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:

The prenatal care issue that I mentioned in my previous postings was not meant to be the focus but I'm glad that is the direction this discussion went to. I would like to again thank everyone who has posted because it has made me look beyond my own feelings about this case.

This was my first stillborn delivery since starting in OB. It, unfortunately, was paired in my mind with the lack of prenatal care. Now, looking at it from different viewpoints has helped to remind me that not everyone views "western" medicine practices as the "right" thing to do. There were probably many reasons that went into why this woman chose not to obtain prenatal care that was available to her. Due to the rapid nature of her delivery, there was no time to explore this with her.

This case will stay with me forever.:crying2: All I can do now is try to learn from it to be a better nurse. As another nurse in my department reminded me: "When OB is good, its really good. But when its bad, its really bad..."

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Specializes in LTC, Psych, M/S.

I've seen stats that say 40%+ of all births in the U.S. are paid for by medicaid. I live in a rural community where it is sited at 60%. All the OB's in my locale are good about accepting it - I know every town is different and each state has different qualifying guidelines - I am not the expert on this but it bothers me and worries me b/c I know what i went thru w/jobs in order to keep my health ins while pg. w/both my kids. Pregnancy discrimination is alive and rampant - happened to me. I wished I was 'poor' enough to qualify for medicaid. It seems to me that you are better off to be 'poor' rather than working, making 'decent' $ with no health ins b/c you could qualify for medicaid or chp - which pays for pnc in some states. My uncomplicated birth cost 15k - obviously w/ complications it could be thousands more. How many people can afford that?

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Specializes in Cardiac, NICU, ED.

I can understand your frustration or confusion. I was a NICU nurse until very recently and would ponder such questions too frequently. I do believe that the decision to not receive prenatal care can be based upon values, beliefs, and a lack of knowledge of resources.

However, in the same sense, (and of course these were all NICU admits) nearly all these infants were experiencing withdrawal. I believe that most of these infants had mec screens just because of the likelihood of drug abuse.

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Specializes in Med-Surg/home health/pacu/cardiac icu.

Prenatal care is generally a "Westernized" idea. My husband is from a Central American country. Most of his friends who have immigrated here do not know what the idea of prenatal care is and really think it is unneeded. I have had to drive the wives to clinics, seek financial assistance and educate the husbands about the necessity of prenatal care. In some countries, it is rare to find prenatal care. In some cultures, prenatal care is mistrusted due to past histories of abuse by physiscians. Also, there is an issue of cost and insurance. I had no insurance and did not qualify for any type of medical assistance when I was pregnant due to making a whopping $10.00 an hour. I ended up with a 15,000 hospital bill that took ten years to pay off.

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Specializes in ortho, hospice volunteer, psych,.

i live in a very rural area with no clinics or many chances for free any type of care, including ob care.

these women must drive to another town for routine ob care and up to 100 miles for specialized care.

for what it's worth, i had excellent prenatal care, am a nonsmoker and nondrinker, and had serveral miscarriages, a stillbirth, and a very premature son,who did not live long. it isn't always lack of prenatal care that causes problems.

there are always women who currently use or have used illicit drugs in the past, who do not seek prenatal care because they fear being drug tested and having their babies taken away at birth.

kathy

shar pei mom:paw::paw:

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i live in a very rural area with no clinics or many chances for free any type of care, including ob care.

these women must drive to another town for routine ob care and up to 100 miles for specialized care.

for what it's worth, i had excellent prenatal care, am a nonsmoker and nondrinker, and had serveral miscarriages, a stillbirth, and a very premature son,who did not live long. it isn't always lack of prenatal care that causes problems.

there are always women who currently use or have used illicit drugs in the past, who do not seek prenatal care because they fear being drug tested and having their babies taken away at birth.

kathy

shar pei mom:paw::paw:

i'm sos sorry for your losses. :crying2:

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Specializes in ortho, hospice volunteer, psych,.

:paw::paw:thank you so much, batman.

we had genetic testing, counseling, he was checked, i was checked... you name it.

we finally concluded that god simply had other plans for us. now we foster and adopt abused and tortured cats. we currently have nine cats, plus manfried, who also comes to "here kitty...kitty...kitty!"

thank you and hugs,

kathy and the zoo:paw::paw:

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Specializes in NICU, PICU, PACU.

Working for a county entity, yes, you can come to our place regardless of ability to pay and be taken care of. But...people don't want to come there, they want to go to the posh places and some of them won't go get care. We also get a lot of no cares for drug addictions, multips (when you have 8 kids, why go to the doc...it's old hat now), and teens. I have a hard time accepting that they didn't get care, esp when anyone and everyone can come to a county hospital. They will get signed up for whatever plan (medicaid, caresource, etc).

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Specializes in LDRP.
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:

IUFD's suck big time. I think hte hardest/saddest thing i've ever done was to be holding the woman's hand when the doctor told her that her baby, whom she thought was alive inside her, was in fact dead. (and they both had excellent private insurance and good doctors, so not an issue prenatal care could have fixed)

anyhoo, on to your post. how could prenatal care have fixed your patient with thick meconium? esp if the baby was doing fine until delivery, its not like it was in distress and a visit to the OB could have fixed it.

a good thing to remember is that you will never know people's motives. people have lots of reasons for doing lots of things that sound totally common sense, or bonkers, to the rest of us. to you, getting prenatal care sounds obvious. When i was 18, pregnant with my first, had no insurance, before i ever went to college, living on my own, I didnt get prenantal care until i was 17 weeks pregnant. Why? No insurance. Sure, there's medicaid. but, it takes a while to get approved, the application is huge and daunting, and i had no idea that there was such a thing as it being retroactive and going back to cover old bills back to when you applied. I hadn't even had a pap smear-had no idea where to call to get prenatal care. (eventually, someone told me that at the clinic, they help you apply, so i went, and was none the worse for my late prenatal care. delivered a fat healthy baby at 41 weeks)

Maybe she has no car to get to the clinic. Maybe she doesn't know about the clinic. Maybe she smokes a little marijuana and is afraid someone will try to take her baby if she goes to the OB and they drug test her? (our hospital does drug test the ones who come in with no prenatal care) Maybe she has an abusive boyfriend who wont let her go to the doctor? (because they might ask about abuse there). Maybe she already has 3 kids she can't afford and is in serious denial. Maybe she can't take time off work. Maybe she can't find a babysitter for her other kids. Maybe she's had a bad experience with a doctor and is scared of them. Maybe she's never been to a doctor in her life and is scared. Maybe she has a mental illness. Maybe she is preoccupied with making sure her electricity doesn't get cut off, that she has enough food to feed her kids, etc that going to the doctor isn't high on her list of priorities.

It's hard not to judge people sometimes, but we have no idea of what is going on behind the scenes and what is motivating them. We can do our best to provide information, so that next time, she will know what to do. Yes, prenatal care can prevent some problems. Not all. Sometimes, even the women who have the best prenatal care, the doctors wives, the ones who do everything right-their baby still dies and bad things still happen.

Please dont be angry with her.

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Specializes in Dialysis, Home health.
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!

Although you stated you understand the frustration......I doubt it because you wouldn't have said the rest.

Keep it real chica...

and if you are keeping it real, I'm glad you'r not my nurse for lack of natural affection. The OP obviously has not been pushed to the point of no return when it comes to "feeling".

As long as you look at your job as just a place where you are the nurse that is just doing her job...you have a long way to go babes.

Stop hardening your heart.

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