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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50 Comments on "No Prenatal Care and No Empathy"

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Diane McElroy
Guest

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

Donna
Guest

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

Your Cousin Sarah
Guest

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!

postpartumRN
Guest

I needed this… thanks

Janice Dorsey Joiner
Guest
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… Read more »
jj
Guest

You’re still sitting high and mighty by assuming they need to “change”. They don’t. You’re stuck in a mindset that simply doesn’t reflect reality.

LDR MSW
Guest
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… Read more »
L&D RN
Guest
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… Read more »
Star
Guest

This was an awesome article!

Kathy Watrous
Guest

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

Meli Love
Guest

Are you a nurse?

Lioness
Guest
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… Read more »
Kim Miller
Guest

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.

Anonymous
Guest

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.

Shari Arner
Guest

not intentionally anonymous….Shari Arner BSN, RNC practiced in Chandler AZ and now retired in Collingswood, NJ

momof3
Guest
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.… Read more »
Nurse Ratched
Guest
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… Read more »
Amber Hansen
Guest
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… Read more »
Chris
Guest

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.

Chris
Guest

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!!

cory rock
Guest
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… Read more »
Chris
Guest

Oh honey! I’m sorry for your miserable experience. I think I’ve only met one nurse of that caliber in 35 years!! Next time (if there is one) will be better. Oh my!

safer midwifery utah
Guest

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.

safer midwifery utah
Guest

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.

Theprimmom4
Guest
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… Read more »
Niki
Guest
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… Read more »
Niki
Guest

Wow, that was a long rant. Sorry.

Meg
Guest
I should note that some women like myself try to get prenatal care but can run into insurance problems. I’ve been trying for two whole months to get an a prenatal appointment…. by now I’m more than 3 months along (or 4…. I’d really prefer an appointment to confirm). I have insurance but it has a tiny network and absolutely sucks, we live in a high COLA area meaning we don’t have a lot of extra, my doc’s office does not allow self pay, husband makes slightly too much to qualify us for medicaid, etc. The US has great care… Read more »
Emily
Guest
The problem with sliding scale clinics is that for people “in the donut hole” of health care, as it were, they are STILL unaffordable. With my oldest we had no insurance until sudden unemployment due to company closure bumped us into medicaid. Neither mine or my husband employer offered health insurance, part of why we found ourselves with an unplanned for the time but very much wanted pregnancy. Out of pocket costs at the sliding scale clinic ate my entire pay check while we ate expired food from the dent and doing store, because as a married household, we made… Read more »
Ac
Guest
This is true. I was treated like scum my last pregnancy, which was my third baby, btw. I didn’t know I was even pregnant, when we suspected/learned (my husband and I) we rushed to the E.R. That night just to make sure everything was okay. Every nurse on the floor came in the room just to chastise me and reiterated how important prenatal care is.”I know this! That’s why we’re here!” I kept repeating. But they just acted so snobby. Finally a younger black female doctor came in, who was super supportive and understanding. I only mention her race and… Read more »
TB
Guest

How did everything turn out? I hope you and the baby are well. I also hope Obamacare will be fixed to make things affordable in the US. Too many people that needed it, could not afford it (the increasing premiums) and out-of-pocket expenses have skyrocketed in order to make up for the losses generated by OCare. My pharmacy alone said they had a quick 40%+ increase in pricing due to Obamacare…so I don’t see the current form as affordable for ALL. I hope any changes under the new admin will be helpful. *fingers crossed*

Sarah
Guest

Please help. 7mos only have seen doctor 2x. 4th child. 40 years old. I want to go to appointments but can’t afford them. Doctor wants approximately 200$ a month. I can’t get Medicaid because I was born in Canada. I can’t afford my appointment s even with insurance. I can’t go to free clinic because I have insurance. What do I do? I’ve called nurses, obgyn’s, ER, hospitals they all say come in when your ready to deliver. I’m lost…..

Centralmichiganpregnantagain
Guest
Centralmichiganpregnantagain
This has been my battle. I’m somewhere between 20-22 weeks now. the ob gyn I seen when pregnant with my ds, her receptionist said I needed to talk to billing. Billing said I need to pay $2700 before I even talk to the nurse. For what? Why would I pay for absolutely nothing? Then another $300 per visit beyond the initial $2700! Because I have no insurance. So I got married, got put on my husbands insurance, called back, now they said I’m not showing up on husbands insurance, though I know it shows I am, but she goes on… Read more »
H.C.710
Guest

Amen!

jj
Guest

Pearl-clutching. The brainwashed who profit from it don’t mind repeating this tripe. Women who receive care from someone other than themselves are at a MUCH HIGHER risk of complications from intervention. To top that off, diagnoses are often nonsense. Go read all the women that were induced for “big baby”, and then the suckers come out 7 lbs.

There is NOTHING anyone can do to keep me from completing all my natal-related care myself. Zzzziiiiilllllcccchhhhh. :)

Shelby
Guest
I’m due any day now and have only been able to see a doctor twice. I’m terrified it wasn’t because i didn’t want to see a doctor, but the father of the baby left me and I have literally had to do it all alone, find a place to live, find a job, prepare for baby and I’ve hardly been able to make ends meet by the time my Medicaid was approved i was 33 weeks and I had an ultrasound on my day off the baby measured fine and I was healthy for the most part up until then… Read more »
Erin
Guest

With your experience in triage, what would you recommend for someone who cannot find a doctor willing to accept them as a patient because they are considered ‘too high risk’? Would it be best for them to goto ER to receive care if no one else will see them? Can triage turn them away if they aren’t actively in labor?

Adventures of a Labor Nurse
Admin

yes triage can, if her only issue is labor. I would recommend that you find a clinic. Call EVERYONE. Have your prenatal records. Don’t give up. The ER is not a place for prenatal care.

Laura
Guest

Same issues I’m 32 weeks and have only been seen once and can’t pay for delivery beforehand. No one will take me As a patient and the government won’t help because my income is just above the cut off.

Cindy
Guest
Honestly we don’t know the situation of some people. To not have any empathy is sad. I currently have health insurance. It doesn’t cover anything prenatal. I had a 25,000 dollar birth with my first, and I had to file Bankruptcy. Here I am pregnant again. 18 weeks pregnant. No prenatal care. Because there is no way in hell I can afford to go. We don’t qualify for anything. I’m waiting to hear back from something from Obama Care. Hopefully I can get somewhere. I cannot afford to file Bankruptcy. I had an IUD and it failed! I will not… Read more »
Hannah Cain
Guest
This post is ridiculous. It seems that the only “uneducated” people are indeed the nurses themselves. For every scared woman out there, pregnant and unable to afford the ridiculous funds it takes in our society to do what is natural for your body to do, I want to encourage you. You have the power to do it alone. Knowledge is your power. Read. Look up everything you can about birthing your own child. Every question about any difficulty that could possibly arise, look it up. That’s all nurses do. That’s why they are constantly in PRACTICE. This author’s story comes… Read more »
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