No prenatal care?!

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Recently our unit has had an increased number of women coming in with NO prenatal care. As scary as this has been, we recently had a stillbirth baby born to one of these women. This was not the woman's first birth without any prenatal care. There was very thick meconium fluid, but we had a fhr in the 150s up until the infant was delivered. As a newer nurse to OB I'm trying to figure out how to cope with the feelings of anger with the mother for not getting prenatal care when its available free and the sadness that I feel for her at the same time. I keep replaying everything in my head, trying to make sense of it all. Any advice would be greatly appreciated. :crying2:

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Do you know why they didn't get any prenatal care? Are they very young? Are they currently without insurance? Are they aware there are other options available to them? It could be a good opportunity to educate.

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Specializes in ER.

My feelings are split with your post. One one hand, I question what prenatal care would have done to prevent this stillbirth you mention. How could anybody have prevented this one? (Please keep in mind that I wasn't there, don't know the whole story, etc.) Stillbirth happens to women that get standard prenatal care, much as many people don't want to admit.

I am not sure where you are from when you state that prenatal care is free. For most in the US, it is not. What are the women's reason for not getting the care? Can't afford it? Denial? Lack of access (ie no providers accepting Medicaid)?

I would also be frustrated at the women with no prenatal care, as I believe some routine monitoring is best for Mom and baby. I know of a few women who choose homebirthing with no attendants because of their views of Western medicine - too many interventions and needless testing. Dangerous in my opinion but it seems to have worked for them.

I don't have much advice for you, except to do your best like you do with every patient in every situation. Show compassion and empathy for the loss of a child, even if you don't have sympathy for the mom.

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I understand your frustration but we have to remember that our job as nurses is to provide non-judgemental care to our patients. All we can continue to do is educate, educate and educate!

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My feelings are split with your post. One one hand, I question what prenatal care would have done to prevent this stillbirth you mention. How could anybody have prevented this one? (Please keep in mind that I wasn't there, don't know the whole story, etc.) Stillbirth happens to women that get standard prenatal care, much as many people don't want to admit.

I am not sure where you are from when you state that prenatal care is free. For most in the US, it is not. What are the women's reason for not getting the care? Can't afford it? Denial? Lack of access (ie no providers accepting Medicaid)?

I would also be frustrated at the women with no prenatal care, as I believe some routine monitoring is best for Mom and baby. I know of a few women who choose homebirthing with no attendants because of their views of Western medicine - too many interventions and needless testing. Dangerous in my opinion but it seems to have worked for them.

I don't have much advice for you, except to do your best like you do with every patient in every situation. Show compassion and empathy for the loss of a child, even if you don't have sympathy for the mom.

I was wondering the same thing. There is NO facility anywhere in my area where one can get free care of any kind, prenatal or otherwise. Actually, the closest facility I can think of is more than 100 miles away.

Also, there was a time not all that long ago when women never went to the doctor until the very end of their pregnancies, if then. There are families who are very old fashioned and don't trust doctors, etc.

Like another poster said, try not to be judgemental of these women without knowing their lives and situations.

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Specializes in Community, OB, Nursery.

It's hard, because so much of the time if just one thing were different, the entire outcome would be changed. At the same time, IUFDs happen for no good reason that we can tell, to women who get PNC and women who don't. I don't know that PNC would have changed the outcome in your scenario, obviously wasn't there and can't make the call with absolute certainty.

One patient I took care of had no prenatal care and delivered a baby girl with anencephaly who lived for a few minutes. Obviously prenatal care wouldn't have changed that. Cord accidents happen too, PNC or not. It stinks.

Keep in mind that the mom may very well be punishing herself far more than you ever could. Vent here all you need - that's part of what this board is for - but she deserves the same care as anyone else. It's not easy but it's far from the last time you'll have to take care of a patient whose life choices aren't what you'd make for yourself. The fact that you're here venting shows you care and want to take good care of her. :up:

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I'd be willing to bet it has something to do with not having any health insurance. I lost my job when I was pregnant and was able to obtain state insurance until I became employed again, but not everyone knows about it and where I live you have to wait months for an appt at a free clinic.

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Recently our unit has had an increased number of women coming in with NO prenatal care. As scary as this has been, we recently had a stillbirth baby born to one of these women. This was not the woman's first birth without any prenatal care. There was very thick meconium fluid, but we had a fhr in the 150s up until the infant was delivered. As a newer nurse to OB I'm trying to figure out how to cope with the feelings of anger with the mother for not getting prenatal care when its available free and the sadness that I feel for her at the same time. I keep replaying everything in my head, trying to make sense of it all. Any advice would be greatly appreciated. :crying2:

Try not to look at it from the prenatal care standpoint. I don't know the history here but it's unlikely that prenatal care would have affected the outcome of having a stillbirth at term with mec. Many stillbirths are unexplained and it stands to reason that the vast majority of them occur in women with prenatal care.

Research has shown that prenatal care does not improve outcomes in low risk women. In high risk women it improves outcomes only under ideal conditions (i.e. Centering Pregnancy model of care, mom has access to other social services and a good home environment, etc). So although we spend tons of money on prenatal testing and prenatal care, our outcomes have not improved as a result.

