Prenatal care in the United States is the recommended health care for women as a type of preventive treatment with the aim of providing routine checks that allow gynecologists or midwives to detect, treat and prevent potential health problems throughout the course of pregnancy while promoting healthy lifestyle that is beneficial for mother and child. Patients are encouraged to attend monthly checks during the first two trimesters and in the third trimester gradually increase to weekly visits. Women who suspect they are pregnant can schedule a pregnancy test before 9 weeks' gestation. After pregnancy confirmed early appointment is scheduled after 8 weeks of pregnancy. The next appointment consists of tests ranging from blood pressure to glucose levels to check the health of the mother and fetus. If not, appropriate care will be given to prevent further complications.
Prenatal care in the United States begins as a precautionary measure against preeclampsia, which includes program visits where medical professionals perform physical, historical, and risk evaluations. Over the past century, prenatal care has shifted focus to low birth weight and other prevention conditions to reduce infant mortality. Increased use of prenatal care was found to reduce mortality rates associated with birth and other preventable medical illnesses such as postnatal depression and infant injuries.
The United States has a socio-economic disparity that prevents the adoption of the same prenatal care across the country. Various levels of prenatal care accessibility can be observed in both developing and developed countries such as the United States. Although women can benefit from prenatal care, there are different levels of health care accessibility between different demographics, based on ethnicity, race, and income. level, across the United States. The level of education can also affect the utilization and accessibility of prenatal care. Nearly a fifth of women in the United States do not access prenatal care during the first trimester of pregnancy. Prenatal health care systems, along with personal attitudes, all contribute to the utilization and accessibility of prenatal care. Recommended steps to improve prenatal care in the United States include the implementation of community-based health care programs, and an increase in the number of those insured.
Video Prenatal care in the United States
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Prenatal care is a health care given to women who is also a type of preventive treatment with the aim of providing routine checks that allow gynecologists or midwives to detect, treat and prevent potential health problems during pregnancy while promoting a healthy lifestyle that benefits both mothers and children. Health professionals instruct mothers about prenatal nutrition, the benefits of breastfeeding, lifestyle changes, injury prevention and disease, and methods to monitor potentially hazardous health conditions. The medical professional will also notify the mother of labor and basic skills to care for the newborn.
During the visit the doctor will determine the due date, family and medical history, perform physical examination and pelvic examinations, and carry out various blood works. Doctors will also perform ultrasound to monitor infant health periodically during pregnancy. Ultrasound is used to measure fetal growth, heart rate, movement, and identification of physically identifiable abnormalities. Regular checks allow physicians to assess changes in maternal blood pressure, weight, uterine size, protein supply from urine samples, and various diseases such as diabetes through screen tests. Prenatal care serves as a tool for telling mothers about the same problem, and methods for taking care of themselves (the amount of rest needed, proper nutrition diet, etc.).
Maps Prenatal care in the United States
Schedule
Prenatal care schedule is recommended to consist of:
- Monthly visits to healthcare professionals for weeks 1 through 28 - (up to month 6)
- Visit twice a month from 28 to 36 weeks of pregnancy - (7th and 8th month)
- Weekly after week 36 (delivery on week 38-40) - (After 8 months)
More frequent visits are guaranteed for women older than 35 or in cases of high-risk pregnancies, with extra amounts and types of control dependent on individual risk factors. On the other hand, it has been suggested that 8 to 11 visits in total can be sufficient for women who are considered to be at low risk of adverse perinatal outcomes.
pre-conception counseling
Pre-concept counseling in the United States is recommended to include:
- Height and weight to calculate BMI
- Blood pressure
- Medical history
- Examination of the abdomen and pelvis
- Rubella screening
- Varicella Screening
- Filtering domestic violence
- Filtering depression
- Test gonorrhea and chlamydia for women at high risk for STD
Vaccinations
Influenza vaccinations
It is recommended that all pregnant women receive influenza vaccination during the flu season. Increased susceptibility to infection in pregnancy may increase the likelihood of influenza complications such as pneumonia, especially in the third trimester. In addition, fever, tachycardia and hypoxemia caused by influenza may be harmful to the developing fetus.
