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.

Political Action Planning

Goals and Objectives:

• Gather support for House Bill 195 throughout the health care community.
• Advance the number of women able to receive prenatal care including ultrasounds.
• Interact with existing state nurses' organization activities focusing our similar goals and objectives as our own.

Action Plan:

1. Educate a small group of people about the bill, answer questions, and gather support through our blog.
2. Contact Free clinic and Planned Parenthood facilities in our community. Ask facility representatives if they are interested in us giving a small presentation to patients and staff about ultrasound use and HR 195.
3. Gather input from key stakeholders and rally support.
4. Contact House representatives from our individual states and educate them about the bill and its importance to women who could not afford ultrasounds otherwise.
5. Email Clifford Stearns and refer him to our blog, ask him further advise how we can further support the bill.

A Supportive Blog

http://www.thepregnancyzone.com/tests-and-procedures/know-the-importance-of-pregnancy-ultrasound-from-conception-to-childbirth/

This is another blog discussing the importance of ultrasound testing from conception to child birth. I feel it is a good resource for everyone to check out regarding the benefits of ultrasound testing if this bill were to be passed!

Governmental Objectives, Political Influences, and the Impact of H.R. 195 Informed Choice Act for the Community

Governmental Objective:

The informed choice act would allow the Secretary of Health and Human Services to make grants to nonprofit community based medical clinics for the purchase of ultrasound equipment to provide free examinations to pregnant women needing such services.

Political influences of the Bill:

This bill will act as a political intervention by extending prenatal care and diagnostics means to all women. If this bill is passed, women would have the ability to seek out care for themselves and their baby with disregard to having adequete funds or availibility to such technology. The government's ability to provide funding for ultrasound and examination in tax-exempt, non-profit clinics could change prenatal care as we know it today.

Potential Impact of the Bill:

According to a scholarly article written by Alana Juman Blincoa "Ultrasounds are able to pick up defects in very early periods of gestation and when acted upon can ensure that the mother is in a position to have a number of options open to her." (Blincoa,2006) If the bill is passed and the government provides funding for ultrasound, examinations, and education for expecting mothers it would significantly impact "the health and economics for both families and their healthcare sytem."(Bincoa,2006) If the bill is passed, clinics can allocate their funding to other services the community needs. Because ultrasounds are very expensive, this would help clinics provide services to women who previously may have not had access to recieve them. In turn, this would increase the amount of education these women are provided with regarding the options concerning their pregnancy.

According to the Informed Choice Act the potential impact on clients receiving an ultrasound would be, "each pregnant woman will be given, according to the best medical judgment of the physician performing the ultrasound examination or the physician’s agent performing such exam, the approximate age of the embryo or fetus considering the number of weeks elapsed from the probable time of the conception of the embryo or fetus, based upon the information provided by the client as to the time of her last menstrual period, her medical history, a physical examination, or appropriate laboratory tests."

The potential impact on nursing care is that with the benefits of ultrasounds, nurses can better counsel women as to what they need to be prepared for with certain conditions of pregnancy such as neural tube defects, fetal anomalies, and basic care of the fetus. Also, the ultrasounds will allow nurses to take the precautions necessary involved with high risk pregnancy.

As of now, medical clinics are based on services at little or no cost to the uninsured and under insured. Clinics accomplish this through the use of volunteer health professionals and other community volunteers. Services are made possible only through the donation of services, volunteers, and community donations. Funding is raised primarily on the local level and there is little to no government support and funding for clinics. The Informed Choice Act would help clinics receive grants for ultrasounds, for example ,"No grant under subsection (a) may be made in an amount that exceeds an amount equal to 50 percent of the purchase price cost of the ultrasound machine involved, or $20,000, whichever is less. Also, it would provide, " The entity will obtain and maintain medical malpractice insurance in an amount not less than $1,000,000, and such insurance will cover all activities relating to the use of the ultrasound machine purchased with the grant under subsection (a)."

For Full Text Version of Bill H.R. 195

A full text version of the proposed bill, H.R. 195, the Informed Choice Act can be found at:

http://www.govtrack.us/congress/billtext.xpd?bill=h111-195

Prenatal Care

http://www.echealthystart.org/HealthInfomation/PrenatalCare.htm

Description

We choose to follow the Informed Choice Act which is currently active in the U.S. House of Representatives. As future nurses we believe that an ultrasound is a vital part of prenatal care for all women who are pregnant. We feel that it is important to provide health care to all women regardless of economic status.

The bill was introduced on January 6, 2009, by Republican Clifford Stearns of Florida who is the bill’s sponsor. No cosponsors exist. Ultrasounds would be provided by a licensed medical physician who is legally qualified to provide medical services to pregnant women. This bill would provide grant money to non-profit tax-exempt organizations such as community based free clinics which do not charge for any services provided. Results from these ultrasounds can provide basic information on the health of the fetus.

After receiving results from the ultrasound the woman is provided with unbiased information about options regarding pregnancy outcomes including childbirth, abortion, and adoption. We view this as a vital and necessary piece of equipment to all clinics; as it can provide vital information concerning baby, mother and family.