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Results for “PRENATAL CARE”

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PubMed1993

The impact of sociodemographic, health care system, and family function variables on prenatal care utilization in a military setting.

BACKGROUND: Appropriate use of prenatal care is associated with more favorable perinatal outcomes. This study examines patient characteristics that influence the use of prenatal care in a total reimbursement setting. METHODS: A cohort analysis was conducted with 368 new obstetric registrants in a military community hospital. The protocol involved the completion of a family function scale and prenatal care survey at the onset of care and a record review at the completion of pregnancy. RESULTS: Several socioeconomic variables were highly associated with low utilization of prenatal care: low income, difficulty in finding child care, lower educational levels, and difficulty in getting transportation. The method of health care delivery, ie, care in the obstetric clinic vs family practice clinic, was also significantly associated with inadequate utilization. Finally, there appeared to be a negative association of cohesion and overall family function scores with the level of prenatal care use (P < .05). CONCLUSIONS: Multiple economic factors influence the use of prenatal care even in a system with total reimbursement. Family practice care is associated with better utilization patterns; family dysfunction is associated with less prenatal care utilization.

Adult↗
PubMed1997

Unintended childbearing, maternal beliefs, and delay of prenatal care.

BACKGROUND: Delay of prenatal care is an important risk for poor birth outcome, yet its association with maternal knowledge and beliefs remains insufficiently studied. This research examined the relationship of unintended childbearing and beliefs about the importance of prenatal care with initiation after the first trimester, adjusting for key sociodemographic determinants. METHODS: One hundred fifty-four Texas hospitals accounting for 80 percent of state births were asked to collect surveys from all women delivering infants during a one-week interval in 1986. Seventy-four percent of hospitals and 70 percent of women participated (n = 2032). No differences occurred between the sample and the population on rates of delayed care and low birthweight or maternal demographics. RESULTS: Since delayed prenatal care is more frequent among low-income women, analyses were limited to those below the 200 percent poverty level. After adjustment for maternal age, marital status, education, parity, race, and health insurance status employing logistic regression, unintended births were 1.6 times more likely to involve delayed care. Mothers who believed prenatal care was unimportant were 2.1 times more likely to delay care. These coefficients exceeded or about equaled those for the covariates. CONCLUSIONS: Preconception education about the value of prenatal care and family planning programs to prevent unintended pregnancies should be conducted together with efforts to overcome financial and structural barriers if progress toward national prenatal care objectives is to be achieved.

Adult↗
PubMed2000

[Malaria and pregnancy: attitude of health care personnel during prenatal care in Cotonou, Benin].

The purpose of this study was to evaluate the state of knowledge and use of drug in pregnant women diagnosed with malaria at the first prenatal examination. Survey data were conducted of physicians and paramedical staff working the public and private sector in Cotonou, Benin from November 1996 to January 1997. A questionnaire including items on the type of antimalarials used, therapeutic regimens and compliance with the treatment posology and duration guidelines as defined by the WHO and recommended by the National Program against Malaria. A study of informational supports allowed validation of responses obtained during the interview on the day of survey. A random two-degree, stratified sample of 208 prescribers including 109 physicians, 51 midwives, and 48 nurses was interviewed. Data analysis showed that chemoprophylaxis was prescribed by all midwives, 87.5 p. 100 of nurses, and 8.2 p. 100 of physicians. Midwives prescribed this strategy in all pregnant women. For 5.5 p. 100 of physicians and 6.3 p. 100 of nurses, primigravid women were considered as a target group. Chloroquine was the most widely used antimalarial. It was sometimes used in association with proguanil. Of the other drugs used for prevention, quinine was prescribed by 2.4 p. 100 of nurses and 1.1 p. 100 of physicians. The therapeutic regimes and posologies used by the health care workers were not in compliance with the policies of the National Program for Control of Malaria. The findings warrant the creation of an organization to promote consultation and communication between health care authorities and workers.

Antimalarials↗
PubMedDate not supplied

Quality care in a medicaid managed care program: adequacy of prenatal care for teens in Chicago.

