Pregnancy and Healthcare: Do Pregnant Women Need Extra Attention?

There are almost 50 million annual prenatal visits in the U.S., which implies how common and fundamental it is for ensuring healthy pregnancy results [1]. “The World Health Organization emphasized that prenatal care in achieving the Millennium Development Goals (reduction of child and maternal mortality) plays an important role, [and] also said that all women should have access to proper care during pregnancy until 2015” [2]. However, does this mean that women are satisfied with the offered prenatal healthcare services?

As previously stated, maternal and child healthcare is part of the Millennium Development Goal, and, since then, the United Nations international agencies have noticed a global decrease in maternal mortality [2]. However, the rate at which this is happening is unsatisfactory [2]. “During 2013, approximately 800 women in the world died daily due to complications of pregnancy and childbirth” [2].

If we focus on the U.S. specifically among industrialized countries, it holds the 29th place concerning infant death rate [1]. The rates of low birth weights and pre-term births are increasing, as well [1]. This is found to be more prevalent among more vulnerable groups, such as minorities and impoverished groups [1].

Many studies show that minorities and impoverished groups were satisfied with the offered prenatal care services, but other studies show the contrary [1]. The complaints included discrimination, stereotyping, sharp treatment, insufficient information, long waits, and difficulty in communication due to the use of medical terms and difference in spoken languages [1].

There are also more reasons why these vulnerable groups are unsatisfied. “African American and Hispanic American pregnant women are more likely than white people to be poor, teenaged, and single. They often have limited support, and high levels of negative life events and depression” [1]. Low-income pregnant women may have no choice in choosing where they live, they may need to move a lot, and may have to live in unsafe neighborhoods [1]. This also means lower chances to access good transportation and childcare [1]. Another issue is health insurance; “while Medicaid covers PNC, 37% of Americans below the poverty level, including many immigrants, are ineligible for Medicaid and are uninsured” [1]. This leads to delays in addressing health needs and therefore may amplify pregnancy risks. [1]

When comparing the prenatal care status of developing countries to that of the U.S., the numbers are more devastating. The risk of maternal mortality in developing countries is 23 times higher than that of developed countries [2]. It is worth mentioning that 83% of expecting women living in developing countries have received antenatal care only once, while in the U.S., there are nearly 12 sessions for expecting women where a thorough examination takes place and patient history is properly recorded [2]. “Return visits include measurement of blood pressure and weight, abdominal examination to assess fetal growth and position and document the fetal heart rate, and referrals for laboratory testing and ultrasounds” [1]. “Only 46% of women in low-income countries benefit from sufficient care during childbirth. This means that millions of births are not assisted by a midwife, a doctor, or a trained nurse” [3].

To be able to effectively redesign the prenatal care offered services, the needs of expecting women must be assessed to get a better comprehension of what needs to be improved and what already is satisfactory to them [1]. Barriers that women face with gaining access to prenatal health care need to be addressed. In addition to individual barriers, there are organizational or health care system barriers; financial barriers, which reflect the economic status of expecting women; structural barriers (e.g., transportation); and social and cultural barriers, such as "languages, different conceptions of gender and sexuality and specific ethnic groups” [3].

A study that focused on offering an integrative review of women’s experience of prenatal care, concluded that six major features of care emerged : “1) incentives/barriers; 2) PNC setting; 3) time spent; 4) components of care; 5) relationships with staff and clinicians, and 6) receipt of information” [1]. Based on this study, the reported women’s experiences were mixed. “Some women received psychosocial services, group support, and coordinated care.”. [1]. However, other aspects were not always present as obtaining sufficient information, the continuity of care in terms of consistency of approach or presence of care before, along, and after the pregnancy journey, and the continuity of healthcare service provider in terms of appointing one single clinician or a small group of clinicians [1]. For the time spent in prenatal settings, expecting women reported in many studies that there are prolonged waiting intervals and/or hurried visits [1].” The prevalence of findings about relationships with staff and clinicians suggests that this feature of care is critical” [1]. Mixed results were reported, many studies showed that expecting women received proper, respectful, trustworthy, and personalized care [1]. However, sometimes they complained about lack of emotional support, focusing on biomedical issues only without offering advice, and that the offered care was “mechanistic, routine, or harsh” [1]. Now the question is, why has this problem not been addressed? “Possible explanations include limitations of “satisfaction” as a measure, adaptive preferences, and the focus on neonatal outcomes;” in addition to that, there has been no review of the papers regarding this topic. [1]. Accordingly, studies reporting a high level of satisfaction cannot be seen as opposing to the discussed finding of the mixed prenatal experience [1].

