Last post I shared with you the story of Mama H who is having some pregnancy complications and really needing some answers. So far, she has had to change OB’s and is waiting for her current OB to gather enough information to not only give her a diagnosis, but also a prognosis for whether or not her pregnancy will progress to a healthy child.
I have since heard back from Mama H and learned that she is being treated by one of the best OB’s in her town in India (India, we are getting around!!). As would be expected she is extremely anxious and wanting to know if her baby will survive (If you’ll recall, she lost the child she was carrying a year ago.).
In our last post I reminded Mamas on Bedrest not to be shy about getting a second opinion if their questions and concerns are not being met to their satisfaction. I still hold to this recommendation because I believe that having as much information as possible when making potentially life changing decisions is critical. I am also a strong proponent of not letting money be a deciding factor. Here’s why.
Being that you are on bed rest, it’s safe to assume there is a suspected complication with your pregnancy. You need to see a specialist, but the specialist recommended is $300 and not on your insurance plan. Do you pay out of pocket or wing it? Let’s look at the possible outcomes.
1) You hem and haw, but decide to shell out the cash for the peace of mind. You meet with the specialist and while your condition is abnormal, it does not warrant any major treatment or intervention other than bed rest. You go on to have an uneventful bed rest pregnancy, deliver your baby at 39 weeks (after spontaneous initiation of labor) and have a healthy baby.
Compare this scenario to what could have happened.
2) Mama A is going along in her pregnancy and at what was to be a routine 2nd trimester prenatal visit, her OB recognizes something abnormal. She recommends a Level II ultrasound. She refers Mama A to a special radiology clinic that does the ultrasound but neither the Maternal Fetal Medicine specialist in charge of the center nor the ultra sound is covered by insurance. When all is said and done, this entire visit will be nearly $750. Convinced She can’t possibly afford the procedure and really “liking” her OB, Mama A decides to stick with her and trust that she will attend to all her needs with no complications.
Mama A goes into labor at 32 weeks. When she gives birth to her son, he is noted to have a loud heart murmur consistent with a hole in his heart that requires major medical attention. The neonatologist who attends the birth mentions that had this abnormality been detected during the pregnancy at the Level II ultrasound, Mama A would have been started on prescription medication and the heart defect would likely have closed itself. Mama A’s little boy is treated and does go on to lead a healthy normal life. But Mama A’s little boy spent several weeks in the NICU and by the time he went home, Mama A’s family was some $500,000 in debt.*
If Mama A had had the Level 2 Ultrasound and taken medication she may have spent a total of $1000. Now I am not saying that this is a trivial amount of money. But I am relatively sure that Mama A could have weathered $1000 far better than $500,000.
Sometimes the best answer to a situation is not the easiest, most obvious or most inexpensive answer. Sometimes that best answer at the time really hurts and blows your budget to bits. But it has been my experience that to be a “out of pocket to be in the best hands” has always served me well. Everyone has to make their own decisions and I am in no way trivializing expenses (I know debt intimately!!!), but I am suggesting that we all look beyond the monetary for the true value for which we seek.
*This is a totally fictitious scenario and Mama A is a totally fictitious mama!!!
I am an ardent supporter paid sick leave for US workers. The United States is one of only 4 countries world wide that offers no sort of paid leave for maternity, medical illness/treatment or to care for an ill family member. While most of us will agree that the United States offers unparalleled employment opportunities, it is shocking and disturbing that the US does nothing to support its workers when they or those they love fall ill.
I suppose with so many workers to choose from, there is no incentive to be loyal to employees. The US unemployment rate is still over 7% and there are many people willing to work for wages well below what they are worth and take jobs well below their skill set in order to simply secure a job and meet the needs of their families. It’s a very precarious work environment.
