Update

Since our last update, there has been no further progress initiating the H.R. 195 Informed Choice Act. The bill is still being processed in the House of Energy and Commerce. Key stakeholders were contacted and we have yet to receive any feedback supporting our bill. Although key stakeholders have not demonstrated support, we still feel very strongly about this bill and have gained increasing support and following from fellow classmates after education. A free clinic was contacted about giving a presentation on ultrasound importance in all healthcare settings, however the staff was reluctant to allow the presentation as the bill has not yet been passed. However they would like to continue to be informed on the bills status.

Responding to Comments and Questions

Natalie: Our bill does not touch upon how awareness will be generated among the target population. The only resource that this bill directly offers is grant money from the government to purchase ultrasound equipment. We felt that it could be part of our job as advocates of this bill to educate the population and legislators and other officials to gain their support in hopes to have access to further resources.


SMC: There are many free clinics that do not have the funding or resources to have ultrasounds offered. Also some places can not afford or contract licensed professionals to run these machines and offer educated advice regarding care for the mother and fetus based off of ultrasound results. This bill would offer grant money to non-profit clinics as an incentive to purchase ultrasound equipment and fund the malpractice insurance needed by the licensed medical professionals who run the machines.

Stakeholders Emailed

1. Professor Jagiello( jagielkp@jmu.edu):

We chose Professor Jagiello because she is currently a women’s health professor and works in the Winchester Medical center maternity ward. She is in the position where she can educate students, staff,and patient s about prenatal care and the different pregnancy outcomes. Being an active maternity nurse she understand the importance of ultrasound technology and usage to backup the purpose of the bill.

2. Lou Markwith Executive Director Virginia Associated Of free Clinics (lou@vafreeclinics.org) :

Mr Markwith is in charge of all the free clinics in the state of Virginia. He can easily reach out to the clinics and make them aware and get them involved.

3. Harrisonburg Free Clinic (rsider@hrfreeclinic.org):

We believe its important to contact the local free clinics to gain their support since the benefits of the bill will be directed towards them. They will be able to give first hand knowledge on how important this technology will be for their patients.

4. Clifford Stearn ( contacted through House. Gov contact your legislator website):

Mr. Stearn is the legislator who created the bill. We would contact him to make him aware of our support and to ask for guidance on how to further support his bill.

5. Bob Goodlatte Harrisonburg’s congressman(Contacted through House.gov contact your legislator website):

We want Congressman Goodlatte support in voting for the bill when it is presented in congress.

6. Jessica Honke Director of public policy for Planned Parenthood (jessica.honke@ppfa.org)

We chose this program because their whole mission is provide trusted health care, informed education, patient advocacy on a global level. Planned parenthood delivers vital health care services , sex education, and sexual health information to millions of women. .

Progress of the Bill

Our bill has not yet had any further developments. The bill was introduced January 6, 2009 and was referred to the House Committee on Energy and Commerce. This bill still needs to be voted on by the House and the Senate. Then it would need to be considered by the President, and only after all of these votes went through would then the bill become a law. We are currently in the process of writing to key stake holders and legislators regarding this bill asking for their support. An ongoing issue that has continued to develop for pregnant women is that of many of these women cannot afford to wait for their insurance plans to kick in after a few months are they are in need of receiving prenatal care, exams, and tests throughout all months of pregnancy. If this bill were to be passed, this waiting period would be eliminated. So far, there have been no advances or developments within the health care field that would significantly reduce this source of stress in not only those women awaiting insurance coverage, but for those who are not eligible at all. Although there are free health clinics developing in areas nationwide, in no way can these clinics receive enough funding without the help of the government to cover all of the pregnant women in need. This is why we feel this bill is such a necessity to pregnant women and why we are trying to push forward and gain further support.

Opinion Continued...

Often it is a concern of expecting parents that costly and high tech ultrasound are not worth having because they commonly yield false positives. In a study done about the accuracy of ultrasounds in the textbook Guide to Clinical preventative Services, Second Edition results showed that “many fetal structural malformations including cardiac, gastrointestinal, renal, limb, and neural tube defects” can be accurately detected through ultrasound. The trial study showed that false positive diagnoses were reported for only 7 cases out of 1,000 pregnant women scanned before 24 weeks. Another study in this textbook explained the importance of follow-up ultrasounds. In this study at initial ultrasound appointments, 8 women received a diagnosis of fetal disability. At the next follow-up ultrasound 6 of the 8 cases were deemed free of fetal anomaly. These studies prove that the use of ultrasound in all health care settings rarely yield false positives. When a fetal anomaly is detected/suspected often these results are later resolved and ruled without fetal disability. These results show that it is important to not only have an initial ultrasound but to continue with follow-up visits and prenatal care. If this bill is passed women and families would have the opportunity to receive repeated ultrasounds thus allowing for detection of fetal anomaly and other birth outcomes. Thus, allowing families to have the opportunity to prepare for the birth of their child.

DiGuiseppi, C. (1996). Ultrasonography in pregnancy. Guide to clinical preventative services (2nd ed., pp. 411). Baltimore, MD: Retrieved from http://odphp.osophs.dhhs.gov/pubs/guidecps/pcpstoc. htm

Key Stake Holders and Legislator

Key stake holders:
· Pregnant Women lacking access to health care
· Fetuses
· Nurses
· Free Clinics
· Hospitals
· Tax Payers

Key Legislator:
· Republican Clifford Stearns of Florida (6th District)

Our Position

As nursing students we strongly support this bill for many reasons. We feel as nurses it is our job to be advocates for all persons seeking health care and in this particular case for pregnant women. It is our responsibility to become involved in making primary prenatal care available to all women so that their right of informed choice regarding their own pregnancy is upheld and respected. If this bill is passed, not only will a step be made forward in primary prevention of maternal and fetal health care, but nurses will be able to better counsel women as to what they need to be prepared for with certain conditions of pregnancy, such as fetal anomalies, and choices regarding such. It has also been suggested that this process may help women be more prepared psychologically, and preserve a sense of well being and control over her own pregnancy should a fetal anomaly or unexpected event be detected (Kohut, 2002). According to an article found in the Journal of Genetic Counseling, “The principles of informed choice are directed by the ethical principles of autonomy and beneficence. Respect for patient autonomy obligates the prenatal provider to acknowledge the values and beliefs of the pregnant woman. Facilitating an informed choice is believed to influence a woman’s sense of control and consequently, their personal well being” (Kohut, 2002).We as nursing students believe these principles of autonomy and beneficence can only truly be established if all women are given equal opportunity to receive ultrasound testing and prenatal care so they themselves are able to make an informed choice regarding their own pregnancy.