Rainbow Clinic, With Compassion and Evidence-Based Care, Helps Mother Deliver a Healthy Second Baby After a Loss

After experiencing a stillbirth at 34 weeks of pregnancy, Chloe Acerra gave birth to a healthy baby through Mount Sinai’s Rainbow Clinic, which offers enhanced clinical care and psychological support to women and their families who have experienced a perinatal loss. Since her successful birth, Ms. Acerra has helped to develop a mentoring program for mothers who experienced a similar loss and are pregnant again.

Mount Sinai’s Rainbow Clinic, named for “the rainbow after the storm,” was founded in 2021 by the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai in collaboration with philanthropic support. It offers multidisciplinary specialty care for patients who have experienced the birth of a stillborn child, multiple miscarriages, or a neonatal loss.

“The Rainbow Clinic gives these women access to state-of-the-art services and support that goes beyond standard prenatal care to meet all of their needs,” says Founding Director Joanne L. Stone, MD, MS, Ellen and Howard C. Katz Chair of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

The physicians are all specialists in maternal-fetal medicine, and the entire staff undergo medical and sensitivity training specific to caring for patients after a perinatal loss. The clinic places great emphasis on the parents’ mental health, has a dedicated social worker, and offers support such as group sessions and—thanks to Ms. Acerra and others—peer mentoring. Perhaps what is most unique about the Rainbow Clinic is that patients have 24/7 access to maternal-fetal medicine specialists and as many appointments and sonograms as they feel they need. The goal is to reduce fear and anxiety, as well as to prevent perinatal losses.

In Ms. Acerra’s case, it was unclear why the stillbirth occurred. She was a healthy 33-year-old, and her pregnancy was uneventful, aside from gestational diabetes that was mild enough not to require treatment. Her first-born, whom she and her husband named Birdie, died in utero at 34 weeks. “Losing my daughter, Birdie, was the hardest thing in my life,” Ms. Acerra says. The couple was determined to try again immediately. They spoke with a number of doctors, all of whom recommended the standard wait time of 18 months before attempting pregnancy. Then they reached out to the Mount Sinai Rainbow Clinic, meeting with Dr. Stone, who advised the couple they could try to get pregnant right away.

“I felt it was enough time—she was healthy and in good physical shape,” Dr. Stone says. “I also think for patients such as this, you also need to consider the emotional benefit to not delaying someone for too long if they feel they are ready.” A few months later, Ms. Acerra was pregnant.

Not knowing what caused Birdie’s death created a medical challenge; an autopsy had been inconclusive. “Our assumption was that it was a cord accident. But you can’t be 100 percent certain of that diagnosis; it’s more a diagnosis of exclusion,” says her obstetrician-gynecologist, Samsiya Ona, MD, a maternal-fetal medicine specialist at The Mount Sinai Hospital and Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

To develop a pregnancy surveillance system without specific insights from Ms. Acerra’s first pregnancy, Dr. Ona used the Rainbow Clinic’s standard monitoring schedule: appointments every two weeks until week 28, then weekly until week 32. After 32 weeks, patients are scheduled for twice-weekly exams and sonograms. But most women come in more often, because the Rainbow Clinic offers unlimited appointments.

Starting at Birdie’s gestational anniversary, Ms. Acerra’s anxiety increased, which is not unusual for Rainbow Clinic patients. “Sometimes the anxiety is so debilitating that the patient is no longer able to perceive fetal movement, even when it is happening,” Dr. Ona says. Ms. Acerra began requesting additional appointments after the gestational anniversary. Sleep became a problem, because when Ms. Acerra was pregnant with Birdie, she had gone to bed feeling fetal movement, then woke up the next morning to find it had stopped. With her new pregnancy, Ms. Acerra spent nights in the hospital in week 36, enabling a middle-of-the-night fetal assessment when needed.

The Rainbow Clinic offers patients the choice to deliver at 37 weeks, the point at which a fetus is considered full term. While the goal is to deliver at 37 weeks, often the patients have so much anxiety about a recurrent stillbirth that they carefully weigh the risks of early-term delivery against the chance of experiencing another loss. “The anxiety of staying pregnant longer with the unknown is far worse than the potential risk, if any, of delivery at 37 weeks,” Dr. Ona says. Like many Rainbow Clinic patients, Ms. Acerra elected to be induced early. After they broke Ms. Acerra’s water, the baby moved, and the umbilical cord slid between the fetal head and the open cervix, requiring an emergency Cesarean delivery. Ms. Acerra delivered a healthy baby, naming her Ruby.

Ms. Acerra expressed regret at not having had the opportunity to speak with someone who had successfully given birth to a rainbow baby. Working with Ms. Acerra and three other Rainbow Clinic mothers, the social worker created a mentoring program for women entering the clinic, developing a manual and training protocol. “People in our trainings tell us they feel like this program honors their babies who aren’t here,” Ms. Acerra says. “The trauma of Birdie allows me to live presently with Ruby and to realize how precious she is. I am so grateful to Dr. Ona and the Rainbow Clinic.”