Participation In Prenatal Care Research Articles

Using Prenatal Advocates to Implement a Psychosocial Education Intervention for Posttraumatic Stress Disorder during Pregnancy: Feasibility, Care Engagement, and Predelivery Behavioral Outcomes

BackgroundPregnant women with posttraumatic stress disorder (PTSD) engage in more high-risk behavior and use less prenatal care. Although treating depression in pregnancy is becoming widespread, options for addressing PTSD are few. This study was designed to test the feasibility of implementing a manualized psychosocial PTSD intervention, Seeking Safety, delivered by prenatal advocates. MethodsAll women entering prenatal care at two federally qualified health centers were screened for current symptoms of PTSD. One site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women that indicated clinical or subclinical PTSD symptoms. Baseline and pre-delivery interviews were conducted, which collected background characteristics and assessed PTSD severity and coping skills. Medical records were collected to document care visits. Documentation of participation rates, fidelity to the treatment, and qualitative feedback from advocates and participants was collected. ResultsMore than one-half (57.3%) of the intervention women received all Seeking Safety sessions and fidelity ratings of the session showed acceptable quality. Using an intent-to-treat analysis, intervention women participated in significantly more prenatal care visits (M = 11.7 versus 8.9; p < .001), and had a significantly higher rate of achieving adequate prenatal care (72.4% vs. 42.9%; p < .001). Although not significant when accounting for baseline differences, intervention women also reduced negative coping skills but not PTSD symptoms. ConclusionsUsing prenatal care advocates to deliver Seeking Safety sessions to women screening positive for PTSD symptoms at entry to prenatal care is a promising intervention that seems to increase prenatal care participation and may reduce negative coping strategies.

Gestational Weight Gain and Breastfeeding Outcomes in Group Prenatal Care.

This study sought to examine the differences in pregnancy outcomes with a focus on gestational weight gain for women attending group prenatal care compared to standard individual prenatal care. A matched case-control study was conducted including 65 women who chose group care and 130 women who chose standard individual care. Women were matched based on prepregnancy body mass index (BMI) category, eligibility for midwifery care, and age within 5 years. Women choosing group prenatal care and women choosing standard individual care had similar gestational weight gain, birth weight, gestational age at birth, and mode of birth. Women choosing group prenatal care did have a significantly higher rate of exclusive breastfeeding at 6 weeks postpartum (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.81-9.15; P < .001) than women choosing individual care. Group prenatal care participation resulted in equivalent gestational weight gain as well as pregnancy outcomes as compared to standard individual care. Breastfeeding rates were improved for women choosing group prenatal care. Randomized controlled trials are needed in order to eliminate selection bias.

Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina.

Objectives This study was undertaken to determine the cost savings of prevention of adverse birth outcomes for Medicaid women participating in the CenteringPregnancy group prenatal care program at a pilot program in South Carolina. Methods A retrospective five-year cohort study of Medicaid women was assessed for differences in birth outcomes among women involved in CenteringPregnancy group prenatal care (n=1262) and those receiving individual prenatal care (n=5066). The study outcomes examined were premature birth and the related outcomes of low birthweight (LBW) and neonatal intensive care unit (NICU) visits. Because women were not assigned to the CenteringPregnancy group, a propensity score analysis ensured that the inference of the estimated difference in birth outcomes between the treatment groups was adjusted for nonrandom assignment based on age, race, Clinical Risk Group, and plan type. A series of generalized linear models were run to estimate the difference between the proportions of individuals with adverse birth outcomes, or the risk differences, for CenteringPregnancy group prenatal care participation. Estimated risk differences, the coefficient on the CenteringPregnancy group indicator variable from identity-link binomial variance generalized linear models, were then used to calculate potential cost savings due to participation in the CenteringPregnancy group. Results This study estimated that CenteringPregnancy participation reduced the risk of premature birth (36%, P<0.05). For every premature birth prevented, there was an average savings of $22,667 in health expenditures. Participation in CenteringPregnancy reduced the incidence of delivering an infant that was LBW (44%, P<0.05, $29,627). Additionally, infants of CenteringPregnancy participants had a reduced risk of a NICU stay (28%, P<0.05, $27,249). After considering the state investment of $1.7million, there was an estimated return on investment of nearly $2.3million. Conclusions Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries.

Improving Access to Maternity Care for Women with Opioid Use Disorders: Colocation of Midwifery Services at an Addiction Treatment Program.

