a new baby, and I want them to feel confident about that.
What does a week in your professional life look like?
It is easier to describe my time as a month. For two weeks a month, I move out of my house and stay in Prestonsburg where I provide coverage at the Highlands hospital. I am on call for any emergencies, of course, but take care of all newborns and any pediatric patients that are admitted. Back in Hazard, I am on call for a week where I provide similar hospitalist support. I also see patients at the Hazard ARH clinic. In my role as system medical director, I am involved in education, development of policies and procedures, peer review, and other administrative tasks. I am also involved in medical staff governance for Hazard ARH.
ARH has been expanding neonatal care throughout Southeastern and Eastern Kentucky. How has this impacted your medical practice?
There are currently four hospitals in the system that provide obstetric and neonatal care. Our goal is to provide care to as many families in the region as possible. Having a Level-II NICU in Hazard and Highlands allows us to keep more babies near their families. As we have established a collaborative relationship with UK Children’s Hospital and our nurseries, there are also more opportunities for education and training.
“ARH is expanding the provision of more specialized neonatal care in Southeastern Kentucky. We are trying to have as many of our infants and children cared for by the ARH system as possible.” — Marjorie Haas, MD
Describe the challenges you encounter in providing neonatal pediatric care in Eastern and Southeastern Kentucky. How has neonatal care improved in the last 10 years?
The challenges in providing neonatal/pediatric care in Southeastern Kentucky are many. There are challenges with substance use, inability to access care, or other social realities that can impact the ability to have a healthy, well-monitored pregnancy. In the last 10 years, we have given some mothers with substance-use disorder an option to be in a monitored program that can provide medication to manage cravings for substances and promote a more stable pregnancy. We are also developing a better understanding and ability to care for newborns who may have been substance exposed.
What’s on the horizon for your medical practice and the specialty? What will be the next innovation and advancement in neonatal pediatric care?
We have definitely impacted newborn care in the area with two Level-II NICUs in the area. We will continue to enhance education to optimize that care. We will be initiating a specialized program, NASCEND, to monitor and optimize care for our newborns who have been substance exposed during pregnancy. It is a multifaceted approach that involves “Mom as medicine” and a focus on nonpharmacologic support for managing their withdrawal symptoms. It is supported by data and nursing-focused, and I believe it will decrease the length of time babies will be hospitalized at this very vulnerable time in their lives.
In the pediatric realm there is a real need for targeted mental health care. I really hope that we can work toward the establishment of a pediatric psychiatric inpatient facility on the Hazard campus that will allow us to keep some of these kids closer to home.
What’s your “why” for being a neonatal pediatrician at ARH?
My “why” was initially to fulfill a need for neonatal/pediatric support in a less intensivist environment but became a recognition that I still have a lot to offer in other roles. I also really wanted to live someplace beautiful.