It is crucial to mention that “despite decades of recommendations for women-centered approaches to PNC—there is limited evidence regarding women's overall experience” [1]. This implies that there is an urge to conduct several types of studies and gap analysis to get an integrated comprehension of overall experience and needs, where “: 1) control and participation, 2) individualizing care, and 3) improving interpersonal communication with PNC staff and clinicians” are on the top of the list [1]. Until then, some suggestions can be deduced; first of all, clinicians should ask women about their needs and customize the offered care accordingly [1]. Expecting women also prefer decreased waiting intervals, unrushed visits with questions and answers about their concerns, a less formal and more welcoming relationship with the clinician, more comprehensive care, dedication of a single clinician or better coordination between a group of clinicians, and more engagement and participation [1].

One other thing that is significantly more preferred than routine care, is group prenatal care [1]. In addition to “shorter waits, increased clinician contact time, active decision-making and participation in care, extensive education, and peer group support,” group prenatal care has lower chances of premature birth, increased antenatal awareness, and higher rates of breastfeeding [1].

Another important question to be asked: do women get enough information regarding prenatal care? What kind of information do they need the most? Their information needs should be assessed to aid them to take proper care of themselves and their loved ones; not only does information increase their knowledge, but it also shares in enhancing the quality of life, psychological outcomes, and in creating better disease management strategies [3].

In a study “conducted on the pregnant women who attended antenatal clinics and obstetricians/gynaecologists’ offices in Kerman, Iran, in 2015,” it was found that 86% requested information about how to care for the embryo, 83% needed to learn about physical and psychological complications after giving birth, 82.5% wanted knowledge about the development and growth of the embryo, 82% sought information about pregnancy nutrition, 81.5% needed to understand more about special tests during pregnancy, and finally 49% “looked for information when they were suffering from a disease or pregnancy complications” [3].

The study showed that the primary source of information for mothers was clinicians followed by the internet and acquaintances [3]. This implies that clinicians have an important role in shaping the mothers’ knowledge through the information they offer or through recommending other complementary sources [3]. “This helps pregnant women make informed decisions and to do well in their motherhood role” [3]. The study also concluded that barriers to gaining information were due to ignorance, financial issues, or language barriers [3].

Finally, it is important to raise awareness about the need to improve the expecting women's experience and supply the needed resources alongside the needed research work regarding this issue [1].

References:

1. Novick G. (2009). Women's experience of prenatal care: an integrative review. Journal of midwifery & women's health, 54[3], 226–237. https://doi.org/10.1016/j.jmwh.2009.02.003

2. Roozbeh, N., Nahidi, F., & Hajiyan, S. (2016). Barriers related to prenatal care utilization among women. Saudi Medical Journal, 37(12), 1319–1327. https://doi.org/10.15537/smj.2016.12.15505

3. Kamali, S., Ahmadian, L., Khajouei, R., & Bahaadinbeigy, K. (2018). Health information needs of pregnant women: information sources, motives and barriers. Health information and libraries journal, 35[1], 24–37. https://doi.org/10.1111/hir.12200

Contributors:

Author: Catherine Sarwat

Editor: Lauryn Agron

Health scientist: Catherine Sarwat

@werise4wellness