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Reasons for action: Women who have access to high-quality, affordable prenatal care and who obtain prenatal care in the first trimester have healthier babies with fewer conditions that interfere with school readiness, such as cognitive impairments, behavioral and learning disorders, and visual and auditory impairments. In addition, the type and amount of support available to a woman during her pregnancy has a significant impact on the mother's capacity to relate to her baby.
Click here to view additional Rationale or Evidence of Effectiveness.
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Health care providers and insurers make high-quality, comprehensive health care available, accessible, and affordable to all women of reproductive age and to all pregnant women.
Providers of prenatal care meet appropriate quality standards, such as those set by the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), and the American Academy of Family Physicians (AAFP). In addition to competent medical care, their services to pregnant women include:
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Fresno County, California's Nurse-Family Partnership Program helps pregnant women acquire healthy behaviors and avoid unhealthy ones through home visits that focus on personal health, the maternal role, family and friends, and connecting pregnant women to services. Visiting nurses have strong interpersonal skills and are sensitive to the values and beliefs of differing racial and ethnic communities. A licensed mental health clinician consults with the nurses and may accompany them on home visits. A support group for first-time mothers aims to prevent depression and isolation.
Social workers at Pregnancy to Employment in Washington state assess the health and social service needs and resources of expectant mothers and parents of infants under age one. Case managers help participants develop and follow a program of services that may include medical care for mothers and infants; child care; transportation assistance; job preparation; and classes on parenting, child development, nutrition, family planning, and life skills. These activities may serve as alternatives to the TANF work requirement during the first 6 months of pregnancy and until infants are 4 to 12 months old.
Birmingham (AL) Healthy Start, a project of the Jefferson County Department of Health, provides enhancements to available clinical services, outreach and case management, broad-based public information campaigns; support services, and individual and classroom-based health education. The Birmingham program was able to improve the adequacy of prenatal care and reduce the incidence of premature and low-birthweight babies. www.performance.hrsa.gov/mchb/MCHProjects/
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- Counseling and support to minimize stress during pregnancy; when informal support (from fathers, family, friends) is insufficient, efforts are made to link with supportive health professionals and trained paraprofessionals
- Nutrition counseling, with referrals to supplementary nutrition as needed (through WIC, food stamps, food pantries, and meal programs)
- Links to (or provision of) health education, especially childbirth preparation, encouragement of breastfeeding, and preparation for the demands of parenting
- Assistance from health care personnel in obtaining family health insurance
- Time for providers to talk with patients about their concerns and develop warm, mutually respectful relationships
- Counseling and treatment regarding the use and abuse of drugs, alcohol, and tobacco
- Information and support to prepare parents for the demands of parenting, including the essentials of infant development
- Pleasant settings and convenient times and locations for prenatal care
Providers of prenatal care pay attention to the living conditions of pregnant women, including homelessness and domestic violence. Someone on the health care team takes responsibility for connecting patients with people and agencies who can help resolve problems.
Health care providers ensure that families have access to positive childbearing experiences by making available:
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At Mercy Hospital Fairfield in Cincinnati, Ohio, mother and baby receive high-quality, family-centered care in a setting that feels like home. Through labor, delivery, and recovery, the mother, baby, and family can stay in one room. Mercy also provides childbirth and family education programs by experienced obstetric nurses who work in the birthing centers as registered nurses. http://216.68.156.42/regions/Cincinnati/
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The UC Medical Center in San Francisco offers classes in labor and birth preparation, baby care, and parenting. In its Birth Center, the hospital provides private birthing suites that have bathrooms with showers, whirlpool tubs, and refrigerators. Patients typically labor, deliver, and recover there and then move to a private postpartum room with a deep-soaking tub and chairs that convert into sleepers for family members or guests. Intensive care nurseries and doctors who specialize in high-risk pregnancies are available if necessary. www.ucsfhealth.org/childrens/
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- Information and support that prepares them for childbirth
- Continuous support during childbirth from family, friends, Doulas, Promotoras, or trained coaches
- Birthing settings that: provide skilled professional care; are safe, family-friendly and culturally sensitive; provide appropriate pain management; minimize separation of mothers and babies at the time of childbirth; and maximize opportunities for early breastfeeding and for bonding between the baby and significant family members.
Community entities work with public and private providers and third-party payers to ensure that a sufficient level of prenatal care, childbirth preparation, parenting preparation, support during childbirth and support for breastfeeding is accessible, culturally appropriate, and affordable. The entities monitor programs and outcomes for an entire population, neighborhood, or community; scan what is available and what is missing to support healthy pregnancies; and take steps to fill in the gaps.
Local coalitions strengthen community connections to prenatal services by publishing annual report cards, creating widely representative citizen advisory boards, and distributing health-related materials in multiple languages. They make formal and informal sources of information, assistance, and support widely accessible and culturally responsive.
Community groups work with public agencies to encourage healthy habits and behavior during pregnancy, including good nutrition and not smoking.
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| Because Marion County (Indianapolis) has an unusually high rate of women who smoke during pregnancy, the Family Strengthening Coalition (part of the local Making Connections initiative) is collaborating with Indianapolis First Lady Amy Minick Peterson, the Marion County Health and Hospital Corporation, Midtown Community Mental Health Centers, the American Legacy Foundation, and other partners to publicize “Quitline.” This hotline offers free, confidential telephone counseling and connects expectant mothers with a trained counselor who will help them develop a plan to quit smoking using written guides, videos, and local smoking cessation programs. www.aecf.org/initiatives/mc/sites | |
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| Community entities monitor the existence of connections between prenatal care and other necessary services to minimize stress and provide treatment for substance abuse and other problems likely to interfere with healthy childbearing or parenting.
Community groups work with public health agencies to ensure a healthy environment, including:
- Adequate sanitation and utility services
- Buildings maintained to code
- Access to safe, affordable, high-quality food supplies, including neighborhood markets
Policymakers work to assure that all pregnant women and all women of child-bearing age have access to comprehensive, continuing, appropriate, and acceptable health care (through public or private health insurance coverage or the provision of direct services).
They work to:
- Expand eligibility for and enrollment in health benefits through Medicaid, State Children's Health Insurance Program (S-CHIP), and other, broader programs
- Minimize barriers to public and private health care coverage through outreach, simplified rules, and other improvements
- Put safety-net policies in place for uninsured individuals and families and the providers serving them
Policymakers and funders create payment structures and other policies that promote effective prenatal care by:
- Supporting training for health care professionals that encourages them to develop strong relationships with high-risk pregnant women
- Allowing presumptive eligibility for insurance when a pregnant women seeks prenatal care
- Recognizing the need for, and funding, non-medical support services such as home visits, social services, and housing assistance
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