Hispanic Women's Perceptions of Patient‐Centeredness During Prenatal Care: A Mixed‐Method Studya

ABSTRACT: 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)     

Trends and Characteristics of Home Births in the United States by Race and Ethnicity, 1990–2006

Background: After a gradual decline from 1990 to 2004, the percentage of births occurring at home in the United States increased by 5 percent in 2005 and that increase was sustained in 2006. The purpose of the study was to analyze trends and characteristics in home births in United States by race and ethnicity from 1990 to 2006. Methods: U.S. birth certificate data on home births were analyzed and compared with hospital births for a variety of demographic and medical characteristics. Results: From 1990 to 2006, both the number and percentage of home births increased for non‐Hispanic white women, but declined for all other race and ethnic groups. In 2006, non‐Hispanic white women were three to four times more likely to have a home birth than women of other race and ethnic groups. Home births were more likely than hospital births to occur to older, married women with singleton pregnancies and several previous children. For non‐Hispanic white women, fewer home births than hospital births were born preterm, whereas for other race and ethnic groups a higher percentage of home births than hospital births were born preterm. For non‐Hispanic white women, two‐thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, most home births were delivered by either physicians or “other” attendants, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations. Conclusions: Differences in the risk profile of home births by race and ethnicity are consistent with previous research, suggesting that, compared with non‐Hispanic white women, a larger proportion of non‐Hispanic black and Hispanic home births represent unplanned, emergency situations. (BIRTH 38:1 March 2011)     

Birth Outcomes Associated with Receipt of Group Prenatal Care Among Low‐Income Hispanic Women

Introduction: Although Hispanic women in the United States have preterm birth and low‐birth‐weight rates comparable to non‐Hispanic white women, their rates fall short of 2010 Healthy People goals, with variability found across states. This study examined the effectiveness of the CenteringPregnancy group prenatal care model in reducing preterm birth and low‐birth‐weight rates for Hispanic women. Methods: Pregnant Hispanic women at less than or equal to 20 weeks, gestation initiating prenatal care between January 2008 to July 2009 at 2 Palm Beach County, Florida, public health clinics selected either group or traditional prenatal care. Data on neonatal birth weight and gestational age were obtained through abstraction of Palm Beach County Health Department medical records. Records were abstracted for 97% of CenteringPregnancy (n = 150) and 94% of traditional care (n = 66) participants. Results: A statistically significant difference was found in the percentage of women giving birth to preterm neonates (5% group prenatal care vs 13% traditional care; P= .04). There were no statistically significant differences in the percentage of women having a low‐birth‐weight neonate when group and traditional care participants were compared. Discussion: The CenteringPregnancy model holds promise for improving the birth outcomes of Hispanic women. Future research should be conducted with larger sample sizes to replicate study findings using experimental designs and incorporating formal cost‐effectiveness analyses.     

Infant mortality,low birth weight,and prematurity among Hispanic,white, and African American women in North Carolina

OBJECTIVES: The study was undertaken to compare Hispanic birth outcomes with those of white and African American women in North Carolina and to examine variables associated with adverse birth outcomes among Hispanic women. STUDY DESIGN: Retrospective comparison of birth outcomes by ethnicity/race, from linked birth/infant death certificates in North Carolina (1993-1997) was conducted. Multivariate, binary logistic regression and chi(2) analysis were used to examine relationships between available medical and sociodemographic index values and composite birth outcomes among Hispanic women. RESULTS: Infant mortality rates were lowest among Hispanic women. Low birth weight and prematurity rates were similar to those of white women and lower than those of African American women. Variables significantly related to healthy composite birth outcomes among Hispanic women included higher education, no preterm delivery history, prenatal care, marriage, and no daily tobacco use. CONCLUSION: Hispanic birth outcomes in North Carolina were better than those of African American women and similar to those of white women, despite use of prenatal care and socioeconomic characteristics similar to African American women.     

Ethnicity and depression treatment preferences of pregnant women

African American, Hispanic, and White women between 12 and 32 weeks gestation were recruited to examine their depression treatment preferences. The 73 women who participated were interviewed after their prenatal visit. Nineteen percent of women had symptoms of moderate or severe depression. Women with moderate or severe symptoms of depression were more likely to believe that antidepressants were an acceptable treatment than those without symptoms or with only minor depression symptoms. There were only small differences among the three ethnic groups for antidepressant use preference but most women found them to be unacceptable. In contrast, approximately half of the White women felt that herbal medicines were acceptable compared with 16 and 22 percent for African Americans and Hispanics, respectively. Only 44 percent of African American women felt that counseling from a mental health professional was an acceptable treatment for depression compared to 68 percent for White and 61 percent for Hispanic women. Similarly, African American women were less likely to believe that waiting and getting over depression symptoms naturally was acceptable compared to Hispanic and White women.     

