Norton Children’s Maternal Fetal Medicine treats mother and child before and after delivery.
LOUISVILLE — Since childhood, Tamina Singh, MD, knew she wanted to make a difference in people’s lives. Now as the director of Norton Children’s Fetal Care Program, she is changing the lives of babies, some while they are still inside the womb, while also recognizing the importance of caring for their mothers.
Singh is a neonatologist with Norton Children’s Neonatology, also serving as the medical director of the NICU at Norton Children’s Hospital. Her love of medicine stems directly from the influence of her own pediatrician.
Born in Mandeville, Jamaica, Singh moved to Kingston for high school and earned her bachelor’s degree in biochemistry from the University of West Indies, where she also earned her medical degree. After a residency at the University of Illinois at Chicago, she did her neonatal-perinatal medicine fellowship at Cincinnati Children’s Hospital.
“From the very beginning of my medical training, I knew I needed to be in pediatrics,” she says. “I had been in love with my pediatrician since I was seven. I wanted to be just like her when I grew up. I always felt better when I left. What you went in for, or even if you weren’t cured when you left, you were healed in some way. I wanted to be able to do that for others.”
It was in Chicago where Singh received training in pediatrics.
“I fell in love with the neonatal population because of their resilience,” Singh says. “They can come back from so many hits and so many traumas and still survive and thrive. It was their strength and their bravery that was so inspiring, and it still inspires me every day.”
Chicago is also where she met her husband, Edward Kim, MD, a pediatric interventional cardiologist at Norton Children’s. The two were able to join Norton Children’s in 2007 to both work in pediatric medicine.
Singh now leads Norton Children’s Fetal Care Program that identifies fetal concerns and coordinates with an interdisciplinary team towards a successful delivery and beyond. The program orchestrates care from maternal-fetal medicine specialists, neonatologists, pediatric subspecialists, and surgeons to create a personalized care plan for mother and baby.
“Our patient is the infant, but maternal health can influence the health of the fetus; it’s a dyad,” she says. “For instance, in moms who have uncontrolled diabetes, their babies can be born with respiratory and cardiac symptoms, or they can have blood sugar fluctuations that are very dangerous to the developing brain.”
Many moms and babies in Kentucky and Indiana need specialized care. Norton Children’s Maternal Fetal Medicine works to keep the two together and to care for them both, Singh says. Pregnant women are screened with an ultrasound between 18 and 22 weeks. This provides a look at the baby’s anatomy that can clue doctors in on any potential abnormal fetal diagnosis that exists.
As an example, if a local physician identifies an issue in the fetus’ heart, they can refer to the Norton Children’s Fetal Care Program. The multidisciplinary team provides a diagnosis and works with the mom’s OB-GYN to develop a plan for both the mother and baby for delivery and postnatal management.
At the time of referral, Singh says, the mother is assigned to a nurse navigator whose job it is to help streamline care for both mom and baby and act as a caring and consistent point of contact for the family.
“We have these two wonderful nurse navigators, Stacie Hartlage, BSN, RN, and Devanae’ Wright, BSN, RN, and their role is to ensure a seamless experience both for the referring providers and for the family,” Singh says. “Rather than folks having to contact multiple offices, these ladies organize the entire visit, and then personally accompany the families to their consults.”
Staying in Home Communities with Added Comprehensive Care
Norton Children’s Fetal Care program is structured so that not only are both the mother and the fetus treated, but the mom and babies are allowed to stay in their communities whenever possible, says Kristine Lain, MD, maternal-fetal medicine specialist and medical director of Norton Children’s Maternal-Fetal Medicine.
“Our vision is to provide the highest quality comprehensive care to pregnant women and their babies in our region and our state,” Lain says. “Norton Women’s Care has the highest number of births in the region, with approximately 9,000 deliveries across our four labor and delivery units. That high volume, combined with the highest level NICU care, and the strong collaboration between pediatric and adult subspecialties at Norton Children’s and Norton Healthcare, made the decision to join the team an easy one. We have the people and resources to care for the highest acuity patients.”
Lain went to medical school at the Pritzker School of Medicine at the University of Chicago, then did her residency in obstetrics and gynecology at the University of Pittsburgh School of Medicine before doing a fellowship there in maternal and fetal medicine.
Now at Norton Children’s Maternal-Fetal Medicine, she says the program sees patients from all over Kentucky and southern Indiana and works with them from diagnosis to delivery and beyond.
