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Kate Piotrzkowki, RN, builds up such a strong relationship with the at-risk pregnant women she works with that she’s often the first person they call when they think they’re in labor. Piotrzkowki is the case manager for Dean Health System’s Prenatal Care Coordination Program, serving at-risk pregnant women in the Madison, WI, area.
She follows the patients through the pregnancy and for 60 days postpartum, meeting with them monthly in her office, visiting the home before the baby is born, and visiting again within a few days after the mother is discharged from the hospital. Often, Piotrzkowki develops such a rapport with the clients that they call her with questions or concerns in between visits. "As a registered nurse, I can talk to [the client] and suggest she go to the physician immediately if I think it’s necessary," she says. "I always refer them to the physician for follow-up."
When she meets with program participants, Piotrzkowki looks for clues as to their needs. "I have a laundry list of barriers to health care," she explains. "I ask them if they have transportation to their appointment, do they sometimes run out of food, do they smoke or use drugs, is the father involved, is there support from family or friends?"
During the initial evaluation, she assesses each patient’s knowledge about medical issues, community resources, nutrition, prenatal care, and baby care and then refers her to community programs where she can get help.
Piotrzkowki assists the clients in other ways. For example, many of the women have trouble accessing dental care, so they may develop an infection. In this case, she coordinates between the dentist, who may be uncomfortable giving antibiotics to a pregnant woman, and the physician.
During the monthly visit, Piotrzkowki conducts an educational program that’s broken down into trimesters and geared to the needs of each client. She gives all of the clients information about what is normal and not normal in pregnancy and asks to be notified right away if something is not normal. Preterm labor, labor in general, and safety issues for the baby are other topics that are included in the educational component. Piotrzkowki encourages the patients to attend breast-feeding and childbirth classes and helps them get enrolled in classes. When appropriate, she refers patients to community-based smoking cessation and drug abuse programs.
The home visit assessment gives Piotrzkowki a clearer picture of the mother’s needs. For instance, if the home reeks of smoke, she steps up her discussion about second-hand smoke and the effects smoking can have on the baby. The home visit enables her to see first-hand how many people are living in the household and what the baby will need. For example, in some households, everyone in the family sleeps on the floor. In that case, Piotrzkowki helps the mother connect with community resources that can provide a crib.
The post-birth home visit gives her an opportunity to see if the baby or mother has any problems that need immediate care. "I always notify the physician of any needs I see in the home," Piotrzkowki says.
Piotrzkowki has developed a wide network of resources in Dane County, as well as through public health departments in other counties. "If I can’t identify the resources, I use outside resources to help me," she says. "Many women will call on their own once I give them the number. If a mother has difficulty hooking up with the services she needs, I will help her get the help."