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Background: The United States physician shortages affect rural health care access, including maternity care. Project aims were to identify and characterize prenatal and delivery care in Michigan's rural counties and to explore access to trial of labor after cesarean (TOLAC) services for women in rural Michigan., Methods: Descriptive, cross-sectional design used 2015 Medicaid claims data and public health plan information to identify maternity care services provided within Michigan's rural counties. Publicly available health plan information was used to identify rural maternity hospitals and prenatal care practitioners; findings were verified by Internet searches and telephone interviews. Medicaid claims data were used to determine services provided. High-risk geographic areas were defined as those where women needed to travel >30 miles for maternity-related care. Expected TOLAC rate was determined based on published national birth data; rural hospitals were stratified based on whether they met the expected TOLAC rate, delivered 20%-60% of expected rate, or billed ≤1 TOLAC birth to Medicaid in 2015., Results: In Michigan's 57 rural counties, only 29 hospitals provide maternity care. Geographic high-risk areas were identified in the Upper Peninsula and northeast Lower Peninsula of Michigan. Only two rural hospitals billed for the expected rate of TOLAC births; six delivered at a lower rate, and the remaining 21 hospitals provided no TOLAC services, resulting in large areas of the state where women were not offered this option locally., Conclusions: Maternity care services are limited for many rural Michigan women. Findings can be used to target specific strategies to improve access to care for these women. Similar analyses, exploring patterns of maternity care delivery in other rural regions worldwide, may uncover similar or additional inequities., (© 2021 Wiley Periodicals LLC.)

Background: Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. Methods: We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual‐level and county‐level characteristics. Results: In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). Conclusions: Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe US freestanding birth center models of prenatal care and to examine how the components of this care contribute to birthing people's confidence in their ability to have a physiologic birth. Design: This was a qualitative descriptive study utilizing semi‐structured interviews with birth center midwives. Data were analyzed using thematic analysis, constant comparative method and consensus coding to ensure rigor. Setting and Participants: Midwives from six urban and rural freestanding birth centers in a Midwestern US state were interviewed. Twelve birth center midwives participated. Findings Six themes emerged: the birth center physical space and organization of care, dimensions of midwifery care within the birth center, continuity of care and seamless service, the empowered birthing person, physiologic birth as normative, and the hospital paradigm and US cultures of birth. Key Conclusions: We identified significant components of birth center models of prenatal care that midwives believe enhance birthing people's confidence for physiologic childbirth. These components may be considered for application to other settings and may improve perinatal care and outcomes. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has dramatically affected pregnant people's prenatal care, labor, and delivery experiences. Given these rapid changes, providers have needed to be proactive in sharing information about COVID‐19‐related care impacts. The purpose of this study was to investigate: (a) Whether patient demographics or disrupted care (eg, canceled appointments and rapid shift to telehealth) is associated with patient‐reported information sharing from the providers; and (b) Whether patient‐reported provider information sharing or disruptions to care are associated with patient satisfaction with provider. Methods: Data come from a convenience sample of 1999 pregnant people living in the United States who completed an online survey between April 16 and May 7 2020. Results: Thirty‐eight percent of participants said that their provider had not discussed how the pandemic would affect their care during pregnancy, labor, or delivery. Participants with lower education, less income, or whose appointments had been canceled or rescheduled because of the pandemic were significantly less likely to report information sharing. Provider satisfaction was significantly lower among participants who did not report information sharing, those who had appointments by way of telehealth, and those who reported that all their appointments had been rescheduled/canceled. Discussion: At the beginning of the pandemic, there were significant socioeconomic inequities in reported information sharing by the providers, which in turn was negatively associated with provider satisfaction. Providers need to be aware of the role implicit bias may play in information sharing—both generally and during public health crises—and consider ways to reduce the impacts of disrupted care delivery on patient satisfaction. If left unaddressed, perceived poor provider communication and associated low satisfaction with providers could contribute to adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effect of high-risk obstetrics (HROB) care management on infant health and Medicaid expenditures.Data Sources/study Setting: Medicaid administrative data and vital statistics from 2011 to 2013. In New York State, all Medicaid managed care plans provide HROB care management to their members.Study Design: We conducted a retrospective cohort study with a nonequivalent control group. Selection bias was addressed by using probit and OLS models with the Heckman correction and inverse probability weight with regression adjustment.Principal Findings: While program enrollment was associated with poor infant health outcomes (low birthweight, very low birthweight, preterm delivery, and gestational age), correcting for sample selection substantially improved most of these outcomes. All infant health outcomes significantly improved as the number of weeks in the program increased. We found that a 1-week increase in program duration is associated with a 0.01 percentage point decrease in low birthweight and a 0.03 percentage point decrease in very low birthweight. Further, a 1-week increase in program duration decreases the probability of preterm delivery by 0.01 percentage points and increases gestational age by 0.14 days. Medicaid expenditures for maternity care and newborn delivery were not significantly or materially affected by program enrollment or program duration.Conclusions: High-risk obstetrics care management appears to successfully identify individuals with high-risk pregnancies and improve health without substantially increasing medical expenses. [ABSTRACT FROM AUTHOR]

