Sierra Hernandez’s life didn’t quite work out the way she
might have hoped. At age 38, she was pregnant with her 2nd child,
and her live-in boyfriend/fiancé had just decided that he wanted to move across
the country to study art. She couldn’t believe it – the two were planning to be
married, and Sierra was shocked that he could be so cavalier about their 2 year
old daughter and the new baby on the way. Sierra didn’t know how she would make
ends meet, but she persevered and was thankful for the apartment she had and
the job that paid pretty well. Sierra was angered, however, by her company’s
decision to eliminate the health care benefit that employees had had for
several years; she had a policy when her first daughter was born and hence had
very little to pay when for the hospital delivery. She now had her own policy
which she could barely afford – and she was worried about what the cost of
having her new baby might be. One thing she knew – that she would name the new
baby after her good friend who helped her through her darkest days – Wendy.
Sierra looked forward to being a mother again, and, though it would be hard,
she welcomed the sleepless nights and growing cries of a newborn.
·
1) What are the typical developmental milestones
for the child in utero? Outline the
stages of pregnancy and the threats to optimal development at each stage. When
are teratogens most dangerous for the developing child?
·
2) What effect does “advanced maternal age” have on
the process of pregnancy? Are there precautions generally taken by an OB/GYN?
What are they? Where in Virginia might one for specialized genetic testing
regarding possible birth defects? When are tests done in the course of
pregnancy? Why are they done at those times?
·
3) Given Sierra’s depression, it is possible that
she might want to go on antidepressants. Are any of those medications
contraindicated during pregnancy?
·
4) What does it typically cost the family/mother to
deliver a baby at a hospital? What options does Sierra have with regard to
health insurance? Is being pregnant considered a “pre-existing condition” that
might prevent one from obtaining health insurance?
DECISION POINT ::: Does Sierra drop her current
insurance policy and try to obtain another one?
1. The first trimester begins at conception and ends with the 12th week, or third month, of pregnancy. After a month a baby’s brain, heart and spinal chord begin forming (Carson, 2011). The arms and legs begin to show, the umbilical chord is visible, and eyes begin to position. The sex organs have also begun to form. The second trimester is from week 13 till week 26, or the 4th through 6th months. Muscles and bones form, skin toughens and the baby’s first bowel movement occurs. During the second trimester individual features such as eyebrows, fingernails and toenails form. Sounds are heard and swallowing occurs during the fifth month (Carson, 2011). The lungs are formed during the 6th month but they do not yet work. Reflexes, taste buds, and fingerprints are also formed. The final trimester is referred to as the “third trimester” and occurs during week 27 till week 40 (Carson, 2011). If a baby is born premature they will miss crucial development in the lungs, which are at a practicing stage. All the features of the baby are now concrete and much movement occurs, even opening and closing of the eyes. A baby is considered to be full term during the 37th week and beyond. A teratogen, or an agent that can cause birth defects, is harmful as early as the first 10 days of pregnancy. The brain and the spine are susceptible to harm from teratogens throughout the entirety of pregnancy. For most organs and general development the first trimester is where extra precaution to avoid teratogens should be taken.
ReplyDeleteCarson, E. (2011). Baby development in the womb week by week. Livestrong. Retrieved from http://www.livestrong.com/article/267425-baby-development-in-the-womb-week-by-week/
2. What effect does “advanced maternal age” have on the process of pregnancy?
ReplyDeleteAdvanced maternal age has a number of different effects on the process of pregnancy. Most often, a chromosome abnormality may occur and the most common is Down Syndrome (Davis, 2009). Other risks include pregnancy induced hypertension, gestational diabetes, placental abruption, stroke, and the need for a cesarean section during delivery.
Are there precautions generally taken by an OB/GYN? What are they?
An OB/GYN provides many tips for women during pregnancy, especially with advanced maternal age. Some precautions they suggest include an increase in supplement intake of vitamins such as calcium, folic acid, iron, vitamin A, and vitamin D (Kirkham, 2005). They also suggest altering diets to low amounts of artificially sweetened foods and drinks, caffeine, dairy products, eggs, raw or undercooked meat, and especially stress limiting seafood intake, especially raw (Kirkham, 2005). OB/GYN often keep close watch of abnormal palpitations, blood pressure, evaluation for edema, fetal heart tones and movements, urinalysis, and weight measurement. In addition to all of those routines, OB/GYN stress genetic testing’s and screenings on the baby.
Where in Virginia might one for specialized genetic testing regarding possible birth defects?
One should go to Fairfax, Virginia for specialized genetic testing to determine possible birth defects (Prenatal, 2012). Fairfax has prenatal doctors who offer multiple DNA tests ranging from invasive to non-invasive procedures, such as chorionic villus sampling (CVS) and amniocentesis.
3. There is much to debate about whether a mother should continue to take antidepressants or totally stop when pregnant because of her mental health. There is the question of untreated depression being detrimental to the development of the baby (Savard, 2009). And lastly, there is a concern of stopping antidepressants with a baby on the way having adverse effects on the development. Serotonin reuptake inhibitors such as Prozac and Zoloft have been thought to cause increased rates of problems in newborns, specifically high blood pressure in the baby’s arteries in the lungs (Albow, 2012). If Sierra is still managing her daily life in a healthy way without treating her depression with medication she should continue on. It will be crucial to keep her stress levels low. If her depression gets in the way of a healthy lifestyle then Sierra should consult her doctor about a proper, less harmful antidepressant medication.
