Preventing Low Birthweight Summary (1985) / Chapter Skim
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Improving the Content of Prenatal Care
Improving the Content of Prenatal Care
Pages 27-34
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From page 27... ...
Finally, recommendations are made for specific actions on content of care issues by the federal government and by professional societies representing the major maternity care providers. Revisions In Care For All Pregnant Women The committee has identified seven components of the prenatal care offered to all pregnant women that merit increased emphasis in the effort to improve pregnancy outcome generally and to prevent preterm delivery and {UGR in particular.
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From page 28... ...
The minimum data required to determine gestational age include the date of the last menstrual period, uterine size by pelvic exam during the first trimester, the time of quickening, the first time fetal heart tones are heard without amplification, and serial fundal height measurements after 20 weeks gestation.
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From page 29... ...
to prevent preterm delivery. Those described in the committee's report include the March of Dimes Birth Defects Foundation's Multicenter Prevention of Preterm Delivery Program, which originated at the University of California at San Francisco; the I os Angeles Prematurity Prevention Program, implemented in selected health centers that provide prenatal care for the Harbor-UCLA Medical Center; and the French Prematurity Prevention Program, which started in the early 1970s in Haguenau, France.
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From page 30... ...
Women at elevated risk of preterm delivery should also be offered special education about the factors associated with prematurity; the importance of early detection of the symptons of preterm labor/ such as bleeding and periodic contractions; how to detect mild uterine contractions and how to differentiate normal contractions that often occur throughout pregnancy from those signaling early labor; and what to do when the signs and symptoms of preterm labor appear, including how to contact an obstetric care provider for consultation and help. Efforts to arrest preterm labor (such as use of tocolytic drugs, clescribed below)
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From page 31... ...
19 Several themes derived from the literature on smoking intervention programs can aid practitioners in establishing effective strategies: · counseling by a woman's physician or other primary clinician appears to be among the most effective intervention strategies for the pregnant smoker group counseling appears to be less effective; 1 -of a- -- r -~ ~~ i- · social support appears to be a critical factor in changing smoking behavior spouses or partners anc} other family members should be involved in intervention efforts; · smoking reduction deserves high priority, but prenatal care providers should be reasonable in their expectations of the pregnant woman she is probably being asked to make many changes in her life at a time when she may be unusually tired and anxious about a range of sexual and social changes associated with pregnancy and planning for a new baby; · the mass media can play a motivating and reinforcing role in encouraging changes in smoking habits, but are probably insufficient as the sole approach. Cigarette labels that explicitly warn of the dangers of smoking during pregnancy should supplement other public information strategies; and
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From page 32... ...
Some are concerned primarily with physical stress and fatigue, others more with psychosocial and emotional stress. The prematurity prevention program in France, mentioned earlier, emphasizes reduction in physical stress for women with several risk factors (especially a history of preterm delivery, incompetent cervix, or a particularly strenuous life-style)
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From page 33... ...
~ An,, ..^ .~ ~ . ~ .~ ~ ~ en, nlgn-rlsK women tor more intensive prenatal services, the importance of prenatal care being tailored to the needs of individual women and thus variable in its content, the value of counseling and education to reduce behavioral risks such as smoking, and the importance of ancillary services such as transportation to health care facilities.
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From page 34... ...
Existing surveys conducted by the National Center for Health Statistics could include a special emphasis on prenatal care content. Consumer experience with prenatal care should be analyzed and the professional societies of the major maternity care providers should be consulted about ways to survey their members regarding various content issues.
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