No Prenatal Care and No Empathy

As an OB nurse, one of the most unfortunate and all too often scenarios we encounter is having to take care of women who have had little or no prenatal care.  When they present to our unit, for a moment we hold our breath.  Will this be the patient that escaped any pregnancy-related complications?  Will she deliver a healthy baby, screaming and pink…or will this be the patient that walks in and makes us all scramble? We have all seen horrible outcomes from these scenarios. It’s easy to lose empathy for people who do not get adequate prenatal care.

Growing up, my mother made sure that I never missed a routine doctor’s appointment and she made me get a dental checkup every 6 months.  When I found out I was pregnant with my daughter, I was all of two weeks pregnant, and living in England.  I was not a citizen, and I wasn’t sure when I was coming back to the United States.  I was twenty-four years old, but felt like I was fourteen.  Pregnant, and in a country that was not my own, I worried about how I would get the care I knew I needed.  My mother-in-law was a midwife in England at the time.  She made an appointment for me to see a provider, who confirmed I was pregnant and gave me prenatal vitamins. Although I ended up flying back to the United States three months later, I was fortunate to be given the care I desperately needed for the three months that I was there.

Once, when working triage, a woman came to the hospital very pregnant.  She did not have a provider, and had only gone to a local clinic once, early in her pregnancy.  She lived in a very rural area, and did not have much family here.  Honestly, she was very young, very poor, and very uneducated.  But here she was in front of me, flushed, sweating, and swollen.  I was still a new nurse, just off of orientation, but even I knew that something was very wrong.  Her eyes were glossy and puffy, and she didn’t seem to be hearing or understanding what I was asking.  When I took her blood pressure, the cuff kept inflating in an endless attempt to take her blood pressure.  The nurse that had been my preceptor came into triage.  She did not speak, but I watched as she glanced at the oxygen on the wall, making sure there was a nonrebreather mask and oxygen tubing readily available.  At the time, I did not know how she could have known I would need it; she had only seen the woman walk in.  She had been at the bedside for less than 30 seconds when the patient starting seizing.

This was the first time that it was my patient, my patient seizing right in front of me.  Other nurses flooded into the triage room, everyone scrambling to do everything that had to be done to save that mom and baby.  Simultaneously, nurses started an IV, nurses administered drugs, a nurse tried to find fetal heart tones. At the same time, nurses were asking me for any information I could provide about the patient that I had literally been taking care of for less than two minutes.  I told them the only thing I knew: The patient was around 36 weeks pregnant, she hadn’t had any prenatal care, and her blood pressure was 289/118.

When the baby was pulled from her mother’s abdomen, the meconium was so thick, the baby’s skin so stained, it was evident that the baby had been in distress for a long time.  Although every detail I had semi-managed to obtain before she seized pointed to her delivering a late pretermer, the baby weighed over nine pounds, which we would later attribute to severely uncontrolled gestational diabetes.  The few minutes it took to perform chest compressions and then intubate that baby felt like forever.  That day when I left the OR, there was no one waiting to see how mom and baby were doing. My entire insides were shaking.  I was shocked and thankful that this mom and baby were both still alive.  I replayed every second in my head, wondering if I could have, should have, done something differently, something that would have made a difference.  I immediately had to take my own blood pressure.

When I went back to the nurse’s station to try to chart every event that had happened from the time the patient had walked into triage to the time she had been taken to ICU by another nurse, all I could think about was how something like this could have happened.  I didn’t understand how someone could not see a provider for their entire pregnancy.  Where had she expected to deliver at? At first, I was angry that someone could be so careless…I mean, didn’t she know that her baby could have died from her uncontrolled diabetes?  Didn’t she know that they both could have died from her high blood pressure, not to mention her seizure?  Didn’t she know that she put everyone at risk walking into a hospital when no one knew a single thing about her?!?  And then I realized—no, she didn’t know any of that.  And I was immediately filled with empathy for a patient who did not have a mother to make sure she went to every routine appointment, and for whatever reason, for whatever circumstance, did not know better or was not in a position to do anything about it.

