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?
Nebraska has recently been on the radar screen for their controversy regarding public funding of “illegal” pregnant immigrants. Although Nebraska’s governor vetoed the bill that allowed funding for prenatal care, the Nebraska legislatures had the good sense to switch the benefits to a state-funded program for children which would include the unborn babies. Should the unborn be penalized because of their mothers’ immigration status?
When the general public hears the word “illegal” associated with the word immigrant, they immediately think of people who are born south of the border. But if the truth be told, there are pregnant women who enter the U.S. as tourists every day, have their babies and then return to their country. Eighteen years from now, these “babies” will be U.S. citizens although their parents never paid taxes or contributed to Social Security. Is that “illegal?”
Money is usually the deciding factor regarding political policies and these policies affect the unborn. When I worked in public health in the pre-9/11 days, there was a wealthy couple from the Middle East who sought prenatal care. The wife was very advanced in her pregnancy and her jewelry was worth more than my month’s salary. My initial impression was “How on earth did an airline allow her to board a plane and travel half-way around the world?” The administrator spoke with me personally to make certain that I would “take care of the patient.”His concern had less to do with the well-being of her baby and more to do with the cash that her husband pulled out of his pocket to pay for her care. He peeled off $2500.00 in one-hundred dollar bills as if they were one-dollar denominations. He then asked how soon could they return to their country after the birth of their child and also mentioned that they were staying at the Ritz Carlton Hotel.
So, which is worse? A baby born to an “undocumented” immigrant whose husband is under the radar screen and working for minimum wage or a wealthy medical tourist who has a baby that will return 18 years later to claim their rights and privileges as an American citizen? I’ll let you be the judge.
The State of Wisconsin is being challenged on their policy of requiring unmarried pregnant women to identify the father of the baby in order to receive Medicaid benefits. Once the alleged fathers are identified, the State of Wisconsin requires them to pay for the birth costs. But here’s the controversy: Wisconsin collected $19 million dollars in 2010 which is the most money earned among the 10 states that use this policy.
ABC for Health, a nonprofit Wisconsin law firm is challenging that policy stating that the longstanding practice could contribute to the state’s high black infant mortality rate. Why? Because, according to ABC, having to identify the father “may discourage unmarried pregnant mothers from getting timely prenatal care services.” The State of Wisconsin encourages collection agencies to be aggressive because it keeps 15 percent of the money.
While the altruism of ABC is admirable, its logic is completely off-base. Based on my 25 years of clinical experience working with Medicaid patients, I can assure you that late prenatal care is not based on fear of repercussions for identifying paternity. A delay in obtaining prenatal care for most women involves waiting for their insurance benefits to begin. Or not wanting to take time off from work to keep prenatal appointments. Or using poor judgment and waiting until the last possible minute to show up for prenatal care because they didn’t have any significant problems with their previous pregnancy. Please do not use infant mortality as an excuse to keep fathers for assuming their financial responsibilities. It’s like comparing apples with oranges. While it’s unfortunate that the State of Wisconsin receives what could only be described as a “commission” for obtaining payments from expectant dads, those payments provide necessary funds to a cash-strapped state funded program. Conversely, the State of Wisconsin should not abuse the system by committing extortion.
If a woman is reluctant to divulge the name of the father of her baby, please don’t eliminate her Medicaid benefit. Dig deeper and find out why.
To be forewarned is to be forearmed. That is the mantra that should be adopted by all potential patients who are engaged in our present healthcare system and especially pregnant women. Information is power and you can never have too much regarding your health. There is a trend for pregnant women to write a birth plan regarding their delivery but there should also be an action plan during the third trimester.
Listed below are questions taken from Harvard Medical School’s Family Health Guide. I strongly encourage you to become familiar with these questions because they could inevitably save your life or the life of your baby. Many of them address the warning signs of pre-eclampsia (swelling of the hands and face) and preterm labor (leaking fluid).
- Do you have adequate support at home from family or friends?
- How do you feel? Have you had any problems since your last visit?
- Have you had any vaginal bleeding or spotting?
- Have you had any pain or uterine cramping?
