Prenatal care: touching the future

Measuring adequacy of prenatal care: does missing visit information matter?

BACKGROUND

Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index is frequently used to classify levels of prenatal care. In the Finger Lakes Region (FLR) of upstate New York, prenatal care visit information late in pregnancy is often not documented on the birth certificate. We studied the extent of this missing information and its impact on the validity of regional APNCU scores.

METHODS

We calculated the "weeks between" a mother's last prenatal care visit and her infant's date of birth. We adjusted the APNCU algorithm creating the Last Visit Adequacy of Prenatal Care (LV-APNC) Index using the last recorded prenatal care visit date as the end point of care and the expected number of visits at that time. We compared maternal characteristics by care level with each index, examining rates of reclassification and number of "weeks between" by birth hospital. Stuart-Maxwell, McNemar, chi-square, and t-tests were used to determine statistical significance.

RESULTS

Based on 58,462 births, the mean "weeks between" was 2.8 weeks. Compared with their APNCU Index score, 42.4 percent of mothers were reclassified using the LV-APNC Index. Major movement occurred from Intermediate (APNCU) to Adequate or Adequate Plus (LV-APNC) leaving the Intermediate Care group a more at-risk group of mothers. Those with Adequate or Adequate Plus Care (LV-APNC) increased by 31.6 percent, surpassing the Healthy People 2020 objective.

CONCLUSIONS

In the FLR, missing visit information at the end of pregnancy results in an underestimation of mothers' prenatal care. Future research is needed to determine the extent of this missing visit information on the national level.

Powerful leverages and counter-currents in the unborn child spiritual care: a qualitative study

In different cultures, pregnancy, birth and motherhood are perceived as spiritual events through their miraculous processes and create an ideal context for spiritual enrichment. However, studies on spirituality and birth are at very early stages. The purpose of this study was to understand the facilitators and barriers of the unborn child spiritual care in Iranian women. Twenty-two mothers with live pregnancy experience who were willing and able to share their life stories were selected purposefully in Tehran (Iran) from May 2012 to April 2013. Qualitative content analysis was used to analyze 27 interviews. Active and passive acquisition of information, inner inspirational messages, receiving effective support from the people around as well as modeling of self and significant others created “powerful leverages” to accelerate mother for caring her unborn child. “Counter-currents” in the form of unsuitable physical conditions during pregnancy, poor economic and social conditions, unsuitable psychological and cognitive conditions and finally understanding unsuitable ideological conditions of the self and care giver were identified as barriers. Iranian cultural and religious perspective on the unborn child physical and mental influence from mother has an important role in mother’s self-care behaviors during pregnancy. It seems that using interdisciplinary professionals’ skills based on understanding facilitators and barriers of mother care of the unborn child can lead to providing comprehensive prenatal care according to mothers’ cultural, religious and social context.