20
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WINTER 2018
WINTER 2018
|
21
Q&A
With Dr. Mark Rosing
Dr. Mark Rosing, chair, Department of Obstetrics & Gynecology, discusses the challenges
of providing prenatal care in the Bronx and some of the solutions offered at SBH.
Prenatal care has long been
established as a critical factor
in the health of both mother
and child. This is especially
important for expecting
women who are overweight,
have a history of diabetes,
cardiovascular disease, or
other health conditions.
Yet, providing prenatal care to women in
the Bronx remains a challenge.
The federal Healthy People 2020
program set a goal that at least 78
percent of all pregnant women receive
early and adequate prenatal care. Yet,
in the Bronx, only 58 percent of Bronx
residents are seen by their obstetricians
during the first three months of their
pregnancies – which means they either
HEALTH DISPARITIES
start late in their pregnancy or get no
prenatal care at all – as compared to
69 percent in the rest of New York
City. As a result, it’s not surprising that
preterm births in the Bronx – which are
associated with low weight and general
poor health outcomes – are also higher,
as are neonatal death rates.
Q:
This is a challenge you must face
every day. Why is it unique to the Bronx?
A:
To start with, this is a very resource-
poor community and the women
we take care of have lots of social
challenges, financial challenges, and
legal challenges that make it difficult for
them even in the best of circumstances.
Many patients go in and out of being
insured by one company, then another.
By not filling out some document that
was necessary but wasn’t clear to them,
all of a sudden they find themselves
uninsured. So, there are breaks in their
continuity of care. Also they often
don’t realize there are programs during
their pregnancy they are eligible for
through Medicaid. Combine this with
issues they may have with childcare
or with employment that don’t allow
them the flexibility to take or keep an
appointment. Many are single parents
without much support. Or they may live
in shelters. If they are undocumented,
they hesitate to access resources that are
indeed available to them because they
are fearful it will put them on the “grid.”
This is why they often give incorrect
phone numbers and addresses and are
afraid of going to the post office to pick
up a certified letter; they may fear being
deported. So, there is a lot of mobility
in terms of where they get their care.
They go from one hospital to another,
one ER to another. All of those barriers
have a profound impact on the quality
of care that we can provide and that
they can receive.
Q
. What happens as a result of missing
prenatal care?
A.
When they start late in getting
prenatal care, they miss opportunities
for specific tests that can only be done at
certain times. They miss opportunities
to optimize their own health and that of
their potential child. So, we have patients
who don’t reach the goal of 14 prenatal
visits because they start late or because
they’ve moved from Brooklyn to the
Bronx, or from Belmont to the south
Bronx, or they switch care if they live
in a shelter, or have financial or social
challenges, or there’s domestic violence,
or something that keeps them away.
Q
. What can be done to alleviate some
of these problems?
A
. We try to help them navigate
the system and be as proactive as
possible. We try to educate them on
the importance of exercise and eating
a healthier diet, about the dangers of
smoking in the house and its effect on
asthma for both the mother and her
children. Teen pregnancy is obviously
a big issue here in the Bronx. [The teen
pregnancy rate in the Bronx is 60.8
per 1,000 in the Bronx, compared to
44.2 in NYC and 35.7 in New York
State.] Getting the word out to an entire
community of youth that you have a
lot to live for is important, letting them
know the ramifications of having a child
so early and how the rest of their life’s
plans can be determined by this decision.
Q
. How is the contraceptive program
SBH is involved in impacting on this?
A.
In 2016, SBH was one of two
hospitals in the Bronx to participate
in the QINCA (Quality Improvement
Network for Contraceptive Access)
program. The goal of this program
is to insure access and quality of
contraception after birth to our most
vulnerable teens – and adults. This
involves offering contraceptive options
to postpartum women, including
long-acting reversible postpartum
placement of an IUD or subcutaneous
implant (Nexplanon) while the new
mother is still in the hospital rather
than in the doctor’s office after the
six-week postpartum visit. This is
particularly important because of the
high patient “no show” rate in these
follow-up visits. Patients now can leave
the hospital with the contraceptive
device in place, confident they will not
have an unintended pregnancy. These
devices are as effective in preventing
pregnancy as tubal ligation, but have
a low complication rate and can be
reversed once the woman chooses
to become pregnant again. This is an
indication of how we at SBH were
not necessarily looking at the bottom
line first, but rather at our patients’
needs first by increasing the number
of desired planned pregnancies and
“THE TEEN PREGNANCY RATE IN THE BRONX IS 60.8
PER 1,000 IN THE BRONX, COMPARED TO 44.2 IN
NYC AND 35.7 IN NEW YORK STATE.”
