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International Journal of Epidemiology Apr 2019Antenatal care and correctly indicated caesarean section can positively impact on health outcomes of the mother and newborn. Our objective was to describe how coverage...
BACKGROUND
Antenatal care and correctly indicated caesarean section can positively impact on health outcomes of the mother and newborn. Our objective was to describe how coverage and inequalities for these interventions changed from 1982 to 2015 in Pelotas, Brazil.
METHODS
Using perinatal data from the 1982, 1993, 2004 and 2015 Pelotas birth cohorts, we assessed antenatal care coverage and caesarean section rates over time. Antenatal care indicators included the median number of visits, the prevalence of mothers attending at least six visits and the proportion who started antenatal care in the first trimester of pregnancy and attended at least six visits. We described these outcomes according to income quintiles and maternal skin colour, to identify inequalities. We described overall, private sector and public sector caesarean section rates. Differences in prevalence were tested using chi-square testing and median differences using Kruskal-Wallis testing.
RESULTS
From 1982 to 2015, the median number of antenatal care visits and the prevalence of mothers attending at least six visits increased in all income quintiles and skin colour groups. Inequalities were reduced, but not eliminated. The overall proportion of caesarean births increased from 27.6% in 1982 to 65.1% in 2015, when 93.9% of the births in the private sector were by caesarean section. Absolute income-related inequalities in caesarean sections increased over time.
CONCLUSIONS
Special attention should be given to the antenatal care of poor and Black women in order to reduce inequalities. The explosive increase in caesarean sections requires radical changes in delivery care policies, in order to reverse the current trend.
Topics: Adolescent; Adult; Brazil; Cesarean Section; Child; Female; Humans; Income; Logistic Models; Longitudinal Studies; Pregnancy; Prenatal Care; Young Adult
PubMed: 30883657
DOI: 10.1093/ije/dyy211 -
BMC Pregnancy and Childbirth Sep 2018Professional guidelines indicate that pregnancy options counseling should be offered to pregnant women, in particular those experiencing an unintended pregnancy....
BACKGROUND
Professional guidelines indicate that pregnancy options counseling should be offered to pregnant women, in particular those experiencing an unintended pregnancy. However, research on whether pregnancy options counseling would benefit women as they enter prenatal care is limited. This study examines which women might benefit from options counseling during early prenatal care and whether women are interested in receiving counseling from their prenatal care provider.
METHODS
At four prenatal care facilities in Louisiana and Maryland, women entering prenatal care completed a self-administered survey and brief structured interview (N = 586). Data were analyzed through descriptive statistics, bivariate analyses, multivariate multinomial logistic regression, and coding of open-ended responses.
RESULTS
At entry into prenatal care, most women reported that they planned to continue their pregnancy and raise the child. A subset (3%) scored as having low certainty about their decision on the validated Decision Conflict Scale, indicating need for counseling. In addition, 9% of women stated that they would be interested in discussing their pregnancy options with their prenatal care provider. Regression analyses indicated some sociodemographic differences among women who are in need of or interested in options counseling. Notably, women who reported food insecurity in the prior year were found to be significantly more likely to be in need of options counseling (RRR = 3.20, p < 0.001) and interested in options counseling (RRR = 5.48, p < 0.001) than those who were food secure. Most women were open to discussing with their provider if their pregnancy was planned (88%) or if they had considered abortion (81%). More than 95% stated they would be honest with their provider if asked about these topics.
CONCLUSIONS
Most women are certain of their decision to continue their pregnancy at the initiation of prenatal care. However, there is a subset of women who, despite entering prenatal care, are uncertain of their decision and wish to discuss their options with their health care provider. Screening tools and/or probing questions are needed to support prenatal care providers in identifying these women and ensuring unbiased, non-directive counseling on all pregnancy options.
Topics: Counseling; Female; Humans; Louisiana; Maryland; Pregnancy; Pregnancy, Unplanned; Pregnant Women; Prenatal Care; Qualitative Research
PubMed: 30261849
DOI: 10.1186/s12884-018-2012-x -
Tropical Medicine & International... Apr 2020Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality...
OBJECTIVE
Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care.
METHODS
We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable random-intercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient-, provider- and facility-level and subnational divisions).
