By Nicole Miele, BA, MSN, CLC, RN
Carla was sitting alone and scared in the neonatal intensive care unit, helplessly staring at her baby that wasn’t supposed to be here for another 8 weeks. She didn’t have support from family, friends or a partner and didn’t how she was going to care for this child. “This is my fault, if only I knew then what I know now”, Carla was referring to prenatal care and taking care of herself during the pregnancy. Carla learned she was pregnant during an emergency room visit for abdominal pain, at this point she was already going into her 7th month of pregnancy. Up to this point Carla had been smoking cigarettes, drinking on occasion and doesn’t remember the last time she went to the doctor. “I just go to the emergency room if I don’t feel well”. Carla is like many other young women because that due to a lack of health education, she does not utilize the healthcare system for preventative care such as well visits and prenatal care. Instead, she visits the local ER for all of her “healthcare needs.” Meanwhile, the average cost of an ER visit is $558 compared to $168 with a primary care physician. Medicaid recipients’ rate of ER visits is 3.5 times that of individuals with private insurance. If Carla had been receiving preventative care through a clinic or private practice, her outcome might have been drastically different. Her pregnancy might have been prevented through proper access to and education regarding birth control options and her pregnancy could have been detected at an earlier stage increasing her prenatal outcomes.
According to the March of Dimes, the average length of stay for a baby admitted to the NICU is 13.2 days. The average cost of a NICU admission is $76,000 with charges exceeding $280,000 for infants born prior to 32 weeks gestation. The average cost for Carla’s baby’s admission is $102,182. The costs of a premature delivery often do not stop after the baby is discharged. Many of these children go on to have long term health complications, need services from early intervention and the school system, and increasing the likelihood of receiving SSI benefits. According to the National Institute of Health the average cost to the United States for premature births is $26.2 billion each year.
I have been working as a maternal-child community health nurse for the past 7 years and have met many young women like Carla. I have been fortunate to start working with these young women during the first-trimester of pregnancy, when education regarding prenatal care is critical. My most recent position has been with a program called Nurse-Family Partnership. We start working with low-income, high-risk, first-time pregnant women prior to 28 weeks gestation and work with them until the child turns two. I am not the nurse that gives injections or takes care of wounds. My job is to provide education to these young women about caring for themselves during the pregnancy and thereafter, breaking the generational cycle we so often see within the lower socioeconomic status population. I visit my clients weekly, discussing everything from taking their prenatal vitamins, proper nutrition, stress reduction techniques, and preventing a second pregnancy to completing their education and getting a job.
If Carla had access to a program such as the Nurse-Family Partnership, the health and cost outcomes might have looked a lot different. The average annual cost per Nurse-Family Partnership participant is $5383. The cost of prematurity, specifically in the lower socioeconomic population, can be drastically reduced by supporting such evidence-based programs as Nurse-Family Partnership.
Nicole Miele graduated from Rhode Island College with a BA in Psychology then went on to pursue a career in nursing, graduating from an accelerated BSN program at the Massachusetts College of Pharmacy and Health Sciences. She recently completed a Master’s in Nursing Leadership and Health Systems Management at Drexel University. She is currently completing a Certificate of Advanced Graduate Study at Northeastern University to become a Family Psychiatric Nurse Practitioner. Nicole is currently working as a maternal-child community health nurse for Children’s Friend in Providence, RI and is a member of Sigma Theta Tau and the Association of Women’s Health, Obstetric, and Neonatal