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.

 

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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Categories: Random

Tags: maternal, morbdity, mortality, nurses, nursing, OB, obstetrics, PIH, preeclampsia