A lot can go wrong in the nine months before a woman bears a child.
Ultrasounds, prenatal vitamins, maternal diabetes and other health concerns can mean the difference between a healthy baby and a complicated labor.
However, undocumented and some uninsured pregnant women rely on emergency Medicaid, which provides coverage only at the time of delivery and not in the nine months prior.
Such a pregnant woman might never see the inside of a doctor’s office until she is in labor.
Dr. Anna Lundeen, a Northwest Colorado Visiting Nurse Association family practice physician, said it has been a dream of hers to work in a medically underserved area such as Moffat County, where the VNA provides preventative options for undocumented people through programs like the Prenatal Assistance Program.
With a new ultrasound machine, fetal monitor, federal grants and Lundeen — who began work at the VNA in August 2009 and has a passion for obstetrics and indigent care — the Prenatal Assistance Program now offers about 70 women 12 free visits during their pregnancies and one postpartum visit to monitor their progress and check for problems that may arise.
“What we need to realize is that we are going to take care of them one way or another,” Lundeen said of undocumented expecting mothers. “Either they’ll be taken to the hospital without having had any care, or we’re going to provide good care to give them good outcomes.”
A healthy outcome for Moffat County babies is all the VNA hopes to accomplish using federal funds and grants.
The Prenatal Assistance Program recently received a one-year grant for $50,000 from the Caring for Colorado Foundation. The program has also received $15,000 from the Colorado Trust Equality in Health Initiative and $15,000 in additional funding from Yampa Valley Medical Center in Steamboat Springs.
The program began four years ago with 12 patients and has since expanded to cover 70 women in 2009 in Moffat and Routt counties, equaling 90 percent of the total undocumented population of pregnant women, said Diane Miller, VNA director of clinical and quality services.
“We’re talking about babies,” Miller said. “Pregnant women and babies, and we just see this as part of what needs to happen. Prenatal (care) is pretty darn important.”
Still, Miller said it’s not cheap to care for these women.
The program costs about $120,000 a year to run for 70 patients.
To alleviate some of the costs, Lundeen put in an application to be granted obstetric privileges so she could perform more procedures and deliver the babies of some Prenatal Assistance Program patients.
Currently, the uninsured prenatal patients are sent out to the five other obstetric-privileged physicians in Craig — doctors Scott Ellis, K.C. Keating, Larry Kipe, Troy Phillips and Greg Roberts — for most of the prenatal visits and the actual deliveries.
Although they get paid less for seeing these patients, Miller said the obstetricians in the community have been enthusiastic about the program.
“It’s the (nurse practitioners) and (physician’s assistants) and the doctors that are just totally dedicated to providing this care no matter their ability to pay,” Miller said. “In a lot of cases, these patients come from some complex situation, and we really just have to treat them.”
In its monthly meeting Feb. 24, The Memorial Hospital board voted, 4-3, to approve Lundeen’s obstetric privileges.
Some board members felt that the number of doctors practicing obstetrics was already sufficient and adding another would dilute that skill set.
“She’s genuine about this,” board member Melton Sullivan said of Lundeen. “But, the hospital has a mission of taking care of anyone that shows up. It’s a good thing, but she’s not providing anything that isn’t already provided. I wish her well, I just think it’s not the perfect situation.”
Miller said she was “thrilled” Lundeen was granted obstetric privileges to add to the services of the VNA’s Prenatal Assistance Program.
“We’ll still continue to refer to those providers who already participate, and hopefully Anna will be able to take on some of them and provide a little continuity of care,” she said. “It’s also a cost benefit for (the VNA).”
Hope Cook, a prenatal nurse at the VNA for five years, said she has seen several positive outcomes in patients of the Prenatal Assistance Program who might have otherwise gone without care.
“I think that the one thing that we all sort of hope is there’s a good outcome,” Cook said. “Whatever you can do to hopefully promote a healthy baby, in the long run costs our society less. A lot of these women are not citizens, but they have jobs and are contributing to society. There is no other place for these women to go.”
She said the prenatal visits for the underinsured and undocumented are also a chance to explain to women who’ve had limited medical exposure that using health care in a preventive sense can cost less.
“Hopefully it can be a better start for them,” Cook said.
For Lundeen, she sees the need for indigent health care as more pressing than ever in difficult economic times.
“There are people just walking into the delivery room and they had no care whatsoever,” she said. “What we’re trying to do is offer care that’s efficient and affordable to give people a primary care base so they don’t use the emergency room as their primary care. By doing so we’re hoping to decrease the burden on the hospital and decrease their bad debt, because we’re keeping most of that here.”
She said even since she moved to Northwest Colorado in August, she has seen the need for health care in the Craig community.
“There are so many people who have lost their jobs, and there’s just nowhere else that does that sliding pay scale for them,” she said. “(Offering preventative care) is just so much better than the alternative.”