Ending delays in prenatal care

A pregnant teenager is turned away from six obstetric practices before getting care. How is this possible?

Ending delays in prenatal care
Ending delays in prenatal care

In my primary care practice for the under served, I recently saw a 17-year-old girl that was 29 weeks pregnant. Although a slim young lady, she claimed she did not know she was pregnant, because she had been having monthly menses up until two months prior.

The first time she missed her “period” was four weeks earlier. She said she went to the emergency room -- a common source of primary care for those without insurance -- because at this point she was a bit suspicious. 

After a dating ultrasound, she was informed that she was 6 months (26 weeks) pregnant.  The emergency room also provided the appropriate prenatal lab testing and even the gestational diabetes screening, along with a prescription for prenatal vitamins. 

What this patient did not receive was any prenatal education from nurses who specialize in obstetrics. This is so crucial for any pregnant woman, but especially for a pregnant teenager. This patient told me she felt like being in school was not good for her pregnancy, and had therefore dropped out immediately. 

The part that is really shocking to me as a healthcare provider, and the reason this patient was in my clinic in the first place, was that she had visited six obstetric practices in the area already. Not one would take her as a patient without insurance.

The patient had then applied for Medicaid and was hoping to get coverage soon, but in the meantime, she thought a referral might help. We gave her a referral and the next week she received her Medicaid verification. The referral we provided still refused to accept her as a patient.

She tried three more offices and finally found one that would take Medicaid.  Our referral department had to send another referral to that provider, after which the patient had her first prenatal visit at 32 weeks gestation. Wouldn't it have been nice if she could have started her prenatal care as soon as she found out she was pregnant?

As a 17-year-old healthy teen, this patient's parents had not kept up her enrollment in Medicaid. Because of this, when the patient found out she was pregnant, she had to apply for Medicaid herself. This option takes time. One thing that someone in this situation does not have is a lot of time. 

Any additional delays in Medicaid coverage could have led to one more woman delivering a baby without the benefits of prenatal care. Pregnant women who do not get prenatal care are more likely to deliver low birth weight infants, have a babies with health problems, and suffer from postpartum depression.

The Affordable Care Act requires that all insurance providers pay for pre-conception, pregnancy and post-partum care regardless of pre-existing conditions.  I hope that the universality of this provision and the Medicaid programs available in most states will make this scenario less likely to occur in the future.

Until then, when a patient like this comes to your office or your ER, take an extra few minutes and get her started with specific instructions on how to apply for Medicaid in your state or instructions for how to access the Healthcare Marketplace, where information on state Medicaid eligibility can also be found. 

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.


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