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Motherhood Beyond Borders: Physician Perspectives on Comprehensive Medical Care

Posted By Alexandra E. Schmidt, Alicia L. Adams, Paul D. Simmons, & Elvira R. Whiteford , Monday, February 29, 2016

I do not speak their language, and most of them do not speak mine. Still, I have great hope that the care I receive in this country will be better for me and my baby than what I can get at home. I am here because my husband found work here, but I do not know many people. I come to appointments on my own because my husband has to work. The doctor, earnest and nice, and I struggle to communicate. She knows a few phrases of my language, which I find endearing and for which I am grateful. But most of our visit together is done with the help of an interpreter on the phone. I hope the interpreter is getting it right, and I’m sure my doctor feels the same way. When we listen to my baby’s heartbeat, we smile at each other – we share that moment in common, even if we use different words.

                                                                                                                                    

But I am afraid. I am afraid of the hospital when the time comes to have my baby – it is so big, so clean and white, full of strange machines. I am afraid of the pain and that I won’t understand what they are doing to me. What if there are problems? Will they be able to explain to me what is going on? My mother told me about when she had me and how scary that first baby can be – but she was surrounded by family and a midwife who had known her for years! I will be in a foreign place, with people who don’t look like me, don’t know me, and don’t understand me. I live in this country, of course, and go to the grocery store and gas station and post office.  I’m able to manage most things in this foreign place. But having a baby is different! So, yes, I am afraid.

 

Pregnancy is often a time of mixed emotions: joyful celebration of new life, hope for the family’s future legacy, and fear of the unknown. These emotions become magnified for mothers who find themselves in a foreign medical system with unfamiliar language barriers. Around the world, pregnancy is understood as a time of increased risk for health complications for women. Although developed countries tend to have lower rates of maternal deaths than less developed countries, a recent report showed that the number of maternal deaths in the United States actually increased from 1990 to 2013, whereas maternal deaths in less developed countries have declined (Erickson, 2015). There are likely a number of factors to explain this curious finding, including the increased provision of prenatal care for pregnant women in less developed countries. However, this discovery presents a reminder that pregnant women in developed countries are not immune to potentially life-threatening complications such as cardiovascular disease, infection, and diabetes. Women with high stress levels and low social support are at an even greater risk for complications.

 

Family-oriented care during pregnancy and childbirth encourages clinicians to consider all aspects of maternal care, including those that extend beyond the borders of traditional medicine. The transition to motherhood includes challenges such as couples’ adjustment to parenting roles, decisions to be made about lifestyle changes (e.g. smoking cessation), and building a support system to adequately manage stress. For mothers who have traveled to another country to give birth, there are additional challenges related to acculturation. A collaborative treatment team, including a medical family therapist, can provide comprehensive, culturally informed clinical care to support mothers in reducing risks of medical complications by following physicians’ recommendations, increasing social support, and engaging in positive health behaviors. This blog presents two physicians’ perspectives regarding the importance of comprehensive care to promote maternal health and reduce the risk of negative outcomes for biomedical and psychosocial health.

 

[AA] A few months ago, I was part of a delivery during an OB rotation that I will not soon forget. This first-time mother was very young and new to this country. Speaking virtually no English, she had fled her country to escape political violence and somehow settled in our small town. She delivered her baby in silence and did not want to hold him. When I spoke with her the next morning using the translator telephone line, she said she was not in any real pain despite her significant lacerations from delivery and begged to go home. Her baby was in the nurse’s station, and she still had not held him. Imagining the difficulty of delivering a baby in a foreign medical system, I wanted to insist that she stay longer to heal and adjust to this new role as mother. She had recovered well, however, so I hesitatingly agreed to discharge her.

 

Reflecting back on this case, I could not shake my desire to offer her more care beyond ensuring a safe delivery. I thought of the trauma she had experienced in her home country, the many unsavory things that could have led to pregnancy at such a young age, and the discomfort she undoubtedly experienced in a small town of people who do not look, act, or speak like her. I yearned for her to be a patient in my own clinic so I could connect her with a behavioral health provider to help her prepare for this new phase of life. Recognizing her need for a safe community and ongoing support, I aspire to provide these resources for my future patients.

 

[EW] At our family medicine residency practice, we have offered group prenatal care for Spanish-speaking-only patients for the last seven years. A key aspect of our clinic’s mission is to provide comprehensive care for the most vulnerable and marginalized populations, which often includes pregnant women without legal status. These women are frequently fleeing traumatic situations, or they have moved away from the only culture, support system and world they knew in hopes of better opportunities for their families. Often, these women speak rudimentary English and only qualify for emergency Medicaid. As this insurance only covers basic costs for the delivery, but not for prenatal care, both the mother and baby are at increased risk for negative health outcomes. As a family physician leading this group, I sought out Dr. Randall Reitz, a medical family therapist, to help blend obstetrical care with family support, cultural sensitivity, and counseling in a group setting. We enthusiastically collaborated to create this group for our Latina obstetrics patients. This teamwork empowered us to create a dynamic group that has provided patients with benefits such as increased education and safety throughout pregnancy and newborn care, life-long friendships started in the group, and partnership with family members who also attend. We, too, as providers, have been moved by these women’s courageous sharing of their stories and are inspired to continue refining this group to address the evolving health needs of pregnant women and their families.

 

References

Erickson, F. (2015, November 18). Maternal health around the world [Infographic]. Retrieved January 1,

2016 from https://online.nursing.georgetown.edu/maternal-health-around-the-world-infographic/


 

Alex Schmidt, MS, LMFT-A is a Medical Family Therapy Fellow at St. Mary’s Family Medicine Residency in Grand Junction, CO. She is a Ph.D. Candidate in Marriage and Family Therapy at Texas Tech University and holds a M.S. in Family Therapy from Texas Woman’s University and a B.A. in Psychology from Baylor University. Her research and clinical interests include adults with type 1 diabetes, couples facing reproductive losses, and integrated care training in rural primary care.

 

Alicia Adams, MD is a first year resident at St. Mary's Family Medicine Residency in Grand Junction, CO. She completed her undergraduate education at Brown University and attended Rush University for medical school. She is passionate about providing care to the underserved and has special interests in maternal and child health.

   

Paul Simmons, MD received his B.A. in History at Baylor University. He received his medical degree from the University of Colorado in 1999 and completed a family medicine residency in 2002 at North Colorado Family Medicine Residency in Greeley. He has practiced the full scope of rural medicine (including endoscopy, obstetrics and sleep medicine) in western Wisconsin and eastern Colorado. He moved to Grand Junction, CO in 2010 to train family medicine residents at St. Mary’s Family Medicine Residency Program.

   

Elvira Whiteford, MD pursued her medical degree in California at Loma Linda University Medical Center and then completed an Obstetrical Fellowship at Arrowhead Regional Medical Center. She has been a part of the faculty at St. Mary’s Family Medicine Residents since 2007 and has greatly enjoyed educating the residents and medical staff about a variety of Family Medicine topics, but she has special interest in Maternal Care. 

 

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