Part Three in a Three-Part Maternal Health Series
As referenced in the prior two blogs, the United States ranks poorly in maternal mortality. Women in this country have a higher death rate during the prenatal and postnatal period than in any other developed country. A literature review reveals that the cause is related to a lack of appropriate prenatal and postnatal care. The Centers for Disease Control and Prevention documents the high rate of pregnancy complications, and encourages prenatal care to all women, because “if health problems are under control and you get good prenatal care, you are likely to have a normal, healthy baby” (CDC, 2018).
Child Health USA is a report published yearly by the United States Department of Health and Human Services, Health Resources and Services Administration. An article included in one of their reports addressed the barriers to prenatal care. The main recommendation needed to ensure a healthy pregnancy, is that women should schedule their first prenatal visit as soon as they think they may be pregnant. In 2010, 17.2% of recent mothers reported they were not able to access prenatal care when they became pregnant, and the current statistics have worsened (Child Health USA, 2013). There is a noted racial disparity as Native American, Alaskan Native, and African American mothers make up almost 70% of those who report delayed access to prenatal care (Child Health USA, 2013).
The Child Health USA report lists the reasons for not getting immediate care during pregnancy. Most women report they did not have insurance or the money to book appointments (Child Health USA, 2013). Those that could make an appointment were not able to be seen until weeks or months after a positive pregnancy test (Child Health USA, 2013). Some were told to apply for Medicaid but there is usually a delay in getting a Medicaid card (Child Health USA, 2013). Recent efforts have been made to speed up the process. Transportation difficulties are also listed as an issue in access to care (Child Health USA, 2013). There are programs that have been put in place to try to improve birth outcomes, including a Medicaid benefit called the Prenatal Care Coordination (PNCC). This program makes provisions for a prenatal care coordinator and a visiting community health nurse to personally assist women during the prenatal and postnatal period.
A large analysis of this program found that women who received PNCC services had significantly better birth outcomes, fewer low-birth weight infants, fewer preterm infants, and fewer pregnancy complications in general (Dijk, Anderko, & Stetzer, 2011). In order to be part of the PNCC program, one must enroll. It is necessary to advertise and educate women about the availability of programs like this, so that PNCC can be successful in these efforts.
When there is prenatal care, it is important for the practitioner to take advantage of the first visit and use prenatal screening tools to determine the risk level. There are many evidence-based screening tools that exist, but few are utilized by providers. Adequate prenatal care and health screenings are necessary for the optimal health of the woman and the fetus (Records & Hanko, 2016). One such screening is called the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, and it can be used for the successful early identification of health deviations in order to avoid negative outcomes for both the mother and the baby (Records & Hanko, 2016).
Over the course of this three-part series blog, there are consistencies concerning the inadequacy of care. There is a lack of appropriate research studies within the United States, which is mainly due to the lack of funding and grants. When information is present, such as the valuable graph shown above, targeted efforts should be made to effect change. Programs have been initiated to aid the new mother in receiving adequate care, but only if that new mother is aware that the programs exist. The racial and income disparity illustrates the areas in which the United States should provide education and programs, and it is the government’s responsibility to intervene. This appalling healthcare situation should not exist in a country such as ours, and steps need to be taken to ensure better outcomes.
CDC. (2018, September 23). Pregnancy complications: Maternal and infant health. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-complications.html