The Role of Nurses in Fetal Care

Review highlights the integral contributions of perinatal, neonatal, critical care and pediatric nurses in fetal therapy programs

Published on in CHOP News

The past five decades have shown major and rapid advancements in the detection and treatment of fetal anomalies during pregnancy. The experience of being an expectant parent who receives a diagnosis of a fetal abnormality has changed drastically, and many fetal diagnoses once considered lethal are now treatable and even curable during gestation.

Nurses have made important contributions to the development of fetal therapy since intrauterine interventions were introduced in the 1960s. Nurses have cofounded fetal therapy programs and have been described as “the glue” of fetal care centers by their physician colleagues. Yet, visibility and understanding of nursing practice in this field have remained limited.

“This year, as we mark the 25th anniversary of our center, we really want to shine a light on the perspective and many contributions nurses have made to the field of fetal diagnosis and treatment,” says Susan S. Spinner, MSN, RN, Advanced Practice Nurse and Senior Manager of clinical operations and Research at Children’s Hospital of Philadelphia’s (CHOP) Center for Fetal Diagnosis and Treatment. “To do so, we performed an integrative review of published literature to develop a comprehensive view of nursing practices in the field of fetal therapy.”

The review, which was led by Spinner, has revealed both the depth and variability of the role perinatal, neonatal, critical care and pediatric nurses play in regard to fetal programs, which includes:

  • Care coordination, education, patient counseling, maternity care (assessment and treatment of pregnancy-related issues), pre- and postoperative bedside care, and care in the operating room
  • Addressing mental health problems, specifically maternal anxiety guided by expert knowledge of fetal anomalies
  • Listening, empathizing and reflecting on how a fetal diagnosis may affect a woman/family
  • Advocating for women and their families
  • Acting as a liaison between team members in the various specialties and the expectant parent and family
  • Developing and disseminating maternal and neonatal guidelines for fetal therapy at the local, national and global level

“Nurses have unique expertise and practices they use to provide clinical care; connect with expectant parents and their families; and develop programs, research and policy in fetal therapy,” says Lori J. Howell, DNP, MS, RN, Executive Director of the Center for Fetal Diagnosis and Treatment. “Our practice is essential to the health and well-being of a woman and her family, including the fetus.”

At the University of California, San Francisco Medical Center, Howell served as the very first fetal surgery nurse coordinator for that institution’s nascent fetal program. While at UCSF, as the Clinical Nurse Specialist for Pediatric Surgery, she also developed the pediatric pain management, tracheostomy and clean intermittent catheterization programs and worked to champion education for patient families.

Howell was integral in launching the Center for Fetal Diagnosis and Treatment in 1995 and in assembling the multidisciplinary team that brings an exceptional depth of experience in every known aspect of fetal diagnosis and therapy. More recently, she spearheaded the creation of the unique Garbose Family Special Delivery Unit and created and led a new training program at CHOP for Surgical Advanced Practice Nurses. She is a recipient of the Founders Award for Excellence in Pediatric Surgical Nursing.

The literature review by the center team revealed a lack of standardized education, training and structure for nurses in fetal therapy programs. Some processes practiced by a perinatal nurse at one center were practiced by a fetal surgery nurse or a care coordinator in others. Based on the review, the team sees a major need for nurses to take on leadership roles in program development and administration, clinician education, and scholarship.

“Nurses have made many important contributions to the field of fetal therapy as it has evolved over the past several decades,” says N. Scott Adzick, MD, Surgeon-in-Chief at CHOP and Founder and Director of the Center for Fetal Diagnosis and Treatment. “By working together, nurses are in a unique position to shape the field of fetal therapy in a way that ensures the best maternal-child care.”

Integrative Review of Nursing Practices in Fetal Therapy. Wilpers A, Francis K, Spinner SS, Kennedy HP. J Obstet Gynecol Neonatal Nurs. 2020 May;49(3):254-262. Epub 2020 Feb 25.

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