Social support in improving perinatal outcome: the Resource Mothers Program.

This report studies the Resource Mothers Program, an organization that improves perinatal outcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, and knowledge of their local community services to reduce the hazards associated with rural adolescent pregnancy. Each Resource Mother is assigned to a pregnant teenage primigravida and serves as part of her support system throughout pregnancy and until the infant's first birthday. We studied 565 matched pairs (case/control) of rural teenage primigravidas with single pregnancies with and without the social support of the Resource Mother. There were significantly more patients with adequate prenatal care in the program group (P less than .000001). The frequency of low birth weight infants was significantly less (P = .006), as was the small-for-gestational-age rate (P = .002).

A randomized trial of nurse-midwifery prenatal care to reduce low birth weight.

In a randomized, controlled trial in five regional centers with state health department clinics, 1458 women at high risk for low birth weight (LBW) outcome received either prenatal interventions provided by nurse-midwives and nurses under their supervision or the standard high-risk prenatal care provided by obstetricians. The intervention administered by the nurse-midwives included patient education to identify the signs and symptoms of preterm labor, activity counseling in response to monitoring of the cervix by frequent examinations, stress reduction by enhancing social support, nutrition counseling with emphasis on weight gain, and substance-abuse counseling. For women in the control group, care was provided by obstetricians according to local standards for the management of high-risk pregnancies. We hypothesized that the LBW rate among live births to women who had received care from nurse-midwives would be lower than that in the control group. Although the LBW rate was lower in the intervention group than in the control group, the observed difference was not statistically significant. Race was not prespecified as a possible effect modifier, but examination of the data post hoc suggested that black women at high statistical risk of giving birth to an LBW infant may have derived benefit from the program. Although the results do not suggest any striking advantage of the nurse-midwifery intervention over standard obstetric care for women at high statistical risk of having an LBW infant, neither do they suggest any disadvantage. Nurse-midwives could provide care to certain populations of high-risk women and facilitate future coverage of these presently underserved populations.

Benefits of a statewide high-risk perinatal program.

A study was undertaken to determine whether newborn infants of women in a statewide high-risk program had less perinatal mortality and higher birth weight than newborn infants of high-risk women not in the program. The number of fetal and neonatal deaths was twice as high in the nonprogram group, but there was no statistical difference in birth weight distribution in the two groups. Possible reasons for the program's effectiveness are the facts that a greater number of program women had more prenatal visits and were delivered in a Level II or Level III hospital by appropriate personnel.

A KAP (knowledge-attitude-practice) approach to the regionalization of perinatal health.

PIP: In 1972 66 of the 68 hospitals with active maternity services in South Carolina responded to a perinatal services questionnaire. The 25-item questionnaire response revealed some interesting data about the delivery of perinatal health care in the state. This study was cross validated by an analysis of the fetal and neonatal deaths from a review of fetal death certificates and matched birth and death certificates for the year 1972. Hospitals were classified into 6 groups according to the size of maternity service. The proposal to regionalize perinatal care is intended to provide resources for the practicing physicians and to make available consultation services and medical facilities for any complexity in maternity and infant care. The private practitioners must be assured that the plan does not pose a threat to their practice but will upgrade their hospital facility. Under such a plan, 3 hospital levels of care would be identified, each with certain characteristics of facility, equipment, and personnel. A concentrated attempt to involve physicians at locations of the 10 Level 2 high risk centers has been made. Each month during the past year 17 teams of an obstetrician-pediatrician have been exposed to the perinatal concept. It is estimated that the present half life of perinatal knowledge is 18 months. Thus, an extensive education program must be continually operating at all levels of care. The most potent block is the attitudes of the physicians; they fear an attempt to develop an elitist group from which they are excluded. They fear also loss of status, medical challenge and of being limited to treating ''normal'' cases. The high cost of medical care is 1 of the main issues exerting pressures for consolidation of obstetrical care.^ieng

Improved perinatal knowledge in community hospitals through a self-instructional program.

The Perinatal Continuing Education Program (PCEP) was conducted throughout South Carolina. The program was well received and greatly valued; however, participants requested more information covering obstetrics. To meet this need, we developed the Perinatal Education Program for Community Hospitals (PEPCH), patterned after and similar to PCEP, and tested it in South Carolina and southern California. In the South Carolina trial, the posttest was found reliable (Kuder-Richardson index = .77). In the California trial, the pretest/posttest reliability was confirmed. Learning for nurses was documented (pretest = 30.8 +/- 5.3, posttest = 36.8 +/- 5.5, P less than .001). Completion rate for this voluntary program was 84%. We conclude that a self-study program based in the community hospital can improve knowledge of perinatal professionals.