This study considers whether obstetricians offer less adequate care to teen prenatal patients in the Healthy Moms, Healthy Kids (HMHK) Medicaid managed care program in Chicago than to non-Medicaid patients. Telephone surveys of obstetricians offices (n = 101) were conducted to determine the content of care in the first prenatal visit. These survey data are combined with demographic and practice background data from The American Medical Association's Physician Master File. Analysis indicates there were no significant differences between groups for receiving: (1) medical histories, (2) physical exam and tests, (3) health promotion counseling, and (4) availability of birthing education materials. Analysis further indicates, however, that teen Medicaid patients are less likely to receive blood tests and some urinalysis-related tests. Not receiving these tests is especially problematic because pregnant teens are more likely to drop out of the prenatal care regimen after their first visit, and teens are more likely to have poorer birth outcomes.

Adolescent↗
PubMed1998

Health care characteristics associated with women's satisfaction with prenatal care.

OBJECTIVES: The objective of this study was to explore the relation between prenatal care characteristics and satisfaction among Medicaid recipients. METHODS: African-American (n = 75) and Mexican-American (n = 26) nonadolescent primiparous pregnant women who had at least three prenatal care visits participated in a 25-minute telephone survey that asked them about satisfaction with prenatal care (art of care, technical quality, physical environment, access, availability and efficacy); prenatal care characteristics (practitioner attributes, service availability, and features of the delivery of care); and, personal characteristics (sociodemographics, health status and behaviors, and pregnancy-related variables). Univariate and multivariable analyses were conducted to explore the relations between personal characteristics and satisfaction and between care characteristics and satisfaction. RESULTS: For the overall sample, the following prenatal care characteristics were associated with increased satisfaction: having procedures explained by the provider, short waiting times at the prenatal care site, the availability of ancillary services, and reporting that the prenatal care practitioner was male. When examining the data by ethnicity, whether the provider explained procedures was the most important determinant of satisfaction for both African-American and Mexican-American women. CONCLUSIONS: Knowledge of the care characteristics that impact low-income pregnant women's satisfaction can be utilized to alter service delivery to increase use of prenatal care and ultimately to improve perinatal outcomes.

Adult↗
PubMed1979

The impact of a maternal and child health care program on the quality of prenatal care: an analysis by risk group.

A typical maternal and child health care program was implemented in an American Indian reservation community, and its impact on the effectiveness of prenatal care was assessed. Evaluation included examination from both the provider perspective (care provided to program users) and the population perspective (care received by a sample of all prenatal patients in the community), as well as examination of outcomes of prenatal care. The study cohorts were sorted into relatively high and average risk as a function of age, gravidity, and history of abortion or miscarriage. The study results suggest that such a program will improve the quality of prenatal care, although the program has a greater impact on the average risk group. Standard methods of assessing program effectiveness, which examine the care provided by the program as opposed to the care received by the community, will not detect this phenomenon.

Adolescent↗
PubMed1989

Organization of prenatal care in Belgium.

Prenatal care in Belgium is characterized by regional variations between the Flemish- and French-speaking communities. Generally, care in the former area is provided by a general practitioner or a gynecologist/obstetrician in private practice, and in the latter by a gynecologist/obstetrician on a private or public basis. The level of use of prenatal care observed is, on average, high, but variations do exist according to the socioeconomic and cultural characteristics of the families and the health care services which they frequent.

Belgium↗
PubMedDate not supplied

Consumer assessment of the quality of interpersonal processes of prenatal care among ethnically diverse low-income women: development of a new measure.

PURPOSE: Consumer assessments of interpersonal processes of care during prenatal care provide important information about how well clinicians satisfy the perceived needs of the women they serve, but few measures are available that tap the various components of these processes. The purpose of this study is to develop a multidimensional measure of prenatal interpersonal processes of care (PIPC) that demonstrates reliability and validity in ethnically diverse women in Medicaid managed care plans. METHODS: A telephone survey of African American, Latino (U.S. and foreign born) and Caucasian pregnant women in four Medicaid managed care plans in California was conducted in English and Spanish in 2001. Factor analytic methods were used to test the PIPC measures. A psychometric evaluation, including reliability, variability, and construct validity, was conducted with the final scales for the total sample and for each racial/ethnic group. RESULTS: Three dimensions, Communication, Patient-Centered Decision Making, and Interpersonal Style, with seven scales were supported with 30 items. The scales for each dimension exhibit acceptable reliability for the total sample (Internal Consistency Reliability ranged from 0.66 to 0.85) and for all racial/ethnic groups. All scales had significant associations with satisfaction with prenatal care and explained considerable variation in satisfaction (19-43%). The scale qualities and validity associations held for all scales and ethnic groups except some scales for U.S.-born Latinas. CONCLUSIONS: The multidimensional PIPC measure for assessing what actually happens between providers and low-income pregnant women of diverse ethnic groups demonstrates acceptable reliability and construct validity.