Perinatal drug and alcohol use is associated with serious medical and psychiatric morbidity for pregnant and postpartum women and their newborns. Participation in prenatal care has been shown to improve outcomes, even in the absence of treatment for substance use disorders. Unfortunately, women with substance use disorders often do not receive adequate prenatal care. Barriers to accessing care for pregnant women with substance use disorders include medical and psychiatric comorbidities, transportation, caring for existing children, housing and food insecurity, and overall lack of resources. In a health care system where care is delivered by each discipline separately, lack of communication between providers causes poorly coordinated services and missed opportunities. The integration of mental health and substance use treatment services in medical settings is a goal of health care reform. However, this approach has not been widely promoted in the context of maternity care. The Dartmouth-Hitchcock Medical Center Perinatal Addiction Treatment Program provides an integrated model of care for pregnant and postpartum women with substance use disorders, including the colocation of midwifery services in the context of a dedicated addiction treatment program. A structured approach to screening and intervention for drug and alcohol use in the outpatient prenatal clinic facilitates referral to treatment at the appropriate level. Providing midwifery care within the context of a substance use treatment program improves access to prenatal care, continuity of care throughout pregnancy and the postpartum, and availability of family planning services. The evolution of this innovative approach is described. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Improving Infant and Maternal Health through CenteringPregnancy: A Comparison of Maternal Health Indicators and Infant Outcomes between Women Receiving Group versus Traditional Prenatal Care

Background: Despite efforts to increase participation in prenatal care, outcomes for women and infants in the United States remain below global and national health targets. CenteringPregnancy, a model of group prenatal care, incorporates practices consistent with national and international guidelines while allowing for greater freedom in providing content tailored to the specific needs of women receiving care. Objective: To determine whether the CenteringPregnancy model improves maternal and neonatal health indicators such as prenatal care attendance, smoking cessation, weight gain during pregnancy, gestational age at delivery, mode of delivery, and initiation and continuation of breastfeeding. Methods: A retrospective study was conducted including all pregnant women participating in CenteringPregnancy at two prenatal clinic sites in southwest Michigan from January 2010 to April 2012 (n = 173). A comparison group of women receiving traditional care from certified nurse-midwives was created using propensity scores to match for age, race, and insurance status (n = 170). A chart review was performed to analyze maternal and neonatal health indicators including attendance at prenatal visits, gestational age at delivery, baseline maternal weight and weight gain during pregnancy, smoking cessation, infant birth weight, mode of delivery (vaginal birth vs. cesarean section), and rates of breastfeeding. Results: There were no significant differences in pre-pregnancy weight, amount of weight gained during pregnancy, prenatal care attendance, gestational age at delivery, mode of delivery or infant birth weight. The CenteringPregnancy group had significantly higher rates of smoking cessation during pregnancy, as well as higher rates of breastfeeding initiation and continuation. Conclusions: This study provides support for the benefits of CenteringPregnancy in improving rates of smoking cessation during pregnancy which is important to both maternal and infant health. Additionally, in this population CenteringPregnancy resulted in improved rates of breastfeeding initiation and continuation, providing benefits to both infants and mothers.