ReplyDeleteAlbow, K. (2012). Antidepressants and pregnancy: What to do now. Fox News. Retrieved from http://www.foxnews.com/health/2012/01/16/antidepressants-and-pregnancy-what-to-do- now/
Savard, M. (2009). Taking antidepressants in pregnancy a tough choice. ABC News. Retrieved from http://abcnews.go.com/Health/MindMoodNews/story?id=8401770#.TxnO-ryF93F
4. In situations that are not complicated deliveries, having a baby via cesarean section is approximately $15,000, while an uncomplicated vaginal birth is about $9,000 in most hospitals. However, it varies depending on where the mother goes, such as state hospitals are typically cheaper than other private hospitals, and whether or not she has complete coverage such as Medicaid (How much does it cost, 2008).
ReplyDeleteThere are many options that Sierra has with regard to health insurance. Depending on factors such as income, she may be able to qualify for Medicaid, but she must apply and qualify before she can have the benefits for her child. Another program that may be useful during her pregnancy and during the first few years of the child’s life is the program that is called the Children’s Health Insurance Program (CHIP). In this program, care from prenatal care to age 19 is covered for those families that have income too high for Medicaid, but also have difficulty obtaining health insurance for their children. She also has options such as other private insurances that may be able to cover prenatal and hospital care during delivery (CHIP, 2010).
Being pregnant can be considered a pre-existing condition, according to most health insurances. However, this will change by 2014, when insurers will no longer be able to discriminate based on any pre-existing condition. Unfortunately for Sierra, this may be the case for a health care policy that she wants. For those in her situation, she may have to shop around for different health care policies that do not consider pregnancy a pre-existing condition or wait until after 2014 (Pre-existing conditions, 2010).
CHIP eligibility standards (2010.). Retrieved from the Medicaid website http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/CHIP-Eligibility-Standards-.html
How much does it cost to have a baby? Hospital costs, baby supplies, and more. (2008.). Retrieved from http://www.webmd.com/baby/features/cost-of-having-a-baby?page=3
Pre-existing conditions (PCIP)-FAQs. (2010). Retrieved from http://answers.healthcare.gov/categories/1702
Decision Point:
ReplyDeleteSierra should first shop around for other health care policies before dropping her current policy so she and her children will not be uninsured for any amount of time. While keeping her own policy, she should apply for CHIP (Children’s Health Insurance Program) so she can have prenatal care and coverage for her child at little to no cost. If she chooses to apply for CHIP, she should apply for it as soon as possible, especially before the third trimester so she can at least have coverage for her hospital stays and post natal care. She could then decide whether or not she needs her current policy after qualifying for CHIP, and if not, she could apply for another private insurance or programs such as Medicaid. She should focus on the unborn child and cost for care, then decide on policies for other needs.
2. (continued)
ReplyDeleteWhen are tests done in the course of pregnancy? Why are they done at those times?
Genetic testing during pregnancy can detect genetic abnormalities before birth such as cystic fibrosis, duchenne muscular dystrophy, hemophilia A, thalassemia, sickle cell anemia, polycystic kidney disease, and tay-sachs disease (Common tests, 2012).
Tests performed during the first trimester include an ultrasound test for fetal nuchal translucency, which examines the area at the back of the neck for increased fluid (Common tests, 2012). Two maternal serum blood tests are also performed to measure levels of protein produced by the placenta, abnormal levels can lead to chromosome abnormality, and a hormone produced by the placenta is also measured through a blood test for the same reason (Common tests, 2012). Those tests are known as plasma protein screening (PAPP-A) and human chorionic gonadotrophin (hCG). When used together as first trimester screening tests, nuchal translucency screening and maternal blood tests have a greater ability to determine if the fetus might have a birth defect, such as Down syndrome, trisomy 18, or trisomy 13.
Second trimester parental screening tests include several blood tests called multiple markers, which also determine whether or not a woman will have a child with genetic conditions or birth defects (Common tests, 2012). Alpha-fetoprotein screening (AFP) is a blood test that measures the level of alpha-fetoprotein, produced by the fetal liver and is present in amniotic fluid and transferred into the mothers’ blood. Abnormal results may suggest the baby will be born with spina bifida, down syndrome, twins, or a miscalculated due date. Ultra sounds are performed during this trimester to determine due dates, and inspect the fetal spine and other body parts for defects (Common tests, 2012). Multiple tests are preformed during these two trimesters because together the results have a greater chance of detecting genetic abnormalities than one test alone. An amniocentesis is also a small procedure preformed to obtain a small sample of the amniotic fluid around the fetus. A risk for miscarriage is associated with the procedure. Chronic villus sampling (CVS) involves taking placental tissue. This contains genetic material, but does not provide results on neural tube defects.
The most common testing throughout the entire pregnancy is ultra sounds. In the third trimester they are used to monitor fetal growth, check amount of amniotic fluid, used as part of other testing such as biophysical profile, determines position of the fetus, and assesses the placenta (Common tests, 2012).
Sources:
Common tests during pregnancy. (2012). Retrieved from Packard Children's Hospital’s website: http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/pregnant/tests.html
Davis Fertility Center. (2009). Advanced Maternal Age. Retrieved from http://californiaivf.com/AMA.htm
Kirkham, C., Harris, S., & Grzybowski, S. (2005). Evidence-based prenatal care: Part I: General prenatal care and counseling issues. American Family Physician. Retrieved from http://www.aafp.org/afp/2005/0401/p1
Prenatal paternity test. (2012). Retrieved from the Innersanctum Inc. website: http://www.dnatesting-paternity.com/testing-services/paternity-tests/prenatal-paternity-test