a registered nurse, and her husband Jack, a physician, were expecting
their first baby. Kelly was in her 11th week of pregnancy when
she enrolled in MedCost’s Smart Starts Prenatal Program.
Her history included three gynecological surgeries that put her
at high risk for a premature delivery.
nurse knew that Kelly’s surgeries could cause cervical
changes that would likely lead to a premature birth. She also
knew that proactive treatments might prevent this from happening.
The prenatal nurse told Kelly about a new, non-invasive ultrasound
technique that could detect early changes in the cervix. She
also explained surgical procedures that could aid in strengthening
Kelly’s cervix during the pregnancy.
this information with her obstetrician. As a result, the doctor
decided to do a cervical ultrasound during Kelly’s 15th
week of pregnancy. This test revealed that Kelly’s cervix
was, in fact, already beginning to change, putting her at risk
for an extremely premature delivery. To prevent this, the doctor
placed a stitch in Kelly’s cervix to strengthen it and
keep it from changing further. He also told Kelly to limit her
pregnancy progressed, her prenatal nurse stayed in close contact
with her and also with her doctor. Thanks to the early, aggressive
interventions suggested by the Smart Starts prenatal nurse, Kelly’s
pregnancy continued to 41 weeks, when she gave birth to a healthy,
Jessica was pregnant with triplets.
She enrolled in the Smart Starts Prenatal Program during the 12th
week of her pregnancy. The Smart Starts prenatal nurse educated
Jessica about risk factors and told her how to recognize the signs
and symptoms of complications.
19th week of pregnancy she became concerned about how she was
feeling and placed a call to her prenatal nurse. As the nurse
listened, she realized that Jessica was describing symptoms of
premature labor. The nurse urged Jessica to call her physician
immediately. The doctor met Jessica in the emergency room and
evaluated her uterine contractions.
Smart Starts prenatal nurse and a MedCost nurse case
manager talked about how to help Jessica. They thought Jessica
might benefit from a home uterine monitor. The case manger called
Jessica’s physician with this suggestion. The physician
agreed, and this equipment was placed in Jessica’s home
so her contractions could be monitored. In addition, the physician
placed Jessica on an oral medication that helps control contractions.
One week later,
the Smart Starts nurse called Jessica to follow up. Jessica described
symptoms that alerted the prenatal nurse that contractions may
not be under control. The prenatal nurse talked with the case
manager again. This time they discussed the possibility of using
a Terbutaline pump. (Tebutaline is a medication that helps relax
the uterus.) The case manager discussed this idea with Jessica’s
doctor, who agreed with this approach. The prenatal nurse arranged
for Jessica to start the Tebutaline pump during the 21st week
of her pregnancy. This home-based measure successfully controlled
Jessica’s contractions and she did not have to be admitted
to the hospital. Jessica delivered her triplets at 34 weeks.
Each of the babies weighed over three pounds and had to stay
less than a month in the hospital.
During LaToya's very first phone
call with a Smart Starts prenatal nurse, the nurse quickly realized
that LaToya was at extreme high risk for delivering a preterm infant.
LaToya's history included five miscarriages and three premature
nurse created a long-term plan of care for LaToya. Managing this
case required frequent phone contact between LaToya and the Smart
Starts nurse. The nurse continually re-assessed LaToya’s
risk factors and encouraged her to comply with her doctor’s
instructions. The Smart Starts nurse also negotiated a discount
on weekly injections of a medication that prevented LaToya from
having premature contractions. As a result of these aggressive
interventions, LaToya was able to sustain her pregnancy for 38
weeks. With the support and help of her Smart Starts prenatal
nurse, LaToya delivered her first full-term, healthy baby!
Rosa spoke Spanish but no English. To mentor Rosa
in the Smart Starts Prenatal Program, her prenatal nurse enlisted
the help of the AT&T Language Line. Language Line is a professional
over-the-phone interpreter service. Whenever the Smart Starts nurse
had a phone appointment with Rosa, or whenever Rosa called her
nurse, the nurse would call a special 800 number and within minutes,
a three-way conference call was underway, with an interpreter translating
between Rosa and her prenatal nurse. Rosa’s prenatal nurse
also mailed Spanish language prenatal educational materials to
her. With these tools, Rosa’s Smart Starts prenatal nurse
was able to communicate with her and establish rapport with this
mom-to-be. Rosa enjoyed the relationship too, calling her prenatal
nurse often to ask questions and express her concerns.