Men’s participation during pregnancy, childbirth and postpartum and

Background and aim Increasing global approach to men's participation in care and reproductive health programs, in the past 15 years, has created a need to research on men’s encouragement to take responsibility for their families’ health through Men's participation. Therefore, the aim the present study is to determine men's participation in reproductive health care programs during pregnancy, in health clinics affiliated to Shahid Behshti University of Medical Sciences. In 1388. Material & methods: This was a descriptive study on 400 cases that had at least one child under 2 years and familly file in health clinics coverage Shahid Beheshti University. Sampling was multi-stage cluster Nonrandomized and research instrument was a questionnaire Findings According to the findings of the study, the mean age of participant was (37/27±5/56). (60/2 Percent) had a child and pregnancy in (24/8 Percent) was scheduled. Generally (74/2 Percent) men demonstrated good cooperation and participation and (0/25) had relative participation (89/0Percent) men had good knowledge and (11/0 Percent) had relative knowledge. There was Significant relationship between participation and education (p<0/0001), If higher education participation was low. There was Significant relationship between participation and job involvement (p<0/004). There was highest participation (83/9 Percent) in men whose job was lndependent. Also between the term Marriage and Participation was found Significant relationship (p<0/0001). There was Significant relationship between kind of Pregnancy and participation (P<0/0001) if It was planned to increase participation. Conclusions: The results of this research imply good men , s participation during pregnancy and childbirth that showe good oppurtunity for education and counseling before pregnancy that is good oppurtunity for Training men by expert person can enhance men , s participation during pregnancy and childbirth. Keywords: men's participation, prenatal care, delivery *Corresponding Author: Sharareh Jannesari, Lecturer, Dept of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Science, Tehran, Iran. E-mail :shararehjannesari@gmail.com Alipoor B Sattari F (2010). [Male participation in prenatal care]. Behvarz Faslname. 19(2)40-41.(Persian) . http://www.magiran.com/temp/mag-pdf/272013/1586-20457240-B91.pdf„ -Carter M, Speizer I (2005). Salvadoran fathers´ attendance at prenatal care, delivery and postpartum care.Revista Panamericana Salud Publica. 18 (3) 149-156 -Dellmann T (2004). The best moment of my life: A literature review of father's experience of child birth. Australian Midwifery.17 (3) 20-26. http://www.journals.elsevierhealth.com/periodicals/ausmid/article/PIIS1448827204800142/abstract -Dragonas TG (1992).Greek fathers participation in labour and care of the infant. Scandinavian Journal of Caring Science.6 (3) 151-9. http://www.ncbi.nlm.nih.gov/pubmed/1439376 -Ghandi M (2009). [Male participation in maternal health]. Women´ s mahnameh.147 I 88. (Persian). http://www.magiran.com/magtoc.asp?mgID=1095& -Gruskin S Cottingham J Hilber AM et al (2008).Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach. Bulletin of the World Health Organization. http://www.who.int/bulletin/volumes/86/8/07-050500/en /print. html (Accessed on 30/05/2010). http://www.who.int/bulletin/volumes/86/8/07-050500/en/index.html Kinanee J Ezekiel-Hart J (2009) Men as partners in maternal health: Implications for reproductive health counselling in Rivers State, Nigeria. African Journal of Psychology and Counseling Vol. 1 (3), pp. 039–044. -Orji EO Adegbenro CO Moses OO etal (2007). Men´ s involvement in safe motherhood. Journal of Turkish- German Gynecology Association.8 (3) 240 -248. -Rahman MM (2009).Factors associated with delivery assistance: Dose differentials exist between Rural and Urban areas in Bangladesh? The Internet Journal of Family Practice 7(2)38-49 -Soul Sista. Inactive (2007). Men: Effective Partners for Safe Motherhood. http://www.nigeriavillagesquare.com/forum/lounge/11259-men-effective-partners-safe-motherhood.html -World Health Organization (2007). Maternal Mortality in 2005: Estimates Developed by UNICEF and UNFPA. Geneva: World Health Organization. http://www.who.int/whosis/mme_2005.pdfw -World Health Organization (2005). The World Health Report: 2005: Make Every Mother and Child Count, World Health Organization, Geneva, 2005 World Health Organization (2002). http://www.who.int/whr/2005/02_ contents_en.pdf -World Health Organization. Programming For Male Involvement in Reproductive Health. Report of the meeting of WHO Regional Advisers in Reproductive Health WHO /PAHO Washington DC, USA, 5–7 September 2001, World Health Organization, Geneva, http://whqlibdoc.who.int/hq/2002

Determinants of Time of Start of Prenatal Care and Number of Prenatal Care Visits During Pregnancy Among Nepalese Women

This study is aimed at investigating the factors determining the timing of first prenatal care (PNC) visit and the number of PNC visits among a national representative sample of Nepali women. Data was drawn from the 2006 Nepal Demographic and Health Survey on women age 15-49 years old who had delivery within three years prior to the survey (N = 4,136). Multinomial logistic regression was used to study the association between socio-demographic variables and two outcome variables--the timing of first PNC and number of PNC visits. Most of the women (45%) started prenatal care after 3 months of pregnancy while 28% had no care. About 43% of women had 1-3 PNC visits, 29% had more than 3 visits. Age, education, parity and wealth were associated with both the timing of PNC and the number of PNC visits such that older women and those socioeconomically disadvantaged had late and fewer PNC visits compared to the younger ones and those with socioeconomic advantage, respectively. Women with higher parity and those in rural residencies were more likely to delay PNC, have fewer PNC or have no care at all. Majority of Nepali women do not attend prenatal care during the first trimester of pregnancy contrary to the WHO recommendation for women in developing countries. Programmes aimed at improving maternal health in general and participation in PNC in particular should target all Nepali women, especially those: in rural residencies, with no education, with high parity; older women and those from poor households.