RESULTS
Only 61-66% of basic elements of competent and respectful care were performed. In adjusted models, better-staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV-positive women received higher-quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage-point gap between Nairobi and the Coast region. Quality was also higher in higher-volume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient-level characteristics in Malawi.
CONCLUSIONS
Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher-volume facilities - along with promotion of respectful care in these facilities - should be considered in sub-Saharan Africa to improve outcomes for mothers and newborns.
Topics: Adolescent; Adult; Delivery, Obstetric; Female; Health Facilities; Humans; Infant, Newborn; Kenya; Malawi; Pregnancy; Prenatal Care; Quality Indicators, Health Care; Retrospective Studies; Surveys and Questionnaires; Young Adult
PubMed: 31828923
DOI: 10.1111/tmi.13361 -
Ciencia & Saude Coletiva Mar 2020The Prenatal Care and Birth Humanization Program (PHPN) establishes a minimum number of procedures to be provided to all pregnant women during prenatal care. This study...
The Prenatal Care and Birth Humanization Program (PHPN) establishes a minimum number of procedures to be provided to all pregnant women during prenatal care. This study aimed to analyze the quality of prenatal care in Sergipe based on the PHPN recommendations. This is a cross-sectional study, with a descriptive and analytic approach, using survey data from the Birth in Sergipe research, conducted from June 2015 to April 2016 with 768 puerperae proportionally distributed among all state maternity hospitals (n = 11). Data were collected from face-to-face interviews and patients' prenatal care cards. The results showed a high coverage of prenatal care (99.3%; n =763), but little more than half of these women started their prenatal care within 16 weeks of gestation (57%; n =435), and 74.7% (n = 570) had six or more visits. We noted that 16.6% (n = 127) of pregnant women were at high risk for complications and almost half continued monitoring prenatal care with professional nurses. Around 61.3% were advised about the maternity care service of reference for delivery, and 29.4% sought more than one health service for childbirth. We concluded that there was a high prenatal care coverage in Sergipe, however, with issues concerning its adaptation to the PHPN.
Topics: Adolescent; Adult; Brazil; Child; Cross-Sectional Studies; Female; Government Programs; Humans; Practice Guidelines as Topic; Pregnancy; Prenatal Care; Quality of Health Care; Young Adult
PubMed: 32159650
DOI: 10.1590/1413-81232020253.13182018 -
Medicine Nov 2021In addition to the maternal death indicator, Stork Network proposes the number of prenatal consultations, the gestational age of onset of prenatal care and the number of...
In addition to the maternal death indicator, Stork Network proposes the number of prenatal consultations, the gestational age of onset of prenatal care and the number of children breastfeeding.The study aims to analyze maternal health indicators representative of the actions proposed by Stork Network in Brazil, after its implementation. Therefore, this is an ecological study of maternal health indicators in Brazil from 2012 to 2017.Thus, it was found that the number of prenatal consultations per pregnant woman in Brazil from 2012 to 2017 increased >4 times between the first and the last year analyzed. The proportion of pregnant women who started prenatal care in the first trimester of pregnancy increased progressively each year in Brazil.The breastfeeding coefficient also increased progressively between 2014 and 2017 in Brazil. It was found that maternal health indicators improved between 2012 and 2017 in the Brazilian territory.
Topics: Brazil; Breast Feeding; Child; Female; Health Status Indicators; Humans; Maternal Health; Maternal Health Services; Maternal Mortality; Pregnancy; Prenatal Care; Time Factors
PubMed: 34871202
DOI: 10.1097/MD.0000000000027118 -
BMC Pregnancy and Childbirth Jul 2018There is a very large population of internal migrants in China, and the majority of migrant women are of childbearing age. Little is known about their utilization of...
BACKGROUND
There is a very large population of internal migrants in China, and the majority of migrant women are of childbearing age. Little is known about their utilization of prenatal care and factors that influence this. We examined this using data from a large national survey of migrants.
METHODS
5372 married rural to urban migrant women aged 20-34 who were included in the 2014 National Dynamic Monitoring Survey on Migrants and who delivered a baby within the previous two years were studied. We examined demographic and migration experience predictors of prenatal care in the first trimester and of adequate prenatal visits.