But I am still baffled as to why employers are so averse to supporting their employees. According to the Center for American Progress, when an employee who earns $50,000 per year leaves a company-regardless of whether they leave voluntarily or are asked to leave-the cost to replace that employee is approximately 20% of that person’s annual salary. In the US, approximately 75% of the workforce earns $50,000 or less annually. Likewise, if the employee earns $75,000 per year and leaves, the employer again has to spend approximately 20% of that employee’s salary or roughly $15,000 to replace that employee. Now considering that 9 out of 10 employees in the United States earns less than $75,000 annually, this can have substantial ramifications if a company has a high turnover rate. The Center for American Progress notes that the cost to replace a worker who makes less than $30,000 annually is slightly less, approximately 16%, yet lower waged service workers are often those with the highest turnover as they seek to increase their annual earnings. And not surprising, the cost to replace an executive or professional employee can be as high as 213% of the employee’s annual salary! Wouldn’t it simply make sense for employers to offer their employees better benefit packages that included health benefits, paid time off and flexible working schedules?
This is a situation that I closely watch for Mamas on Bedrest & Beyond. Many, many mamas have contacted me and my colleagues distraught because of mounting debt and job loss due to being placed on prescribed bed rest. As a result, I do what I can to advocate for paid family leave including presenting cases to Senator Barbara Mikulski (D-MD) with my friend, colleague and the Executive Director of Better Bedrest Joanie Reisfeld, supporting the Paid Medical Leave Initiatives advocated for by the National Partnership for Women and Families, Working Mother Magazine and MomsRising and educating women and families about their leave options. According to the National Partnership for Women and Families, To date:
The Portland City Council voted unanimously to approve an ordinance that will let tens of thousands of workers in Portland earn the paid sick days they need. The bill is awaiting signature from Mayor Hales, making the bill law, and making Portland the fourth city to provide paid sick days.
The Philadelphia City Council, once again, approved a similar measure that would guarantee Philadelphians the same right. Hopefully Philadelphia Mayor Nutter, who vetoed the paid sick days bill in 2011, will take a second look and sign this common sense proposal.
Laws are already in place and working well in San Francisco, Washington, D.C., Seattle and Connecticut. And there are dozens of efforts to advance similar proposals across the country, including in New York City, Massachusetts and Vermont.
Given the economic benefits to companies and the benefits to working families, paid medical leave just makes sense. We Mamas on Bedrest know this, economists know this, advocates know this and yet the fight continues. Hopefully corporate CEO’s and lawmakers will evaluate the data and see that paid medical leave just makes sense. As the Center for American Progress noted,
“This brief documents that the cost of employee turnover for businesses is high, regardless of the level of wages being paid to the departing or incoming employees. Companies typically pay about one-fifth of an employee’s salary to replace that employee. While it costs businesses more to replace their very-highest-paid employees, the costs for most employers remains significant and does become less significant for those with low earnings.
Workplace policies that improve employee retention can help companies reduce their turnover costs. Family-friendly policies such as paid family leave and workplace flexibility help retain valuable employees who need help balancing work and family. For example, research has found that access to any form of parental leave makes women more likely to return to work after giving birth. Moreover, by 2050 up to 20 percent of Americans will be older than age 65, and improved leave policies would allow workers to provide the care their elderly parents may need without having to sacrifice their livelihoods.”
Good Morning Mamas!!
Question: Did any of you undergo “preconception” counseling before becoming pregnant?
I ask this question because a couple of days ago, I was trolling twitter and inserted myself into the #acogchat. The topic of discussion was preconception evaluations. When I entered the discussion, I’m thinking a good 20-30 minutes into the chat, the group was discussing how more women need to be aware of their health histories and essentially should have all their “medical ducks in a row” prior to becoming pregnant to avoid complications. Well you all know me. The statements were making my neck hairs stand on end because they seemed to be saying that when pregnancy complications arise, it’s because of something mamas haven’t addressed prior to getting pregnant, a sort of negligence. In my experience with Mamas on Bedrest that simply isn’t true. For many mamas, there is no rhyme or reason that they have the complications they have. And on that note, I jumped into the conversation.
