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Mrs Prenatal Care: Preventing the Complications Prenatal Care: Preventing the Complications Prenatal care is widely accepted as an important element in improving pregnancy outcome. (Gorrie, McKinney, Murray, 1998). Prenatal care is defined as care of a pregnant woman during the time in the maternity cycle that begins with conception and ends with the onset of labor. A medical, surgical, gynecologic, obstretic, social and family history is taken (Mosby’s Medical, Nursing, and Allied Health Dictionary, 1998). It is important for a pregnant woman as well as our society to know that everything that you do has an effect on your baby. Because so many women opt not to receive the benefits of prenatal care, our society sees the ramification, which include a variety of complications primarily related to the baby. According to the American College of Obstetricians and Gynecologists recommendations, prenatal care must be started prior to the fourth month of gestation and have more than 13 visits to be considered adequate. Any deviation in the guidelines deems the care as inadequate. The focus of this paper is to inform not just women about the problems that can arise from inadequate care, but our entire society. By being well informed about the benefits of prenatal care, people can make more accurate decisions. We must also focus on the reasons why women choose not to obtain adequate care, and strive to improve medical care in hopes of increasing the number of women who receive prenatal care. It is essential for nurses to have a clear understanding of prenatal care, why some women did not have it, and how to educate clients and families about the benefits. Approximately 475 newborns were born each day to mothers who began prenatal care in the third trimester or had no prenatal care at all (as cited in Gorrie, McKinney, & Murray, 1998). Of this number, 7.3% weighed less than 5lbs. 8oz. and were thus considered low birth weight births. Preterm births increased from 9.4% in 1984 to 11% in 1993(as cited in MCN, 1998). African Americans had low birth weights that more than doubled those of whites and very low birth weights were three times higher. Many of the low birth weight births resulted in death. According to the National Vital Statistics Report, the figures for the United States from 1998 are as follows: 82.8% of mothers received first trimester care 63.2% of teen mothers age 15-19 received first trimester care 8.8% of teen mothers received late or no care 12.6% was the median number of care visits While some women who received no prenatal care had normal, uncomplicated births, others did not. Most of the women who did not receive adequate prenatal care gave birth to an underweight and underdeveloped infant. Among the benefits of early, comprehensive prenatal care are decreased risk of preterm deliveries and low birth weight (LBW)-both major predictors of infant morbidity and mortality. (Dixon, Cobb, Clarke, 2000). Preterm deliveries, deliveries prior to 37 weeks of gestation, have risen. Since the studies in 1987, which showed the rate of preterm deliveries as 6.9% of births, the 1997 rate shows an increase to 7.5%. Low birth weight, defined as an infant weighing less than 2500 grams (5lbs. 5oz) is often preceded by preterm delivery. Low birth weight has two primary causes: intrauterine growth restriction (a baby who is small for gestational age) and preterm delivery (Frick, 1999). These components together are the leading causes of infant mortality in the United States. (Frick, 1999). These often-preventable abnormalities can lead to other serious problems in the infant. Without proper care during pregnancy, infants are often born with chromosomal and congenital abnormalities. While many of these babies are carried to term, often times they result in infant death. Of 80 patients studied twenty-two anomalies were diagnosed by chorionic villus sampling and fifty-eight by amniocentesis. The severity of the chromosome anomaly and associated ultrasound findings in the first versus second trimester were correlated with patients’ decisions (Drugan, A., Greb, A., Johnson, M., Krivchenia, E., Uhlmann, W., Moghissi, K. and Evans, M., 1990). Here the patients were given an option to terminate or carry the infant to term if it posed no increased risk to the mother. This finding emphasizes the importance of early prenatal care since these abnormalities are primarily found during the first trimester of pregnancy and gives clients time to make such crucial decisions. The risks of complications are increased with multifetal pregnancies. Perinatal mortality for twin gestations is at least five times greater than that for singleton gestations (as cited in JOGNN, 1998.) 1 in 43 births in the United States is twins and 1 in 1341 is triplets. With the doubled or even tripled need for maternal well being at hand, prenatal care plays a crucial role. Infant mortality is considered the most reliable measure of a nation’s health status. Although the United States leads the world in health care received per capita, the infant mortality rate continues to exceed those of many comparable countries. These statistics show the prevalence of inadequate prenatal care and indicate the increased need for education of the society as a whole and early intervention in pregnancy. To understand the incidence of those not receiving prenatal care, it is important to look at the socioeconomic and psychosocial aspects of clients. Many women did not have access to a health care provider, had trouble finding one, could not get an appointment or were frustrated with the long wait time associated with an office visit. Others just simply did not have the transportation. Though many see these explanations as excuses, some of them are valid excuses. Other barriers to prenatal care include parking difficulty, childcare issues, fear of the provider, negative attitudes toward the provider and lack of coordination of services (Beckmann, Buford and Witt, 2000). In a study of 15 postpartum women, they reported that their primary reasons for not obtaining prenatal care were related to low motivation, knowledge deficit, fear and fatigue (Higgins and Woods, 1999). The best time to begin preterm and low birth weight birth prevention is before conception. For the 40% of planned pregnancies, a preconception health visit can address several issues related to preterm births. These include smoking