1. Health Care of at Risk Aggregate: Low Income Pregnant Women Kelley Deaton College of Nursing University of Central Florida

2. At Risk Aggregate Across the board all women no matter the race, ethnicity, or cultural background can fall in to this category. Low income pregnancies are common all over the United States, but with proper guidance all women have a chance to receive adequate healthcare during pregnancy.

3. Demographics Age: From Menarche to Menopause Sex: Female Ethnicity: Of all live births in the United States during 2003-2005 (average), 23.0% were Hispanic, 55.9% were white, 14.1% were black, 1.0% were Native American and 5.3% were Asian. (March of Dimes, 2008)

4. Health Status “The uninsured pregnant woman is less likely to have had a Pap smear, less likely to know if she has undiagnosed diabetes or high blood pressure.” (Maternity Care Coalition, 2005) Sexually Transmitted Diseases are very common, and without proper testing they may never be treated.

5. Prevalent Health Problems Related to Low Income Pregnant women Depression Domestic Violence Inadequate maternal weight gain Inadequate Nutrition Unsanitary Living Conditions Sexually Transmitted Diseases

6. Statistics 47 million pregnant women gave birth without skilled Healthcare in 2006. (WHO, 2008) There are approximately 13% of pregnant women each year who are not insured, which often results in inadequate prenatal care. (American Pregnancy Association, 2008) “Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care.” (United States Department of Health and Human Services, 2008)

7. Problems Associated with Low Income Pregnant Women Poor nutrition is often a factor associated with women of low income. According to the March of Dimes, “Women who don’t gain enough weight during pregnancy increase their risk of having a low-birth weight baby.” (March of Dimes, 2008) Lack of education is a very important factor in this population. This factor can play a major role in the reason they are considered low income.

8. Risk Factors No prenatal care Smoking During Pregnancy Inadequate weight gain Alcohol consumption Taking over the counter drugs that may be contraindicated during pregnancy. Infections

9. Social Factors Women with an education are more likely to receive health care. According to the National Center for Education Statistics, “Teenagers who have children are less likely to complete high school than their peers who do not have children…The birth rate for Hispanic (83), Black (63), and American Indian/Alaska Native (53) teenage females was higher than that of the general population of teenage females.” (NCES, 2007)

10. Healthy People 2010 Access to Quality Health Services Educational and Community-Based Programs Immunization and Infectious Diseases HIV Sexually Transmitted Diseases Maternal, Infant, and Child Health Mental Health and Mental Disorders Nutrition and Overweight (Healthy People 2010, 2005)

11. Prioritize Health Problem: Outcome 1. Begin with assessing the situation and assessing the need to educate. Then make the patient aware of the benefits that are available for them. 2. Perform testing to see exactly how far along the patient is in terms of gestation, and make sure the baby is measuring appropriately. Also, test for any infections that the patient may be unaware of. 3. Finally, ongoing education and monitoring could ensure these patients a healthy lifestyle for them and their child.

12. Plan of Care: Primary Education is Essential - Diet: Eating a balanced diet on a regular basis is a great way to improve your overall health. So I would begin by educating about a balanced meal. Pre-natal Vitamins: Educating women on the importance of getting all of the nutrients that are needed during this crucial time for the baby. Activity: Educating on the importance of regular non-vigorous activity while pregnant. Smoking Cessation: Explain the effects of smoke on the fetus while pregnant, if she is a smoker. Government Funded Programs: Make women aware of the programs offered to them.

13. Plan of Care: Primary Government Funded Programs Medicaid – “is the state and Federal partnership that provides health coverage for selected categories of people in Florida with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children.” WIC – “this program provides supplemental foods, nutrition education and referrals to health care, at no cost, to low-income pregnant, breastfeeding and postpartum women, infants, and children up to age 5 who are determined to be at nutritional risk.” Food Stamp Program – “helps ensure that eligible low-income families and individuals are able to obtain a nutritious diet. Food stamp benefits are intended to supplement other household income and may only be used to purchase food.” (GovBenefits.gov, 2008)

14. Plan of Care: Secondary An ultrasound would be the first test performed to make sure that everything appears normal, and so we have a baseline for future tests. Then we would make sure patient was caught up on education. Next we would make sure that the patient is free of infections, including Sexually Transmitted Diseases.

15. Plan of Care: Tertiary As a Public Health Nurse I Would : Encourage nutrition and regular activity. Assure that patients are familiar with all programs that are provide for them. Encourage ongoing check ups for them and their new baby. Encourage annual visits to an obstetrician.

16. References American Pregnancy Association (2008) Health insurance for pregnant women, retrieved on October 15, 2008 from: http://www.americanpregnancy.org/planningandpreparing/affordablehealthcare.html GovBenefits.gov (2008) Benefits, retrieved on October 15, 2008 from: http://www.govbenefits.gov/govbenefits_en.portal;jsessionid=pVPML9jZQrb5FYJLcnXlgGbsj1km0ZR4sj9S9qlkQ0 Qh9bhDv0VQ!561605500?_nfpb=true&_pageLabel=gbcc_page_benefits&_nfls=false Healthy People 2010 (2005) What Is Healthy People 2010?, retrieved on October 17, 2008 from: http://www.healthypeople.gov/About/hpfact.htm March of dimes ( 2008 ) low Birth Weight Babies, retrieved on October 15, 2008 from: http://www.marchofdimes.com/professionals/14332_1153.asp#head1 Maternity Care Coalition (2005) Pregnant and Uninsured, retrieved on October 15, 2008 from: http://www.momobile.org/news/PregnantandUninsured.html National Center for Education Statistics, (2007) retrieved on October 15, 2008 from: http://nces.ed.gov/pubs2007/minoritytrends/ind_5_21.asp United States Department of Health and Human Services (2008) A Healthy Start: Begin Before Baby's Born, retrieved on October 15, 2008 from: http://mchb.hrsa.gov/programs/womeninfants/prenatal.htmhttp://mchb.hrsa.gov/programs/womeninfants/prenatal.htm World health organization (2008) World Health Statistics http://www.who.int/whosis/whostat/en/