A range of local health care programs is working to improve outcomes for mothers and infants, from complex in utero surgical procedures to supporting mothers who are grappling with substance abuse and mental health concerns.
Beginnings and Blessings
Placentas used to be routinely incinerated along with other medical waste, but a Mercy program now helps ensure that this powerhouse of stem cells and nutrients—among the most promising and useful types of tissue for healing burns and wounds—no longer ends up in the trash. A simple blood test and signature are all it takes for a woman to donate her placenta after childbirth.
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Through the Beginnings and Blessings program, new mothers can donate their placenta, which nourishes the fetus until it is born. Mercy collaborates with Cardinal Biological, a company that removes the inner layer of donated placentas—known as amniotic chorion—and produces amniotic membrane patches that can treat burns and wounds. These patches, rich with regenerative components unique to placental tissue, are highly effective in healing skin with an extremely low risk of rejection.
Of the women who are candidates to donate, about 70 percent typically agree, says Dr. Margaret Marcrander, Mercy St. Louis chief of staff and a practicing OB-GYN. “It’s completely voluntary and done with informed consent,” she notes. Marcrander emphasizes that the tissue is donated, not sold, and it’s de-identified to safeguard patient information. Since last July, more than 800 St. Louis–area women have donated their placentas through the program.
Kayla Jacobs is one of them. “For me, it was a simple choice,” she says. “Either my placenta could help someone in need, or it would be discarded. I chose to give it purpose, to turn something that would be thrown away into a chance for healing and hope.”
Surgery and Spina Bifida
It’s a terrifying diagnosis for expectant parents: myelomeningocele, a severe form of spina bifida in which a fetus’s spinal cord develops in a sac outside of the back. About 20-30 patients per year receive a spina bifida diagnosis at WashU Medicine’s Fetal Care–which is a partnership among Barnes-Jewish Hospital, St. Louis Children’s Hospital, and WashU Medicine Physicians–and 5-10 of them meet the criteria and choose to undergo a remarkable in utero surgical procedure.
WashU Medicine surgeons operate on the fetus before birth, placing the spinal cord into its correct position and closing the back to protect it. The procedure occurs between 24 and 26 weeks of pregnancy, and the fetus continues to develop in utero until delivery. Since 2017, WashU surgeons have performed the procedure 44 times.
The surgery used to involve opening the mother’s abdomen and uterus, operating on the fetus, and closing the uterine and abdominal incisions. “Since 2023, we perform the same surgery via a more minimally invasive approach called fetoscopy,” says Dr. Kathy Bligard, a WashU Medicine Maternal-Fetal Medicine specialist at the Fetal Care Center. “We still make an incision on the maternal abdomen, but instead of the uterine incision, we place three tiny ports into the uterus, each less than half a centimeter, and then perform the repair this way. The great things about this approach are that we can allow the patient to be more mobile during the pregnancy and offer vaginal delivery.”
The complex procedure and care between surgery and delivery involves a team of at least seven specialists who are present during birth. Three surgeons perform the procedure together and collaborate with a pediatric cardiologist, neonatologists, and pediatric anesthesiologists.
Babies born after undergoing the in utero procedure need fewer interventions, such as shunts to remove fluid from around the brain and orthotics for early walking. “Our outcomes really speak to how careful we are with our surgery, and the fact that we see the same benefits for our fetuses having a fetoscopic repair speaks to how thorough we were to ensure that we are able to do the exact same surgery without compromising our outcomes,” Bligard says. “We have these babies follow up in our spina bifida clinic that brings all those specialists together so that families have a one-stop shop for all the specialist care for their child.”
Providing Support
According to the Missouri Department of Health, the state ranks 44th in the nation in maternal mortality, with 32 deaths for every 100,000 births. Maternal mental health conditions and substance use disorder are leading causes. Dr. Dan Jackson, a Mercy high-risk obstetrician and substance-use-recovery specialist, wanted to change that.
“These deaths and the resulting devastating impact on families are preventable,” he says. So, Jackson and Dr. Kimberly Brandt, a perinatal psychiatrist who is board certified in addiction medicine, created BRAVE (Building Recovery, Advocacy, Validation, and Empowerment). The clinic is the first program at Mercy dedicated to pregnant and postpartum women who have substance use disorder.
Patients connect to BRAVE clinic staff via telehealth or in-person appointments. The team includes Brandt, Jackson, two nurse practitioners, two counselors, a peer support specialist, two care coordinators, and a nurse navigator.
“This allows us to provide care for not only substance use disorder but any psychiatric or medical comorbidity, as well as fetal conditions that may complicate the pregnancy,” Jackson says. “Our care coordinators and therapists allow for our patients to receive full wraparound care, such as trauma therapy, assistance with finding housing, and navigating the legal and health care system, all in a single clinic.”
The results speak for themselves. “We recently saw a patient in follow-up who is doing great postpartum,” Jackson says. “When we met her, she was using fentanyl daily, had some fetal problems, as well as severe depression. Our clinic was able to see her and address all of these issues. She told us that both she and her baby were alive because of our clinic. That was amazing to hear and really drives home what we come to work to do.”
