What if You Can’t Find Prenatal Care?
Prenatal care is becoming harder to find, especially in rural areas. Several scenarios seem to be common:
-A woman finds out she’s pregnant, maybe unexpectedly, and takes some time to process the news and get her financial ducks in a row. When she calls the local OB’s office, she’s told that she’s waited too long to start care (somewhere around 18 weeks) and that office won’t take her.
-A woman receives timely prenatal care in another city but moves half way through her pregnancy. The OBs in her new city won’t accept her as a patient.
-A woman calls her OBs office when “the stick is still wet” and is told they’re already full or not taking new patients.
In all of these cases, the women will have to go without care and walk into the hospital in labor or drive an hour or more for prenatal care and to give birth. It’s mind boggling that the same doctors turning women away are the ones who will catch these babies later when they’re on call for walk-ins at the hospital. I am told it’s a liability issue but it makes no practical sense.
In some cases, families are in a “maternity desert” with no care providers for miles. For instance, in my home county of Montague, there are zero maternity care providers. The county south (Wise) has four OBs as of this writing but one is retiring and another leaving. Are 2-4 OBs enough to provide care for Wise, Montague and some Clay county residents?
So what do you do if you can’t find prenatal care?
You may have a couple of options. Midwives are sparse in rural Texas but we’re here. Now many women who are going without prenatal care do not desire and/or can not afford midwifery care since insurance doesn’t cover it well. If a woman wants to give birth in the hospital but no OB will give her an appointment for care, what can she do?
I’ve been pondering this predicament for about a year now. My solution is to offer prenatal care at a reasonable cost to women who will plan to walk into the hospital in labor. She won’t know who the OB will be but she will at least have had her pregnancy monitored beforehand. She will have her records in hand so that the delivering physician can see her lab work, blood pressures, any complications, etc. Everyone can be reassured of her health status. Prenatal care decreases her risk of preterm labor and improves outcomes for her and her baby. This is a win-win.
So the big question is how to do this. Some women who aren’t getting prenatal care can’t afford it and don’t qualify for Medicaid. This is the hardest situation because even if the midwife were to reduce her fees drastically, there are still lab tests, ultrasounds, medications, and supplies to pay for. And midwives deserve to get paid, of course. My preliminary thoughts are that churches and individuals could be made aware of this need and help cover the cost of care for these cases. Maybe a non profit organization needs to be formed or a church needs to step in and create a fund (and fundraising) for the “least of these.”
For families who can afford it, the pricing could be flexible depending on their needs. Maybe a sliding scale is put into place so that everyone can get care who needs it, regardless of their financial status.
One piece that will grieve every midwife who considers this type of care is that the continuity of care is broken when the client goes to the hospital to deliver. One way to help remedy this is for a doula to work with the family prenatally and through the birth. For the woman who desires a community based birth (not in the hospital) maybe a student midwife and her preceptor would take over for the birth, taking a lower fee since they didn’t have the expense of the prenatal care. Of course the student could attend some of the prenatal visits with the client to provide that important continuous thread of support.
Another part of the how is overhead. Midwifery is not free. The midwife must pay for office space, an EMR system, advertising, her website, her license, CEUs, training, and supplies. If she lowers her price, which is already less since she’s not offering birth services, how can she make a sustainable wage?
There are many moving parts but I am certain it can all come together to work for the benefit of moms and babies in our area. I met with a mom in one of the above scenarios last week and she agreed this is a “God thing” for both of us. We’ve set a payment plan that works for both of us and she’s thrilled to have care prior to her planned in-hospital birth in a few months. If you want to be part of this “God thing” as a mother needing care, a birth workers seeking to give back to her community or an individual with office space or donations to offer, reach out to me via email or text/call me at 940.366.5982. I’m excited about what’s ahead and would be glad to have you be a part.