Objective: To evaluate impacts of state Medicaid expansions for low-income parents on the health insurance coverage, pregnancy intention, and use of prenatal care among mothers who became pregnant.Data Sources/study Setting: Person-level data for women with a live birth from the 1997-2012 Pregnancy Risk Assessment Monitoring System.Data Collection/extraction Methods: The sample was restricted to women who were already parents using information on previous live births and combined with information on state Medicaid policies for low-income parents.Study Design: I used a measure of expanded generosity of state Medicaid eligibility for low-income parents to estimate changes in health insurance, pregnancy intention, and prenatal care for pregnant mothers associated with Medicaid expansion.Principal Findings: I found an increase in prepregnancy health insurance coverage and coverage during pregnancy among pregnant mothers, as well as earlier initiation of prenatal care, associated with the expansions. Among pregnant mothers with less education, I found an increase in the adequacy of prenatal care utilization.Conclusions: Expanded Medicaid coverage for low-income adults has the potential to increase a woman's health insurance coverage prior to pregnancy, as well as her insurance coverage and medical care receipt during pregnancy. [ABSTRACT FROM AUTHOR]

Background Variations in care for pregnant women have been reported to affect pregnancy outcomes. Methods This study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers ( AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio-behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored. Results Medicaid beneficiaries enrolled at AABC sites had diverse socio-behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low-risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery-led prenatal care, and 84% with midwifery- attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4-times greater risk of cesarean birth among medically low-risk childbearing Medicaid beneficiaries. Conclusions The birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value. [ABSTRACT FROM AUTHOR]

Objectives: To understand hospital- and county-level factors for rural obstetric unit closures, using mixed methods.Data Sources: Hospital discharge data from Healthcare Cost and Utilization Project's Statewide Inpatient Databases, American Hospital Association Annual Survey, and Area Resource File for 2010, as well as 2013-2014 telephone interviews of all 306 rural hospitals in nine states with at least 10 births in 2010. Via interview, we ascertained obstetric unit status, reasons for closures, and postclosure community capacity for prenatal care.Study Design: Multivariate logistic regression and qualitative analysis were used to identify factors associated with unit closures between 2010 and 2014.Principal Findings: Exactly 7.2 percent of rural hospitals in the study closed their obstetric units. These units were smaller in size, more likely to be privately owned, and located in communities with lower family income, fewer obstetricians, and fewer family physicians. Prenatal care was still available in 17 of 19 communities, but local women would need to travel an average of 29 additional miles to access intrapartum care.Conclusions: Rural obstetric unit closures are more common in smaller hospitals and communities with a limited obstetric workforce. Concerns about continuity of rural maternity care arise for women with local prenatal care but distant intrapartum care. [ABSTRACT FROM AUTHOR]

