(This is a sidebar in a four-part series that was published in the Charlotte Observer from Nov. 14-17, 2010.)
When Shannon and Kips Brooks decided to continue their pregnancy with a baby that would not survive a birth defect, they were thankful for the support of their nurse midwife, Marcia Ensminger, and obstetrician Dr. Susan Roque.
"We told her anything we could do to help her through this, we would do, " said Ensminger, who works with Roque at All About Women, an obstetrics-gynecology practice in Mooresville.
The duo performed seven procedures in the last nine weeks of Shannon's pregnancy to remove excess amniotic fluid from her uterus. The condition occurs in some cases of anencephaly when the fetus is unable to swallow normally. As fluid accumulated, Shannon had contractions and discomfort.
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Some health care providers at Lake Norman Regional Medical Center questioned whether the procedures should have been done, Ensminger said. But without them, she said, Shannon probably would have gone into early labor, dashing the couple's hopes to donate the baby's liver cells and heart valves.
The "amnio reduction" procedure involves sticking a long needle into the uterus. It could cause a uterine infection or induce labor - the very thing Shannon was trying to avoid. But Shannon knew the risks and wanted to go ahead.
Dr. William Goodnight, a maternal-fetal specialist at UNC Chapel Hill School of Medicine, said the fluid-reduction procedure is appropriate if the mother is having symptoms of discomfort.
"It's too bad she had to have seven procedures, " said Goodnight, who had no role in Shannon's care. "But an amnio reduction is fairly low-risk and (a) not super-expensive intervention that would be reasonable to do."
The Brookses have received bills of about $3,000 per procedure. They don't yet know the total charge for the pregnancy and the delivery. Health insurance will cover much of the cost. So far, they expect to owe out-of-pocket about $3,000 to the doctor and midwife and about $1,400 to the hospital. They are arranging payment schedules.