The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2017) define prenatal care as “A comprehensive antepartum program involves a coordinated approach to medical care, continuous risk assessment, and psychosocial support that optimally begins before pregnancy and extends throughout the postpartum and interpregnancy period.” As promulgated by John Ballantyne, such care has been a bedrock to improve pregnancy outcomes for more than 100 years (Reiss, 2000).
PRENATAL CARE IN THE UNITED STATES
Almost a century after its introduction, prenatal care has become one of the most frequently used health services in the United States. According to the Centers for Disease Control and Prevention (CDC), only 1.6 percent of women who gave birth in 2016 received no prenatal care (Osterman, 2018). African-American and Hispanic women have high rates of inadequate or no prenatal care that reach 10 and 7.7 percent, respectively. This figure is greater for adolescents, particularly those younger than 15 years, compared with older age groups. These data highlight areas of potential improvement by the health-care system.
Prenatal Care Effectiveness
Care designed during the early 1900s focused on lowering the extremely high maternal mortality rate. Prenatal care undoubtedly contributed to the dramatic decline in maternal deaths from 690 per 100,000 births in 1920 to 50 per 100,000 by 1955 (Loudon, 1992). Data from 1998 to 2005 from the Pregnancy Mortality Surveillance System identified a fivefold increased risk for maternal death in women who received no prenatal care (Berg, 2010).
Goldenberg and McClure (2018) have emphasized the importance of prenatal care to reduce stillbirth rates as well. In a study of almost 29 million births, the risk for preterm birth, stillbirth, early and late neonatal death, and infant death rose linearly with decreasing prenatal care utilization (Partridge, 2012). Similarly, from Parkland Hospital, Leveno and associates (2009) found that a significant decline in preterm births correlated closely with any use of prenatal care by medically indigent women. And in women with diabetes, adherence to prenatal care resulted in lower rates of neonatal admissions to the intensive care unit (Sperling, 2018a).
Group prenatal care is acceptable and effective (American College of Obstetricians and Gynecologists, 2018g). Ickovics and coworkers (2016) compared this with individual prenatal care. Group care provided traditional pregnancy surveillance in a group setting with special focus on support, education, and active health-care participation. Women enrolled in group care had significantly better pregnancy outcomes. Carter and colleagues (2017) cited similar results. Childbirth education classes are also reported to result in better pregnancy outcomes (Afshar, 2017). Pregnancy in adolescents carries special risk, and guidelines have been developed that focus on this age group (Fleming, 2015).
Pregnancy is usually identified when a woman presents with ...