Adult↗
PubMed1995

Canadian First Nations women's beliefs about pregnancy and prenatal care.

Evidence links adequate prenatal care to improved birth outcomes. Research, however, indicates that First Nations women do not attend regularly for prenatal care. In the current study, seven informants, representing three First Nations tribes, were extensively interviewed to examine their beliefs about pregnancy and participation in prenatal care. First Nations women conceptualized pregnancy in a spiritual context and believed it to be a healthy, natural process requiring no intervention. Since they believed they were responsible for "taking care of themselves" during pregnancy, cultural practices that were thought to promote a healthy pregnancy were espoused. First Nations women were reportedly often dissatisfied with health-care providers in prenatal clinics. Their expectations of freely offered explanations and a friendly non-authoritarian approach were often not realized and their beliefs about pregnancy were in conflict with those of health-care providers. Barriers to prenatal care might be reduced by improving communication and providing holistic culture-specific care.

Adolescent↗
PubMedDate not supplied

Prenatal care: limitations and opportunities.

Prenatal care is a venerable tradition in the U.S. health care system and one that deserves critical examination. Inordinate amounts of public and personal resources are expended on a tradition of care that has not proven itself equal to current perinatal prevention challenges. In this article, the evolution of prenatal care is reviewed, its efficacy is critiqued, and efforts at restructuring the content and processes of care are examined. Three promising alternatives to the dominant medical model are described: the comprehensive prenatal care approach illustrated by many publicly funded prenatal clinics, the prenatal empowerment model as exemplified by midwifery care, and the prenatal group model as illustrated by CenteringPregnancy. Nurses are called upon to champion prenatal options for women.

Evidence-Based Medicine↗
PubMed2004

Factors associated with inadequate prenatal care in Ecuadorian women.

BACKGROUND: Although inadequate prenatal care has been associated with adverse perinatal outcomes, reports on the factors associated with poor prenatal care in developing Latin American countries are scarce. OBJECTIVE: To determine factors associated with inadequate prenatal care among women from low socioeconomic circumstances. METHOD: Women delivered after a pregnancy duration of more than 20 weeks at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador, were surveyed. The questionnaire collected sociodemographic data and reasons for having inadequate prenatal care. Adequacy of prenatal care was measured with the Kessner index and correlated to the sociodemographic data. RESULTS: During the study period, 1016 pregnant women were surveyed. Among them, there were adolescents (23.7%), primigravidas (30.8%), and women with a high-risk pregnancy (29.3%). According to the Kessner index, prenatal care was considered adequate or inadequate in 24.5% and 75.5% of cases, respectively. Knowledge regarding the importance of adequate prenatal care and the effects of poor prenatal care was lower among women who had received inadequate prenatal care. The women that were considered to have had adequate prenatal care had at least one visit, and they were more often cared for by a specialist than women who considered having inadequate prenatal care. The three most important reasons associated to inadequate prenatal care in this series (n=767), were economic difficulties having to care for a small child, and transportation difficulties. Logistic regression analysis determined that women with undesired pregnancies who resided in rural areas and were para 5 or higher had an increased risk of inadequate prenatal care. On the other hand, an adverse outcome to a prior pregnancy (abortion, intrauterine fetal demise, or ectopic pregnancy) decreased this risk. Marital status and educational level were confounding factors. CONCLUSIONS: Although prenatal care at our institution is free, adequacy was thought to be low. The main factors associated with poor prenatal care were mostly conditions related to poverty.

