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BMC Pregnancy and Childbirth Jan 2015Socioeconomic disparities in the use of prenatal care (PNC) exist even where care is universally available and publicly funded. Few studies have sought the perspectives...
BACKGROUND
Socioeconomic disparities in the use of prenatal care (PNC) exist even where care is universally available and publicly funded. Few studies have sought the perspectives of health care providers to understand and address this problem. The purpose of this study was to elicit the experiential knowledge of PNC providers in inner-city Winnipeg, Canada regarding their perceptions of the barriers and facilitators to PNC for the clients they serve and their suggestions on how PNC services might be improved to reduce disparities in utilization.
METHODS
A descriptive exploratory qualitative design was used. Semi-structured interviews were conducted with 24 health care providers serving women in inner-city neighborhoods with high rates of inadequate PNC. Content analysis was used to code the interviews based on broad categories (barriers, facilitators, suggestions). Emerging themes and subthemes were then developed and revised through the use of comparative analysis.
RESULTS
Many of the barriers identified related to personal challenges faced by inner-city women (e.g., child care, transportation, addictions, lack of support). Other barriers related to aspects of service provision: caregiver qualities (lack of time, negative behaviors), health system barriers (shortage of providers), and program/service characteristics (distance, long waits, short visits). Suggestions to improve care mirrored the facilitators identified and included ideas to make PNC more accessible and convenient, and more responsive to the complex needs of this population.
CONCLUSIONS
The broad scope of our findings reflects a socio-ecological approach to understanding the many determinants that influence whether or not inner-city women use PNC services. A shift to community-based PNC supported by a multidisciplinary team and expanded midwifery services has potential to address many of the barriers identified in our study.
Topics: Attitude of Health Personnel; Canada; Culturally Competent Care; Family Practice; Female; Health Services Accessibility; Healthcare Disparities; Humans; Male; Midwifery; Nurse Practitioners; Obstetric Nursing; Obstetrics; Pregnancy; Prenatal Care; Public Health Nursing; Qualitative Research; Social Support; Time Factors; Transportation; Urban Population; Workforce
PubMed: 25591945
DOI: 10.1186/s12884-015-0431-5 -
Public Health Reports (Washington, D.C.... 2001Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate....
Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of the research controversies and challenges facing investigators and advocates who seek to establish the value of prenatal care. In addition, the authors recommend directions for future research to address persistent questions regarding the function, structure, and significance of prenatal care in improving US perinatal outcomes.
Topics: Evidence-Based Medicine; Female; Health Services Research; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Pregnancy; Pregnancy Outcome; Prenatal Care; Quality of Health Care; Treatment Outcome; United States
PubMed: 12037259
DOI: 10.1093/phr/116.4.306 -
Revista Gaucha de Enfermagem Jun 2019To analyze the repercussions of using the Birth Plan in the parturition process from the national and international scientific production.
OBJECTIVE
To analyze the repercussions of using the Birth Plan in the parturition process from the national and international scientific production.
METHODS
Integrative literature review performed in the LILACS, PUBMED, CINAHL and SciELO, comprising 13 articles published in English, Spanish and Portuguese, in the period from 2008 through 2018.
RESULTS
The construction of the Birth Plan during prenatal influences positively the process of parturition and maternal-fetal outcomes. Unrealistic expectations can cause dissatisfaction with the experience of childbirth. Care providers play a central role in supporting its planning and fulfillment.
CONCLUSIONS
The analyzed publications justify the clinical implementation of the Birth Plan, once it represents an intensifying technology of humanized care and maternal satisfaction. There are still some challenges related to the use of this instrument concerning women's adherence and professional support to improve the fulfillment of the Birth Plans.
Topics: Adult; Delivery, Obstetric; Evidence-Based Medicine; Female; Humans; Medicalization; Parturition; Patient Preference; Personal Autonomy; Personal Satisfaction; Pregnancy; Prenatal Care; Qualitative Research
PubMed: 31188973
DOI: 10.1590/1983-1447.2019.20180233 -
BMC Pregnancy and Childbirth Aug 2017The recent WHO report on health promotion interventions for maternal and newborn health recommends birth preparedness and complications readiness interventions to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The recent WHO report on health promotion interventions for maternal and newborn health recommends birth preparedness and complications readiness interventions to increase the use of skilled care at birth and to increase timely use of facility care for obstetric and newborn complications. However, these interventions are complex and relate strongly to the context in which they are implemented. In this article we explore factors to consider when implementing these interventions.
METHODS
This paper reports a secondary analysis of 64 studies on birth preparedness and complication readiness interventions identified through a systematic review and updated searches. Analysis was performed using the Supporting the Use of Research Evidence (SURE) framework to guide thematic analysis of barriers and facilitators for implementation.