That patient would not leave the hospital for weeks, and when she was finally able to the leave the hospital, she left with kidney failure and detached retinas in both eyes.  After delivery, her baby was immediately transferred to another hospital, where they would use hypothermia therapy in an attempt to prevent long-term brain damage. When any baby is transferred to another hospital, it’s hard to find out how everything turned out, but even after all these years, I still hope that the baby made it, and was able to recover.

If you are a patient, know that seeing a provider throughout your pregnancy is crucial to the health of you and your baby.  Women must take good care of themselves before, during, and after pregnancy.  Talk to your healthcare provider before getting pregnant about how you can best prepare your body for pregnancy.  If you are already pregnant, try to make the best choices possible for you and your baby.  Choose to eat healthy foods, exercise, stay away from stress, quit smoking (or at least cut back!), and see a provider throughout your entire pregnancy.  Don’t be afraid to ask questions. If you need help, ask people for it. Don’t be afraid to tell people what you need.

And if you are the nurse that has ever had to take care of a woman who did not take care of herself, who inadvertently did not take care of her baby, remember to step back, take a breath, and find your empathy. Every life that we witness being brought into this world, we have no idea how their little life will turn out.  That baby may be the girl who grows up and does everything right, is afforded every opportunity, or that baby may grow up and be the girl who does not have anyone to tell her better, who just doesn’t know.  Be the nurse that teaches people to be better by the compassion that you show, by the care that you give.  The work we perform on a daily basis has the ability to change so many lives in so many different ways.  There will be more patients with no doctors, there will be more patients with no prenatal care, but I hope I’m never the nurse with no empathy.

JME Portraits-girl

 

Until my next delivery ❤

Health Resources and Services Administration

  • Every year nearly one million American women deliver babies without receiving adequate medical attention.
  • Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care.
  • If you are pregnant, programs in your State can help you have a healthy baby. These programs offer medical care, support and advice for pregnant women, information about health insurance and other services you and your baby may need.

Prenatal Services



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35 replies

  1. Great article as always but, please use provider. Many women use midwives or nurse midwives and we are wonderful providers of care for women.

    Liked by 1 person

  2. Love to here some of you cnm stories (as a cnm myself)

    Liked by 1 person

  3. Unfortunately this was me with Cam. I didn’t see a doctor until 33 weeks. It wasn’t due to my negligence but insurance problems. I was scared and praying hard those 33 weeks. Every thing came out ok though, thank God! Great read as always!

    Liked by 1 person

  4. I needed this… thanks

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  5. Beautifully spoken! I was an L&D RN for 14 years before continuing on to become a CNM. Both roles have been so fulfilling in their own different ways. But as I have evolved as the provider who takes care of these women for roughly 7-8 months before they step thru the doors of L&D, I get to know them on many levels. Many have no skills for parenting unfortunately because they basically have been raised by wolves! I try very hard to care for them as a complete person and not just that pregnant belly. I challenge the nurses in L&D to not be judgmental with women that walk through their doors because they do not know where they have been or where they are forced to go to when they leave that unit. It is not our job to judge and any compassion we extend to them can be the pebble that starts a big ripple. In the 30+years of caring for women, I have known at least a dozen that I met as those patients that would have been judged harshly. But people can change and they are now nurses and one even became a midwife! It is so gratifying to see people break a cycle and become the women they deserve to be! So remember, “There, but for the Grace of God go I…” Sorry for the length but few things are as important as compassion! ADORE your blog posts, you are as skilled a composer of thoughts as you are an L&D nurse, I am sure!

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  6. I am a social worker in L&D. Thank you for this post. To be completely honest, when a pt like this walks through the door it is frustrating and hard not to judge. Your post served as a reminder to dig for a little more empathy and get the full story before thinking awful things about the pt. Not everyone has the intellectual and emotional capacity to understand the importance of adequate follow up while pregnant.