Confounding Factors, Epidemiologic↗
PubMed2004

Private care and public health: do vaccination and prenatal care rates differ between users of private versus public sector care in India?

OBJECTIVE: To determine whether patients who use private sector providers for curative services have lower vaccination rates and are less likely to receive prenatal care. DATA SOURCES/STUDY SETTING: This study uses data from the 52d round of the National Sample Survey, a nationally representative socioeconomic and health survey of 120,942 rural and urban Indian households conducted in 1995-1996. STUDY DESIGN: Using logistic regression, we estimate the relationship between receipt of preventive care at any time (vaccinations for children, prenatal care for pregnant women) and use of public or private care for outpatient curative services, controlling for demographics, household socioeconomic status, and state of residence. DATA COLLECTION/EXTRACTION METHODS: We analyzed samples of children ages 0 to 4 and pregnant women who used medical care within a 15-day window prior to the survey. PRINCIPAL FINDINGS: With the exception of measles vaccination, predicted probabilities of the receipt of vaccinations and prenatal care do not differ based on the type of provider at which children and women sought curative care. Children and pregnant women in households who use private care are almost twice as likely to receive preventive care from private sources, but the majority still obtains preventive care from public providers. CONCLUSIONS: We do not find support for the hypothesis that children and pregnant women who use private care are less likely to receive public health services. Results are consistent with the notion that Indian households are able to successfully navigate the coexisting public and private systems, and obtain services selectively from each. However, because the study employed an observational, cross-sectional study design, findings should be interpreted cautiously.

Adolescent↗
PubMed1999

Prenatal care for low-income women enrolled in a managed-care organization.

OBJECTIVE: To determine barriers to prenatal care among managed-care enrollees who receive Medicaid. METHODS: In-person interviews were conducted with women 13-45 years old who were members of the Prudential HealthCare Community Plan in Memphis, Tennessee. Interview data were linked to medical chart reviews for 200 women who were currently pregnant or had delivered a baby since enrollment in Prudential. Factors related to untimely entry to prenatal care and inadequate prenatal visits were examined. RESULTS: More than half of the respondents had either untimely entry to or inadequate prenatal care. Overall, 89% of respondents had favorable attitudes about prenatal care. Several system and personal factors were associated with receipt of early or adequate prenatal care. Multivariate analysis showed that one system and two personal factors remained significantly related to entry to prenatal care. Women who entered Prudential during pregnancy were 2.4 times more likely (95% CI 1.1, 5.0) to receive late care than women who enrolled before pregnancy. Women who felt too tired to go for care were 2.2 times more likely (95% CI 1.0, 4.9) to receive late care. Women who experienced physical violence during pregnancy were 3.5 times more likely (95% CI 1.0, 12.0) to receive late care. Multivariate analysis with adequacy of prenatal care as the outcome showed several personal factors that increased odds of receiving inadequate prenatal care; however, only help from the infant's father was significantly related to adequacy of prenatal care. Women who did not have much help from the infant's father were 1.9 times more likely not to have adequate care (95% CI 1.0, 3.6). CONCLUSION: Even when affordable care was available, many low-income women did not avail themselves of it. Although women knew the importance of prenatal care, there was a gap between attitudes and actually seeking appropriate care. System and personal factors need to be addressed to overcome barriers to prenatal care.

Adolescent↗
PubMed1995

The role of prenatal care in preventing low birth weight.

