FOR HEALTH CARE PROVIDERS

Whether you are an obstetrician, a family practitioner, or a pediatrician, you have enormous influence on the choices your patients make about a whole range of issues related to healthy births and healthy babies.  Of course you are providing the best possible medical care.  But you have an opportunity to enhance that medical care by providing clear and direct guidance on issues ranging from smoking to breastfeeding.  Following are some suggestions for approaches to these issues that can be implemented within a practice with minimal additional time.  The impact on your patient and on her baby can be immeasurable.

For Smoking Cessation information and links click HERE

Perinatal Depression

In the past, physicians have been reluctant to screen their patients for perinatal mood disorders because they did not have a simple and effective screening tool and they did not have a ready resource list to refer patients for further assessment and treatment.  But many women who suffer from depression and anxiety during pregnancy or postpartum do not seek help because they are ashamed that they are not “appropriately” happy, or they think they can just shake it off.  A few simple questions from a health care provider can open the door to identification and treatment of clinical depression.

The Edinburgh Postnatal Depression Scale (EPDS) is a simple, ten-question self report that has proven effective in identifying perinatal mood disorders.  The questionnaire and protocol for its use can be downloaded here.  If a patient scores above the indicated threshold, consider a referral to one of these mental health providers.

The New York State Department of Health has extensive information, resources and links. Here is a downloadable fact sheet on Perinatal Mood Disorders.

Domestic Violence

It can be easy even for health care providers to think that domestic violence is one thing they do not have to worry about during a woman’s pregnancy.  Our own deeply held values about pregnancy and motherhood may mask the reality that pregnancy does not always protect a woman, and in some cases may actually precipitate or exacerbate domestic violence.  Nearly 325,000 pregnant women in the United States each year experience violence from an intimate partner. 

The consequences harm both the woman and her baby.    A woman who is abused during pregnancy is more likely to have a miscarriage, infections, bleeding, anemia, and other health problems.  Clinical issues related to domestic violence include depression, eating and sleep disorders, substance abuse, self-neglect, suicide attempts, and poor adherence to medical recommendations.  She is twice as likely to have a low-birth-weight baby.

Physicians can help break the cycle of violence by following a simple protocol recommended by The American College of Obstetricians and Gynecologists (ACOG).  If a woman is experiencing domestic violence, you can refer her to one of these sources of support.

Breastfeeding

Formula is not equivalent to breast milk.  Breastfeeding confers benefits and protects from health deficits for both mothers and babies.  (See the Department of Health and Human Services Blueprint for Action on Breastfeeding for a detailed discussion of the benefits of breastfeeding, the challenges, and suggestions for a public health approach to increasing breastfeeding rates.) 

While the decision to breastfeed is influenced by many factors, many women report that they rely on their physician for advice.  But many physicians do not make a clear statement that breastfeeding is best.  That simple intervention – explaining the problems associated with formula feeding, expressing a preference for breastfeeding – can be enough to convince a woman to initiate breastfeeding. 

For women who attempt breastfeeding and have difficulties, every hospital has lactation consultants who can help (and they are nearly always successful in solving the problem so that breastfeeding can continue).  Here is a list of numbers to call for breastfeeding information and support.

Centering Pregnancy – Group Prenatal Care

Picture the standard model of prenatal care delivery:  One woman, one provider, 15 minutes.  The provider repeats yet again the message s/he has been delivering all day, struggling to fully address the psycho-social as well as medical needs of the mother and her baby.  The woman asks a question, doesn’t quite understand the answer, and is embarrassed to ask again.  Visit ends.  The visit leaves both provider and woman feeling less than satisfied.

Now picture an alternative model:  8-10 women, 1-2 providers, 2 hours.  The women collect and record their own physical data, then visit with the medical provider for a quick measurement and listen to the heartbeat.  Then the women and medical providers sit in a circle and for the next hour and a half share information, concerns, and support.  The providers facilitate rather than lecture; the women learn from one another – not just the facts, but the emotional support needed for a healthy pregnancy. 

Obstetricians, Family Practice physicians, and midwives all over the country are opting for the second scenario in a program called Centering Pregnancy®.  While some prenatal group care dates back 25 years or more (including pioneering work by Rochester’s own Beth Cooper), the particular model called Centering Pregnancy was developed by Sharon Schindler Rising, MSN, CNM, FACNM and piloted in 1993-94.  Today, over 50 practices offer Centering Pregnancy group care nationwide. 

Centering Pregnancy integrates the three major components of prenatal care --  health assessment, education, and support -- into a unified program.  The model combines a rigorous and structured curriculum with a flexible and nurturing delivery process.  Through the course of 10 2-hour sessions, providers cover much more information than is possible in traditional individual care and women engage fully in their own care as they learn that they are not alone in their experiences.  Group care provides support and motivation to women to learn and adopt healthful behavior.

The Centering Pregnancy model is being used in Rochester by both Strong Health and Via Health (Rochester General) for their teen programs.  PNMC will sponsor training in the model if there is sufficient interest.

For a detailed discussion of the model and the outcomes of the research on its impact, see Redesigning Prenatal Care Through Centering Pregnancy.