Ethnicity and depression treatment preferences of pregnant women

African American, Hispanic, and White women between 12 and 32 weeks gestation were recruited to examine their depression treatment preferences. The 73 women who participated were interviewed after their prenatal visit. Nineteen percent of women had symptoms of moderate or severe depression. Women with moderate or severe symptoms of depression were more likely to believe that antidepressants were an acceptable treatment than those without symptoms or with only minor depression symptoms. There were only small differences among the three ethnic groups for antidepressant use preference but most women found them to be unacceptable. In contrast, approximately half of the White women felt that herbal medicines were acceptable compared with 16 and 22 percent for African Americans and Hispanics, respectively. Only 44 percent of African American women felt that counseling from a mental health professional was an acceptable treatment for depression compared to 68 percent for White and 61 percent for Hispanic women. Similarly, African American women were less likely to believe that waiting and getting over depression symptoms naturally was acceptable compared to Hispanic and White women.     

USE OF PRENATAL SERVICES BY HISPANIC WOMEN IN SAN DIEGO COUNTY: A Comparison of Urban and Rural Settings

The purpose of this study was to investigate patterns of prenatal care use among urban and rural Hispanic women in San Diego County, California. A cohort study of Hispanic women delivering at one of five San Diego County hospitals between July 1991 and January 1992 was conducted (N = 587). Data were collected by in-person interview and medical record abstraction. Logistic regression was used to identify variables associated with late entry into prenatal care, while simultaneously adjusting for important confounding variables. Three factors were found to be significantly associated with late entry into prenatal care. Women who resided in urban areas were two times more likely to enter prenatal care late as compared to women who lived in rural areas (odds ratio = 2.11; 95% confidence intervals (CI) = 1.12, 4.0). Women who reported not having initially “wanted” the pregnancy were 2.2 times more likely to enter prenatal care late (95% CI = 1.05, 4.59). The risk of entering prenatal care late increased by 20% for each additional barrier to care that was reported (95% CI = 1.09, 1.34). Results indicate that timely entry into prenatal care may be improved among San Diego Hispanic women by targeting specific barriers to prenatal care identified in this study and by providing greater family planning assistance to this population to decrease unwanted pregnancies.     

Group Prenatal Care for Women Receiving Medication‐Assisted Treatment for Opioid Use Disorder in Pregnancy: An Interprofessional Approach

Opioid use disorder among pregnant women is common and rapidly increasing nationwide. Group prenatal care is an innovative alternative to individual care for pregnant women and has been shown to improve women's and health care providers’ satisfaction and adherence to care. We describe a novel group prenatal care program colocated in an opioid treatment program that integrates prenatal care, substance use disorder counseling, and medication‐assisted treatment. Our interprofessional model draws on the unique contributions of physicians, midwives, nurses, and mental health professionals to address the complex needs of pregnant women with opioid use disorder. Participants reported increased trust and engagement with health care providers and peers, improved prenatal care and birth experience, and increased resilience for relapse prevention. Group prenatal care is an accepted and promising model for women with opioid use disorder in pregnancy and has the potential to improve outcomes for women and newborns.     

Satisfaction and Use of Prenatal Care: Their Relationship Among African‐American Women in a Large Managed Care Organization

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 prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee‐for‐service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003)     

The Use of Complementary and Alternative Medicines Among a Sample of Canadian Menopausal‐Aged Women

Introduction : Despite questionable efficacy and safety, many women use a variety of complementary and alternative medicine (CAM) therapies to relieve menopause symptoms. Methods : We examined the determinants and use of CAM therapies among a sample of menopausal‐aged women in Canada by using a cross‐sectional Web‐based survey. Results : Four hundred twenty‐three women who were contacted through list serves, e‐mail lists, and Internet advertisements provided complete data on demographics, use of CAM, therapies, and menopausal status and symptoms. Ninety‐one percent of women reported trying CAM therapies for their symptoms. Women reported using an average of five kinds of CAM therapies. The most common treatments were vitamins (61.5%), relaxation techniques (57.0%), yoga/meditation (37.6%), soy products (37.4%), and prayer (35.7%). The most beneficial CAM therapies reported were prayer/spiritual healing, relaxation techniques, counseling/therapy, and therapeutic touch/Reiki. Demographic factors and menopausal symptoms contributed to 14% of the variance (P < .001) in the number of CAM therapies tried. Discussion : Results support previous research showing that menopausal women have high user rates of CAM therapy and show that specific demographic factors and somatic symptomatology relate to use of CAM therapies. Health care providers can benefit from understanding the determinants and use of CAM by women during the menopause transition if they are to help and provide quality care for this population.     