Vaccination with inactive trivalent influenza vaccine is a relative cost savings on providing supportive care only in pregnant populations, but the 2009 review concluded that there was insufficient evidence to recommend routine use during the first trimester of pregnancy. Inactivated vaccine for influenza is considered safe at any gestational age. On the other hand, live attenuated influenza vaccines such as nasal spray vaccine are not recommended in pregnancy. Preservative-free vaccines are available in cases of hypersensitivity to eggs or vaccine components.
Rubella
Rubella is a contagious viral disease, with symptoms such as mild measles. Screening for rubella vulnerability based on a history of vaccination or with serology is recommended in the US for all women of childbearing age at their first preconceptional counseling visit to reduce the incidence of congenital rubella syndrome (CRS). Due to concerns about possible teratogenicity, the use of MMR vaccine or measles vaccine is not recommended during pregnancy. Pregnant women who are vulnerable should be vaccinated as soon as possible in the postpartum period.
Varicella
Varicella is a herpes virus that causes smallpox and shingles. Provision of varicella vaccine during pregnancy is contraindicated. Immune status against varicella should be obtained during preconception preconception visits.
Tetanus and pertussis
If an urgent need for tetanus protection occurs during pregnancy, Td vaccine should be given. If there is no urgent need and the woman has previously received the tetanus vaccine, T vaccination should be postponed until the postpartum period. All postpartum women who have not received Td or Tdap vaccine in the past two years are recommended to receive Tdap before discharge after delivery. It is recommended for pregnant women who have never received a tetanus vaccine (ie, never received DTP, DTaP or DT as a child or Td or TT as an adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against the mother and newborn tetanus. In such cases, administration of Tdap is recommended after 20 weeks of pregnancy, and in early pregnancy a single dose of Tdap may be replaced for one Td dose, and then this series is supplemented with Td.
Attitude to prenatal care
The study found no difference between women's attitudes from different ethnic or social backgrounds regarding prenatal care. Browner and Press found no significant differences between demographics in women's attitudes toward their personal prenatal care practices. Women, regardless of demography, are also affected by certain health behaviors, stressful events, environmental stress, social support, mental health, and previous obstetric history. No ethnic influence, marital status, availability of transportation, rural vs. settlement urban, clinical distance from the clinic, or prenatal care at the time of woman's first access to prenatal care. The first prenatal visit of a woman is associated with self-referral for care, prenatal care support, and fewer children. The greater the number of children means that mothers have lower facilities, and higher physical time and loads that prevent them from attending regular prenatal care appointments.
Positive Influence
The social networking of family, friends, and people around it plays an important role in influencing the utilization of prenatal services by individuals. Prenatal care networks that are underutilized and acting against medical recommendations tend to be larger and higher in density than women who take proper care. This suggests that populations affected by underutilized prenatal care outweigh the population using proper care. Sharing social networking opinions, reaching consensus, and acting to communicate and strengthen their suggestions and expectations; all of which are valued higher than health care professionals. First-time mothers, and a number of supportive family members and friends, their social support, play an important role in women's decisions to seek early prenatal care and subsequent prenatal care services. Their "social support" measures encourage participation in prenatal care, increasing the likelihood of prenatal care early in the first trimester. As the time elapsed increases, women who do not yet have encouraging "social support" to seek early prenatal care may attend prenatal care at their own will; However, this is usually after the first trimester passes.
Negative effect
Attitudes influence the decision to accept or not accept specific prenatal care recommendations based on the knowledge they gain from personal experience and outside information from social networks. One reason women do not follow doctor advice is because of the perception that the information provided is wrong. Women often hear and experience situations in which the health profession is wrong. Subsequent recommendations are then weighed to determine the correctness of the evaluation. Many women who do not believe in biomedicine will reject certain pregnancy tests, calling their own body knowledge as more reliable than their doctor's high-tech interpretation. Some minority women may choose to avoid the hardships and discomforts of medical care and refuse full prenatal care.