Prenatal care has long been endorsed as a means to identify mothers at risk of delivering a preterm or growth-retarded infant and to provide an array of available medical, nutritional, and educational interventions intended to reduce the determinants and incidence of low birth weight and other adverse pregnancy conditions and outcomes. Although the general notion that prenatal care is of value to both mother and child became widely accepted in this century, the empirical evidence supporting the association between prenatal care and reduced rates of low birth weight emerged slowly and has been equivocal. Much of the controversy over the effectiveness of prenatal care in preventing low birth weight stems from difficulties in defining what constitutes prenatal care and adequate prenatal care use. While the collective evidence regarding the efficacy of prenatal care to prevent low birth weight continues to be mixed, the literature indicates that the most likely known targets for prenatal interventions to prevent low birth weight rates are (1) psychosocial (aimed at smoking); (2) nutritional (aimed at low prepregnancy weight and inadequate weight gain); and (3) medical (aimed at general morbidity). System level approaches to impact the accessibility and the appropriateness of prenatal health care services to entire groups of women and population-wide health promotion, social service, and case management approaches may also offer potential benefits. However, data on the effectiveness of these services are lacking, and whether interventions focused on building cohesive, functional communities can do as much or more to improve low birth weight rates as individualized treatments has yet to be explored. The ultimate success of prenatal care in substantially reducing current low birth weight percentages in the United States may hinge on the development of a much broader and more unified conception of prenatal care than currently prevails. Recommendations for actions to maximize the impact of prenatal care on reducing low birth weight are proposed both for the public and for the biomedical, public health, and research communities.

Female↗
PubMedDate not supplied

Evaluation of a program for prenatal care case management.

A prenatal care case-management program in Tennessee was evaluated to determine its effectiveness in improving the adequacy of prenatal care reducing the odds of preterm birth (gestation less than 37 weeks) and very low birth weight births (less than 1,500 g). The case-management program, Project HUG, included care provider referrals, visit scheduling, assistance with transportation and nutritional and health education. In a cohort of 66,051 Medicaid women with a birth during the period July 1989 through December 1991, 6% received HUG services. HUG participants had improved utilization of prenatal care, significantly decreased odds of inadequate perinatal care (an odds ratio of 0.71) and significantly increased odds of obtaining prenatal vitamins within 120 days of the last menstrual period (1.79). The apparent benefit of Project HUG was greater among blacks than among whites. However, there was no significant reduction in the incidence of preterm births or very low birth weight births among program participants

Black People↗
PubMedDate not supplied

Family dysfunction and Native American women who do not seek prenatal care.

OBJECTIVE: To test the hypotheses that, in a health system with few external barriers to care, women with no prenatal care (NPC) have higher rates of nuclear family dysfunction and disproportionate amounts of adverse neonatal outcomes compared with women with prenatal care. DESIGN: Case-control study. SETTING: Indian Health Service system. PATIENTS: Nuclear families of women not seeking prenatal care compared with those who did seek prenatal care. MAIN OUTCOME MEASURES: Dysfunctional outcome measures in nuclear families were children adopted, placed, or under protective surveillance; mothers denying pregnancy, being abused, or attempting suicide; and parents with alcoholism. Neonatal outcome measures were low birth weight and neonatal intensive care days. RESULTS: Dysfunctional markers occurred significantly more frequently in families of women with NPC than in families of women with prenatal care (57% of NPC and 12% of control families; McNemar odds ratio, 14; 95% confidence interval, 4.7-41.6). Neonatal outcome in this Native American population showed that women with NPC had only 2.6% (58/2222) of the total births but accounted for 11% of the low-birth-weight infants (< 2500 g), 18% of the very-low-birth-weight infants (< 1500 g), and 24% of the level II and 41% of the level III newborn intensive care days. CONCLUSIONS: Women not seeking prenatal care in a system with few external barriers to care have significantly more family dysfunction (P < .001) than women seeking prenatal care. Infants of women with NPC generated a disproportionate amount of adverse neonatal outcome. The combination of NPC and family dysfunction was more predictive of adverse neonatal outcome than was NPC alone.

Adolescent↗
PubMedDate not supplied

Issues in determining and measuring adequacy of prenatal care.

Research has demonstrated that adequate prenatal care is an effective intervention that improves pregnancy outcomes, including reducing infant mortality rates. Currently, there are three methods to determine the adequacy of prenatal care, including American College of Obstetricians and Gynecologists Standards, Kessner Index, and Adequacy of Prenatal Care Utilization Index. All three methods have been used to measure prenatal care for women with low-risk pregnancies. Their use in women with a high-risk pregnancy is problematic. Use of a ratio index for women with a high-risk pregnancy is suggested. Following the criteria suggested by the Public Health Expert Panel on the Content of Prenatal Care to assess the effectiveness of prenatal care is recommended. Evaluating both quantity and content of prenatal care visits would more accurately reflect adequacy of prenatal care.

Female↗