In today’s tough U.S. economy, healthcare is in the forefront because of the three trillion dollars spent each year. Patients are not seeing their money’s worth and neither is the U.S. government who writes the check for a large percentage of it. The cost of women having babies too early or prematurely costs our society $26 billion dollars each year. Something has to give.
Women’s health is the topic of great political debate as you may well be aware if you listen to the news or watched both political parties’ national conventions during the past two weeks. Do women control their destinies? Do we and will we continue to have control over our bodies? These are the questions at hand. While there’s great chatter about this topic as the U.S. election nears, there’s also a quiet revolution occurring in our healthcare system that will directly affect pregnant women.
Prenatal care as we know it will begin to change, especially if you receive Medicaid or government sponsored insurance. The current trend is to visit your healthcare provider’s office individually and wait to be seen. In the future, you will be seen by your healthcare provider as a member of a group, not as an individual. This is called enhanced prenatal care with group appointments and will be the wave of the future.
Groups of 10 pregnant women will be seen at the same time for approximately 10 prenatal visits that will last approximately 90 minutes. It is anticipated that 2 healthcare providers will not only take your vital signs, listen to your baby’s heartbeat, but will also allow you to interact with the other patients in this group setting to discuss prenatal issues, receive health education information and any concerns that you may have. Believe it or not, this model of care is not new. The concept was called Centering Pregnancy and was developed by nurse midwife Sharon Shindler-Rising in 1989.
In the future, doulas and social workers along with midwives will become more prominent in terms of prenatal care as things continue to evolve. Are you ready for group prenatal visits?
At one time, a hospital would be called a 24-hour institution but now it’s a business. Within this business are shift workers that include nurses, technicians, clerical staff and even hospital employed doctors who are now called hospitalists. In a teaching hospital resident physicians also work in shifts so the responsibility of patient care is always being transferred from one group of healthcare providers to another. Do they always communicate effectively? Regrettably, “no.”
Sign-outs, handoffs, shift changes, nurses’ report. These are the multiple names for the process where a departing provider is responsible for letting the arriving provider know what’s going on with the patient. According to statistics, 80% of medical mistakes occur during shift changes and 50 to 60% of them are preventable. Listed below is an excerpt from The Smart Mother’s Guide to a Better Pregnancy that teaches pregnant moms what things should be known during a shift change.
“While in labor, there will most likely be a change of shift and a transfer of information should occur. However, it is not always successful. Information is sometimes lost, incomplete, misunderstood or inaccurate. Your doula or a family member should make a list of all tests that have been ordered since your admission. He or she should also know your most recent vital signs, including your blood pressure and whether your baby’s fetal tracing was reassuring. Other important include:
The length of time since your membranes ruptured: the longer your membranes have been ruptured, the greater your chances of developing an infection in the amniotic sac around the baby called Chorioamnionitis
A positive group B strep that must be treated with antibiotics to prevent your baby from contracting the infection
The length of time you have been receiving Pitocin. The status of your fetal tracing should be noted to make certain that the baby can tolerate the contractions caused by Pitocin.
Any other significant clinical issue that might have been discussed that could adversely affect your labor
Before the end of a shift, your family member or doula might ask the departing nurse or provider to review his or her notes regarding your care and ask “Is this correct?” When the new shift takes over, your doula or family member would show them the notes and ask whether they received the same information that was verified by the previous shift.
The path to a successful delivery becomes much straighter when everyone marches in the same direction. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Ten years of reviewing obstetrical malpractice cases has taught me that the incidence of newborn brain injuries can be greatly reduced if people would respond to emergencies in a timely manner. Therefore, every pregnant woman needs a contingency plan and should have a basic understanding of the three stages of labor. Pushing for more than two hours while giving birth suggests there might be an arrest of labor and the baby might be too big to be delivered vaginally.
Ideally, first-time pregnant moms should obtain the services of a doula for support and ask the doula if she is able to perform basic fetal monitor interpretations. Doulas and child birth educators can become powerful Labor Room Advocates if they are able to recognize reassuring and nonreassuring fetal tracings. Not only will this increase their marketability, but also help educate patients’ families if there is a problem during labor that is not being addressed by hospital staff in a timely manner.
Because a hospital is a 24-hour institution, there will most likely be a change of shift during the course of labor. During this change of shift, a transfer of information should occur but is not always successful. Is the incoming shift aware that the fetal tracing has been nonreactive for the past 20 to 30 minutes or that the patient’s blood pressure is now high? A Labor Room Advocate or doula should keep a list of all ordered tests and inquire about the results.
An admitted patient should receive some form of direct communication from their healthcare provider. The management of labor should not be solely delegated to a nurse or resident physician. Problems occur when the physician or midwife is missing in action or doesn’t show up until a patient is pushing. The physician or midwife needs to have “real-time” up-to-date information regarding your progress (or lack of) in labor. If the provider is not an obstetrician, inquire as to whether the provider will have an obstetrician on standby in the event of the need for an emergency c. section.
Labor is unpredictable. By taking these pro-active steps, you greatly improve the chances of delivering a healthy baby and making the hospital accountable for providing quality care. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what do.
If unborn babies could speak, they would tell their pregnant mothers to please have someone watch their fetal monitor to make certain that they’re doing okay and not in serious trouble.
Electronic fetal monitoring was first used at Yale University in the 1950s and is a great asset in terms of checking fetal well being. Unless a woman delivers at home, most pregnant women will have fetal monitoring during the time that they’re in labor. The fetal monitor measures both the baby’s heart rate and the mother’s uterine contractions. Why is this important? Because the vein in the baby’s umbilical cord receives oxygen which is necessary for growth and development, especially in the brain. When the uterus contracts, the blood flow to the baby is reduced, then increases once the contraction is over. The fetal monitor essentially tells us two important things: (1) whether the baby is tolerating labor and (2) whether it’s receiving enough oxygen.
Of four million babies born in the US each year, approximately 875,000 will experience birth injuries. What is a birth injury? It’s any type of injury suffered by an infant as a result of the birthing process. Most birth injuries can be avoided if someone is paying attention. Babies can’t tell us when they’re in trouble with their mouths, but they can certainly do so with their hearts. The signs of normal and abnormal fetal heart tracings are included in The Smart Mother’s Guide to a Better Pregnancy. Fetal tracings are either reassuring (meaning good) or nonreassuring (not good). If the fetal tracing is nonreassuring, then the baby needs to be delivered as quickly as possible.
Despite our current healthcare challenges, babies will continue to be born. I therefore encourage all pregnant women, childbirth educators and doulas to take these bold new steps:
Become familiar with fetal tracings and the distinction between reassuring and nonreassuring traces (pages 201 and 202 of The Smart Mothers Guide®)
Doulas should become Labor Room Advocates who can be another set of eyes and ears that can address any issues during labor and make certain that appropriate communication of hospital staff (including the status of the fetal tracing) is known during a shift change
Become familiar with a high-risk specialist who can offer a second opinion in case there is a disagreement regarding labor room management
When your baby’s fetal monitor attempts to “talk” to you, everyone should understand what it’s saying.