RESULTS
Differences in definitions, indicators and evaluation strategies of birth preparedness and complication readiness interventions complicate the analysis. Although most studies focus on women as the main target group, multi-stakeholder participation with interventions occurring simultaneously at both community and facility level facilitated the impact on seeking skilled care at birth. Increase in formal education for women most likely contributed positively to results. Women and their families adhering to traditional beliefs, (human) resource scarcities, financial constraints of women and families and mismatches between offered and desired maternity care services were identified as key barriers for implementation.
CONCLUSIONS
Implementation of birth preparedness and complication readiness to improve the use of skilled care at birth can be facilitated by contextualizing interventions through multi-stakeholder involvement, targeting interventions at multiple levels of the health system and ensuring interventions and program messages are consistent with local knowledge and practices and the capabilities of the health system.
Topics: Delivery, Obstetric; Female; Health Knowledge, Attitudes, Practice; Health Plan Implementation; Health Promotion; Humans; Parturition; Pregnancy; Prenatal Care
PubMed: 28854902
DOI: 10.1186/s12884-017-1448-8 -
Revista Brasileira de Enfermagem 2024To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy. (Review)
Review
OBJECTIVE
To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy.
METHOD
Scoping review that used PRISMA-ScR guide to report this review. Searches were carried out in PubMed, CINAHL, PsycInfo, LILACS and Scopus. Google search engines and public health agency websites assisted in searches of gray literature and Rayyan in screening studies.
RESULTS
A total of 406 articles were identified, of which 16 made up the final sample. Five elements make up an involved fatherhood: feeling like a father, being a provider and protector, being a partner and participant in pregnancy, participating in prenatal appointments and feeling prepared to take care of a baby.
CONCLUSION
Fathers want to be involved in prenatal care, but feel excluded from this process. Public policies that encourage paternal involvement and healthcare professional training to better welcome and promote paternal involvement are of paramount importance.
Topics: Humans; Fathers; Pregnancy; Female; Male; Prenatal Care
PubMed: 38716905
DOI: 10.1590/0034-7167-2023-0029 -
Health Care Financing Review 1994International systems are frequently offered as models for health care reform. This study, focusing on preventive services for children and pregnant women in six... (Comparative Study)
Comparative Study Review
International systems are frequently offered as models for health care reform. This study, focusing on preventive services for children and pregnant women in six industrialized countries, finds that a broad range of preventive services can be provided through health care systems with divergent financing and cost containment, utilizing multiple entry points into the health care system, and employing targeted programs for high-risk patients. Despite variability in form and financing, health outcomes are not compromised, suggesting that health care reformers in this country need not be restricted to any single model to strengthen preventive health care for children and pregnant women.
Topics: Canada; Child; Child Health Services; Data Collection; Female; Financing, Organized; France; Germany; Health Expenditures; Health Services Accessibility; Health Services Research; Humans; Insurance, Health; Japan; Models, Organizational; Pregnancy; Prenatal Care; Preventive Health Services; Sweden; United Kingdom; United States
PubMed: 10138486
DOI: No ID Found -
BMC Health Services Research Nov 2010In China, the New Co-operative Medical System (NCMS), a rural health insurance system, has expanded nationwide since 2003. This study aims to describe prenatal care use,... (Comparative Study)
Comparative Study
BACKGROUND
In China, the New Co-operative Medical System (NCMS), a rural health insurance system, has expanded nationwide since 2003. This study aims to describe prenatal care use, content and costs of care in one county where prenatal care is included in the NCMS and two counties where it is not. It also explores the perceptions of stakeholders of the prenatal care benefit package in order to understand the strengths and weaknesses of the approach in the context of rural China and to draw lessons from early implementation.
METHODS
This study is based on the data from a cross-sectional survey and a qualitative investigation conducted in 2009. A survey recruited women giving birth in 2008, including 544 women in RC County (which covered prenatal care) and 619, and 1071 in other two counties (which did not). The qualitative investigation in RC included focus group discussions with women giving birth before or after 2007, individual interviews with local policy makers and health managers, NCMS managers and obstetric doctors in township hospitals.
RESULTS
There were no significant differences in prenatal care use between RC County (which covered prenatal care) and other two counties (which did not): over 70% of women started prenatal visits early and over 60% had five or more visits. In the three counties: a small proportion of women received the number of haemoglobin and urine tests recommended by the national guideline; 90% of women received more ultrasound tests than recommended; and the out-of-pocket expenditure for prenatal care consumed a high proportion of women's annual income in the low income group. In RC: only 20% of NCMS members claimed the reimbursement; the qualitative study found that the reimbursement for prenatal care was not well understood by women and had little influence on women's decisions to make prenatal visits; and several women indicated that doctors suggested them taking more expensive tests.