RESULTS
12.6% of migrant women reported no examination in the first trimester and 27.6% had less than 5 prenatal visits during their latest pregnancy. Multivariate analysis indicated that demographic predictors of delayed and inadequate care included lower educational level, lower income and not having childbearing insurance. Migrating before pregnancy, longer time since migration, having migrated a greater distance, and not returning to their home town for delivery were correlated with better prenatal care.
CONCLUSIONS
Many internal migrant women in China do not receive adequate prenatal care. While internal migration before pregnancy seems to promote adequate prenatal care, it also creates barriers to receiving care. Strategies to improve prenatal care utilization include expanding access to childbearing insurance and timely education for women before and after they migrate.
Topics: Adult; China; Delivery of Health Care; Female; Health Services Misuse; Humans; Needs Assessment; Patient Acceptance of Health Care; Pregnancy; Pregnancy Trimester, First; Prenatal Care; Quality Improvement; Rural Population; Socioeconomic Factors; Transients and Migrants; Urban Population
PubMed: 30005631
DOI: 10.1186/s12884-018-1934-7 -
BMC Pregnancy and Childbirth Sep 2017Group prenatal care (GPC) models have been gaining popularity in recent years. Studies of high-risk groups have shown improved outcomes. Our objective was to review and... (Review)
Review
BACKGROUND
Group prenatal care (GPC) models have been gaining popularity in recent years. Studies of high-risk groups have shown improved outcomes. Our objective was to review and summarize outcomes for women in GPC for women with specific high-risk conditions.
METHODS
A systematic literature review of Ovid, PubMed, and Google Scholar was performed to identify studies reporting the effects of group prenatal care in high-risk populations. Studies were included if they reported on pregnancy outcome results for women using GPC. We also contacted providers known to be utilizing GPC for specific high-risk women. Descriptive results were compiled and summarized by high-risk population.
RESULTS
We identified 37 reports for inclusion (8 randomized trials, 23 nonrandomized studies, 6 reports of group outcomes without controls). Preterm birth was found to be decreased among low-income and African American women. Attendance at prenatal visits was shown to increase among women in GPC in the following groups: Opioid Addiction, Adolescents, and Low-Income. Improved weight trajectories and compliance with the IOM's weight recommendations were found in adolescents. Increased rates of breastfeeding were found in adolescents and African Americans. Increased satisfaction with care was found in adolescents and African Americans. Pregnancy knowledge was increased among adolescents, as was uptake of LARC. Improved psychological outcomes were found among adolescents and low-income women. Studies in women with diabetes demonstrated that fewer women required treatment with medication when exposed to GPC, and for those requiring treatment with insulin, GPC individuals required less than half the dose. Among women with tobacco use, those who had continued to smoke after finding out they were pregnant were 5 times more likely to quit later in pregnancy if they were engaged in GPC.
CONCLUSIONS
Several groups of high-risk pregnant women may have benefits from engaging in group prenatal care. Because there is a paucity of high-quality, well-controlled studies, more trials in high-risk women are needed to determine whether it improves outcomes and costs of pregnancy-related care.
Topics: Adolescent; Adult; Female; Health Knowledge, Attitudes, Practice; Humans; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Premature Birth; Prenatal Care; Psychotherapy, Group; Young Adult
PubMed: 28962601
DOI: 10.1186/s12884-017-1522-2 -
BMC Pregnancy and Childbirth Oct 2019Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand...
BACKGROUND
Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007-June 2009).
METHODS
Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects' research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage.
RESULTS
Individual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession. Associations between late/no prenatal care utilization and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly with young maternal age and having less than a high school education remaining the largest contributors to late/no prenatal care utilization. In contrast, individual maternal enrollment in a supplemental nutrition program for women, infants, and children (WIC) exhibited a protective association against late/no prenatal care utilization. The magnitude of association between community-level partisan voting patterns and expenditures on some maternal child health programs increased in non-beneficial directions. Simulated scenarios show a high combined impact on prenatal care utilization among women who have multiple disadvantages.
CONCLUSIONS
Our findings provide a compelling picture of the important roles that individual characteristics-particularly low education and young age-play in late/no prenatal care utilization among pregnant women. Targeted outreach to individuals with high disadvantage characteristics, particularly those with multiple disadvantages, may help to increase first trimester entry to utilization of prenatal care. Finally, WIC may have played a valuable role in reducing late/no prenatal care utilization, and its effectiveness during the Great Recession as a policy-based approach to reducing late/no prenatal care utilization should be further explored.
