Background:

The current economic recession in the United States has had a profound impact on the nation healthcare system. One specific population at risk is the pregnant woman and their infants. ACOG reports that "Uninsured pregnant women are more likely to experience an adverse maternal outcome. Uninsured newborn are more likely to experience adverse health outcome and are more likely to die than insured newborns" (ACOG Committee Opinion, 2008). It has been reported that 18% of uninsured pregnant women have reported that they did not receive needed medical care versus 7.6% of privately insured and 8.1% of Medicaid-enrolled pregnant women (ACOG Committee Opinion, 2008). These uninsured women face barriers such as access to healthcare providers, diagnostic testing, and alternate insurance coverage.

Case:

The presentation identifies a 39 y/o G2 P0100, who was seen in the Emergency Room (ER) prior to delivery diagnosed with kidney stones. During that visit, she was also found to be 23 weeks pregnant with elevated blood pressure and blood glucose. She stated that she was unable to obtain her medications due to a lack of health insurance, secondary to her spouse losing his job. However, due to the lack of insurance she was able to attend only one prenatal visit.

At 25 weeks gestation she presented to the ER with reported tonic/clonic seizures. Upon admission to a Prenatal Special Care Unit (PSCU), complications included advanced maternal age, morbid obesity, insulin dependent diabetes, chronic hypertension and undiagnosed sleep apnea as well as a preterm delivery. Due to elevated blood pressures and recurrent eclamptic seizures, the decision was made to deliver by repeat c-section for a baby boy who expired 145 days following delivery.

Conclusion:

The presentation will include the need for early identification of potential barriers to adequate prenatal care to achieve the best maternal-fetal outcome. Healthcare providers are a crucial source of on-site or referral support services to buffer the health-damaging effects of hardship on women and children (Braveman et al., 2008). It is important to offer information on national and state programs such as Medicaid, community programs like Healthy Beginnings (in Delaware), health care discounted programs, and free clinics. A multidisciplinary healthcare team approach can optimize perinatal outcome in this population.

Keywords:  

Uninsured, perinatal, hardship, complications, recession