An Analysis of Group Prenatal Care in a High-Risk Obstetric Population

Abstract

Abstract Problem: Preterm birth and low birth weight (LBW) are the second leading causes of infant mortality after birth defects. In 1985, an expert panel from the Institute of Medicine concluded that prenatal care services reduce low birth weight. Despite this, and recommendations to expand prenatal care services, the rate of LBW infants has risen. A preliminary study of Strong Start for Mothers and Newborns, a four-year initiative begun in 2012, demonstrated that women whom received birth center and group prenatal care (GPNC) were less likely to have a preterm birth or LBW newborn compared to women that received care in a more traditional model at a maternity care home. Project Aims: GPNC has not been widely studied in women with high-risk pregnancies, who are at increased risk of preterm birth and LBW infants. The aim of this project was to assess perceptions of GPNC among high-risk prenatal care providers at an academic health center. A secondary aim was to assess prenatal care experiences of women receiving care in a high-risk obstetrics clinic. Project Method: A SWOT analysis was completed assessing strengths, weaknesses, opportunities, and threats to GPNC in the high-risk obstetric patient population at an academic health center. A survey was sent to clinic stakeholders assessing past experiences with GPNC and their perceptions of internal and external environments relative to GPNC in the high-risk obstetric patient population. A second survey was administered to pregnant patients with high risk obstetric medical conditions, assessing their experience with traditional care in the high-risk obstetric setting at the academic health center and determine their interest in participating in GPNC. GROUP PRENATAL CARE IN A HIGH-RISK OBSTETRIC POPULATION 3 Findings: For the staff survey, perceived strengths of GPNC in the high-risk OB population included community/peer support and improved patient knowledge and preparation for pregnancy, labor, and birth. The primary perceived weakness to GPNC in the high-risk OB population was difficulty in implementation. Outside referrals were considered an opportunity for success in this population and reimbursement and cost were the most prominent perceived threats to GPNC. In the patient survey, perceived benefits of participating in GPNC included feeling more prepared for pregnancy, labor, and birth, and social support. Scheduling, lack of childcare, and lack of transportation were perceived barriers to attending GPNC. More than 50% of women believed attending GPNC would strengthen their belief in themselves to complete a task or reach a goal in some area of their lives and most women believed attending GPNC could influence them to make healthier lifestyle choices. Conclusion: Findings from this SWOT Analysis may provide insight for other organizations serving women with high-risk pregnancies interested in implementing GPNC. Key Words: prenatal care, group prenatal care, high-risk obstetric, preterm birth, low birth weight