Participation in Prenatal Care in the Paso del Norte Border Region: The Influence of Acculturation

Women who resided on the El Paso, Texas/Juarez, Mexico border (the Paso del Norte region) were surveyed to determine the barriers and facilitators to receiving early and adequate prenatal care. Postpartum interviews and medical chart abstractions were conducted among 493 Hispanic women. Primary facilitators were all factors that made prenatal care services more accessible to women and a priority among other issues competing for time and resources. The factors reported by these women as barriers to timely entry and sustaining enrollment in prenatal care were related to the availability of social support networks and affiliation with the Mexican/Hispanic culture (acculturation).

Pregnant Adolescents’ Preferences for Labor Pain Management

The purpose of this study was to examine the obstetric anesthesia method used, based on the patient's age. Confounding variables analyzed were the effect on labor pain management choices of parity, race, prenatal care participation, insurance status, and length of labor. This was a case control study from the Medical University of South Carolina (MUSC). The primary outcome measured was regional anesthesia (RA) use in labor. The exposure groups were based on the patient's age. All women aged 11 years and older who delivered vaginally from 1996 to 2001 were included; 7,583 patients met inclusion criteria. Results were analyzed using chi2 statistic, univariate analysis, ANOVA, and logistic regression. We found that primiparous adolescents used RA less than primiparous women over age 20. This association is not found in multiparous teens. Patients with shorter labors, black women, those without prenatal care, and older patients lacking private insurance declined RA more often. RA is the most utilized form of obstetric pain management in the last decade. In primiparous adolescents, declining RA cannot be explained by length of labor, race, insurance status, or prenatal care participation.

The impact of prenatal care on preterm births among twin gestations in the United States, 1989-2000

Objective The purpose of this study was to determine the association between prenatal care and preterm births among twin gestations in the presence and absence of high-risk pregnancy conditions. Study design Twin birth data in the United States were used to determine the association between preterm birth and prenatal care with the use of logistic regression. Results Of the 779,387 twin births, 54.7% twin births were delivered preterm. The rate was higher among black women than among white women in the presence (57.0% vs 51.2%, respectively) and absence (70.3% vs 61.6%, respectively) of prenatal care. The absence of prenatal care increased the relative risk for preterm birth by 1.24-fold among black women and by 1.22-fold among white women. Lack of prenatal care was associated with increased preterm birth rates in the presence of most high-risk conditions. Conclusion Prenatal care is associated with fewer twin preterm births in the presence and absence of high-risk conditions. Increased prenatal care participation may help decrease preterm birth rates and also narrow the black-white twin preterm birth disparity.

The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions

Objective: This study was undertaken to determine the association between prenatal care in the United States and preterm birth rate in the presence, as well as absence, of high-risk pregnancy conditions for African American and white women. Study Design: Data were derived from the natality data set for the years 1995 to 1998 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred at ≥20 weeks' gestation. Multiple births, fetal deaths, congenital malformations, chromosomal abnormalities, missing data on gestational age, and birth weight less than 500 g were excluded. Multivariable logistic regression analyses were used to adjust for the presence or absence of various antenatal high-risk conditions, maternal age, gravidity, marital status, smoking, alcohol, and education. Prenatal care was considered present if there was one or more prenatal visits. Preterm delivery was defined as delivery at less than 37 completed weeks of gestation. Results: For 14,071,757 births analyzed, 1,348,643 (9.6%) resulted in preterm birth. Preterm birth rates were higher for African American women than white women in the presence (15.1% vs 8.3%) and absence (34.9% vs 21.9%) of prenatal care. The absence of prenatal care increased the relative risk for preterm birth 2.8-fold in both African American and white women. There was an inverse dose-response relationship between the number of prenatal visits and the gestational age at delivery both among African American and white women. Lack of prenatal care was associated with increased preterm birth rates to a similar degree in the presence of pregnancy complications for both African American and white women, ranging from 1.6-fold to 5.5-fold for the various antenatal high-risk conditions. Conclusion: In the United States, prenatal care is associated with fewer preterm births in the presence, as well as absence of high-risk conditions for both African American and white women. Strategies to increase prenatal care participation may decrease preterm birth rates. (Am J Obstet Gynecol 2002;187:1254-7.)

