The Cupertino Courier
Cover Story
Photograph by Brian Connelly
Paul Draper inspects the budding grapes June 20 in the vineyard at Ridge Winery in Cupertino.
Healthy Babies
Perinatal program at Kaiser couples RNs with at-risk moms-to-be
By MICHELLE MAGHRIBI
Can a weekly telephone call become a lifeline? Cupertino resident Veronica Mendoza, 35, and her 13-month-old daughter, Savannah Eve Contreras, are proof it can.
Diagnosed by a Kaiser Permanente doctor with gestational diabetes and high blood pressure during her pregnancy, Mendoza was offered help from Kaiser that included weekly phone monitoring by nurses.
"I was diagnosed with diabetes during the 14th week of my pregnancy, and later on, in my eighth month, I was monitored for high blood pressure," Mendoza said. "One of the most difficult things was changing my eating habits."
Mendoza found the diet prescribed for diabetics extremely difficult, particularly for someone who liked fast foods and sweets.
"I thought when I became pregnant I'd be able to have sweets, which I love," Mendoza said. "When I was diagnosed with diabetes, I was really surprised."
The Kaiser Regional Perinatal Service Center, located in Cupertino, is a doctor-ordered service. It offers monitoring and support to Kaiser's high-risk obstetrical patients such as Mendoza, whose diagnoses include diabetes, high blood pressure and incompetent cervix. Each condition could end up in pre-term labor and/or birth if not monitored closely.
The center utilizes technology and the telephone to help patients with support, education and direct communication. Translation services are provided by Kaiser through AT&T for those who speak languages other than English.
Mendoza gained approximately 17 pounds during the entire pregnancy and delivered a healthy 7-pound, 4-ounce baby girl. She credits nurse Dina Laboriante for being her guiding light and inspiration.
"It was so hard because I didn't have time to cook my own foods," Mendoza said. "Dina never made me feel bad or made me feel like she was judging me. She gave me encouragement and let me know that I was doing fine, even though sometimes I felt that I was not."
Nurse manager Jenny Ching has been with the program since its inception 15 years ago. She said no other health plan has such a service.
"Our goal at the perinatal center is to empower the patient to take care of themselves and educate them on symptoms and signs of pre-term labor and birth," Ching said. "Many patients are able to control their diabetes and high blood pressure without medication through diet and careful monitoring."
Mendoza is married, has five stepsons and worked full time during her pregnancy. Having a difficult pregnancy and a busy life made things stressful, including having to test her blood sugar levels one hour after she ate.
She remembers she had virtually no time to cook her own food before running to work and would have to eat "on the run," which often conflicted with the strict diet.
"I was always rushing around, and sometimes when I was having trouble with the diet, I felt like a failure," said Mendoza. "Dina made me feel better and would say, 'OK, let's just start fresh tonight,' and would make suggestions for other food I could eat while I was out."
According to Ching, the service operates around the clock with two shifts of six nurses from the hours of 7 a.m to 11:30 p.m. with one nurse on call for the late evening/early morning shift. Nurses wear headsets while they talk to patients and are able to view a patient's medical information on the computer.
Patients are first educated and trained on how to operate technical equipment needed for monitoring of blood sugar levels and blood pressure readings and, depending on the condition, readings are monitored carefully by a nurse on a weekly or daily basis.
Mendoza says Laboriante was like an old friend and would phone her weekly, usually during the dinner hour at Mendoza's request. The nurse would listen to the blood glucose levels Mendoza recorded for the week and advise her on her progress, giving her an extra dose of positive support.
When Mendoza was diagnosed with hypertension toward the end of her pregnancy, Laboriante monitored her blood pressure readings over the phone on a daily basis, along with the diabetes reports.
"It was a very emotional time, and Dina never made me feel bad. She gave me plenty of TLC," says Mendoza.
Laboriante has been a registered nurse for more than 25 years and has been with Kaiser Permanente for approximately 20.
Working as an advice nurse for 15 years, she has been part of Kaiser's regional perinatal service center for the past four years.
Laboriante has fond memories of Mendoza.
"I remember she was very nice to talk to," Laboriante said, adding that giving positive reenforcement comes naturally to her and she treats patients the way she likes to be treated.
Laboriante has tried the diet for diabetics, learning first-hand how hard it can be to follow, especially when pregnant. She said Mendoza was dedicated and didn't give up even when things got tough.
"The diet is really hard, and you have to eat every three hours," Laboriante said. "People who have tried it in our department have lost weight while on the diet."
Mendoza said while both diagnoses during pregnancy were unexpected, many of her family members have hypertension and diabetes.
"With the help of Dina and some other nurses, I was able to control the diabetes and the hypertension solely through diet," Mendoza said. "They did not administer medication for the high blood pressure until I went into labor."
The Kaiser Perinatal monitoring experience was so positive for Mendoza that if she didn't have six wonderful kids already, she would think about having another, and said all the co-operative hard work paid off.
"The emotional part was the hardest, but it was all worth it, every bit," Mendoza says. "I have a beautiful baby girl who luckily started sleeping through the night only three days after she was born."
About the Service Center
The program is doctor-ordered for those Kaiser obstetrical patients who are considered high risk for preterm labor and/or birth. The center was founded in 1991 by Dr. Donald Dyson and was based on his 51/2 year study geared at finding the best way to care for at-risk moms. According to Kaiser representative Karl Sonkin, the center was probably the first tele-medical program in Northern California. At its inception more than 15 years ago, the center monitored approximately 20 patients. Today it is estimated the center services an average of 900 at-risk moms in Northern California. Regional coverage for the center extends as far south as Fresno and as far north as Santa Rosa. According to Sonkin, the perinatal service boasts a 94 percent patient satisfaction rating and reports indicate the rate of pre-term births for Kaiser Permanente Northern California remains very low at 2.8 percent to 2.9 percent. Currently conditions that are monitored by the center include diabetes developed during pregnancy (gestational diabetes), high blood pressure, and a condition called incompetent cervix where a mom-to-be has problems carrying the child due to a weak or short cervix.
Conditions defined
Gestational Diabetes
Diabetes or intolerance for glucose developed during pregnancy. It is estimated between 2 percent and 7 percent of moms-to-be develop the condition, making it one of the most common health problems during pregnancy. Kaiser reports of all the conditions monitored by the center, diabetes represents the highest percentage. Women are usually tested for gestational diabetes during the 24th to the 28th week of pregnancy. The Kaiser phone center reported a 27 percent lower chance of babies born over 10 pounds for women who used the monitoring service. Risks can include extra large babies weighing more than 10 pounds (macrosomia), jaundice and pre-eclampsia.
Incompetent Cervix
A condition where a pregnant mother's cervix is weaker or abnormally shorter than normal making it difficult to support the weight of the baby as it develops. The center's nurse manager, Jenny Ching, said approximately 6 percent of the women monitored by the center have the condition. According to Ching, most of the women have had previous miscarriages and are usually on bed rest. The center monitors and educates the moms-to-be on how to detect the warning signs for pre-term birth. Ching said emotional support is also an important part of the monitoring for these patients.
"Most of them have miscarried before and are fearful of losing their baby. When you help these women through this difficult time and they deliver healthy babies, it is the best feeling," Ching said.
Risks can include miscarriage or premature birth.
High Blood Pressure in Pregnancy
The center provides blood pressure cuffs to patients who are hypertensive so that they can report their results to the nurse. According to Ching, most patients develop hypertension in their third trimester. High blood pressure can be hereditary and have contributing factors that are ethnically oriented. Risks, if not monitored, can include harm to the mother's kidneys and other organs, low birth weight, pre-term delivery and pre-eclampsia .
