Expectant Mother Refuses to Give Up When Offered No Treatment Options
Mom-to-be Amber Cessac seeks specialty care from fetal medicine specialist Kenneth Moise, Jr., MD, when told she would lose her twin babies only 20 weeks into her pregnancy
Reviewed by: Amber Cessac (former patient) and Kenneth Moise, Jr., MD
Written by: Ashley Lawrence
The worst feeling a new mother can experience is knowing her baby, or babies, are in danger and being told there is nothing she can do about it. Mom-to-be Amber Cessac refused to accept this reality after being diagnosed with a fetal condition that was deemed untreatable. Instead, she sought specialty treatment from fetal medicine specialist Kenneth Moise, Jr., MD, who now serves as Co-Director of the Comprehensive Fetal Care Center, a clinical partnership between UT Health Austin and Dell Children’s Medical Center.
Led by Michael Bebbington, MD, MHSc, and Dr. Moise, who have developed fetal centers across the country, the Comprehensive Fetal Care Center provides high-quality care for all types of fetal conditions. The Comprehensive Fetal Care Center care team provides families with extensive support and education regarding their unborn child’s condition, development, and neonatal care to ensure patients and their families receive the highest level of specialized care before, during, and after delivery.
“I met Dr. Moise 10 years ago under what is probably classified as the most terrible circumstances,” explains former patient Amber Cessac. “I was terrified and traumatized and just hoping that he could help us. I was around 20 weeks pregnant and had just been diagnosed with twin-to-twin transfusion syndrome. At that time, my obstetrician informed me there were no options and told me, ‘I’m so sorry, but you’re going to lose both of your babies.’ I was basically advised to just wait and see what happens, see how long my babies would last. As a mother that just really fills you with the sense of hopelessness and helplessness.
Twin-to-twin transfusion syndrome (TTTS) is a rare condition that only occurs in monochorionic pregnancies (e.g., identical twins). In this situation, the fetuses share one placenta as well as the same network of blood vessels that supply oxygen and nutrients essential for their development in the womb. TTTS occurs when an imbalance in blood exchange exists, causing one twin (the recipient twin) to receive too much blood while the other twin (the donor twin) receives too little. Receiving too much blood puts the recipient twin at risk for heart failure as the heart tries to work harder and faster to compensate for the extra blood flow. Giving away more blood than what is being received in return puts the donor twin at risk of malnourishment and organ failure. Fetal surgery is usually necessary to save one or both babies.
“I managed to find Dr. Moises’s information and called the listed phone number,” says Amber. “I spoke to his wife, Karen, the nurse navigator for their fetal center, on the phone. When we realized that I lived in the same city that Dr. Moise was practicing in, Karen asked, ‘Can you be here at two o’clock this afternoon?’ And I said, ‘Yes! Yes! Yes!’ When I got there, I had the longest ultrasound ever, and Dr. Moise said, ‘We need you in the OR first thing tomorrow morning if we’re going to save these babies.’ So, it was only about 36 hours from the time of my diagnosis to my being in the OR and having surgery with Dr. Moise to correct my TTTS.”
Dr. Moise’s wife, Karen Moise, RN, is a licensed registered nurse and serves as both a Nurse Navigator and the Nurse Manager for the Comprehensive Fetal Care Center, which is housed in the new Specialty Pavilion attached to Dell Children’s Medical Center. At the Comprehensive Fetal Care Center, all patients are assigned a nurse navigator, who serves as their primary source of communication, education, and support. The patient’s designated nurse navigator will be present at all of their prenatal visits as well as accompany the patient to surgery if an operation is needed during pregnancy. Nurse navigators are valuable members of the Comprehensive Fetal Care Center care team and are committed to seeing patients and their families through both a successful pregnancy and a successful delivery.
“I’m happy to report,” exclaims Amber, “that after my surgery, my babies thrived! Of course, it was still a difficult, stressful pregnancy. I still had to come in and see Dr. Moise over and over again. But every visit ended with a good report, and here my girls are today, just perfect!”
Since giving birth to her twins, Amber has become the proud mother of five beautiful, healthy daughters.
“After my girls were born, I started connecting with a lot of other mothers who are also in the same situation through an online support group and social media. And that was when I started to realize how incredibly lucky we were. There are so many mothers who simply don’t have access to doctors like Dr. Moise or to a fetal care center. They either live too far away or have all of these other hurdles and obstacles that they have to figure out to receive this kind of specialized care. And it really impacted me, knowing that they my girls are here when so many other babies aren’t given that option,” shares Amber.
The Comprehensive Fetal Care Center is the first and only comprehensive program in Central Texas that provides care for babies with congenital conditions before, during, and after birth, including care for the mother and baby during pregnancy, delivery of the baby, and care of the baby after birth, all in one place.
“I see Dr. Moise every couple of years,” says Amber, “and every time, I feel this compulsion to tell him everything that the girls are doing. At one point it was that they could say their ABCs, another time it was that they had just started ballet, and now it’s that they have braces! For a while, I wondered, ‘Why do I do that? Why do I feel this compulsion to tell him every little detail?’ And I know that it’s because I want him to remember, although he already knows, that this is not just a job, and these are not just numbers and statistics. These are lives, and these are souls that are here that wouldn’t otherwise be here. To be here, today, and think about what the future holds in which there are going to be that many more ballerinas and that many more sets of braces on teeth, that is really what his work is all about.”
Patients being cared for by the Comprehensive Fetal Care Center are able to receive their obstetrical care at the Maternal Care Center (MCC), a high-risk obstetrics clinic located in the same suite as the Comprehensive Fetal Care Center. This integration of maternal and fetal care enhances the overall experience for patients and their families and allows for close collaboration between fetal medicine specialists and obstetricians. Consultation with fellowship-trained maternal-fetal medicine specialists is also available at the MCC for more complicated maternal medical conditions.
Dell Children’s recently opened a Specialized Delivery Unit (SDU), an 11-bed labor and delivery unit that provides comprehensive care to healthy mothers, such as Amber, and their high-risk babies who are being cared for at the Comprehensive Fetal Care Center. Through this addition, special delivery services are available 24 hours a day, 7 days a week.