“We have team members located not only in Louisville, but also in Bowling Green and Paducah,” she says. “We provide in-person as well as telemedicine care for patients requiring imaging and consultative services. As we near the end of pregnancy, optimal location of delivery is often a question. When complex patients would benefit from delivering with us, then the next step is often to have a multidisciplinary telecare conference with all of the subspecialists that may be involved with their care, either in the intrapartum or postpartum period.”
While the goal is to have mothers deliver at their local hospitals as often as possible, the team has to consider whether or not the mother and baby will receive the level of care needed in their home communities. The challenges of too few obstetricians in the state, coupled with lack of access to labor and delivery services, means sometimes advising patients to deliver outside of their hometown. For the highest level of care, moms can deliver at Norton Hospital, which is connected by pedway to the Level IV NICU at Norton Children’s Hospital, or Norton Women’s & Children’s Hospital, home to a Level III NICU.
“A major factor for the safety of some of these complex patients is their local resources,” says Lain. “If we can provide consultation and support to have them deliver with their primary OB, we definitely try to do that.”
Specialized Care for Childbearing Women
Norton Children’s Maternal Fetal Medicine also offers two mom-specific programs – the Wendy Novak Diabetes Institute Perinatal Program, and the Norton Maternal Opiate and Substance Treatment (MOST) Program – that are expanding what care is available for pregnant women in the region.
Lain says the Wendy Novak Diabetes Institute Perinatal Program is unique in the region. It has a dedicated clinical suite equipped for in-person and telemedicine consultations, expanding services available to women with diabetes who want to have children or are currently pregnant. The program has four nurse practitioners and two nutritionists who are certified diabetes educators. The team works with women who have diabetes to help them through their pregnancies.
“The expansion of our personnel has really allowed us to serve more women with diabetes during pregnancy, not only locally, but many patients in the region,” Lain says. “Not all the patients will deliver with us. Many of them will come into the perinatal program for care during pregnancy but then deliver in their home communities.”
The Wendy Novak Diabetes Institute Perinatal Program offers preconception counseling for women with type one or type two diabetes, and for women who end up developing gestational diabetes. Lain says the program gets about 7,000 visits a year from 900 unique patients.
The MOST program is a specialized, compassionate care initiative that helps pregnant and postpartum women with substance use disorders. Led by Kendall Stevens, MD, the program features social workers and doulas who specialize in the care and education of women with substance abuse disorders during pregnancy and provides women with hospital stabilization and detoxification services as well as an outpatient recovery program. This allows qualified professionals to help women manage withdrawal while monitoring the fetus, and helping the mothers through recovery programs that can include medical therapy, pregnancy care, parenting support and other substance abuse disorder recovery resources.
“What we have seen as a trend over the last several years is the use of additional substances as opposed to traditional opiate abuse,” Lain says. “We’re seeing much more polysubstance use, including fentanyl and other synthetic opioids. The program has embraced care plans for these complex substances that extend beyond traditional opiate use. We offer the initiation of medical treatment, whether that’s with Suboxone/subutex or methadone. The program is also one of the first programs that got Narcan into patients’ hands readily in terms of a quick treatment for overdose.”
Norton Children’s Opening Fetal Care Center
As the need for specialized fetal care increases in the region, Norton Children’s is expanding to ensure the best possible outcomes for both mother and baby. This fall, Singh says the Fetal Care Program will become the Norton Children’s Fetal Care Center. The center will bring maternal-fetal medicine specialists, pediatric sub-specialists, and advanced fetal imaging together in one location to make the experience even easier for the patients.
“We will have all of the sub-specialists and additional support staff, including social work and genetic counsellors available for consultation with these families,” Singh says. “The goal is to have a network of OBs and pediatricians throughout the state that know us and trust us, so they know these resources exist in their own state.”
Once opened, the Fetal Care Center will be located at 601 South Floyd Street, directly across from Norton Children’s Hospital. But the beauty of the center is not where it’s housed, Singh says.
“The beauty of the Fetal Care Center is that it’s not just about the building,” she says. “It’s about the dedicated and talented people who provide the care for these families who are facing a difficult, and sometimes life-limiting diagnosis for their baby. This has been a journey of more than 10 years, and we are thrilled and grateful that we have this opportunity to expand our program and to ensure the best outcomes for the communities that we serve.”