Illuminating the path: Maternal-fetal medicine in Alaska and the dance of the aurora borealis

As a lifelong Alaskan, I vividly remember each time I have seen the aurora borealis. Colors have ranged from faint to extremely bright as lights dance across the canvas of the evening northern sky. The northern lights have etched memories in my mind and an impression on my soul.

There are countless myths and fictional stories dating back centuries to explain the existence of the northern lights as they relate to multiple diverse cultures and regions of the world. These explanations of the aurora’s appearance include bad omens, positive premonitions and the communication of souls reaching out to those they have left behind on earth. There are even Icelandic myths that the aurora can help alleviate the pain of childbirth—a myth that may resonate with patients during labor!

As a scientist and physician, I cannot neglect to mention that there is a factual and detailed scientific theory of electrically charged particles that explains the phenomenon of the aurora borealis. The Geophysical Institute of the University of Alaska Fairbanks even specializes in the atmospheric science of forecasting the future activity of the northern lights. Each performance is a new experience—with infinite iterations possible with each show.

The correlation between the aurora and my career as a maternal-fetal medicine (MFM) specialist is that no patient case is exactly the same, and all encounters must be individualized to understand the importance of each condition that may be affecting a pregnancy. Many perspectives should be explored to understand the patient presentation in relation to multiple realms of diagnosis, which may include physical, emotional and social determinants of health.

Training for longevity in a medical career

When I left Alaska to attend medical school, I knew in my heart that I would be back someday to work as a physician in my homeland. The process of training beyond medical school took approximately eight years, but it was worth it for the ability to serve the community in which I was born and raised.

This pathway of training included a traditional osteopathic internship, four years of OB-GYN residency and three years of maternal-fetal medicine fellowship. MFM subspecialists typically work with patients who have high-risk pregnancies, pregnancy complications and pregnant patients with chronic health conditions.

When I entered medical school, I had originally planned to pursue family medicine, but after attending my first delivery during my obstetrics rotation in medical school, I discovered a new pathway that aligned with my interests. The exhilaration of being a part of one of the most important experiences of a patient’s life—having a child—was enough to convince me to pursue it as a career.

The need for subspecialty care in rural areas

The field and practice of a physician specializing in MFM can vary significantly depending on the surrounding resources and medical practice atmosphere. There can be a broad range of outcomes in complicated pregnancies, ranging from triumphant to tragic. There is never a “routine” day when seeing patients, as most are referred for specialty care when an abnormality or complication has been identified during the pregnancy course.

In a rural setting, there are additional challenges to consider when taking care of the most vulnerable patients. Committed physicians who understand the difficulties encountered in underserved areas are needed to provide successful interventions in emergent situations. Identifying patients who may need to be transported early in pregnancy (prior to expected complications) is crucial to improving outcomes for both mothers and their babies.

As a solo MFM practicing in the last frontier of Alaska, I see patients from rural hubs who travel long distances to Anchorage to have an in-person perinatal consultation and ultrasound (areas such Fairbanks, Juneau, Bethel, Soldotna, Homer, Barrow and Nome).

Although I am located in Anchorage, the largest city in the state, services can be limited due to the lack of subspecialty physicians in the area, and this is where a physician has to rely on creativity when searching for resources that may be more readily available in significantly populated states.

For instance, there is not a pediatric cardiothoracic surgeon in Alaska. Reliable prenatal diagnosis of major fetal cardiac defects with echocardiogram is paramount to the planning and survival of neonates who may not otherwise survive without immediate life-saving cardiothoracic surgery in regional medical centers with pediatric subspecialty surgeons to repair defects after delivery. Identification of fetuses with cardiac defects needs to occur on a regular basis with MFM ultrasound to ensure the organization of proper transport of a patient to a facility with appropriate resources that are not available locally.

Maternal-fetal medicine: An experience as varied as the aurora borealis

It has been an honor to help patients of diverse cultures and backgrounds successfully navigate the difficulties that can arise in a high-risk pregnancy in my career as a physician. Given the vast distances between communities in the state, I have found that collaboration and telemedicine play a crucial role in improving patient outcomes. A typical day for an MFM specialist tends to involve conversations with other obstetricians, midwives, neonatologists and support staff to ensure comprehensive and organized care for patients.

Alaska’s vast and rugged landscape poses significant challenges for both patients and those caring for them. The state’s remote communities are often inaccessible by road, requiring patient care teams to rely on air transportation to help patients get to major medical hubs. Often, this happens when patients are severely ill or in danger of imminent delivery, leading to a stressful situation for all parties involved.

Logistical hurdles can delay critical interventions and add an extra layer of complexity to patient care. Communication of a safe transport plan with all medical personnel involved is a major key to a successful transport when directing medical transports via air or land as an MFM.

The importance of collaboration and telemedicine

Telemedicine has emerged as a lifeline for patients in remote areas. Through video consultations and remote monitoring of chronic conditions (such as diabetes in pregnancy), MFM specialists can provide expert advice and guidance to health care providers and patients in distant locations. This technology allows for timely interventions, reduces the need for patient travel in the earlier stages of pregnancy and improves access to specialized care.

Ensuring that patients understand the situation to the fullest extent possible is also the responsibility of the MFM. Interacting with and explaining conditions and plans to patients is crucial to establishing patient trust and promoting shared decision-making that is agreeable to both care teams and expecting pregnant patients and their families.

Unique cases and challenges

The experiences of working in a rural area encompass a wide range of unique cases and challenges. I commonly work with pregnant patients who have complications such as poorly controlled gestational diabetes, preeclampsia and multiple pregnancies.

The remote nature of rural communities means that these complex cases may require transfer to larger medical centers outside the patient’s hometown, adding additional stress and logistical challenges for both the patient and the health care team. Recognizing and respecting the struggles of the patients in these situations allows treatment to proceed with compassion.

Additional considerations of practicing in a remote area include environmental factors, such as exposure to extreme cold and limited access to fresh produce and supplies. This can affect the health of pregnant women and their unborn babies. MFM specialists must consider providing culturally sensitive and trauma-informed care that respects the traditions and beliefs of their patients, especially when they are displaced from their familiar home surroundings for a higher level of care.

Innovation to promote optimal patient outcomes

Being a maternal-fetal medicine specialist in Alaska is a profession that demands adaptability, resilience and a deep commitment to improving the health outcomes of mothers and neonates. Despite the challenges of practicing in a remote setting, MFM specialists in rural areas can have a significant impact on the lives of their patients.

Through collaboration, telemedicine, a multidisciplinary team approach to care and a deep understanding of the unique needs of their respective populations, MFMs are at the forefront of providing specialized care to expectant mothers and their unborn children.

Related reading:

Insights from a rural OB-GYN: A Q&A with Tammie Koehler, DO

Protecting our most vulnerable patients beyond the NICU/nursery with the Access to Donor Milk Act