Obstetric medicine niche builds slowly.(News)

By most odds, the patient would have died. Only 10%-15% of women survive a postcesarean amniotic fluid embolus.

"She was coded numerous times," recalled Kathleen Cote Bowling, M.D., an ob.gyn. at Women and Infants Hospital, Providence, R.I. Still, the patient survived and is doing well today "due to the huge team effort and the fact that we had an obstetric medicine specialist there to take care of the code," she said.

The obstetric medicine specialist made specific recommendations related to the physiology of the amniotic fluid embolus, and worked with the obstetrician and anesthesiologist on the scene to pull the patient through until she could be transferred next door to Rhode Island Hospital, which has an ICU.

Women and Infants Hospital is the epicenter of obstetric medicine in the United States, with the oldest and largest obstetric medicine service and a 2-year fellowship that has prepared 14 fellows to start obstetric medicine practices across North America. Most obstetric medicine specialists are internists who get extra training in managing medical problems such as diabetes, hypertension, asthma, or preeclampsia during pregnancy.

"Having this department has really done only good things for the care of women in Rhode Island," said Dr. Bowling, also of Brown University, Providence.

Founded 14 years ago, the department now claims six full-time obstetric medicine physicians. The hospital's staff also includes a gastroenterologist who can practice obstetric medicine, psychiatrists with expertise in behavioral health care for pregnant women, and other subspecialists with skills related to pregnancy.

The need for obstetric medicine is greater than ever, said Raymond Powrie, M.D., an internist and director of the fellowship program at Women and Infants Hospital. He also is president of the North American Society of Obstetric Medicine. About 500,000 of the 5.5 million pregnant U.S. women each year develop medical complications.