    For those who postpone prenatal care due to lack of insurance – I urge you to look up your local community health center. These facilities provide services to all people despite their socioeconomic status. Fees for service are typically on a sliding scale based on income and assets and all pt’s are screened for Medicaid (most pregnant women qualify for Medicaid. This varies by state.)

    Again, thank you for this post. We all need a reminder sometimes.

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  7. I needed to read this today. Yesterday I took care of a G2 Guatemalan girl with no prenatal care. We have a growing Guatemalan population in our area, and while our community is working to make sure they receive prenatal care and understand the importance of it, we still have them come in without receiving care to deliver every couple of weeks. It is very difficult to communicate with them because they don’t usually speak Spanish. I get irritated that they could be so careless, but then think about how scary the situation must be. To be in a foreign country where nobody speaks your language and to come from a village with no running water or electricity and have to walk 3 hours to get to a hospital. The type of care that is routine here is not what is done where they are from. Luckily,most of the time, the outcome is ok. I love the way you write and enjoy reading your articles! Thank you for sharing your stories and information.

    Liked by 1 person

    • It’s very easy to lose empathy with these situations. I have to remind myself too. But I always remember that this could have been me in so many ways. Growing up I made so many stupid, crazy choices. What if I didn’t have parents that kept putting me back onto the right path? I was never into drugs, but it just took me forever to finally finish college! It’s hard being poor.

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  8. This was an awesome article!

    Liked by 1 person

  9. When you lose your empathy for your patients whatever the circumstances, it may be time to look for another job!

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    • Are you a nurse?

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    • Well said and it’s scary how many of them admit to prejdice of this sort that can effect a patients future dealings with medical care. To the person who asked if she’s a nurse? Shame on you, you don’t get points for being a nurse in order to speak. You feel it’s okay to judge others but not be judged as nurses yourselves for the lack of empathy. If you truly lack empathy of any sort for any patient the responsible thing to do would be to leave the profession people don’t need care from the cold hearted when they are in possible life threatening circumstances.

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  10. These women and families who com into our care are almost always the ones who teach me most about empathy and grace. I hope for some teachable moments with them and that they will not feel judged. Thank you.

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  11. I recently retired after 40 years as a L&D nurse. Sometimes I swear your posts are from a younger me. I’ve always said I should have written a book of all the stories….love reading your blog. Keep up the good work with patients and telling your story.

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  12. I had no prenatal care with my first pregnancy. I went to two appts and got signed up for medicaid, but every time I would go to the hospital where the office was, my heart would pound and I couldn’t catch my breath. A couple of times I stood in the lobby, willing myself to go in, in tears, but I couldn’t. Eventually I gave up. I didn’t make a connection between the sexual violence and physical abuse I’d experienced earlier in life with my inability to get through an OB appt. It just seemed unbearable to me, and dangerous. I was so afraid they would hurt my baby. It made perfect sense to me that they would, because I lived in a world where big people hurt smaller people. Doctors and nurses were big people to me.

    But when I went into labor, I showed up at the hospital anyhow. The nurse who checked me in to triage was clearly irritated with me, maybe even angry, but she asked me why I’d had no care and I managed to squeak out that I was afraid of doctors. I didn’t know how else to explain it. A little while later, they sent a new nurse over and she was so kind to me. There was no judgment, just a few encouraging words and a kind look. She stayed after her shift was over to see me deliver my baby. She was the one who made sure my daughter was breathing well before handing her back to me. I’ll never forget her. Later I was able to look back at her compassion as evidence that the world wasn’t always dangerous, and that people wanted to help me and my daughter, not hurt us.

    That was five years ago. I’m starting my second semester of nursing school in a few weeks. What that nurse did for me and my daughter in one shift has rippled outward in countless ways, ways too numerous to mention here.