As far as free prenatal care, imagine going to the DMV. Now imagine having to do that to get your medical card. Then having to be treated poorly at a health department or doctor's office because you are using that medical card. Having to find someone to watch your other kids and someone to give you a ride to the doctor. Maybe you work and you have to take unpaid time off to go to your appointments. Maybe you can't take time off or you will get fired. Probably getting referrred to social workers and asked all kinds of questions. It's easy to see why someone would opt out. Maybe you have an addiction that you can't get help for and you are afraid to get tested. Maybe you have an abusive partner who won't allow you to get prenatal care for fear you will disclose the abuse. Maybe you have a history of sexual assault and having an exam brings back those memories. Maybe your partner works and takes the car and you don't have a ride. Maybe you are in this country illegally and too scared to get help for fear of being deported. Maybe you don't speak English. Maybe you were raped or afraid to tell people about your pregnancy...

I'm not saying it's the choice I would make. It's just that for some women navigating the system and finding a ride to an appointment and childcare for their older kids is sometimes just too much on top of everything else. And if they know that last time they couldn't get to the doctor and everything turned out okay they are not as worried. Also- prenatal care in the US lacks a lot when compared with other countries- maybe they had been disappointed by it previously and didn't want to go back.

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I know for a fact that this pt had access to very good prenatal care that she would not have been charged for. I didn't mean to sound judgemental of this woman. She is now going through something that I would never, ever wish on anyone. I think my anger/frustration is that with even minimal prenatal care, we would have had at least known if she really was close to her due date. Thank you all for pointing out different viewpoints about my posting. I'm still trying to process everything that happened and my own feelings about it all.

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Try not to look at it from the prenatal care standpoint. I don't know the history here but it's unlikely that prenatal care would have affected the outcome of having a stillbirth at term with mec. Many stillbirths are unexplained and it stands to reason that the vast majority of them occur in women with prenatal care.

Research has shown that prenatal care does not improve outcomes in low risk women. In high risk women it improves outcomes only under ideal conditions (i.e. Centering Pregnancy model of care, mom has access to other social services and a good home environment, etc). So although we spend tons of money on prenatal testing and prenatal care, our outcomes have not improved as a result.

As far as free prenatal care, imagine going to the DMV. Now imagine having to do that to get your medical card. Then having to be treated poorly at a health department or doctor's office because you are using that medical card. Having to find someone to watch your other kids and someone to give you a ride to the doctor. Maybe you work and you have to take unpaid time off to go to your appointments. Maybe you can't take time off or you will get fired. Probably getting referrred to social workers and asked all kinds of questions. It's easy to see why someone would opt out. Maybe you have an addiction that you can't get help for and you are afraid to get tested. Maybe you have an abusive partner who won't allow you to get prenatal care for fear you will disclose the abuse. Maybe you have a history of sexual assault and having an exam brings back those memories. Maybe your partner works and takes the car and you don't have a ride. Maybe you are in this country illegally and too scared to get help for fear of being deported. Maybe you don't speak English. Maybe you were raped or afraid to tell people about your pregnancy...

I'm not saying it's the choice I would make. It's just that for some women navigating the system and finding a ride to an appointment and childcare for their older kids is sometimes just too much on top of everything else. And if they know that last time they couldn't get to the doctor and everything turned out okay they are not as worried. Also- prenatal care in the US lacks a lot when compared with other countries- maybe they had been disappointed by it previously and didn't want to go back.

BRAVO!

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I know for a fact that this pt had access to very good prenatal care that she would not have been charged for. I didn't mean to sound judgemental of this woman. She is now going through something that I would never, ever wish on anyone. I think my anger/frustration is that with even minimal prenatal care, we would have had at least known if she really was close to her due date. Thank you all for pointing out different ideas about my posting. I'm still trying to process everything that happened and my own feelings about it all.

How do you know that for a fact? Do you also know for a fact that she had transportation? Do you know for a fact that none of the circumstances described above pertain to her?

Just curious.

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As far as free prenatal care, imagine going to the DMV. Now imagine having to do that to get your medical card. Then having to be treated poorly at a health department or doctor's office because you are using that medical card. Having to find someone to watch your other kids and someone to give you a ride to the doctor. Maybe you work and you have to take unpaid time off to go to your appointments. Maybe you can't take time off or you will get fired. Probably getting referrred to social workers and asked all kinds of questions. It's easy to see why someone would opt out. Maybe you have an addiction that you can't get help for and you are afraid to get tested. Maybe you have an abusive partner who won't allow you to get prenatal care for fear you will disclose the abuse. Maybe you have a history of sexual assault and having an exam brings back those memories. Maybe your partner works and takes the car and you don't have a ride. Maybe you are in this country illegally and too scared to get help for fear of being deported. Maybe you don't speak English. Maybe you were raped or afraid to tell people about your pregnancy...

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^^^^^^^^^^^^THIS..........All true. I did have to go to 3 different OB's to be treated like a human being instead of like cattle.

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