Religion,Spirituality, Social Support,and Perceived Stress in Pregnant and Postpartum Hispanic Women

Objective:To examine the association between religion/spirituality and perceived stress in prenatal and postpartum Hispanic women.Design:Cross‐sectional survey.Setting:An urban, publicly funded hospital in California.Participants:Two hundred and forty‐eight pregnant and postpartum Hispanic women between age 18 and 45 years.Method:Patients presenting for prenatal or postpartum care or for the first infant visit were recruited to participate in the current study. Participants completed surveys consisting of questions about demographic characteristics, religiosity, spirituality, social support, and stress.Results:Most participants were unmarried, low‐income women with low educational attainment. Ninety percent of women reported a religious affiliation, with more than one half (57.4%) listing their religious affiliation as “Catholic.” Overall religiousness/spirituality was significantly associated with increased negative experiences of stress in women who selected English language instruments (Spearman's r=.341, p=.007); there was no such relationship in women who selected Spanish language instruments. Social support and greater relationship quality with a significant other were significantly associated with reduced perceived stress in Spanish reading and English reading women.Conclusions:In this sample of pregnant and postpartum Latinas, religiousness/spirituality was not associated with reduced perceived stress and was in fact associated with increased perceived stress among women who selected English‐language surveys. Additional research is needed to investigate this association. On the other hand, the current study reinforces the importance of social support and relationship quality for pregnant and postpartum women.     

Use of anti-emetic herbs in pregnancy: women's choices, and the question of safety and efficacy

The majority of North American pregnant women experience some degree of nausea and vomiting, usually in the first few months of pregnancy. Women utilize many coping strategies, including self-treatment with herbal medicine and other alternative therapies. In a qualitative study of self-care in pregnancy, birth and lactation within a non-random sample of 27 women in British Columbia, Canada, 20 women (74%) experienced pregnancy-induced nausea. Ten of these women used anti-emetic herbal remedies, which included ginger, peppermint, and Cannabis. The safety and efficacy of each of these herbal remedies is discussed here. Only ginger has been subjected to clinical trials among pregnant women, though all three herbs were clinically effective against nausea and vomiting in other contexts, such as chemotherapy-induced nausea and post-operative nausea. While safety concerns exist in the literature for all three herbs with regards to their use by pregnant women, clinical evidence of harm is lacking.     

Knowledge on periconceptional use of folic acid in women of British Columbia

OBJECTIVE: Our purpose was to evaluate the knowledge of folic acid and its use preconceptionally in women of British Columbia. METHODS: The study was conducted at British Columbia Women's Hospital in Vancouver, Canada, between April 15 and June 15, 1999. Pregnant women and women in the postpartum period were asked to complete a survey on folic acid. RESULTS: In total, 1,004 women completed the questionnaire during the study period. Seventy-one percent of the women knew that vitamins could help prevent birth defects. Of those, 76.3% identified folic acid as the one vitamin specifically associated with reduction of birth defects. It was identified that 49.4% of all women took vitamins prior to pregnancy. CONCLUSIONS: Women in the population studied were relatively well informed about the benefits of folic acid, but less than 50% of them took vitamins prior to conception.     

Early versus Late Prenatal Care in New Mexico: Barriers and Motivators

ABSTRACT: Background : Adequate prenatal care is important for ensuring a good outcome for pregnant women and their children, and its initiation in the first trimester is a major component. We investigated barriers and motivators for women receiving early versus late prenatal care. Methods : A self-administered questionnaire was distributed to 205 women who began prenatal care at the University of New Mexico Hospital Obstetrics Clinic in Albuquerque, New Mexico. The questionnaire assessed demographic information, insurance status, feelings about the pregnancy, health behaviors, and barriers and motivators to initiating prenatal care. The participants were Hispanic (41%) and non-Hispanic white (46%), low-income women with Medicaid (42%) or no health insurance (41%). They were divided into early (1st trimester 67%) and late (after 1st trimester 33%) care groups. Results : Ethnicity, education, income, and age did not predict initiation of prenatal care. Late initiators cited financial problems (26%), not being aware of the pregnancy (15%), and dislike of going to doctors (14%) as reasons for the delay in seeking prenatal care. Over two-thirds of the pregnancies were unplanned, but 82 percent of the women felt positive about the pregnancy. Conclusions : Our study documents the continuing need for public health efforts to encourage women to seek early prenatal care. Specific attention should be directed toward women's perceived reasons for not initiating early care.     

Self-reported zidovudine adherence among pregnant women with human immunodeficiency virus infection in four US states

OBJECTIVE: Our purpose was to identify clinical and psychosocial factors associated with rates of prenatal zidovudine use and adherence among human immunodeficiency virus-infected pregnant women. STUDY DESIGN: Two hundred sixty-four women completed 2 interviews between October 1996 and November 1998 at prenatal clinics in Miami, Florida; Brooklyn, New York; Connecticut; and North Carolina. Interviews took place after 24 weeks' gestation and then between 32 weeks and delivery. RESULTS: Prenatal zidovudine had been prescribed for 94% of the women, 37% of whom received monotherapy. Among women taking zidovudine, 20% reported incomplete adherence. In multivariate analyses having missed zidovudine doses was positively associated with prenatal illicit drug use (odds ratio, 3.49; 95% confidence interval, 1.30-9.42; P <.05) and missing prenatal vitamins (odds ratio, 2.71; 95% confidence interval, 1.30-5.67; P <.01). CONCLUSIONS: Zidovudine therapies have been successfully implemented in prenatal care settings in the United States. The success of these therapies may be limited among some patients by incomplete regimen adherence, particularly among illicit drug users.