    Liked by 1 person

  13. It IS hard to care for some at the bedside with compassion, and I see it all the time in some of my coworkers: the open hostility and judgment based on report and/or what they see in 5 minutes of assessment. I distinctly remember one night taking care of a NPNC patient who was a drug user and who had had a very emergent, very preterm, very complicated c-section delivery. My coworkers said, “how can you be so NICE to her???” I simply told them: it’s my job to be her nurse, not to judge her. As hard as it is some days, and it IS hard, because I’m not God, I’m human, I always try to remember to check myself mentally. I have no idea where this woman has been before she landed in this bed before me, and yes, the care I give her now could affect her (positively) for a lifetime. Nurses hold so much power in the respect that what we do for our patients and how we treat them matters SO MUCH. They don’t remember their doctors a lot, but they remember their nursing care.

    Liked by 1 person

    • Nurse Ratched, that was such a true and sincere response! ❤ I agree!!!

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    • You just described me 13 years ago. I was the one with the emergent, preterm, drug addicted baby. I was hopelessly selfish and lost. I gave up my kids for adoption. I knew I was toxic to them. I quit using drugs over 10 years ago. I now work at a Hospital. When parents and patients come in with drug problems or mental health problems, they are who I gravitate towards most. They already feel unwelcomed and unloved in their own head, and judgement won’t make them “change their ways.” I just tell them my story, and offer assistance to help them find support. Most won’t make it. That’s a cold hard fact, but the few that break free, is poetry in motion.

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      • I call those ‘divine appointments’ when you have people put in your path like what you describe. Though I don’t have a ‘past’, I am drawn to patients other would not care for. I have some beautiful memories!

        I now work in the land of the privileged. This carries it’s own set of problems. For me, it’s hard. But maybe I’m here to learn to be more tolerant.

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  14. Love, love, love your blog and everyone who takes the time to respond. We learn so much from your posts, even an RN who’s practiced for 35 years!!

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  15. This is something more nurses need to read I guess. I am not the no prenatal care patient. I had excellent prenatal care, never missed an appointment, my last routine OB appointment my BP was high and my OB decided to induce me. I had one L&D nurse who started out very hostile, I overheard her talking about me in the hallway about why was I so “dressed up, who gets their hair and makeup done to have a baby”. I was on my way to work, I was a high roller host for the casino. We have to look like we represent luxury and glamour! It was basically just my work uniform. She proceeded to treat me badly, assuming I expected to be treated like a princess, telling me every step of the way I wasn’t getting special treatment. She became more hostile when my gorgeous, loving, devoted husband got there, and my friends and family after him with my hospital bags and birth plan. She wouldn’t allow me to wear my special L&D gown I ordered so I wouldn’t have to wear the hospital gown. She wouldn’t allow my birth plan. Any of it. My induction was ragged, she didn’t administer the medicine when the dr ordered or let me sleep at all. She turned off the power to my room to “test the generator”. She instructed me to push for 7&1/2 hours. She took 2 hours to prep and take me in for my “emergency” c section. So long that I heard my Dr yell at her in the hallway. She ruined the birth of what will be our only child. All because she decided she didn’t like how I looked.

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  16. Reblogged this on Ex Natural Childbirth Advocates and commented:
    I wish that it was always ignorance, but it isn’t. There is a movement out there right now called “freebirth”, and its full of women that exhaustively looked into child birth options and chose an unassisted pregnancy and birth. Home birth midwives (who are not nurses) teach classes to women wishing to freebirth in order to rake in a few thousand dollars off of this horrendously dangerous practice.

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  17. Non-nurse midwives that do home births teach classes that encourage unassisted pregnancy and child birth. If only it were just ignorance… there are many people profiting from selling quackery. I follow a lot of groups about unassisted pregnancy and child birth and its like a religious belief in the safety of birth. The stories that end like this one are not updated with happy pictures so no one hears about them, thank you for sharing this case with the world. Maybe you will convince someone to seek prenatal care.

