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/ AbstractIndexes/..%5CCollection%5CHealthy %20Start%5C2003%5COther%5CHTML%5C BirminghamALABSTRACT.html

• 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:

	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/ content/ffbirthvt.asp 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/ medical_services/preg

• 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.