Topics: Adult; Birth Certificates; Economic Recession; Female; Health Services Accessibility; Humans; Medicaid; Patient Acceptance of Health Care; Pregnancy; Pregnancy Outcome; Pregnant Women; Prenatal Care; Reproductive History; Social Determinants of Health; Socioeconomic Factors; United States
PubMed: 31664939
DOI: 10.1186/s12884-019-2486-1 -
Obstetrics and Gynecology Apr 2017To compare gestational weight gain among women in group prenatal care with that of women in individual prenatal care.
OBJECTIVE
To compare gestational weight gain among women in group prenatal care with that of women in individual prenatal care.
METHODS
In this retrospective cohort study, women who participated in group prenatal care from 2009 to 2015 and whose body mass indexes (BMIs) and gestational weight gain were recorded were matched with the next two women who had the same payer type, were within 2-kg/m prepregnancy BMI and 2-week gestational age at delivery, and had received individual prenatal care. Bivariate comparisons of demographics and antenatal complications were performed for women in group and individual prenatal care, and weight gain was categorized as "below," "met," or "exceeded" goals according to the 2009 Institute of Medicine guidelines. Logistic regression analysis estimated the association between excessive weight gain and model of care, with adjustment for confounders, stratified by BMI.
RESULTS
Women in group prenatal care (n=2,117) were younger and more commonly non-Hispanic black, nulliparous, and without gestational diabetes (P≤.005 for all). Women in group prenatal care more commonly exceeded the weight gain goals (55% compared with 48%, P<.001). The differences in gestational weight gain were concentrated among normal-weight (mean 34.2 compared with 32.1 pounds, P<.001; 47% compared with 41% exceeded, P=.008) and overweight women (mean 31.5 compared with 27.1 pounds, P<.001; 69% compared with 54% exceeded, P<.001). When adjusted for age, race-ethnicity, parity, education, and tobacco use, the increased odds for excessive gestational weight gain persisted among normal-weight (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09-1.51) and overweight (OR 1.84, 95% CI 1.50-2.27) women. Nulliparity was associated with increased excessive gestational weight gain (OR 1.49, 95% CI 1.33-1.68), whereas Hispanic ethnicity was associated with decreased excessive gestational weight gain (OR 0.68, 95% CI 0.59-0.78).
CONCLUSION
Among normal-weight or overweight women, group prenatal care, compared with individual prenatal care, is associated with excessive gestational weight gain.
Topics: Adult; Body Mass Index; Demography; Female; Gestational Age; Group Structure; Humans; Models, Organizational; Odds Ratio; Parity; Pregnancy; Prenatal Care; Retrospective Studies; Risk Factors; Socioeconomic Factors; South Carolina; Weight Gain
PubMed: 28277365
DOI: 10.1097/AOG.0000000000001940 -
Midwifery May 2023To explore and define a woman-centered perspective on health during pregnancy.
OBJECTIVE
To explore and define a woman-centered perspective on health during pregnancy.
DESIGN
Qualitative study using abductive thematic analysis of semi-structured interview data.
SETTING & PARTICIPANTS
Twenty pregnant participants, primarily single and low-income, were recruited from an urban women's health clinic in the Midwestern United States and interviewed during mid-to-late pregnancy.
FINDINGS
Women experienced health as "deeper than physical health" to include emotional well-being, financial stability, and support. We defined the central theme of Deep Health to be an embodied sense of happiness, energy, stability, and purpose (Being) supported through positive health practices (Doing) and adequate financial and social resources (Having).
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE
While the Doing aspects of health are often a focal point for health promotion efforts in prenatal care, a restricted focus on lifestyle behaviors may contribute to a lack of shared understanding about health between women and their healthcare providers. Greater attention to the Being and Having aspects of health may work to bolster shared priorities for health between pregnant women and their providers.
Topics: Pregnancy; Female; Humans; Pregnant Women; Prenatal Care; Women's Health; Qualitative Research; Health Personnel
PubMed: 36870255
DOI: 10.1016/j.midw.2023.103628