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Columnist Deena Rubin: Protect health of pregnant women and their babies 

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Thursday, May 18, 2017

I was pregnant and gave birth to my daughter, Ayala, in Cambridge, England. This was my first introduction to universal health care.

I began my pregnancy by going to the gynecologist, getting ultrasounds and having blood and urine tests. As the pregnancy progressed, a nurse came to my home to assess how I was doing. Again, she collected urine samples and blood tests and measured my growing belly. I gave birth in the Rosie Maternity Hospital. Twenty-seven years later, I am still thankful for the fine prenatal health care that I received in England.

Now the Republicans cut Medicaid drastically. Millions of low-income people will not be able to pay for health insurance or health costs. In addition, a long list of preexisting conditions that insurances do not have to cover was announced. This frightened people with these conditions. One condition on the list is pregnancy. Pregnant women will be at the whim of their states to see how much they will be charged for their numerous appointments.

Pregnancy is different from most of the other “preexisting conditions.” Pregnancy affects at least two people. The health of the mother affects the health of the child or children being born. Also, pregnancy is temporary, it ends with giving birth. It is not chronic. This is one of the many women’s issues which we have seen attacked by this administration.

Health care during pregnancy requires gynecological appointments in each of the three trimesters. A blood test and ultrasound is given to determine a pregnancy. For a healthy pregnancy, prenatal visits are monthly between four and 26 weeks. Weeks 26 to 36 jump to a prenatal visit every two weeks. Toward the end of the pregnancy in weeks 36 to 40, prenatal visits are weekly.

Ultrasounds are conducted in each of the trimesters. In the first, the doctor sees the growth of the baby, detects abnormalities, estimates the due date and determines how many babies are being carried. The doctor checks to see if the baby is growing in the uterus instead of the fallopian tube to rule out ectopic pregnancy.

In the second trimester, the doctor checks on the baby’s growth and makes sure all the organs are developing properly. This is the most thorough checkup the baby will get before being born. The doctor looks for abnormalities in the heart rate, brain, kidneys and liver. The doctor counts fingers and toes and looks for birth defects.

The gynecologist checks the placenta, because if it is dangerously low at the time of giving birth, the delivery will need to be done by cesarean section. Amniocentesis is conducted between 14 and 20 weeks to check for Down syndrome. If the woman is over 35, a last ultrasound takes place at 20 weeks. Doctors test for the Zika virus in pregnant women in vulnerable regions.

A number of problems can arise during pregnancy. Bleeding or high blood pressure and protein in the urine can be a sign of preeclampsia (this affects 5 percent of pregnant women). Miscarriage or premature labor and birth can occur. Ultrasound is used to test for each of these at the first sign of a change.

The doctor will follow patients with low amniotic fluid to be sure the baby continues to grow normally. If it is low at the end of the pregnancy, the birth is induced. Gestational diabetes is tested with glucose screening between 24 and 28 weeks.

Any complications that arise should be checked by the gynecologist. If the baby is moving or kicking less, a visit to the gynecologist is necessary. Severe or persistent abdominal pain or tenderness, vaginal bleeding or spotting, vaginal discharge or change in discharge, pelvic pressure or new lower back pain and menstrual-like cramping all warrant gynecological visits.

President Trump signed legislation April 13 that allows states to deny funding to Planned Parenthood. He failed to recognize that Planned Parenthood supports women with reproductive services. Staff members typically work with low-income individuals who benefit from good advice and guidance about their pregnancies.

Trump tweeted earlier this month that “Of course the Australians have better healthcare than we do — everybody does. ObamaCare is dead! But our healthcare will soon be great.”

I disagree, the Affordable Care Act was our first step in the right direction. It brought our own health care system closer to these European systems to which he was alluding.

I fear that many pregnant women will not be able to afford the prenatal care that they deserve. Families will find it difficult to pay for each of the many necessary appointments and tests. The health of all pregnant women and their babies should be protected by our health care system.

Deena Rubin is an educator who lives in Amherst.