Having childbearing healthy children increases the likelihood that mothers will not follow clinical recommendations, linking positive pregnancy situations to their past experiences. Personal health can be determined on their own with the acknowledgment of their own symptoms and determine whether they need to seek professional medical care.
Some mothers feel very uncomfortable with the lack of clearly communicated information and consequently are hesitant to perform prenatal examinations and counseling that health professionals would consider recommended.
Accessibility disparity
Although attitudes toward prenatal care can be assessed equally between different socioeconomic backgrounds, there is still a difference between prenatal care services and knowledge of prenatal care resources available across the country. Trend analysis illustrating the use of prenatal care services continues to show underutilized problems, especially in disadvantaged populations in the United States. Non-conformity rates at which disadvantaged populations benefit from prenatal care can be explained by social factors such as limited availability of service providers, inefficiencies, poorly arranged health care delivery systems, and inadequate coverage of insurance. Maternal rates accessing late or no prenatal prenatal care have decreased; though, since 2003, tariffs have stabilized.
Low socio-economic area
Urban population in urban settings has an increased risk of under-standard prenatal care. Low socioeconomic regions have higher rates of neonatal mortality, which are mostly due to low birthweight, rather than high-income women. These statistics have a decreased chance of increasing the number of women entering prenatal care programs. It is likely that high-income women seek prenatal care compared with low-income women. Black, Hispanic, single women, low education (less than 12 years), under-18s, women over 40, women with three or more previous deliveries, and women with fewer socioeconomic resources have a much lower chance for satisfactory health care services.
Minority access'
Studies have shown significantly higher risks for blacks and Hispanics in receiving inadequate prenatal care. African-American pregnant women are 2.8 times more likely to be non-Hispanic white mothers to start their prenatal care in the third trimester, or to receive no prenatal care during the entire pregnancy. Similarly, Hispanic pregnant women are 2.5 times more likely than non-Hispanic white mothers to start their prenatal care in the third trimester, or to not receive prenatal care at all. Latino women and African American women tend to visit different types of health care professionals; Latin women are more likely to go to obstetricians while African American women are more likely to see a practitioner. The minority's perspective on their prenatal care experience is partly based on interactions with their medical providers and whether they also have the same minority and gender backgrounds because of cultural familiarity in how doctors interact with their patients.
Latina paradox
A very consistent finding on the health of the Latino population is that Latina women, despite many social and economic disadvantages (eg, low socioeconomic status, lower levels of education, less use of prenatal care, fewer access to health insurance) giving birth to significantly lower birth-weight babies and fewer baby losses for any and all causes during infancy compared to non-Hispanic white women. This phenomenon is part of what is known as the "Latina Paradox" or the "Epidemiological Paradigm", which is the superiority of mortality in the Latino population. This cultural advantage begins to fade as Latin women acculturate into mainstream American culture; thus, more Latin-faced Latin women experience higher infant mortality rates and deliver low-birth-weight infants. Exploring the factors that bring the Latina paradox at the individual and community level can help identify new opportunities for policy interventions to optimize prenatal outcomes in the United States that Latinas is born with other non-Hispanic whites. There is no definitive explanation for what leads to mortality. Behavioral factors such as drug use, alcohol consumption and tobacco use can serve as a contribution to the paradox, because Latina women smoke less, consume less alcohol, and use fewer drugs while pregnant than with non-Hispanic white peers. Cultural factors may be relevant to the Latina paradox because Latina-born foreign women have low-birth-weight low birth rates than US-born Latinos and non-Hispanic white women. Alternatively, community factors such as community acculturation and community values ​​can also contribute to paradoxes.
Contributing factors
Unwanted pregnancy
Unwanted pregnancies preclude pre-conception counseling, and pre-conception care, and delayed initiation of prenatal care. In unintended pregnancies, prenatal care will begin later, and is inadequate. This has an adverse effect on the health of women and children, and women are less prepared to become parents. The delay of unwanted pregnancy is other than that of other risk factors for delays.
