Our latest guest contribution came from Lee Perrin Seese. She wrote the comment below on the last post on the rise in low birth weight babies among African Americans in Cambria County. I suggested to her this story on prenatal care disparities in Johnstown would make a good post on the site.

When I had my children 20 years ago, there were obvious disparities between the quality and accessibility of prenatal care in Johnstown, and much of it depended on which insurance you had.

Partway through my second pregnancy, my insurance changed. I wasn’t expecting what would happen next. When I showed up at the doctor’s office with my new insurance, they conferred a few minutes, then told me I would have to be seen at the women’s clinic. One of the nurse receptionists walked me down from the top floor OB office with its wide glass doors, potted plants, and comfortable upholstered chairs to the clinic on the floor below.

Opening a plain gray metal door, she revealed a small, drab waiting area with beige lino tiles and hard chrome chairs with plastic seats. Instead of potted plants and magazine-filled baskets on polished end tables, the only decor was clear acrylic racks lining the far wall. The racks were filled with “poverty pamphlets” – trifold instructions on the importance of infant car seats, toddler-appropriate snacks, domestic violence hotlines, pamphlets for WIC, child care assistance, formula advertisements, and flyers about postpartum depression with phrases like “If you have the urge to hurt your baby”.

While I appreciate educational materials, they were prominently displayed in a way that carries an implicit message, much different from the welcoming atmosphere in the vast, comfortable office upstairs. In great contrast to the imagery of smiling mothers cradling plump, swaddled infants, the focus was not on welcoming your new infant, it was on surviving your new infant.

Here, receptionists stood behind a thick glass window, barricaded from patients, with a narrow slot at the bottom to pass papers through. The receptionist slid a clipboard through the slot and asked me to fill out several forms. After I slid the clipboard back through the slot, a nurse opened a solid door to my left and invited me to wait in an exam room. The examination tables and cabinets here were from some previous era, and a fluorescent light bulb flickered in the corner of the room. I waited alone in the room until someone finally arrived to see me.

Much unlike my visits upstairs, I never saw the doctor again until the moment of delivery, despite being labeled as high-risk. During my previous visits at the upstairs office, the doctor would often cheerfully poke his head into the room, even if only to say hello. I still had the same doctor, and I learned that he cared for patients on both floors, splitting his time between these two offices and the hospital across the street. When I asked why there were two separate offices, each sharing the same doctor, in the same building, segregating expectant mothers with private insurance from those with state insurance, the only answer I received was that the insurance required it.

The nurses and midwives in the clinic did their jobs well, but were left to operate with what appeared to be state minimum staffing requirements. While upstairs, I saw a variety of medical staff, and the busy atmosphere was one of welcome anticipation. Downstairs, I was often left for long minutes in a room alone, and the overall experience filled me with a sense of utilitarian burden or even dread. Nothing about the office ambiance exuded a buoyant embrace of motherhood; it was grim, dreary, and it evoked the feeling of being an obligation, a task.

Despite how shocking and deeply unsettling it was then, I was grateful to have had that experience. If my insurance had stayed the same, I would have never known about the hidden clinic on the lower floor, nor witnessed those disparities firsthand.