- Have you had any discharge or leakage of fluid from your vagina?
- Have you noticed swelling of your face or ankles?
- Have you had any problems with your vision?
- Are you getting frequent headaches?
- Have you noticed a change in the frequency or intensity of fetal movement?
- Are you planning to breast-feed or bottle-feed?
- Have you selected a pediatrician for your baby?
- Are you taking classes on labor and delivery?
- Have you made arrangements for your family’s health insurance to cover your baby when the baby is born?
- Have you purchased a special car seat to hold your baby when riding in your car?
- Have you decided on whether the baby will have a circumcision, if a boy?
- Have you talked with your doctor about the length of your stay in the hospital?
- Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).
A good defense begins with a good offense. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
A perfect pregnancy is an admirable goal but not always realistic, despite the efforts of all concerned. As pregnancy becomes obtainable in high risk patients, the desired goal will no longer be a perfect pregnancy but the best possible outcome. For example, if a patient is obese, her physician or midwife is obligated to discuss the risks associated with pregnancy and obesity so that the mother is prepared to do the necessary preparation in order to have the best possible outcome associated with her pregnancy. The preparation will involve effective communication and trust by both patient and physician. How does one achieve effective communication with their physician? By letting them know what you do and don’t understand regarding your pregnancy. Here are 10 things that your physician or midwife should do:
- Periodically stop and ask whether you have questions before the end of the appointment
- Give you lab results in plain English without additional medical jargon
- Discuss any potential psychosocial skills with the patient and other healthcare staff members such as a nurse or social worker
- Assume the patient does not understand her given instructions and ask her to repeat the instructions that were given to her at the onset of her appointment
How can a level of trust be established?
- Your physician or midwife should Introduce themselves at the first visit
- Make proper eye contact
- Ask about your belief system and discuss possible conflicts of interest if any
- Explain all options and alternative treatments that adhere to the standard of care
- Explain the importance of informed consent and the right to refuse consent for a particular treatment including the consequences of that refusal
- Write in a legible manner so that both the patient and nursing staff are able to decipher treatment notes in the patient’s chart
It is extremely important to keep your OB provider abreast of any new complaints or developments as they arise in your pregnancy. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Those of us from the Boomer Generation can recall the days of “shotgun” marriages and “Home for Unwed Girls” when a teen became pregnant. In some cultures, pregnant teens were sent “Down South” to live with an extended relative until after the baby was born and then reintegrated back into their community. For unmarried college girls, an unexpected pregnancy usually meant “life-interrupted” and dreams eternally deferred. Thank goodness those days are over.
While researching information for my previous blog regarding murdered pregnant women, (7 Reasons Why Pregnancy Becomes a Deadly Affair) there was one recurring theme: the men were not ready to become fathers and felt that their lives were “ruined.” If only they had a little more faith.
Wright State in Dayton, Ohio has developed a unique Women’s Center and Child Development Center that helps its pregnant students and expectant fathers. They offer pregnancy tests and assistance in referrals to prenatal clinics and hospitals in the community. It also serves as a resource center for pregnant students and those who already have children. The proposed services in the future include information regarding financial aid, scholarships, housing, childcare, academic advice, family-friendly activities and breastfeeding stations on campus. The school also plans to offer three scholarships for students with dependent children which is admirable. The intent of the program is to encourage pregnant students to complete their higher education as opposed to dropping out which was the only option for many pregnant college students until the recent past.
Last month, the federal government awarded 20 states a cumulative grant of $27 million to assist pregnant teens and young parents. The Pregnancy Assistance Fund, as it is known, was designated to help pregnant women, teen parents finish high school, get childcare, healthcare and housing. The funds may also be used to prevent violence against pregnant women and mothers. Pregnant teen students and student mothers should inquire as to whether these grants are offered in their states. Pregnancy does not necessarily mean life interrupted. The child within your womb could turn out to be your greatest blessing.
Do you know how to anticipate and manage the unexpected events that could occur during your pregnancy? You will if you purchase The Smart Mother’s Guide to a Better Pregnancy available on Amazon.com or wherever books are sold.