Demand for Prenatal Care for Poor Strains Localities

Nurse-midwife Kate Curtis, left, performs an ultrasound on Veronica Vasquez, 16, at Mary's Center for Maternal and Child Care in the District.
Nurse-midwife Kate Curtis, left, performs an ultrasound on Veronica Vasquez, 16, at Mary's Center for Maternal and Child Care in the District. (By Susan Biddle -- The Washington Post)
By Delphine Schrank
Washington Post Staff Writer
Tuesday, August 28, 2007

Glenda Ordo?ez gave birth to her son on a cold night in September 2005 on a wooden bench outside her basement apartment in Leesburg.

For months, the uninsured woman from El Salvador had sought access to prenatal care, which studies show reduces the chances of infant mortality, low birth weight and a variety of health troubles. She said her boyfriend's $13-an-hour paycheck disqualified her for care through the Loudoun County Health Department, where patients must fall within the lowest brackets of the state poverty levels. He had left her, Ordo?ez said, but she couldn't prove it. The Loudoun Community Free Clinic in Leesburg didn't offer prenatal services. She couldn't afford a doctor in Herndon who would charge $3,000 for several months of care. Another doctor in Sterling refused to take her five months into her pregnancy.

Like many women in the Washington area, Ordo?ez, now 25, fell through the cracks. She was too poor for insurance but not poor enough to get the help she needed from the county.

But recent efforts in Loudoun and Prince William counties to expand services to keep up with the demands of the growing population of uninsured or low-income pregnant women have stalled, and local health-care communities are scrambling for solutions.

"So many are going through pregnancy without care. And the only option is to deliver the baby as an emergency," said Nora Lobos, a case manager with MotherNet/Healthy Families Loudoun, a nonprofit group that provides support to low-income families in the county, including Ordo?ez and her two children.

The Loudoun County Community Health Center was supposed to provide help, with prenatal care provided through a family practitioner. But the week before the center opened May 22, its director, Debra Dever, discovered that the insurance the center had bought would not cover prenatal care. Purchasing adequate additional coverage would have been too expensive, Dever said. The Loudoun center is funded through grants and donations and charges patients as little as $10 a visit, based on their ability to pay.

"To give you an example, the insurance costs of a family practice in minor surgery is $14,400 per physician" each year, Dever said. "If we add prenatal, that's $62,413 for every year." Costs rise more for extra insurance to cover doctors after they leave a practice -- coverage most doctors expect, Dever said.

"It's not an unreasonable request," she said. "If we're going to recruit an excellent provider, we need to provide excellent malpractice coverage," she said.

David Goodfriend, director of the Loudoun Health Department, pushed for six years for creation of the center as demand for low-income health care grew in the county. He said he had hoped the center would provide continuous care to indigent pregnant women that his department is unable to offer. He and his team of nurse practitioners see about 300 patients a year for the first two-thirds of their pregnancy before sending them to a physician at the hospital.

"It's not the best care because it's disjointed," Goodfriend said. As a primary care physician, he is also unable to offer the specialized care that high-risk patients often need. In some instances, pregnant women who are carrying twins or who have diabetes are sent hours away to a hospital in Charlottesville, "a big inconvenience for women who are often working full-time jobs," he said.

Prince William faces a similar situation.

"Last year, we were absolutely swamped" with requests for low-income prenatal care, said Alison Ansher, director of Prince William's Health Department. Because of limited staffing and resources, the department had to restrict eligibility to patients at its clinic to the lowest income bracket of the federal poverty guidelines, Ansher said. As of Aug. 1, the clinic has been able to raise the eligibility threshold to 180 percent of the poverty level, but that still leaves many women with few options, she said.

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