What can be safer than having a baby in the USA?
Many things, regrettably—even in our 21st century health care system. I have an idea for a strategy to change the situation.
Young women should be compensated for using whatever contraceptive they choose by being given vouchers that can be redeemed for material goods at select venues or free minutes for their cellular phones.
- All women who qualify for Medicaid coverage of pregnancy should be aggressively encouraged to have a preconception visit at least 3 to 6 months before they plan to become pregnant to assess any risks to themselves or their fetus and have a program put in place to maximize outcomes. This encouragement can take place at any visit in which contraception is discussed.
At this visit, an attempt can be made to optimize their clinical condition by:
- counseling them about drug and alcohol use and smoking
- assessing their risk of genetic disorders
- initiating folic acid and dietary modifications
- performing appropriate screening tests (i.e., blood glucose).
Appropriate consideration should be given, and discussion held, during the visit about whether the patient should even consider becoming pregnant. She should be given a realistic assessment of the risk of pregnancy and childbirth to her and the baby—including the potential for death.
The preconception assessment should be conducted by a physician, a midwife, or a nurse practitioner who has not been involved in the care of the patient. Doing so will minimize the introduction of any bias into the conversation by a treating physician.
When it is in a woman’s medical best interest not to conceive, she should become eligible for expedited adoption and be compensated for each reproductive year in which she does not conceive.
Last, a strong financial incentive should be offered to women who complete this preconception evaluation.
Many will say that such a program is unfair and prejudicial to women of lower socioeconomic status. But a precedent exists: Medicaid prohibits the performance of a sterilization procedure unless a signed permit has been in place 30 days or longer.
- Pregnant women who adhere to a prenatal care plan should be compensated with vouchers that can be redeemed for baby items, maternity clothes, or food for the family at select venues. They should also be compensated for keeping prenatal appointments; obtaining timely laboratory tests; attending prenatal classes; avoiding drugs, alcohol and smoking; returning for postpartum assessment; and using reliable contraception.
Education + contraception = fewer deaths?
Would such a plan work? I am convinced that it is worth trying. What do you think? Send your comments to me at obg@qhc.com!