Unwanted US pregnancy rates are higher than the world average, and much higher than in other industrialized countries. Nearly half (49%) of US pregnancies are unintentional, more than 3 million unwanted pregnancies per year. Unwanted pregnancy rates are even higher among the poor. In 1990 about 44% of births were unintentional at the time of conception; among poor women nearly 60% of births are caused by unwanted pregnancies.
Health insurance
Of pregnant women annually in the United States, 13 percent are uninsured, resulting in very limited access to prenatal care. According to the Children's Defense Fund website, "Almost one out of every four pregnant black women and more than one in three uninsured Latin pregnant women, compared to one in nearly seven pregnant white women." Without coverage, Black mothers and Latin are less likely to access or pay for prenatal care. "Today, pregnancy is considered a" pre-existing condition, "making it more difficult for uninsured pregnant women to actually afford private health insurance. In 1990, 1995, and 1998, MediCal's expansion increased the use of prenatal care and reduced ethnic differences in those who used health services.
Data have shown that those who have access to Medicaid accounts for 58% of women who do not use prenatal care; those who have access to another type of insurance account for 11% of women who do not perform pre-natal care.
Formal education
Women with less than 12 years of age are at high risk of under-utilization or lack of access to adequate prenatal care services. Often, Black and Hispanic pregnant women have fewer formal education, which triggers the domino effect of consequences related to prenatal care. Lack of formal education results in poor knowledge about the exact pregnancy prenatal overall health, fewer job opportunities, and lower income levels throughout their adult life.
Consequences of lack of prenatal care
Without timely, comprehensive, and appropriate pre-natal care, disadvantaged populations and those not using prenatal health services face a higher risk of facing the consequences during prenatal, labor and postnatal experiences. Mothers who receive late pregnancy care or none are more likely to deliver babies with health illness. Some health problems can be prevented by improving both appropriate applications and access to adequate prenatal care. Nearly a fifth of women in the United States do not seek prenatal care during their first trimester.
Delivery completion
Without proper prenatal care services, there is an increased level of complications such as:
- Intrauterine growth restriction: poor baby growth in the mother's womb
- Preeclampsia: hypertension occurs during pregnancy
- amniotic and chorion rupture more than an hour before the onset of labor
- Gestational diabetes: women who had not previously had diabetes before pregnancy showed high blood glucose levels during pregnancy because of a lack of a mother's ability to secrete insulin.
- Placenta previa: the placenta is attached to the uterine wall near or cover the cervix
- Premature birth: babies are born less than 37 weeks of their full gestational age. Premature newborns may suffer from immature lungs associated with respiratory complications.
Every year in the United States 875,000 women experience one or more pregnancy complications and 467,201 premature infants.
Low birth weight
Every year in the United States, 27,864 newborns are born with low birth weight. Newborns of mothers who did not use prenatal care were three times more likely to have low birth weight and were five times more likely to die than newborns whose mothers regularly attend pregnancy checkups. Sesia et al. found a positive relationship with the number of prenatal care visits and birth weight. Low birthweight is associated with prematurity and contributes to infant mortality.
Congenital malformations
Every year in the United States, 154,051 children are born with birth defects. Congenital malformations can be caused by:
- Genetic disorders
- Intrauterus environment
- The morphogenesis error, the biological process that causes the organism to develop its shape.
- Chromosomal abnormalities
Some of the common congenital malformations are:
- Cleft palate: slit or opening on the lips
- Cardiac abnormalities
- Down syndrome: the presence of all or part of the extra 21st chromosome.
The deficits of prenatal care and the postnatal environment work together in a complex way to influence the outcome of congenital disorders.
Infant Death
In 2000, the United States was ranked 27th among the industrialized countries because of their relatively high infant mortality rate. Data from 2003 showed that the infant mortality rate was 6.9 deaths per 1,000 per live birth. Every year in the United States, 27,864 babies die before their first birthday. The US mortality rate is among the highest among the other developed countries. This is related to maternal health, socioeconomic conditions, and public health practices. Inadequate use of prenatal care is a strong predictor of low birth weight, prematurity, and infant mortality.