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  18. Not everyone that chooses no prenatal care are uneducated, drug addicts, young mothers or ignorant! I believe choosing the prenatal care that is best for yourself is very wise. Pregnancy & birth is WAY too medicalized these days! Birth is best when left alone. I am currently pregnant with my 4th child…and received prenatal care with my first. I did everything my doctor told me…had all tests done. But with my other pregnancies I did things differently. Little prenatal care & opted out of all testing. I think the outcome of good births & healthy babies is due to good nutrition…and a healthy mindset. With this pregnancy I am doing my own prenatal care (checking my BP…tracking weight…I have a Fetoscope) I won’t be doing ‘routine’ prenatal testing. But it doesn’t worry me. Pregnancy & Birth is a natural process of life…our bodies were created to grow babies & birth those babies NATURALLY!
    All my births have been okay….my babies have all been perfect & I received no pain medication….the only thing I found wrong was that I delivered in hospital….where I was criticized…bullied…disrespected. Won’t make that mistake again!
    I’m not saying women that choose ‘routine’ care or put all their faith in hospitals instead of their own bodies are wrong. To each their own. But women should be able to make decisions on how they continue their pregnancy (and birth) without being worried about medical staff criticizing them.

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  19. In N.F Ontario where I had my first 5 babies, I had normal regular prenatal care. I had gestational diabetes with my fourth and fifth and they only weighed a lb more than my first 2, never had to take insulin, had my 2 ultrasounds, dating and 20 weeks, had all the blood tests, NEVER had the tests for downs or anything because it wouldn’t influence my decision whether to continue the pregnancy and only causes unnecessary stress. My 6th pregnancy I had all new Drs in another province and I hated my life thought that pregnancy. I had to take insulin which made me itch uncontrollably, my baby came out only 7lbs 11oz, I had to drive 2 hours both ways twice week to have an ultrasound and the other day have a non-stress test with maternal fetal medicine, and had to drive and hour 2 other days a week for non-stress tests. Had to see a diabetes Dr a third day. So basically I spent my pregnancy in the car stressed beyond belief, feeling like I was gonna pass out from low blood sugar because I followed their directions to a T. Had to go in at 36 weeks(turned out I was barely 35 weeks) to be induced since normally my labours take a half hour at least 3 weeks early and the only hospital that would deliver a baby who’s mother has diabetes was 2 hours away. Then after my little girl was born we were home one day before we were back in the hospital for a week for jaundice while my husband was home doing God only knows what. Needless to say, I HATE prenatal care where I live and will only tell my Dr and husband I am pregnant when it is time for the 20 week ultrasound, and will refuse any care after that. I don’t see the problem with it if I take my prenatal vitamins, take folic acid, stop my psych meds till the dangers of birth defects are gone, stop them a month before to avoid withdrawals in the baby, eat healthy and maintain healthy blood sugars through diet, stop smoking, don’t take OTC meds, etc. I don’t see how it would be beneficial for me, the baby, my pregnancy, or my family for me to be so stressed out through my whole pregnancy, and all the constant non-stress tests were doing were showing me my constant never ending Braxton hicks contractions. Also being induced in Ontario only slowed my labour down to 4 hours from first drop of medicine. Here, it took 2 1/2 horribly long painful days with pretty much forced morphine, and I had to do it all alone because only people over 13 are allowed to be there and my husband had to take care of 3 children who were at the hospital with us and so wasn’t allowed in the room. I actually gave in and used the gas they provide because I couldn’t handle it alone. I was so disappointed in myself the hospital and everyone. Very surprised I didn’t slip into deep postpartum depression, but luckily my bi-polar kicks me into a manic episode a week or 2 after labour. I would love to hear your opinion on what I should do instead of avoiding all prenatal care for the sake of my baby and my sanity. Again, I follow all advice the Drs in Ontario gave me.

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  20. Wow, that was a long rant. Sorry.

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