CONCLUSIONS
Whether or not prenatal care was included in the NCMS, prenatal care use was high, but the contents of care were not provided following the national guideline and more expensive tests were recommended by doctors. Costs were substantial for the poor.
Topics: Adult; China; Cross-Sectional Studies; Delivery of Health Care; Evaluation Studies as Topic; Female; Health Care Costs; Health Plan Implementation; Humans; Insurance, Health; Maternal Health Services; National Health Programs; Pregnancy; Prenatal Care; Risk Assessment; Rural Health Services; Young Adult
PubMed: 21040560
DOI: 10.1186/1472-6963-10-301 -
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 Jan 2020Evidence suggests that cigarette smoking and alcohol consumption during pregnancy negatively impacts fetal health. Health agencies across countries have developed...
Midwives' engagement in smoking- and alcohol-prevention in prenatal care before and after the introduction of practice guidelines in Switzerland: comparison of survey findings from 2008 and 2018.
BACKGROUND
Evidence suggests that cigarette smoking and alcohol consumption during pregnancy negatively impacts fetal health. Health agencies across countries have developed specific guidelines for health professionals in perinatal care to strengthen their role in smoking and alcohol use prevention. One such example is the "Guideline on Screening and Counselling for prevention of cigarette smoking and alcohol consumption before, during, and after pregnancy" introduced by the Swiss Midwives Association in 2011. The current study assesses the changes in midwives' engagement in smoking and alcohol use prevention before (2008) and after the introduction of the Guideline (2018). Further, the current study examines differences across regions (German vs. French speaking regions), graduation years (before and after the introduction of the Guideline) and different work settings (hospital vs. self-employed).
METHODS
Survey data were collected in 2008 (n = 366) and in 2018 (n = 459). Differences in how midwives engaged in smoking and alcohol use prevention between 2008 and 2018 were assessed with chi-square tests, as were differences across German and French speaking regions, graduation years (before and after the introduction of the Guideline) and across different work settings (working in hospitals or as self-employed).
RESULTS
An increase in midwives' awareness of the risks of consuming even small quantities of cigarettes and alcohol for the unborn child between 2008 and 2018 is evident. Explaining the risks to pregnant women who smoke or use alcohol remained the most frequently reported prevention strategy. However, engagement with more extensive smoking and alcohol use preventive strategies across the whole course of pregnancy, such as assisting women in the elaboration of a plan to stop smoking/alcohol use, remained limited.
CONCLUSIONS
Seven years after its introduction, the effectiveness of the Guideline in increasing midwives' engagement in smoking and alcohol use prevention appears limited despite midwives' increased awareness.
Topics: Adult; Alcohol Drinking; Female; Health Knowledge, Attitudes, Practice; Health Plan Implementation; Humans; Midwifery; Practice Guidelines as Topic; Pregnancy; Prenatal Care; Smoking Prevention; Stakeholder Participation; Surveys and Questionnaires; Switzerland
PubMed: 31931742
DOI: 10.1186/s12884-019-2706-8 -
Journal of Community Health Feb 2019Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance...
Prenatal care coordination programs direct pregnant Medicaid beneficiaries to medical, social, and educational services to improve birth outcomes. Despite the relevance of service context and treatment level to investigations of program implementation and estimates of program effect, prior investigations have not consistently attended to these factors. This study examines the reach and uptake of Wisconsin's Prenatal Care Coordination (PNCC) program among Medicaid-covered, residence occurrence live births between 2008 and 2012. Data come from the Big Data for Little Kids project, which harmonizes birth records with multiple state administrative sources. Logistic regression analyses measured the association between county- and maternal-level factors and the odds of any PNCC use and the odds of PNCC uptake (> 2 PNCC services among those assessed). Among identified Medicaid-covered births (n = 136,057), approximately 24% (n = 33,249) received any PNCC and 17% (n = 22,680) took up PNCC services. Any PNCC receipt and PNCC uptake varied substantially across counties. A higher county assessment rate was associated with a higher odds of individual PNCC assessment but negatively associated with uptake. Mothers reporting clinical risk factors such as chronic hypertension and previous preterm birth were more likely to be assessed for PNCC and, once assessed, more likely to received continued PNCC services. However, most mothers reporting clinical risk factors were not assessed for services. Estimates of care coordination's effects on birth outcomes should account for service context and the treatment level into which participants select.
Topics: Female; Humans; Medicaid; Pregnancy; Prenatal Care; Risk Factors; United States; Wisconsin
PubMed: 30022418
DOI: 10.1007/s10900-018-0550-9