Improving prenatal care
Although disadvantaged populations continue to face reduced access to high quality prenatal care, there is a recommended action plan with the goal of reducing the level of health inequality. The Healthy People's Program 2010, a series of national goals for health promotion and disease prevention, sets the goal that by 2010, 90% of mothers, both high and low incomes, will be able to access adequate care early on. The goal of Healthy Persons 2020 for prenatal care is that 77.6% of pregnant women receive prenatal care early and adequate; 70% received such treatment in 2007.
Preventing unwanted pregnancy
Preventing unwanted pregnancies will have many desired health, social and financial outcomes, including increasing the proportion of pregnancies with adequate and timely access to prenatal care. Programs to help reduce unwanted pregnancies include increased education about and access to contraception and increased sex education.
Connection between doctor and patient
For many patients, it is difficult to develop long-term relationships and trust with health care providers. Regardless of socioeconomic background, women will incorporate useful lifestyle changes that are easily incorporated into their daily lives. Data from Browner et al. found that pregnant women did not consider prenatal recommendations to be authoritative simply because they were excluded by clinical professionals, with which they tend to follow recommendations with their own discretion. Using prenatal diagnostic tests may uphold the importance of following doctor's orders. Medical staff should aim to build effective communication channels with health care providers to ensure increased awareness of women's health while building trust with their patients. If the patient can not be matched with a healthcare provider culturally, then they should at least be able to visit a specially trained doctor to deal with cultural differences. This awareness and sensitivity can come in many forms, such as familiarity with a foreign language, an understanding of how a particular ethnic look at a mother, or knowing how family networks play a role in the decision-making process of mothers. All of these options have the potential to improve the physician-patient relationship, and the establishment of such relationships can be implemented in medical training in the US both in medical school settings and on-site training programs.
It has been suggested that physicians and other health care providers examine their patients for both abuse and sexually transmitted diseases to ensure their overall wellbeing. They should also help them get proper care, health, social and legal services if there is a problem.
Increase insurance
The lack of adequate health insurance, especially health insurance in the United States, can contribute to the limitations and lack of utilization experienced by women. Hessolhas two studies showing that insurance status is a strong determinant of the utilization of prenatal care; as health insurance feasibility increases, the use of prenatal care increases and ethnic differences decline. Although, while private health insurance is one method in which women can access or pay for prenatal care, private health insurance does not always prove to be always helpful or reassuring.
Sesia et al. found no significant difference indicating that the managed care program required for prenatal care increased or inhibited access to prenatal care services. A study conducted on women using prenatal care services found that resources provided by HMO programs, such as prenatal education classes, recommendations for diet, exercise, weight, and rest, pregnancy books, and magazine subscriptions, were not seen by women as helpful.
Community outreach program
Community outreach programs will train members of the minority population in basic health education; then this community health worker will help facilitate the relationship between pregnant women and local health care agencies. Community health workers may even continue their relationship during pregnancy, serving as liaison of patients during tests, appointments, and conversations. Low-income communities should employ community members to encourage and support the use of health care services.
Those with outreach contacts were more likely to serve disadvantaged populations as reported with obstetric risk, younger than 19 years, and likely to have no significant partner. Targeting this population through community outreach programs that take community projects can have a positive effect on the level of women accessing and utilizing the available prenatal care services.
Advice to support teenage health centers has been created to provide health care services. The resources of this study strongly suggest that prenatal care delivered in community-based settings is a more efficient and cheaper method for delivering positive health outcomes; however, the mission of a community-based care program is different. In relation to adolescent or adolescent medicine, focused community programs can lead to increased use of contraceptives and subsequent declines in pregnancy rates.
See also
- Pregnancy and prenatal care in US jails
- Education in the United States
References
Source of the article : Wikipedia
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