Perinatal Institute
High Risk Delivery - What to Expect

What to Expect, Before, During and After Birth

Most pregnancies progress routinely, and the majority of newborns in Greater Cincinnati are healthy. But sometimes, mom or baby develop complications during pregnancy. When that happens, specialized care can make all the difference.

At the Perinatal Institute, our experienced team is here for families experiencing such complications — before, during and after the baby is born. From patient care and research to public health and education, we are dedicated to improving the lives and health of all newborn babies.

Preparing for Your Baby’s Delivery

If your obstetrician-gynecologist (OB-GYN) has concerns about your pregnancy, the first step may be to refer you to a maternal-fetal medicine (MFM) specialist. MFM specialists (sometimes called perinatologists) are OB-GYNs. They have additional training and experience in treating mothers and babies when health concerns arise during and shortly after pregnancy. These types of pregnancies are called “high risk.”

Our community is fortunate to have many highly skilled MFM specialists. Some work at Cincinnati Children’s and others at different organizations throughout the region. These physicians lead the care team when a woman is having a high-risk pregnancy.

During your first appointment, the MFM specialist will do a physical exam, talk to you about previous test results and possibly schedule more tests. The doctor may refer you to a neonatologist (a pediatrician who cares for premature and critically ill newborns). The neonatologist can talk to you about your baby’s health and possible medical needs, explain what may happen in the delivery room and answer your questions.

Before delivery, the MFM specialist will work with you and other team members (such as neonatologists, nurses and respiratory therapists) to ensure your pregnancy is as safe and healthy as possible. They also will monitor you and your baby for any concerns. Together you will create a labor and delivery plan (sometimes called a birth plan).

Deciding Where to Deliver Your Baby

One of your MFM specialist’s goals is to make sure you deliver at the hospital best suited to care for you and your baby. Which hospital you choose depends in part upon the level of care your child will need after delivery. Our region’s hospitals offer four different levels of care in their nurseries:

  • Level I: Basic newborn care for healthy, late preterm (born at 35 or 36 weeks gestation) and full-term babies (born at 37-42 weeks gestation).
  • Level II: Special care nursery for babies who are born at 32 weeks or more gestation and need advanced (but not critical) care.
  • Level III: Neonatal intensive care units (NICUs) for babies with a critical illness. These nurseries offer comprehensive care from a full range of medical specialists, advanced imaging and respiratory support for babies with breathing issues.
  • Level IV: Regional NICU for babies with complex, critical needs, including surgical repair. Our region’s only Level IV NICU is at Cincinnati Children’s.

Your MFM specialist will talk with you about the level of care your child may need. All NICUs in our region are staffed by neonatologists and pediatricians from a group called Newborn Care Associates. These 70+ physicians provide 24/7 coverage at all NICUs in our region.

Delivering Your Baby

Most women in our community experiencing a high-risk pregnancy deliver their baby at Good Samaritan Hospital or University of Cincinnati Medical Center in Cincinnati or St. Elizabeth Hospital in northern Kentucky. These hospitals have Level III NICUs.

However, if the care team believes your baby will need immediate surgery or intensive breathing support after birth, the delivery will take place at the Cincinnati Children’s Special Delivery Unit. This is a labor and delivery unit where pediatric subspecialists can provide immediate treatment and care in the hospital’s Level IV NICU. After delivery, you will recover at Cincinnati Children’s. This allows you to be near your baby at all times, which encourages bonding and reduces stress for you and your family.

If Your Baby Needs to be Transported to a Different Hospital After Delivery

Sometimes, babies born in one hospital must be transferred to another hospital where a higher level of care is available. For example, a baby may have medical issues that weren’t detected during pregnancy. When this occurs, your care team will arrange to transport your baby to a hospital that can provide specialized treatment.

A registered nurse and respiratory therapist will travel with your baby to the new hospital in a medical intensive care unit — either an ambulance or helicopter. Each transport team member is highly trained to provide continuous care during transport. A member of the NICU team will call you to let you know when your baby arrives and how your baby is doing.

What to Expect After Delivery

NICUs in Greater Cincinnati offer exceptional care for your baby. Each NICU is a bit different, and your MFM specialist will talk to you about what to expect during your baby’s stay.

Babies with critical medical needs often are admitted to the NICU at Cincinnati Children’s. This Level IV NICU is staffed by nationally recognized experts in neonatology, pediatric specialists in various other disciplines, and highly trained and experienced nurses.

Comprehensive Care for Babies with Complex Fetal Conditions

Some babies have a complex fetal condition that may require treatment or even surgery during pregnancy. The Cincinnati Children's Fetal Care Center offers comprehensive care for these babies and their moms. Maternal-fetal medicine specialists, neonatologists and fetal surgeons provide the most sophisticated therapies available for complex and rare fetal conditions. Since 2004, the Fetal Care Center team has evaluated about 7,300 high-risk pregnancies.