Prenatal Care and Black–White Fetal Death Disparity in the United States

In Brief OBJECTIVE To determine the impact of prenatal care in the United States on the fetal death rate in the presence and absence of obstetric and medical high-risk conditions, and to explore the role of these high risk conditions in contributing to the black–white disparity. METHODS This is a population-based, retrospective cohort study using the national perinatal mortality data for 1995–1997 assembled by the National Center for Health Statistics. Fetal death rate (per 1000 births) and adjusted relative risks were derived from multivariable logistic regression models. RESULTS Of 10,560,077 singleton births, 29,469 (2.8 per 1000) resulted in fetal death. Fetal death rates were higher for blacks than whites in the presence (4.2 versus 2.4 per 1000) and absence (17.2 versus 2.5 per 1000) of prenatal care. Lack of prenatal care increased the (adjusted) relative risk for fetal death 2.9-fold in blacks and 3.4-fold in whites. Blacks were 3.3 times more likely to have no prenatal care compared with whites. Over 20% of all fetal deaths were associated with growth restriction and placental abruption, both in the presence and absence of prenatal care. Lack of prenatal care was associated with increased fetal death rates for both blacks and whites in the presence and absence of high-risk conditions. CONCLUSION In the Unites States, strategies to increase prenatal care participation, especially among blacks, are expected to decrease fetal death rates. Prenatal care in the United States is associated with decreased fetal death rate.

Prenatal care and black-white fetal death disparity in the United States: heterogeneity by high-risk conditions.

To determine the impact of prenatal care in the United States on the fetal death rate in the presence and absence of obstetric and medical high-risk conditions, and to explore the role of these high risk conditions in contributing to the black-white disparity. This is a population-based, retrospective cohort study using the national perinatal mortality data for 1995-1997 assembled by the National Center for Health Statistics. Fetal death rate (per 1000 births) and adjusted relative risks were derived from multivariable logistic regression models. Of 10,560,077 singleton births, 29,469 (2.8 per 1000) resulted in fetal death. Fetal death rates were higher for blacks than whites in the presence (4.2 versus 2.4 per 1000) and absence (17.2 versus 2.5 per 1000) of prenatal care. Lack of prenatal care increased the (adjusted) relative risk for fetal death 2.9-fold in blacks and 3.4-fold in whites. Blacks were 3.3 times more likely to have no prenatal care compared with whites. Over 20% of all fetal deaths were associated with growth restriction and placental abruption, both in the presence and absence of prenatal care. Lack of prenatal care was associated with increased fetal death rates for both blacks and whites in the presence and absence of high-risk conditions. In the Unites States, strategies to increase prenatal care participation, especially among blacks, are expected to decrease fetal death rates.

Barriers to prenatal care in Europe

Background: In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades. Methods: A case–control study was performed in ten European countries (Austria, Denmark, Germany, Greece, Hungary, Ireland, Italy, Portugal, Spain, and Sweden). Postpartum interviews were conducted between 1995 and 1996. A total of 1283 women with inadequate prenatal care (i.e., with 0, 1, or 2 prenatal care visits or a first prenatal care visit after 15 completed weeks of pregnancy) and 1280 controls with adequate prenatal care were included in the analysis combining data from the ten countries. Results: Based on combined data of the ten countries, lack of health insurance was found to be an important risk factor for inadequate prenatal care (crude odds ratio [OR] at 95% confidence interval [CI]: 30.1 [20.1–47.1]). Women with inadequate prenatal care were more likely to be aged <20 years (16.4% vs 4.8%) and with higher parity (number of children previously borne) than controls. They were more likely to be foreign nationals, unmarried, and with an unplanned pregnancy. Women with inadequate care were also more likely to have less education and no regular income. They had more difficulties dealing with health services organization and child care. Cultural and financial barriers were present, but after adjusting for confounders by logistic regression, perceived financial difficulty was not a significant factor for inadequate prenatal care (adjusted OR [95% CI]: 0.7 [0.4–1.3]). Conclusions: Personal, socioeconomic, organizational, and cultural barriers to prenatal care exist in Europe.