Background: The National Children's Study (NCS) was established as a national probability sample of births to prospectively study children's health starting from in utero to age 21. The primary sampling unit was 105 study locations (typically a county). The secondary sampling unit was the geographic unit (segment), but this was subsequently perceived to be an inefficient strategy. Methods and Results: This paper proposes that second-stage sampling using prenatal care providers is an efficient and cost-effective method for deriving a national probability sample of births in the US. It offers a rationale for provider-based sampling and discusses a number of strategies for assembling a sampling frame of providers. Also presented are special challenges to provider-based sampling pregnancies, including optimising key sample parameters, retaining geographic diversity, determining the types of providers to include in the sample frame, recruiting women who do not receive prenatal care, and using community engagement to enrol women. There will also be substantial operational challenges to sampling provider groups. Conclusion: We argue that probability sampling is mandatory to capture the full variation in exposure and outcomes expected in a national cohort study, to provide valid and generalisable risk estimates, and to accurately estimate policy (such as screening) benefits from associations reported in the NCS. [ABSTRACT FROM AUTHOR]

The article focuses on Patient Protection and Affordable Care Act signed by U.S. President Barack Obama on March 2010. It says that the affordable care act provides childbearing woman and newborns special benefits including greater access and affordability of maternity care, provisions that close prior loopholes, and new benefits and programs. The act also provides pregnancy assistance fund and award grants to assist pregnant and parenting teens enrolled in higher education program.

Objective. This study investigates the impact of welfare reform on insurance coverage before pregnancy and on first-trimester initiation of prenatal care (PNC) among pregnant women eligible for Medicaid under welfare-related eligibility criteria. Data Sources. We used pooled data from the Pregnancy Risk Assessment Monitoring System for eight states (AL, FL, ME, NY, OK, SC, WA, and WV) from 1996 through 1999. Study Design. We estimated a two-part logistic model of insurance coverage before pregnancy and first-trimester PNC initiation. The impact of welfare reform on insurance coverage before pregnancy was measured by marginal effects computed from coefficients of an interaction term for the postreform period and welfare-related eligibility and on PNC initiation by the same interaction term and the coefficients of insurance coverage adjusted for potential simultaneous equation bias. We compared the estimates from this model with results from simple logistic, ordinary least squares, and two-stage least squares models. Principal Findings. Welfare reform had a significant negative impact on Medicaid coverage before pregnancy among welfare-related Medicaid eligibles. This drop resulted in a small decline in their first-trimester PNC initiation. Enrollment in Medicaid before pregnancy was independent of the decision to initiate PNC, and estimates of the effect of a reduction in Medicaid coverage before pregnancy on PNC initiation were consistent over the single- and two-stage models. Effects of private coverage were mixed. Welfare reform had no impact on first-trimester PNC beyond that from reduced Medicaid coverage in the pooled regression but separate state-specific regressions suggest additional effects from time and income constraints induced by welfare reform may have occurred in some states. Conclusions. Welfare reform had significant adverse effects on insurance coverage and first-trimester PNC initiation among our nation's poorest women of childbearing age. Improved outreach and insurance options for these women are needed to meet national health goals. [ABSTRACT FROM AUTHOR]

