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Pregnancy Outcomes for Hispanic Women in Washington, DC A Comparison of the Centering Pregnancy Curriculum and Prenatal Education. Joanna Bloomfield Dept of Prevention and Community Health George Washington University May 5 th , 2011. Research Questions.
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Pregnancy Outcomes for Hispanic Women in Washington, DCA Comparison of the Centering Pregnancy Curriculum and Prenatal Education Joanna Bloomfield Dept of Prevention and Community Health George Washington University May 5th, 2011
Research Questions What is the impact of two prenatal group programs on Hispanic participants in Washington, DC? How effective are the programs as measured by satisfaction outcomes?
Definitions Prenatal Care –medical care, education and counseling from a clinical obstetric provider. Group Prenatal Care- Prenatal care in the group setting includes check-ups, vital measurements, and psychosocial assessments; support group meeting with a group of other women at similar gestational ages. Group is facilitated by clinical provider with obstetric expertise. Entry to care initiates in first trimester or early on in the second trimester. Group Prenatal Education- Incorporates healthy lifestyle recommendations with information relevant to the lead up to labor and delivery experiences. These courses typically serve women and partners in the last trimester of the pregnancy. Prenatal education does not include a medical care component and medical professional are not always present. Low Birth Weight (LBW)- infant born under 2500 grams (5 pounds, 8 ounces). American College of Obstetricians and Gynecologists, 2011
Why Groups? Opportunity to share happiness and concerns Develop community Inspired problem-solving Efficient way to share materials Better evidence-based outcomes
Health and Behavioral Objectives Health Objective: To reduce morbidity and mortality in Latina/Hispanic women of childbearing age in Washington, DC during antenatal and postnatal periods by 10% over a three year period. Behavioral Objective: To increase the seeking out of prenatal education courses among Hispanic women in Washington, DC by 50% over a two year period
Aim of Culminating Experience To evaluate and compare two group prenatal models serving Hispanic women in Washington, DC • Mary’s Center for Maternal and Child Care Prenatal class • Providence Hospital- Center for Life Centering Pregnancy curriculum
Background: Low Birth Weight in the United States and in Washington, D.C. As of 2007, the national average for LBW was 8.2% while DC’s overall rate was 11.6% From 2006-2008, average LBW rate in DC was highest for African American infants (14.3%), followed by Asians (8.1%), Hispanics (7.0%) and Caucasian (6.8%)
The Hispanic Population in DC 31% of DC Hispanic population is uninsured 67% begin PNC during 1st trimester Fertility rate among foreign born Hispanic women is 86 (per thousand women) 7.7 % of DC Hispanic population delivers LBW infants
Providence Hospital Centering Pregnancy program • Located in Brookland, Washington, DC (Ward 5) • Staffed by OB-GYN physicians and nurse midwives • Mostly African American & Hispanic populations • OB population is 60% uninsured
Providence Hospital Centering Pregnancy program • Groups of 8 - 12 women, same month/block EDD invited to group • Begin between 14-18 weeks GA • Partners encouraged to attend • 10 two-hour sessions facilitated by group leader, usually the health care provider • Women take their own vitals (e.g. weight, blood pressures) during first part of group
Mary’s Center for Maternal and Child CarePrenatal Class Located in Adams Morgan Washington, DC (Ward 1) Staffed by Health Promotion Department staff 21% of clinic patients are uninsured; 73% receive public insurance coverage Serves Hispanic women (and their partners)
Mary’s Center for Maternal and Child CarePrenatal Class 8 class sessions, partners encouraged to join Themes include nutrition, relaxation during labor, family planning, among others Each sessions is facilitated by a different group leader with particular expertise Participants come at varied gestational ages
Methods • Quantitative • Reviewed and analyzed data on birth weights, delivery types, gestational ages from both sites • Analyzed client assessments of both programs • Qualitative • Interviews with Mary’s Center Health Promotion staff and with Mary’s Center class participants • Reviewed qualitative data from Providence Hospital • Observation of Mary’s Center class (2011)
Results: Participant Satisfaction Mary’s Center Providence Hospital Unanimous report of satisfaction (100%) 75% reported using information from class during the perinatal period 98% “felt prepared for labor and delivery” 99% “preferred group care” 91% “felt program areas were well covered”
Results: Mary’s Center Staff Satisfaction Overall Satisfaction among staff at Mary’s Center Interest in enhancing participant recruitment and improving retention Offer incentives for participants Staff development opportunities Team meetings
Summary and Recommendations Providence Hospital and Mary’s Center have similar goals of health promotion and self-efficacy for expectant women Initial research says Providence has more favorable birth outcomes Birth outcomes are similar to national data Recommend further research that explores barriers to attendance
Works Cited Bronfenbrenner, U. (1977). Toward and Experimental Ecology of Human Development. American Psychologist, 32, 513-531. Centering Healthcare Institute. (2009). Retrieved January 20, 2011, from Centering Healthcare Institute: http://www.centeringhealthcare.org/index.php Downs. (2003). Fertility of American Women: June 2002. Washington, DC: United States Census Bureau. March of Dimes. (2004). Born Too Soon: Prematurity in the US Hispanic Population. White Plains: March of Dimes. State Center for Health Statistics. (2008). Briefing Paper on the 2006 Infant Mortality Rate for the District of Columbia. Washington, DC. US Department of Health and Human Resources, Health Resources and Services Administration, Maternal and Child Health Bureau. (2009). Child Health USA 2008-2009. Rockville: DHHS.
Acknowledgements I would like to extend my appreciation to Dr. Karen McDonnell for her continued support and assistance through the duration of my studies and throughout my culminating experience. Thank you Alis Marachelian for guiding my research at the Mary’s Center for Maternal and Child Care, Providence Hospital staff for directing my Centering Pregnancy program research, and to my family for their ongoing support and curiosity in my academic endeavors. Thank you!