Prenatal Care; Take it or Leave it…or Something In Between?

Last week I attended a Maternal and Child Health leadership retreat at the University of Illinois’ Chicago campus. I was involved in a particularly interesting discussion about the state of prenatal care in the U.S. Our group was posed with an evidence-based challenge and discussion questions which were as follows (paraphrased):

Medicaid expansions in the late 80’s and early 90’s have increased financial access to prenatal care, but there has not been the substantial decrease in rates of low birthweight and preterm delivery that was expected from an increase in prenatal care.
1. What are the ramifications of continuing prenatal care services as they are now when there is not evidence to show that it is having the desired effect?
2. Should prenatal care in its current form be abandoned and what are the ramifications/constraints to abandonment?
3. What are the pressures for prenatal care in the U.S.?
4. Based on the evidence that does exist, what are some other ways to think about prenatal care services?
5. What would be involved in re-aligning the services in the context of public health?
6. Are there alternative models or system changes that have been or can be tested to create support for prenatal care?

There was a lot of great discussion about the questions posed, and notes from the discussion will eventually be found here. Most of the discussion circled back around to the fact that prenatal care provides health care to pregnant women that is needed. Prenatal services are now expected by the public in the U.S. so completely abandoning them was not an option for most in the group. Many, however, were in favor tweaking the system. Others were in favor of finding or creating an alternative and then transitioning some of the prenatal services over to this newer model. There was much discussion about centering pregnancy which is, among other things, a group model of care in which women receive their care in a group setting with other women. This model is proving to be very successful in getting women to present for prenatal care, as well as addressing racial disparities by reaching a number of women who respond to peer/group settings including an increase in African-American women who present for prenatal care.

So what are your thoughts about prenatal care in the U.S.? Are there ways that it can be improved and changed to fit more successfully in the larger public health framework, should it be melded in to a new intervention, or should it be abandoned altogether for something else?

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Image: Newscom