cessation, nutrition counseling to achieve appropriate weight for height, assessment and treatment of urovaginal infections, choosing an interval of 16 months or more from a previous birth, assessment and referral for domestic violence and substance abuse, and the teaching of basic relaxation skills (Moore and Freda, 1998). As a healthcare provider, it is important to have a full history and assessment on all clients. According to priorities established by Healthy People 2000, prenatal care should be initiated during the first trimester of pregnancy and include early and continued risk assessment, health promotion, and medical, nutritional, and psychosocial interventions and follow up (Beckmann, et. al., 2000). It should also be considered that outcomes vary. We must remember that some women who received inadequate prenatal or late prenatal care gave birth to normal healthy babies. With this in mind, one must also look at the outcomes of births to women who received inadequate prenatal care. The consequences of inadequate care well outweigh the outcomes. The incidence of inadequate prenatal care and its consequences, low weight births and infant mortality is much higher than that of women who received no prenatal care and had a positive outcome. Instructions should be given that the consequences of inadequate care are not worth chancing the baby’s life. To improve the use of prenatal care, health care workers must explore what maternal, paternal, and social factors contribute to the proper use of prenatal care. Interventions that improve compliance with advice to obtain prenatal care early and continuously throughout pregnancy have been found to improve compliance with other advice given during prenatal care visits, for example, to stop smoking. Studies have found that women who receive adequate prenatal care are more likely to obtain preventative care for their infants (Alexander and Korenbrot, 1995). This finding emphasizes the need for early interventions, which benefit not only the mother, but the baby as well. Allowing women to set their own agendas for prenatal care and serving as advocates and resource persons rather than authority figures might better support women’s self-care behaviors during pregnancy (Hawkins, Aber, Cannan, Coppinger, and Rafferty, 1998). Nurses should encourage a healthy partnership with pregnant women and allow them to focus on the changes that occur during pregnancy. When we look at the barriers, which include health care delivery, we should advocate change in these barriers. Helping to develop ways to offer support during pregnancy is paramount. Through the research findings, health care providers developed a care management program that included case management and utilization management. Case management would be conducted in community based settings and would involve monthly follow up by telephone, triage, and home care visits. The case manager assures the woman receives WIC, if she is eligible. If the woman is determined to be at risk for any of the previously mentioned barriers, her prenatal care is provided in the home by her case manager and the home care obstretic department. Utilization management would be implemented once the woman enters the hospital on an in-patient basis. The overall goal of the program is to bring prenatal care directly to women who will not seek care, so that costs can be reduced and good neonatal outcomes can be achieved (Higgins and Woods, 1998). Although nurse home visitation does not claim a direct impact on birth outcomes, it is well documented that improved health behaviors lead to improved birth outcomes (Hays, Kaiser, McMabon and Kaup, 2000). My research on the topic of prenatal care has educated and given me more insight on this problem. I feel that the overview of the literature on this topic has greatly enhanced my knowledge as a future nurse because before we, as nurses, can teach, we have to be adequately equipped with knowledge. Careful examination of the data produced by clinical documentation can help to build nursing’s knowledge base for specific populations by assisting a nursing agency to be more precise in the design and evaluation of nursing interventions (Hays et. al., 2000). Through my research, I have found that with all of these interventions, some women comply and still have negative outcomes in their pregnancy. This aspect presents the only downside to promoting early prenatal care. Alexander, G., and Korenbrot, C. (1995) The Role of Prenatal Care in Preventing Low Birth Weight. The Future of Children, 5 (1), 103-20. Anderson, K., Anderson, L., and Glanze, W. (1998). Mosby’s Medical, Nursing, & Allied Health Dictionary (5th ed.). St. Louis: Mosby, Inc., 92. Beckmann, C., Buford, T., and Witt, J. (2000). Perceived Barriers to Prenatal care services. MCN, 25 (1) 43-46. Dixon, D., Cobb, T., and Clarke, R., (2000). The First Prenatal Visit. Retrieved on October 13, 2000 from http://www.medscape.com. Drugan, A., Greb, A., Johnson, M., Krivchenia, E., Uhlmann, W., Moghissi, K. and Evans, M. (1990). Determinants of parenteral decisions to abort for chromosome abnormalities. Prenatal Diagnosis, 10 (8), 483-490. Ellings, J., and Bowers, N. (1998). Prenatal Care and Multiple Pregnancy. JOGNN, 27 (4), 457-464. Frick, K. (1999, December). How well do we understand the relationship between prenatal care and birth weight? Health Services Research. Retrieved on October 8, 2000 from http://www.findarticles.com. Gorrie, T., McKinney, E. and Murray, S., (1998). Foundations of Maternal Newborn Nursing. Philadelphia: W. B. Saunders, p.45. Hawkins, J., Aber, C., Cannan, A., Coppinger, C. and Rafferty, K., (1998). Women’s reported self-care behaviors during pregnancy. Health Care for Women International, 19, 529-538. Hays, B., Kaiser, K., McMabon, C., and Kaup, K., (2000). Public Health Nursing Data: Building the Knowledge Base for High-Risk Prenatal Clients. MCN, 25 (3), 151-158. Higgins, P., and Woods, P., (1999) Reasons, health behaviors, and outcomes of no prenatal care: research that changed practice. Health Care for Women International, 20, 127-136. Moore, M. and Freda, M., (1998). Reducing Preterm and Low Birthweight Births: Still a nursing Challenge. MCN, 23 (4). Retrieved on October 18, 2000 from http://www.nursingcenter.com. Prenatal Care. National Vital Statistics Report, 48, (3). Retrieved on October 19, 2000 from http://www.cdc.gov/prenatstats. Bibliography:

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