Let me begin by saying that the moderators and participants of the chat were very gracious and receptive to me and my views. I didn’t exactly “tip toe” my way into the chat, I went in full throttle in defense of mamas! But as the chat progressed, we all reached a really good consensus about preconception health care and health care in general. With a candid discussion about the limitations of our current health care climate as well as cultural and societal opinions, we all left the chat with the following “agreement” regarding preconception evaluations/examinations/counseling:
A Preconception Exam/Evaluation is really preventive maintenance. As the chat progressed, we all realized that if health care providers ask, AT EACH AND EVERY VISIT, about a person’s medical history; if any new complications have arisen, if the patient has any new concerns, is there any change in family history…Then we are doing preconception counseling-the way that it should be done. A woman’s health (or anyone’s health) should always be optimized at any doctor/patient interaction. When we providers don’t ask these questions and update a patient’s record each and ever visit, we drop the ball not the patient.
Preconception Exams/Evaluations must be done for men as well as women! Conception takes 2 PEOPLE!! We focus so much on women (as the carriers) but we cannot forget the fact that the sperm quality will also affect whether or not conception takes place and has just as significant an impact on the health of the baby as the quality of the egg and mama’s health. Just as it’s important for mamas not to smoke or drink if they are trying to get pregnant, fathers who smoke, drink or have other health issues won’t impart healthy genes to their offspring and may also be impeding the conception process.
Preconception Exams/Evaluations must begin in pediatrics. This is one area in which there was some controversy. We all know that teen pregnancy is an issue in the United States. Yet, there is no consensus on when/how to teach sex education in schools. What we as a group came up with is that if we teach children to always take exemplary care of their bodies; stressing the importance of not smoking, not drinking alcohol in excess, avoiding recreational drugs, maintaining a healthy weight for height, getting regular exercise, avoiding risky sexual behavior, etc…We are teaching not only good health habits, but imparting good preconception habits. By focusing on good health, we can reduce the stress many parents feel regarding “sex education” and not step on toes. For example, talking to a teenager about how condoms work and how they prevent the spread of disease is a different conversation than, “You should use condoms at every sexual encounter. ” We impart the medical information and allow parents to speak to the moral implications as they see fit. (And while we know that many parents won’t speak with their children about sex, it is still the parents’ right to impart their moral code on children, not ours-no matter how much we feel it is needed. We can suggest to parents that they discuss certain issues with their children, but in the end, as it was brought up by a parent on the chat, it’s the parent’s obligation, responsibility and right to educate their children (or not) about sex.)
Do discuss medical costs. I brought this to the attention of the group that many insurance companies don’t cover maternity care and require a separate rider on policies. So many woman have been caught by this. Who wouldn’t? It’s natural to assume that if you have insurance, it will cover you if you become pregnant. This just isn’t the case! So as clinicians, we must ask our patients at each and every visit if their insurance has changed, and to give them a simple “heads up” that many treatments and procedures aren’t covered and they should review their insurance policies annually (and most especially if they are planning to become pregnant).
Make Sure Pre-Existing Conditions are Well Controlled Prior to Conception. Again, this was a topic that got us wound up for a minute. But as we discussed it, we all realized, that if health care providers are truly monitoring their patients’ medical conditions, say diabetes, then the goal should always be tight control. At each office visit the importance of blood sugar control should be discussed and emphasized-whether the patient is trying to become pregnant or not. So again, it’s not a question of preparing the patient for pregnancy, it’s about making sure the patient is in optimum health always.
I really am glad that I “crashed the chat”. I had the opportunity to speak on behalf of Mamas on Bedrest and to contribute to a really great discussion on patient care. The one area we were not able to address is the notion that all of this can be done in 8-12 minutes. But I am confident that given the passion and dedication to this group of health care professionals, even that “obstacle” will soon be eliminated.