A mother delivered a 34 week gestation baby this morning. The baby is doing fine. Mother's history is remarkable for chronic high blood pressure and 4 strokes, although it has been hard to find evidence of those strokes on imaging. Also, in a tragic note, the mother lost two children eight years ago in a house fire (an all too common occurence in the poor urban area in which I work.)
Wouldn't you think that a pregnant woman with chronic hypertension would seek prenatal care? Wouldn't you think that a pregnant woman with 4 strokes would get prenatal care? Wouldn't you think that maybe a mother who had two children die in a house fire would consider each child precious and get prenatal care? Wouldn't you think that such a mother might be able to forego her marijuana smoking during pregnancy?
This mother did none of those things. She said she had no health insurance, but in our state any woman who is poor can get Medicaid, and since she was hospitalized for 6 days at about 27 weeks gestation - the extent of her prenatal care - I know a social worker discussed getting Medicaid with her. This mother simply did not follow through, did not do the responsible thing for herself and her baby.
I've always considered myself sort of a bleeding heart liberal, one who tries to see the problems and difficult life of a woman like this and feel pity for her, and try not to blame her for her lack of prenatal care. But I get a little tired of it when I see case after case similar to this. Maybe it isn't as easy for her to get prenatal care as it is for a suburban woman with good health insurance. Maybe it would require her to take a trip to the Medicaid office, or to fill out some forms and mail them in. But that's not a valid excuse; doing the right thing in life takes a little effort sometimes, and this woman simply didn't put out the effort. I'm sick of it.
The Institute for Healthcare Improvement recently surveyed patients and families about what they want and expect from healthcare providers. The first item they wanted was to be listened to, taken seriously, and respected as a care partner. I would love to do all those things for my patients and families. But first they have to respect themselves.