When Rebecca Hermanski had her first child, Graham, at Marin General Hospital, it was a relatively easy, natural birth. However, as often happens during delivery, some of Graham’s blood was naturally transferred to his mother. As it turns out, Graham had inherited a rare red blood cell protein called E Antigen, from Rebecca’s husband Greg. Because Rebecca’s red blood cells lack this protein, her body’s natural response was to produce Anti E antibodies. This became a problem two years later, when Rebecca became pregnant with her second child, Grace. In her fourth month, Rebecca had a blood test that detected Anti E antibodies. Further testing determined that the baby carried the anti E protein, like her brother and her dad. That meant there was a risk that Rebecca’s immune system would start attacking her own baby’s blood, potentially causing severe fetal anemia. Rebecca and her baby would need careful, frequent monitoring throughout the pregnancy.
Fortunately, Marin General Hospital has a special arrangement with UCSF Benioff Children’s Hospital. We arranged for perinatologists, a subspecialty of obstetrics that focuses on high-risk pregnancies, to work with our experts. By her last trimester, Rebecca was seeing a UCSF specialist at the UCSF Greenbrae Prenatal Diagnosis Center near Marin General Hospital, for a weekly ultrasound. She was also getting frequent stress testing and heart beat checks. Rebecca’s OB/GYN, Dr. Brian Demuth, collaborated closely with the specialists from UCSF on Rebecca’s care during the entire pregnancy.
Because Rebecca’s antibody levels kept rising, her doctors knew that her body was potentially attacking her baby’s blood. Yet the baby seemed undisturbed. Grace was not stressed and was growing at a normal rate. Rebecca’s doctors upped the monitoring to three times a week, repeatedly checking the baby’s heartbeat and movement, and measured the level of amniotic fluid in Rebecca’s uterus. The main concern was whether the baby would eventually need an in-utero blood transfusion, a delicate procedure that would require going to UCSF. Everyone was hoping for the best-case scenario: a full–term birth, natural delivery and maybe some time under the bilirubin lights, as the baby would likely have jaundice.
Rebecca’s doctors agreed that she should deliver early and scheduled her to be induced at 37 weeks at Marin General Hospital. Although the Family Birth Center encourages women to write birth plans, Rebecca’s particular situation was too unpredictable. In addition to the anti- E complication, baby Grace was in the breech position. (She spontaneously turned 2 days before delivery). Rebecca did request an unmedicated birth and had a doula/acupuncturist to assist her.
At 7 am on a Friday morning, Rebecca came in to be induced. She was hardly dilated and her labor progressed very slowly until the decision was made to break her water. She immediately went into fast, hard labor and delivered baby Grace in two hours.
Rebecca and Greg had been told in advance that Grace would need immediate blood work and then be whisked away to the NICU for observation and treatment under the bilirubin lights. The lead nursery RN obtained blood from Grace’s foot right after birth and sent a blood sample to the lab for testing, allowing more time for Rebecca and Grace to have skin-to-skin contact and for the family to bond with the baby before she was taken to the NICU. Rebecca and Greg were able to have a room in the birth center after Rebecca’s discharge, along with a courtesy that allowed the family to spend as much time as possible with Grace.
As expected, Grace remained under observation in the hospital for nine days. She was jaundiced and was placed under the bili lights in a newborn isolette. Her parents were able to spend a lot of time with Grace in the NICU. Rebecca has nothing but praise for the NICU nurses. Because Grace needed frequent blood and infant blood coagulates very quickly, the staff worked with the lab to speed up testing so as to prick her foot as little as possible. Grace was only allowed out of the isolette every two hours for 30 minutes, during which Rebecca and Greg were able to diaper, hold and feed her.
The team monitoring Grace included pediatric hospitalists from Marin General Hospital and UCSF neonatologist Dr. Thomas Shimotake. Rebecca praises their high degree of collaboration. “They didn’t just give us lab results. They would come to us and explain in person what was going on, told us what to expect and what the game plan was. We were practically being informed in real time. The doctors kept checking in to ask us how she was eating, how she was doing. We felt like part of her care team.”
As it turns out, Grace never needed a blood transfusion, although Marin General Hospital's hospitalists were prepared, just in case, so that the baby would not have to be moved to UCSF. As Rebecca explains, “As a family unit, this was really hard on our toddler. It was great that we could stay here in Marin. One of us could go home and be with Graham every day.” Eventually, Grace’s condition stabilized and she was taken off the bilirubin lights. Even after Grace went home, she still needed a few more blood tests, just to be on the safe side. On the family’s first day back home, the hospital graciously sent them a home nurse to do the testing.
Today, Grace is a chubby, happy baby who enjoys playing in the sand with her brother Graham at Sausalito’s Schumacher Beach. Rebecca gives Marin General Hospital her unqualified endorsement: “We had excellent care with both of our kids. Marin General is outstanding in that they really promote the health of both the baby and the mom, and they are very supportive of your choices.”