Transcript Pregnancy Outcomes for Hispanic Women in Washington, DC …

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
M A Y 5 TH, 2 0 1 1
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 Care
Prenatal 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 Care
Prenatal 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
Socio Ecological Model
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: Birth Outcomes
Results: Participant Satisfaction
Mary’s Center
Providence Hospital
 Unanimous report of
 98% “felt prepared for
satisfaction (100%)
 75% reported using
information from class
during the perinatal
period
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
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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 20082009. 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!