Background: Assessing the quality of prenatal care received by Hispanic women is particularly important, given the rapidly growing Hispanic population in the United States. The purpose of this study was threefold: to assess the prevalence of Hispanic mothers who perceived their prenatal care to be patient-centered, to determine whether Hispanic mothers were less likely to perceive their prenatal care to be patient-centered than non-Hispanic mothers, and to better understand Hispanic women's perceptions of the patient-centeredness of their prenatal care. Methods: Semistructured interviews were conducted with a proportionate, stratified random sample of 359 women initiating prenatal care in their first trimester and 68 women initiating prenatal care in their third trimester who delivered at 10 Palm Beach County, Florida, maternity hospitals between May and December 2003. Interviews assessed three aspects of patient-centered prenatal care using quantitative and qualitative methods. Results: Hispanic mothers were less likely than non-Hispanic mothers to perceive that doctors and nurses treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.10–0.86), and to perceive that office staff treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.12–0.73). Hispanic mothers were more likely to experience language or communication problems than non-Hispanic mothers (adjusted OR, 3.30; 95% CI, 1.40–7.76). Qualitative analyses found that lack of patient-centered care limited Hispanic mothers’ ability to understand information given during prenatal visits, ability to ask questions about their prenatal care, and desire to return for subsequent appointments. Conclusions: Hispanic women could benefit from prenatal care that is more culturally and linguistically competent as well as care that is responsive to the group's cultural norms. One recommendation is the use of group prenatal care, which encourages groups of women with similar gestational ages to articulate and discuss cultural norms and attitudes about pregnancy during structured prenatal care sessions. (BIRTH 32:4 December 2005) [ABSTRACT FROM AUTHOR]

Examines which components of the HealthStart comprehensive prenatal care program in New Jersey were most effective in improving birth-weight outcomes. Number of pregnant women who enrolled in HealthStart between 1988 and 1996; Percentage of program participants who received various prenatal services.

ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States—a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks’ gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first... [ABSTRACT FROM AUTHOR]

Evaluates the effectiveness of the Rural Oregon Minority Prenatal Program (ROMPP) in improving patterns of prenatal care utilization by rural-dwelling low-income Mexican-American women at risk of poor pregnancy outcomes. Services provided by ROMPP; Barriers in access to prenatal care encountered by low income Mexican-American women; Increase of the utilization of prenatal care because of ROMPP.

The state of Hawaii has had near-universal health insurance coverage for the last 20 years. Its highly diverse population offers the opportunity for a unique, natural experiment in the United States on the examination of social differences in health care utilisation when financial barriers are removed. Therefore, the objective of this study is to examine predictors of prenatal care utilisation patterns in the four major ethnic groups in Hawaii. The data used in this study are the 1979-92 Hawaii livebirth vital record files. A total of 165,301 singleton livebirths to Hawaii-resident mothers of Caucasian, native Hawaiian, Japanese or Filipino ancestry were selected. Despite near-universal health care coverage in Hawaii, a surprising number of women did not adequately utilise prenatal care, with large differences between groups. Multivariate analyses indicated that similar maternal socio-demographic factors were associated with prenatal care use in each ethnic group. Social variation continues to exist among all ethnic groups even in the presence of universal access to care. These data emphasise the need to address the distinct cultural needs of populations for providing health services, and further challenge the assumption that removal of financial barriers will ensure a high level of prenatal care use. [ABSTRACT FROM AUTHOR]

The article discusses the reports from the Centers for Disease Control and Prevention (CDC) on opportunities to improve quality of maternity care in the U.S. The reports featured data from 2008 birth certificates, and the national hospital breastfeeding surveys that were carried out in 2007 and 2009. The need for more timely use of prenatal services is crucial since four percent of pregnant mothers lacked insurance for childbirth.

In this article, the authors discuss the increased risk of adverse neurological development for late preterm infants and the maternal medical conditions on their morbidity risk in the U.S. They attribute maternal medical conditions or pregnancy complications to early deliver or obstetric intervention. They note the study showing that late preterm infant is at risk for adverse neurological outcomes in childhood. They point out that the risk follows the gestational age.

The article offers world news briefs related to prenatal care in 2007. A new policy controlling the timing of elective cesarean sections in New South Wales, Australia, was issued in April. Some rural cities in Japan have adopted a system that examines pregnant women using real-time data transmitted to a physician's cellular phone. The U.S. Agency for Healthcare Research and Quality has released new evidence that breastfeeding decreases the risk of having many short-term and chronic diseases.