Advanced practice nursing in maternal-fetal medicine

Posted by Susan Bryar, MN, ARNP on Apr 26, 2022 5:00:00 AM
5 minute read

Nurse practitioners (NPs) play important roles at Pediatrix® Medical Group. You may be aware that neonatal nurse practitioners care for fragile babies and pediatric nurse practitioners care for children, but did you know Pediatrix also employs nurse practitioners in maternal-fetal medicine, or MFM?

Maternal-Fetal Medicine is a specialty caring for high-risk pregnancies. Our Pediatrix MFM practices care for pregnant women with any medical condition that affects them or their developing babies, such as:

  • Cancer.
  • Cardiac disease.
  • Endocrine disease.
  • Liver or kidney disease.
  • History of stroke, deep venous thrombosis (DVT) or pulmonary embolism (PE).

More common pregnancy-specific conditions, such as preterm labor, preeclampsia and gestational diabetes, are a routine part of our practices. Families may also be referred to MFM specialists for issues pertaining to the baby. Fetuses may be growth restricted, have a genetic or structural disorder or be affected by a viral syndrome or multiple gestation pregnancy.

To care for these women, one needs to attend to the effects of pregnancy on these conditions, as well as the condition’s effects on the pregnancy. Our MFM specialists work closely with genetic counselors, specialists in ultrasound (sonographers), diabetes educators and social workers to provide comprehensive care to each family referred to us.

Women’s health nurse practitioners (WHNP) and certified nurse-midwives (CNM) also work in maternal-fetal medicine for Pediatrix. Many of our NPs and CNMs have previously worked in labor and delivery or have a strong interest in high-risk pregnancy.

To become a specialist NP in many disciplines, such as dermatology, endocrinology or cardiology, you learn your specialty through additional educational offerings and on the job. This is also the case in MFM, where our formal education may have had limited high-risk pregnancy training. Therefore, at Maternal-Fetal Medicine Specialists of Puget Sound, part of Pediatrix Medical Group, when we hire an NP or CNM, our practice collaborates to train them in outpatient and inpatient MFM.

Our orientation process takes at least six weeks, but even when it’s completed, we don’t practice alone. Instead, we all support and educate each other. While NPs in Washington state can practice independently without physician oversight, the unique nature of working in MFM requires that we collaborate closely with our physician partners. Our offices are committed to practicing evidence-based medicine, and we apply protocols and best practices from Pediatrix, the Society for Maternal-Fetal Medicine, the American College of Obstetrics and Gynecology and our partner hospitals. We also follow strict internal policies and procedures.

Our NPs are credentialed through national nursing specialty boards and our state board of nursing and follow their practice guidelines. In addition, our partner hospitals require medical staff credentials for all NPs.

Nurse practitioners are valued team members. Physicians feel that our NPs are well equipped to provide education, obstetric and postpartum care. All our patients are initially seen by a maternal-fetal medicine physician for consultation. Nurse practitioners may then have a visit to establish prenatal care for the pregnancy, routine obstetric care and check-ups and delivery planning and education. Postpartum care may include wound care, hypertension or diabetes management, contraceptive counseling and initiation and handoffs back to the primary care team after completing the postpartum course.

Our satellite clinics are equipped with ultrasound and consultative services, and nurse practitioners provide follow-up consultations in those settings.

In addition to clinic work, we provide care to postpartum patients in the hospital. We discuss postpartum changes and provide anticipatory guidance to support families after the birth of their child.

When I began my career with Maternal-Fetal Medicine Specialists of Puget Sound, I was a registered nurse with labor and delivery experience. After several years with the practice, my medical director arranged for my master's degree to be sponsored by Pediatrix. I obtained my degree as a women’s health nurse practitioner, focusing on women’s health throughout their lifespan. My graduate thesis was related to my work in the MFM practice, as I explored the experiences of women after they made the difficult choice to end a pregnancy due to fetal or maternal complications. I was the third nurse practitioner hired to the practice, and we have refined and developed the NP role significantly over many years.

The patients who come to us may already know they will have a high-risk pregnancy because of their medical history, but many never expected to see a specialist. The referral can lead to significant anxiety and worry for families.

We do not tend to talk about pregnancy complications in society, so many possibilities are unknown to the greater public. Not all pregnancies end well or happily, which our patients sometimes discover when they come to our clinic. We work diligently to treat every patient with compassion and respect and want to partner with them for the best possible outcome for their family. One of the greatest gifts of working with complicated pregnancies is the opportunity to walk with people during exceptionally challenging moments and provide both medical and emotional support.

In addition, there is always something new to learn in our specialty. As ultrasound capabilities and genetic testing options increase, we are faced with new and challenging diagnoses. Women with more complex medical histories are becoming pregnant as our ability to manage their conditions improve. For instance, a patient may have a history of myocardial infarctions or a stroke, which, in the past, would have contraindicated pregnancy but now is a common occurrence.

As a nurse practitioner working in maternal-fetal medicine, I hope others find their way to this rewarding specialty. I encourage women’s health NPs and nurse midwives to consider high-risk obstetrics for their careers, as the work will be challenging, gratifying and constantly evolving.


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Topics: Maternal-Fetal Medicine, Careers, High-Risk Obstetrics