Providing Patient-Centered Prenatal Care by Jonna Mosoff

My role as Prenatal Patient Advocate role at the Health Annex encompasses a little bit of many things, guided by the simple directive to help the women who walk into the Health Annex navigate and prepare for pregnancy and parenting. Most often, that means providing outreach and enrollment assistance to apply for insurance to cover the cost of ultrasounds, consults, labor and delivery. Sometimes, it involves scheduling appointments because the American healthcare system is complicated, especially to a recent immigrant. Part of being an advocate is providing education, on nutrition, vaccination, or sleep and car seat safety. The best part of the position is that my role changes with the needs of each patient; the barriers to care have to be identified before they can be addressed.

The Family Practice and Counseling Network, of which Health Annex is one site, is centered in a belief in wraparound care. The first prenatal visit is the epitome of this. A provider meets with the new patient first and determines medical history, and the path forward to managing the pregnancy, including necessary tests and consults. Next, a social worker checks in to see how the patient is handling the often unexpected news. Then, the prenatal nurse offers education on nutrition, breastfeeding, parenting and answers any remaining questions. I usually meet a patient last and help them enroll with insurance and schedule the appointments the provider requested. Often, it is at this time that a patient asks about other resources, like housing, food, clothing, car seats or cribs. I am able to refer patients to specific organizations or other staff at the Health Annex to address each need. 

Recently, a patient arrived at the Health Annex seven months pregnant and without previous prenatal care. She had been in the U.S. for only one month. Her medical history included complex diagnoses, and due to her immigration status her presence in the U.S. was precarious. She needed every resource available, and thankfully there were many. I submitted an emergency application for health insurance, and followed up to have it approved quickly. A coworker gave me the name of an immigration lawyer who was willing to work pro bono to answer her questions and help with next steps. She also attended a nutrition consult and received an emergency food delivery along with information on nearby food banks. I was able to give her a starter pack of clothes and baby supplies from an organization that partners with the Health Annex. Together, the midwife, social worker, nurse, dietitian, and me worked to provide her with everything she needed for a safe pregnancy, and to prepare her for being a new mother.

One of the first thing we learned in training was about trauma-informed care and how to ask “what happened?” instead of “what’s wrong?” In this instance an entire team of people, of which I was happy to be a part, intentionally provided patient centered care that acknowledged that medical diagnoses are intrinsically tied to situation and experience.