Guidelines for client selection in the home birth midwifery practice

Numerous studies have documented the safety of planned home birth; yet, few have identified specific criteria for selection of the home birth candidate. Home birth midwifery practice achieves successful outcomes by appropriate evaluation of medical and obstetric risk factors, as well as an ongoing evaluation and development of the client's psychosocial resources and the midwife-client relationship. Relevant medical and obstetric factors include significant medical illnesses, antenatal course, smoking history, commitment to breastfeeding, and the woman's nutritional profile. Social and environmental factors include the need for a stable birthing environment, practical means for hospital transfer, and the presence of loving support for the client during and after delivery. The client's psychological preparedness is a critical variable that may affect the ability to deliver in the home setting without analgesia or labor augmentation. Active participation in prenatal care, preparation of the home and family members, and a realistic attitude regarding the risks, benefits, and potential complications of planned home delivery are all components of this preparedness. Because midwifery practice promotes midwife-client rapport by careful attention to both medical and psychosocial issues during prenatal care, this relationship is itself an important predictor of the client's suitability for home birth. The quality of midwife-client interactions may influence not only the decision to plan a home birth but the indications for hospital transfer should problems arise. In this article, existing literature is reviewed and criteria are proposed for selecting home birth candidates within the American midwifery practice setting.

Using incentives to increase participation in prenatal care

To test the effectiveness of offering two kinds of incentives to encourage low-income women's participation in prenatal and postpartum care. Two hundred five Medicaid-eligible women enrolled in a prenatal clinic were randomly assigned to receive a $5.00 gift certificate (N = 51) or a gift certificate and a chance to win a $100 raffle (N = 53) for each prenatal appointment they kept. Controls (N = 101) and the two experimental groups were interviewed postpartum about their satisfaction with prenatal care. Women in the three groups were compared for the number of prenatal and the postpartum appointments, satisfaction with care, length of gestation, and birth weight. Thirty-nine percent missed one to seven prenatal appointments, and 45% missed the postpartum appointment. There were no significant differences among the three groups in any of the outcome variables. Women missed appointments because of the lack of transportation, poor weather, and illness. Providing incentives does not overcome barriers to receiving prenatal care.

Are fathers prepared to encourage their partners to breast feed? A study about fathers' knowledge of breast feeding

In order to study fathers' knowledge of breast feeding and its relationship with paternal factors, fathers of 92 breast feeding and 89 non-breast feeding newborns were compared. Paternal factors included previous children and the way they were fed, participation in prenatal care, attendance at prenatal classes, breast feeding information provided by health professionals, use of reading materials and interest in learning more about the subject. The results indicated that fathers had poor knowledge about breast feeding, especially those whose children were being bottle fed. After adjustments for confounders, fathers who had previous breast-fed child(ren), had attended prenatal classes and who received information about breast feeding from medical personnel had a significantly higher chance of having a better knowledge of breast feeding. It seems that fathers need to be better prepared to assume their new role as breast feeding supporters. Prenatal care was shown to be a good opportunity to improve fathers' knowledge of breast feeding.

Physical Violence During the 12 Months Preceding Childbirth—Alaska, Maine, Oklahoma, and West Virginia, 1990-1991

This study examined the prevalence of physical violence against women during the 12 months preceding childbirth and its relation to maternal characteristics in Alaska Maine Oklahoma and West Virginia. Using the 1990 and the 1991 data from the Pregnancy Risk Assessment Monitoring System varied percentages of women reporting physical abuse among the four states were noted: from 3.8% in Maine to 6.9% in Oklahoma. Overall the report indicated that in each state higher rates of physical violence were associated with low educational attainment race marital status age living conditions participation in prenatal care and unintended pregnancy. In addition this article cites recommendations for health care providers to be aware of the risk among all pregnant women; for efforts to effectively identify victims; for evaluations of intervention programs; and for further examinations of the patterns of violence during pregnancy.

Barriers and motivators to prenatal care among low-income women

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the women's perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mother's beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.

Drawing Women into Prenatal Care

Participation in prenatal care services in the United States is low relative to that in many other developed countries, and rates of use are declining among some high risk groups. In 1986, 18 percent of all U.S. infants were born to women who delayed care until the second trimester of pregnancy; four percent, to women who initiated care in the third trimester; and about two percent, to women who obtained no prenatal care at all. Among the major barriers to prenatal care are inadequate insurance coverage, limitations in the Medicaid program, inadequate capacity in the maternity care system, lack of coordination between health and social services for low-income women and inhospitable conditions at some sites where prenatal care is delivered. The personal beliefs, knowledge, attitudes, fears and lifestyles of some pregnant women also constitute obstacles to care. For example, having an unwanted pregnancy, attaching little value to prenatal care and having a tenuous connection to the health care system in general are important predictors of insufficient care. Encouraging universal participation in prenatal care will require a major overhaul of the maternity care system. However, while consensus for fundamental reform builds, several immediate steps should be taken--such as reducing financial barriers to care; expanding the capacity of the maternity care system; improving the policies and practices that shape prenatal services at the site where they are delivered; and increasing public information.